5. Obesity in elderly: prevalence

Today, as standards of living continue to rise, weight gain is posing a growing threat to the health of inhabitants from countries all over the world. Obesity is a chronic disease, prevalent in both developed and developing countries, and it is affecting all age groups. Indeed, it is now so common that it is replacing the more traditional public health concerns, such as infectious diseases and undernutrition, as the most common and significant contributors of ill health [64–67] (Figure 3).

As per World Health Organisation (WHO), globally, approximately 2.3 billion elderly people are overweight and more than 700 million elderly people are obese [68]. Most elderly belonging to the middle and high socio-economic groups are prone to obesity and complications related to obesity, due to sedentary lifestyles and a reduced physical mobility [69]. Obesity is considered as one of the major risk factors which causes the onset and increases the severity of non-communicable diseases (NCDs). It is a worldwide health problem, affecting elderly from both developed and developing countries. In elderly, obesity contributes to the early onset of chronic morbidities and functional impairments which lead to premature mortality [70].

#### 5.1. Obesity among elderly: developed countries

The population in developed countries have proportionally a greater number of older adults living to older ages, and the prevalence of obesity is rising progressively, even among this age group [71].

The prevalence of obesity among elderly belonging to United States ranges from 42.5% in women to 38.1% in men, belonging to the age group 60–79 years. The prevalence differs for the elderly belonging to the age group 80 years and above, that is, 19.5% for females and 9.6% for males [72–74].

Comparatively, the prevalence of obesity in Europe is slightly lower but it is still a significant health issue. The prevalence of obesity among elderly in the United Kingdom is 22% among women and 12% among men aged 75 years or older [70, 75–77]. These statistics bode ill as the proportion of world's elderly population is growing rapidly (Figure 4).

Figure 4. Trends in weight by age cohort, 1980–2000 (Australia). Source: Bennett et al. [81].

Figure 5. Worldwide prevalence of obesity among elderly women and men with BMI of ≥30 kg/m<sup>2</sup>

Analysis of health survey data.

. Source: OECD [79].

Ageing Process and Physiological Changes http://dx.doi.org/10.5772/intechopen.76249 11

In Australia, the percentage of weight gain has been so high that instead of losing weight with an increase in life, men and women aged 60–70 weigh more on average than they did when they were 20 years younger (Figure 5). Australian studies show that the prevalence of obesity

Figure 3. Prevalence of obesity among elderly aged 60 years and above, by sex: The United States, 2013. Source: [68].

Figure 4. Trends in weight by age cohort, 1980–2000 (Australia). Source: Bennett et al. [81].

that it is replacing the more traditional public health concerns, such as infectious diseases and undernutrition, as the most common and significant contributors of ill health [64–67] (Figure 3).

As per World Health Organisation (WHO), globally, approximately 2.3 billion elderly people are overweight and more than 700 million elderly people are obese [68]. Most elderly belonging to the middle and high socio-economic groups are prone to obesity and complications related to obesity, due to sedentary lifestyles and a reduced physical mobility [69]. Obesity is considered as one of the major risk factors which causes the onset and increases the severity of non-communicable diseases (NCDs). It is a worldwide health problem, affecting elderly from both developed and developing countries. In elderly, obesity contributes to the early onset of chronic morbidities and functional impairments which lead to premature mortality [70].

The population in developed countries have proportionally a greater number of older adults living to older ages, and the prevalence of obesity is rising progressively, even among this age group [71]. The prevalence of obesity among elderly belonging to United States ranges from 42.5% in women to 38.1% in men, belonging to the age group 60–79 years. The prevalence differs for the elderly belonging to the age group 80 years and above, that is, 19.5% for females and 9.6%

Comparatively, the prevalence of obesity in Europe is slightly lower but it is still a significant health issue. The prevalence of obesity among elderly in the United Kingdom is 22% among women and 12% among men aged 75 years or older [70, 75–77]. These statistics bode ill as the

In Australia, the percentage of weight gain has been so high that instead of losing weight with an increase in life, men and women aged 60–70 weigh more on average than they did when they were 20 years younger (Figure 5). Australian studies show that the prevalence of obesity

Figure 3. Prevalence of obesity among elderly aged 60 years and above, by sex: The United States, 2013. Source: [68].

proportion of world's elderly population is growing rapidly (Figure 4).

