Obesity - Age 65+ in United States

United States

Obesity is a complex health condition with biological, economic, environmental, individual and societal causes. Research suggests that the strength of the association between obesity and mortality risk increases with age, making obesity among older adults an area of particular concern. Contributing factors for obesity include behaviors such as poor diet and physical inactivity, certain health conditions, genetic predisposition and environmental elements like neighborhood safety, food access and infrastructure.

Obesity in older adults can lead to a variety of health challenges, including heart disease, high blood pressure, stroke, diabetes, certain cancers, and mental illnesses like depression and anxiety. Maintaining a healthy weight or losing weight, where possible, may reduce these risks and improve overall health outcomes. 

Obesity complicates end-of-life care by making weight loss harder to assess, requiring more caregiving resources and complicating medical treatment. These challenges are linked to lower hospice use, fewer in-home deaths and higher Medicare costs for older adults with obesity.

While body mass index (BMI) can serve as an easily accessible proxy for population health, it has its limitations. BMI does not distinguish excess fat from muscle or bone mass, and the relationship between BMI and body fat is influenced by sex, age and ethnicity. BMI cannot adequately capture the complexity of human health. For example, some individuals may have a high BMI and good cardiovascular health, while others may have what is categorized as a “healthy” or “normal” BMI and poor cardiovascular health. The American Medical Association adopted a policy recognizing BMI as an imperfect clinical measure of health and recommending it only be used in clinical settings alongside other metrics like body composition or genetic factors. 

Furthermore, weight stigma — also known as weight-based discrimination or weight bias — has harmful effects on health and can lead to mood and anxiety disorders and avoidance of exercise. Weight stigma has been pervasive in health care, with reports of medical professionals spending less time with higher-weight patients, engaging in less education and even being reluctant to perform certain procedures on patients with a higher BMI. Weight stigma in the clinical environment can make patients feel uncomfortable or marginalized, causing many individuals to avoid seeking health care.

According to America’s Health Rankings analysis, the prevalence of obesity is higher among:

• Black, American Indian/Alaska Native and multiracial older adults compared with Asian older adults. 
• Older adults without a college degree compared with college graduates.
• Older adults with an annual household income less than $25,000 compared with those who have incomes of $75,000 or more.
• Older adults living in nonmetropolitan areas compared with those in metropolitan areas.
• Older adults who have difficulty with self-care compared with older adults who do not have a disability. 

According to 2007-2010 data from the National Health and Nutrition Examination Survey, obesity is also higher among those ages 65-74 compared with older adults age 75 and up.

Key strategies for decreasing and preventing obesity should target environmental factors as well as individual behaviors. Successful interventions include:

• Creating community-based physical activity programs to help older adults maintain regular, multicomponent exercise as recommended by the Department of Health and Human Services.
• Encouraging older adults to eat a healthy diet high in whole grains, fruits, vegetables and lean protein and limit intake of sugary and fatty foods.
• Improving access to healthy foods in neighborhoods and care facilities.
• Tailoring weight loss diets to older adults’ nutritional needs and particular health risks.
• Providing individualized support and dietary suggestions, ideally maintained through a consistent patient-physician relationship.
• Prioritizing safe public outdoor spaces in disadvantaged areas to promote physical activity among older residents and reduce obesity-related health disparities. 

The Centers for Disease Control and Prevention provides additional useful strategies for community-level interventions and healthy living tips designed to prevent obesity. 

The Food and Drug Administration (FDA) approved a class of drugs that can help combat obesity, called GLP-1 agonists. These medications reduce appetite and hunger, resulting in decreased food intake often followed by weight loss. They work best when used along with lifestyle changes.

Healthy People 2030 has several weight-related goals, including: 

• Reducing the overall proportion of adults with obesity.
• Increasing the proportion of health care visits by adults with obesity that include counseling on weight loss, nutrition or physical activity.

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