• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

The Epidemic of Obesity: Obesity and Health of the Aging Male

Posted on: Thursday, 9 June 2005, 06:00 CDT

Obesity is becoming a major health problem, its prevalence having dramatically increased over the last 20 years, reaching epidemic proportions. The serious health consequences are recognized worldwide and it is not surprising, therefore, that obesity was the mean theme of the 86th Annual Meeting of the Endocrine Society and the theme of the June issue of the Journal of Endocrinology and Metabolism as well as of the December 2003 issue of Endocrinology and Metabolism Clinics of North America. We want to emphasize here that obesity is also for the elderly population a major health problem as is illustrated in this small survey of recent publications.

Prevalence of obesity

The importance of the obesity epidemic is illustrated by the fact that in the United States the prevalence of obesity increased in males, aged 20-74 years from 11 % in 1960-1962 to 21 % in 1988-1994 and has risen by 1999-2000 to 28% [1], 2 out of 3 adults being overweight (BMI < 25) or obese (BMI > 30) [2]. Comparing the period 1976-1980 with the period 1999-2000, the prevalence of overweight has increased by 40% and of obesity by 110 % from 14.5 to 30.5 %. Moreover, the prevalence increased with age in both men and women, reaching a maximum in the age range 60-74 years [1,3] illustrating the fact that in the elderly also, obesity is a major health problem.

The trend in increase of prevalence of obesity is not limited to the USA, similar trends being observed world wide [3-5]. In Spain for example, Gutteriez et al. [6], in a sample of 4009 person, representative of the non institutionalized population over 60 years old, observed a prevalence of overweight and obesity of 49 % and 31.5 % respectively, in men.

Health risk factors of obesity

Obesity would only be a cosmetic problem, were it not that excessive weight is an important determinant of morbidity and premature mortality [7]. Waist circumference seems to be better predictor of obesity related morbidity than BMI [8], indicating that it is mainly abdominal, visceral obesity which constitutes obesity- related health risk. According to Sturm et al. [9] obesity is already associated with a greater morbidity and poorer health related quality of life than smoking and might soon overtake smoking as the primary preventable cause of death [10]. Allison [10] estimates that close to 300000 deaths/year may be attributable to obesity in the United States.

Bray [11] distinguishes disabilities arising from increased fat mass itself, from risks resulting from the metabolic changes associated with excess fat.

Among the first he mentions sleep apnea, a consequence of the decrease of residual lung volume, associated with increased abdominal pressure on the diaphragm, and osteoarthritis, mainly of the knee and hip [12] which is directly related to the degree of excess body weight [11,13].

The metabolic changes occurring in obese subjects are mainly the consequence of the accumulation of visceral fat, which induces insulin resistance, leading to impaired glucose tolerance, diabetes mellitus type 2 and syndrome X. It has been considered that as much as 80% of type 2 diabetes could be attributed to the combined effects of inactivity and overweight [7]. Obese individuals have almost 10 times the risk of diabetes compared to non-obese persons [14].

As to cardiovascular disease, it can be estimated that 20-30% of CV mortality (myocardial infarction, ischemie stroke) may be attributed to excess body weight [15], overweight increasing the risk for CVD by a factor 2-3 [16].

Dey and Lissner [17] in a cohort study involving 737 males, 70 years old, studied the role of obesity as risk factor for 15 year coronary heart disease incidence: the relative risk for CVD in the highest waist circumference and BMI quartile was 1.42 for BMI and 1.36 for WC. It can be estimated that 20-30% of CVD mortality (myocardial infarction, ischemie stroke) may be attributed to excess body weight [15], overweight increasing the risk of CVD by a factor 2-3 [16].

There is a strong association between BMI and blood pressure, overweight being positively associated with the development of hypertension [18].

Finally, it is estimated that overweight and obesity may account for 14% of all cancer deaths in men [19].

Luchsinger et al. [20] reported that moderate obesity was related to a higher risk of hospitalisation in individuals 75-89 yrs.

Groessl et al. [21] in 1326 older adults (mean age 72 yrs), using the Quality of Wellbeing Scale (QWB), found that the QWB was significantly lower for the obese than for normal controls or overweight subjects, which according to the authors translates into millions of quality adjusted life years lost each year in the USA.

As to life expectancy, data from the Framingham Study suggest that 40 year old obese non-smokers with a BMI >30 lost 5.8 years! [22].

Does weight loss reduce the mortality risk induced by overweight and obesity?

Sjstrm et al. [23] showed than an intentional weight loss of 5- 10% reduces significantly all causes of mortality by 20-25%, whereas for most comorbities, a 10% weight loss is sufficient to significantly improve factors. The National Health Interview Survey, with a 9 year follow-up, shows that intentional weight loss lowers mortality rates. (Hazard Rate Ratio) by 24% [24]. Gregg et al. [25] showed that as little as 2 h walking a week reduced all causes of mortality for 8 years by 34%!

In conclusion, all data from the literature confirm the very important impact of obesity on health, quality of life and well- being of the elderly population, whereas intentional weight loss lowers mortality rate. It is evident that prevention or treatment of obesity in the elderly will improve well-being and, in addition, will add years to life.

