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Facts
of Life
Facts of Life:
Issue Briefings for Health Reporters
Vol. 9, No. 12
December 2004
Weighing the Data: Obesity
Affects Elderly, Too
The Issue
The Facts
Catching the problem early
Expert Sources
References
The
Issue:
When people
think of poor health in the elderly, images of frail and underweight individuals
often come to mind. But older Americans have not escaped the obesity epidemic.
A 2004 study estimates that the prevalence of obesity in adults age 60 and
older will increase from 32 percent in 2000 to more than 37 percent in 2010.
[1] Obesity in children and younger adults has attracted a great deal of
recent attention, but there is a lingering “ageism” in how the
public and health professionals think about obesity and the elderly.
Why
worry about weight?
Old age can bring chronic
disease, lifestyle limitations, money woes and other issues that make the
problem of extra pounds pale by comparison for many individuals. Physicians
may avoid talking about obesity with their older patients because they think
it may be too late to encourage a change in health behavior. Obesity among
older Americans may also be overlooked in a society that considers a trim
body to be a matter of youthful beauty rather than health.
Problem Without
A Plan
Rates of obesity among
the elderly are guaranteed to rise within the next two decades, if only because
obese members of the Baby Boom generation are moving into old age. Unfortunately,
there are very few studies of obesity and old age or evidence-based tools
to treat this growing problem.
The
Facts:
- One in four people
older than 50 is considered obese, with obesity indicated by a body mass
index equal to or higher than 30. [2]
- Sarcopenic obesity
(a change in body composition associated with a reduction in muscle mass
during aging) and accumulated intra-abdominal fat are prevalent obesity-related
conditions among the elderly. [3]
- A recent study predicts
that by 2020, there will be an 18 percent to 22 percent increase in the
prevalence of Americans between the ages of 50 and 69 who have difficulty
bathing, dressing or walking across a room if the current rate of weight
increase for this age group continues. [4]
- In a group of 7,080
people age 65 and older, obesity was associated with poor perception of
health, poor physical functioning and poor social functioning among women.
[5]
- In a British study
of 4,232 men age 60 to 79, obese men had a doubled risk of major cardiovascular
disease and were three times more likely to have diabetes as were older
men at a normal weight. [6]
- The vascular problems
posed by obesity and related syndromes like hypertension and type 2 diabetes
are important influences on the risk of vascular and Alzheimer’s
dementia. [7]
- According to a 1998
survey, only 52 percent of adults age 50 and older reported being asked
during routine medical check-ups about physical activity or exercise. The
likelihood of being asked about exercise during a routine check-up declined
with age. [8]
- Nearly 18 percent
of individuals who are older than 85 are considered to have a poor diet,
compared to 16 percent of all Americans. [9]
- According to the Centers
for Disease Control and Prevention, only 37 percent of Americans who are
older than 65 get the daily recommended level of exercise. Another 35 percent
of individuals in this age group do not get enough exercise, and 28 percent
get no exercise. [10]
- Behavioral counseling
combined with exercise therapy may help older adults at risk for heart
disease increase their weekly exercise by as much as 45 minutes a week
compared with adults who exercise but don’t get counseling, according
to a 2003 study. [11]
Catching
the Problem Early
In July
2004, Department of Health of Human Services Secretary Tommy Thompson announced
at a Senate hearing that the Medicare Coverage Issues Manual would drop
its reference stating that obesity was not a disease.
The change
did not officially grant disease status to obesity in the eyes of Medicare,
but Thompson and Mark McClellan, the head of the Centers for Medicare and
Medicaid Services, said the change might pave the way for Medicare coverage
of certain obesity treatments.
“The
medical science will now determine whether we provide coverage for the
treatments that reduce complications and improve quality of life for the
millions of Medicare beneficiaries who are obese,” McClellan announced.
The change
could mean Medicare would start paying for a solution to a problem that
is already costing millions of dollars each year. According to recent research
led by Eric Finkelstein, Ph.D., a health economist at RTI International,
health conditions related to obesity and overweight contribute $93 billion
a year to national medical expenses. Medicare pays about 41 percent of
obesity-related costs. [12]
The money
pays for regular treatments and emergency hospitalizations for chronic
diseases related to obesity, such as type 2 diabetes, cardiovascular disease
and even falls and injuries. Medications add to the costs as well. In 2000,
obese elderly and near elderly individuals had higher mean expenditures
for prescribed medicines compared to overweight and not overweight or obese
persons. [13]
Finkelstein
now says the government insurance program for those 65 and older bears
a significant share of lifetime medical costs for obese Americans as well.
He and his colleagues will soon publish work describing these costs across
a variety of demographic groups in the United States.
Although
extra weight takes its toll on the life expectancy of obese people, the
lost years don’t do much to bring lifetime health care costs down,
Finkelstein and colleagues found. Even in the older population, medical
costs are higher among the obese.
