Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Obes Facts. 2012;5(3):460-83. doi: 10.1159/000341193. Epub 2012 Jun 30.
The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.
肥胖的患病率正在逐步上升，甚至在老年人群体中也是如此。到 2030-2035 年，超过 20%的美国成年人口和超过 25%的欧洲人口将年满 65 岁。2010 年，美国 60 岁及以上人群肥胖的预测患病率为 37%。2015 年，根据所使用的模型，欧洲肥胖的预测患病率在 20%至 30%之间变化。这意味着 2010 年美国有 2090 万 60 岁以上肥胖者，而 2015 年欧盟有 3200 万肥胖老年人。尽管老年人（或不同种族的老年人）的 BMI、腰围和体脂肪百分比的截止值尚未确定，但从几项荟萃分析中可以清楚地看出，超重和肥胖相关的死亡率和发病率仅在 BMI 超过 30kg/m(2)时才会增加。因此，只有那些肥胖而非超重、且存在功能障碍、代谢并发症或肥胖相关疾病、能够从体重减轻中获益的患者才应接受治疗。减肥治疗的目的应是尽量减少肌肉和骨量的流失，同时还要警惕肌少症性肥胖的发生——这种肥胖是一种不健康的体脂肪过多与肌肉和去脂体重（包括骨骼）的有害丧失的结合，在易受这种后果影响的老年人中尤为重要。生活方式干预应作为第一步，包括饮食摄入减少 500 千卡（2.1 兆焦耳）能量，以及摄入高生物学质量的蛋白质、钙和维生素 D，行为疗法和多组分运动。多组分运动包括柔韧性训练、平衡训练、有氧运动和抗阻训练。大多数研究的依从率约为 75%。了解身体活动不足的限制因素和调节因素应有助于让老年人参与身体活动。在老年人中，药物治疗和减肥手术的作用在很大程度上是未知的，因为在大多数研究中都排除了 65 岁及以上的人群。