The cause of obesity being an imbalance between energy intake and expenditure which translates into an excessive food intake and less energy expenditure due to sedentarism. Mechanical devices having replaced physical activity, modalities of prevention and treatment of overweight and obesity are straightforward: on the one hand increasing physical activity; less television watching, more walking or cycling for shopping, health club activities, and less intake of energy dense food, soft or alcoholic drinks. Physical (and mental) activity and a healthy diet, aiming at an ideal weight, remain the corner stones for a successful, healthy old age.

References

1. Ogden CL, Carroll MD, Flcgal KM. Epidemiologic trends in overweight and obesity. Endocrine Metab Clin N Am. 2003;289:229- 230.

2. Manson JE, Bassuk SS. Obesity in the United States-A fresh look at a high toll. JAMA 2003;269:229-230.

3. Kiss C, Poor G, Donath J, Gergely P Jr, Paksy A, Zajkas G, Antal M. Prevalence of obesity in an elderly Hungarian population. Eur J. Epidemiol 2003;18:653-657.

4. International Agency for Research on Cancer. In: Vainio H, Bianchini F, editors. International Agency for Research on Cancer Handbooks of cancer prevention vol. 6. Lyon: IARC Press; 2002.

5. Haftenberger M, Lahmann PH, Panico S, Gonzales CA, Scidcll JC, Boeing H, Giurdanella MC, Krogh V, Buneo-de-Mesquita HB, Peelers PH, et al. Overweight, obesity and fat distribution in 50-64 year old participants in the European Prospective Investigation into Cancer and Nutrition. Publ Health Nutr 2002;5:1147-1162.

6. Gutierrez-Fisac, Lopez E, Banegas JR, Graciani A, Rodriguez- Artalejo F. Prevalence of obesity in elderly people in Spain. Obes Res 2004; 12:710-715.

7. Stein CJ, Colditz GA. The epidemic of obesity. J Clin Endocrinol Metab. 2004;89:2522-2525.

8. Janssen L, Kartzmaryk PT, Ross R. Waist circumference and not body mass index explains obesity - related health risk. Am J Clin Nutr 2004;79:379-384.

9. Sturm R, Wells KB. Does obesity contribute as much to morbidity as poverty and smoking. Public Health 2001;115:229-235.

10. Allison DB, Fontaine KR, Manson JE, Stevens J, Van Itallie TB. Annual death attrbutable to obesity in the United States. JAMA 1999;282:1530-1538.

11. Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab 2004;89:2583-2589.

12. Wendelboe AM, Hegmann KT, Biggs JJ, Cox CM, Portmann AJ, Gildea JH, Gren LH, Lyon JL. Relationships between body mass indices and surgical replacement of knee and hip joints. Am J Prev Med 2003;25:290-295.

13. Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee osteorthritis. The Framingham Study. Ann Im Med 1988;109:18-24.

14. Chan JM, Rimm EB, Colditz GA, Stampfcr MJ, Willett WC. Obesity, fat distrbution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-969.

15. Seidell JC, Verschuren WM, van Leer EM, Kromhout D. Overweight, underweight and mortality . A prospective study of 48.287 men and women. Ann Intern Med 1996;156:958-963.

16. Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegelman D, Colditz GA, Willett WC. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol 1995;137:1117-1127.

17. Dey DK, Lissner L. Obesity in 70 year old subjects is risk factor for 15 year coronary heart disease. Obes Res 2003;11:817- 827.

18. Ascherio A, Rimm EB, Giovanucci El, Colditz GA, Rosner B, Willett WC, Sacks F, Stampfer MC. A prospective study of nutritional factors and hypertension among US men. Circulation 1992;86:1475- 1483.

19. Calle EE, Rodriguez C, W\alker-Thurmond K, Thun MJ. Overweight, obesity and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003;348:1625-1638.

20. Luchsinger JA, Lee WN, Carrtasquillo O, Rabinowitz SH. Body mass index and hospitalization in the elderly. Geriatr Soc 2003;51:1615-1620.

21. Groessl EJ, Kaplan RM, Barren-Connor E, Ganiats TG. Body mass index and quality of well-being in a community of older adults. Am J Prev Med 2004;26:126-129.

22. Pcctcrs A, Barendregt IJ, Willenkens F, Mackenbach JP, Manum A, Bonneux L. Obesity in adulthood and its consequences for life expectancy : a life table analysis. Ann Int Med 2003;138:24-32.

23. Sjstrm CD, Lissner L, Sjstrm L. Relationships between changes in body composition and changes in cardiovscular risk factors: the SOS Intervention Study. Swedish obese subjects. Obes Res 1997;5:519- 530.

24. Gregg EW, Gerzoff RR, Thompson TJ, Willamson DV. Intentional weight loss and death in overweight and obese US adults 35 years of age and older. Ann Intern Med 2003;138:383-389.

25. Gregg EW, Gerzoff RG, Caspersen CJ, Williamson DF, Narayan KM. Relationship of walking to mortality among US adults with diabetes. Arch Int Med 2003;163:1440-1447.

ALEX VERMEULEN

Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium

Correspondence: Alex Vermeulen, Department of Internal Medicine, Endocrinology section, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium. e-mail: Alex.Vermeulen2@pandora.be; alex_vermeulen@hotmail.com

Copyright CRC Press Mar 2005

Source: Aging Male

More News in this Category