ABSTRACT
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Increased body fat, redistribution of body fat to the abdomen, and loss of muscle mass (sarcopenia) are all problems in old age, which are increasing in frequency. Decreased physical activity and decreased energy expenditure with aging predispose to fat accumulation and fat redistribution. The risks of obesity in old age are dependent on the distribution of the fat, increasing with a predominant visceral distribution; prior weight history; and associated sarcopenia. The use of the body mass index (BMI; kg/m
) to assess obesity in the elderly may be misleading. An increased BMI has a smaller effect on overall and cardiovascular mortality in the elderly, although it is associated with decreased mobility. Overall mortality is more likely to increase when the BMI decreases. Waist circumference is a more useful measure since intra-abdominal fat is clearly related to increased morbidity and mortality. Increased physical activity is a preferable management strategy to diet-induced weight loss, other than in those with predominantly obesity-related mobility disorders, and also has beneficial effects on muscle strength, endurance, and overall well-being. Those exercise regimens that include strength training have benefits over and above those focusing on endurance training alone. An active lifestyle should be promoted early and maintained through adulthood to prevent substantial weight gain and obesity with age.
