The consequences and health problems associated with obesity are many, varied and often are preventable through a healthy and active lifestyle. As overweight and obesity becomes more prevalent in the general population, it also increases among our aged care residents. So should we be encouraging these residents to lose weight as we do so with the younger population?
In aged care residents, overweight and obesity is associated with increased survival and stable functionality. Therefore residents have better health outcomes if they are on the heavier side. This is referred to as the obesity paradox: whereby obese people with diseases such as hypertension and other cardiovascular related diseases have better health outcomes than their normal weight counterparts. The exact mechanism behind this observation is unclear however extra body weight in the elderly can assist with general wellbeing such as increased bone mass, hip protection and the protective effects of certain fat-derived factors such as cytokines.
The healthy weight range for residents in aged care homes is more appropriately a BMI of 22-27 rather than 20-25 recommended for younger adults. Hence, there is no need to encourage active weight loss for residents over 65 years with a BMI up to 30.
Even though obesity (BMI > 30) is associated with a number of health problems such as reduced mobility, breathing difficulties and pressure area issues, there is no evidence that deliberate weight loss in the obese elderly leads to positive health outcomes. In fact, the consequences of weight loss in the absence of weight bearing exercise can be loss of muscle and bone.
If a resident is overweight or obese and their weight is affecting their quality of life, mobility, and ability to transfer then a plan to prevent further weight gain may be required. This could include limiting sugar containing drinks or reducing the usual added cream, butter or margarine that are routinely recommended in aged care. However, any formal strategies aimed at weight control require a specialised nutritional care plan which should be planned and monitored by a dietitian with experience in aged care. The resident should also be encouraged to undertake weight bearing exercise with the guidance of a physiotherapist or exercise physiologist in order to prevent muscle and bone loss.
It is also worth acknowledging that quality of life and choice are important considerations in aged care and that imposing dietary restrictions is unnecessary and may have negative consequences. Loss of weight without trying is always of concern, even in those who are very overweight or obese. It is important to remember that malnutrition and obesity can co-exist.