Obesity
Without a doubt, one of the most challenging things to a person’s mobility with age is decreasing muscle mass and increasing adipose tissue (fat mass). This is a change that is physiologic and expected. What is unexpected is the increase in overall obesity in the United States (and elsewhere) over the past 30 years.
Obesity is a challenge to define, but a generally accepted definition is a BMI (Body-Mass Index) over 30. I say that it is a challenge to define as some persons can meet that definition, however not be considered obese. Body-builders are a classic example as they have a significant amount of muscle mass, and as muscle is more dense than fat tissue it weighs more, and thus these individuals can meet the definition but can be excluded from the significant health risks that obesity entails.
I am am placing obesity under the “Mobility” section of the blog as obesity is a significant risk factor for a decline in mobility and general ability. I have had multiple patients in skilled nursing facilities because of obesity and an inability to participate in daily care. There are many risk factors for becoming obese, and like all aging, some things are out of our control. Obesity as a physical manifestation of being overweight, is dependent on our SDOH (Social Determinants of Health) along with genetic risk factors, psychologic risk factors, weight stigma, dietary habits, and physical inactivity. I want to be sure to include this as physics dictates the law of thermodynamics, and many obese persons have heard “Calories out must be greater than calories in.” I wish it were as simple as this math equation, however we humans are not simple math equations.
I want to encourage everyone, as a part of healthy aging, to be honest with themselves and their weight. Being overweight and underweight are significant risks for functional status decline, and this topic is fraught with emotional distress. However, we as physicians and health care workers are being disingenuous and putting people at risk for this functional decline if we do not have these conversations. I often tell patients the best two things I can do as your physician are:
To help you stop smoking
To help you achieve a healthy weight
To achieve these things is very personal. I recommend speaking with your physician about a healthy program for you! More and more is currently being investigated about healthy dietary habits and caloric restriction, and in fact, caloric restriction is one of the few things proven to increase longevity (however little is known about quality of life improvement).
Key Points:
Obesity in the United States is increasing in prevalence
A healthy personal weight is key to healthy aging