Finkelstein
says part of the problem is that obesity and overweight are still undertreated
in children and younger adults.
Medicare
coverage for obesity treatments will depend on their evidence base, McClellan
said at the Senate hearing. However, evidence-based treatments for obesity
in general are scarce. For instance, a 2003 recommendation from the U.S.
Preventive Services Task Force concluded there was insufficient evidence
to determine whether weight loss for overweight adults was more beneficial
than harmful. [14] At a Nov. 4 Medicare advisory committee meeting, experts
testified that there is not enough data to know whether treatments like
bariatric surgery are safe and effective in elderly obese patients.
Expert
Sources:
Roland Sturm, Ph.D.
RAND
(703) 413-1100, x5117
Roland_Sturm@rand.org
Eric Finkelstein, Ph.D.
RTI International
(919) 541-8074
finkelse@rti.org
Jeffrey Rhoades, Ph.D.
Agency for Healthcare Research & Quality
(301) 427-1471
jeffrey.rhoades@ahrq.hhs.gov
Barbara McNeil, M.D., Ph.D.
Harvard Medical School
(617) 432-1909
mcneil@hcp.med.harvard.edu
References
1. D.E. Arterburn et
al. (2004) The coming epidemic of obesity in elderly Americans. Journal of
the American Geriatric Society, 52, 1907-1912.
2. J. A. Rhoades et al. (2001) Obesity in the elderly and near elderly (age
50 and older) in the United States, 1987, 2000 and 2001: The 1987 National
Medical Expenditure Survey and the 2000 and 2001 Medical Expenditure Panel
Surveys. Agency for Healthcare Research and Quality.
3. R.L. Kennedy et al. (2004) Obesity in the elderly: who should we be treating,
and why, and how? Current Opinions in Clinical Nutrition and Metabolic Care,
7, 3-9.
4. Center for Healthy Aging, University of Pittsburgh. AoA Grants, Summary
of Topic Areas. January 26, 2004.
5. L.L. Yan et al. (2004) BMI and health-related quality of life in adults
65 years and older. Obesity Research, 12, 69-76.
6. S. Goya Wannamethee et al. (2004) Overweight and obesity and the burden
of disease and disability in elderly men. International Journal of Obesity-Related
Metabolic Disorders, 11, 374-382.
7. M.N. Haan and R. Wallace (2004) Can dementia be prevented? Brain aging
in a population-based context. Annual Review of Public Health, 25, 1-24.
8. Prevalence of health-care
providers asking older adults about their physical activity levels — United
States, 1998. Morbidity and Mortality Weekly Report. May 17, 2002, 51, 412-414.
9. Center for Nutrition Policy and Promotion. (1999) A focus on nutrition
for the elderly: It's time to take a closer look. Nutrition Insights 14.
10. .R. Sturm et al. (2004) Increasing obesity rates and disability trends.
Health Affairs, 23, 199-205.
11. J.W. Rejeski et al. (2003) Older adults with chronic disease: Benefits
of group-mediated counseling in the promotion of physically active lifestyles.
Health Psychology, 22, 414-423.
12. E.A. Finkelstein et
al. (2003) National medical expenditures attributable to overweight and obesity:
How
much and who’s paying?” Health Affairs
(Web Exclusive), W3-219—W3-226.
13. J. A. Rhoades et al. (2001) Obesity in the elderly and near elderly (age
50 and older) in the United States, 1987, 2000 and 2001: The 1987 National
Medical Expenditure Survey and the 2000 and 2001 Medical Expenditure Panel
Surveys. Agency for Healthcare Research and Quality.
14. U.S. Preventive Services Task Force. Screening for Obesity in Adults:
Recommendations and Rationale. November 2003. Agency for Healthcare Research
and Quality, Rockville, MD. Last accessed 11-15-04 at http://www.ahrq.gov/clinic/3rduspstf/obesity/obesrr.htm.
The
Center for the Advancement of Health is an independent nonprofit organization
that promotes greater recognition of how psychological, social, behavioral,
economic and environmental factors influence health and illness. The Center
advocates the highest quality research and communicates it to the medical
community and the public. The fundamental aim of the Center is to translate
into policy and practice the growing body of evidence that can lead to the
improvement and maintenance of the health of individuals and the public.
The Center was founded by the John D. and Catherine T. MacArthur Foundation
and the Nathan Cummings Foundation, which continue to provide core funding.
Funding for this series was provided by the Robert Wood Johnson Foundation.
For Information Contact:
Kristina Campbell
Editor, Health Behavior News Service
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
p. 202.387.2829 / f. 202.387-2857
press@cfah.org
http://www.cfah.org
© Copyright 2004, Center
for the Advancement of Health
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