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Am Fam Physician. 2006;73(11):2074-2077

Obesity has major implications in the older population because it can worsen age-related deterioration in health and cause frailty. However, management of older patients who are obese is difficult considering the risks associated with increased body mass index as well as the effects of weight loss, which is potentially harmful in older patients. The American Society for Nutrition (ASN), the North American Association for the Study of Obesity (NAASO), and the Obesity Society have issued a joint position statement that includes a review of concerns related to obesity in older persons and weight management guidelines for patients in this age group. The recommendations were published in the November 2005 issue of The American Journal of Clinical Nutrition.

When beginning weight-loss therapy for older patients, all appropriate information should first be collected (i.e., medical history, physical examination, laboratory tests, medication assessment, and evaluation of the patient's of inclination to lose weight). When deciding on the type of weight-loss therapy to use, programs that can reduce bone and muscle loss are recommended for older persons who have physical or metabolic complications. Physicians should assist their patients in making lifestyle and behavioral changes by setting goals, supervising progress, and motivating patients to adhere to a weight-loss program. Changing an older patient's diet or physical activity may be difficult because of many underlying factors (e.g., depression, disabilities, disease, dependency on others). All of these challenges should be addressed because they can make weight loss more difficult.

A diet consisting of a reduction of 500 to 750 kcal per day is recommended. However, diets that restrict energy intake to less than 800 kcal per day should be avoided because they may increase health complications. A diet should include multi-vitamins, mineral supplements, and 1.0 g of protein per kg of body weight to make sure daily requirements are met.

Before beginning an exercise regimen, exercise stress testing should be performed if necessary. The exercise regimen should be gradually incorporated into the patient's routine and tailored to each person, taking into consideration their current disabilities or problems. Routine physical exercise is important in preserving bone and muscle mass and improving physical abilities.

It is also important to evaluate the medications a patient is taking. Older patients are at higher risk of medication-related problems. Some medications can be the source of weight gain (e.g., steroids, antidepressants). Although there is little evidence for the use of obesity pharmacotherapy in older persons, orlistat (Xenical) may be the safest available agent for use in conjunction with lifestyle change, especially in patients with constipation.

Bariatric surgery should be used only in cases when a patient has a disability caused by obesity that can be improved with weight loss and when he or she meets the conditions required for surgery.

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