5.1. Obesity among elderly: developed countries

for males [72–74].

10 Gerontology

Figure 5. Worldwide prevalence of obesity among elderly women and men with BMI of ≥30 kg/m<sup>2</sup> . Source: OECD [79]. Analysis of health survey data.

among elderly has increased in the age group of 60–69 years at about 24% for males and 30% for females, whereas it is less common among the elderly belonging to age group 80 years and above [78, 80]. Studies show that the percentage of Australian elderly reporting increased abdominal fat is markedly increasing over the years. Based on waist circumference, more than 30% of elderly males and 44% of elderly females in Australia are currently at a substantially increased risk of NCDs [78, 80, 81].

As per the WHO report, the prevalence of overweight and obese elderly in China was 19.0 and 2.9%, respectively. However, the prevalence has increased over the past years; in the latest study, the prevalence of overweight and obesity among elderly was 21.0 and 7.4% [94, 95]. There was a slight increase in the prevalence of overweight and obesity among women than

Ageing Process and Physiological Changes http://dx.doi.org/10.5772/intechopen.76249 13

According to WHO estimates, among all Gulf regions, Kuwait ranked number one with the highest prevalence of overweight and obesity (78.8%) among elderly (60 years and above) [92]. Worldwide, Kuwait is ranked 11th, that is, the highest in obesity among the Arab countries and the Middle East [93, 96]. Studies from Sri Lanka show a prevalence rate of 25.2% for overweight and 9.2% for obesity. The prevalence of central obesity among elderly was highest at 26.2% [97, 98]. The prevalence of overweight and obesity in Brazil was 41.8% for females and 23.4% for males. According to the prevalence studies of obesity among elderly in Nigeria [99], overweight among elderly ranged from 20.3 to 35.1% and obesity ranged from 8.1 to 22.2%. WHO reported that the prevalence of obesity in Sub-Saharan African countries ranged between 3.3 and 18.0% and that obesity has become a leading risk factor for diabetes mellitus and cardiovascular diseases in the urban areas of Africa [93, 99]. The situation can get worse within a decade if the present trend continues and overweight could emerge as the single most important public health problem in adults. Overweight or obesity may not be a specific disease but it is certainly considered as a major contributory factor leading to various degenerative diseases in adult life. Prevention and control of this problem must, therefore, claim priority

As per a study done in Delhi on urban elderly, nearly 14% of men and more than 50% of women belonging to what may be a higher-income group (HIG) were overweight (BMI >25) and obese (BMI >30) [101]. The prevalence of abdominal obesity among the elderly group was also reported as high. Assuming that the HIG in India number is around 100 million (half the number of the middle class), it may be computed that there are roughly 40–50 million overweight subjects belonging to the HIG in the country today. Visweswara et al. [102] studied females of Hyderabad (60 years and above) belonging to the high socio-economic status and reported the prevalence rate of obesity as 36.3%. Gopinath et al. [103] studied urban elderly in Delhi and reported the rate of prevalence of obesity as 33.4%. A study done in the Union Territory of Chandigarh showed an increase in BMI (>25) resulting in the high prevalence rate

The relationship between energy intake and energy expenditure is an important determinant of body fat mass. Obesity occurs when the consumption of calories is more than the calorie expenditure. The possible causes of obesity are depicted in Figure 6. Various studies indicate that how much we eat does not decline with advancing age; therefore, it is likely that a decrease in energy expenditure particularly in the beginning of old age (50–65 years) contributes to the increase in body fat as we age [62, 106]. At the age of 65 years and above, hormonal

of overweight (33.14%) and obesity (7.54%) among elderly [104, 105].

6. Causes of obesity among elderly

among men in China.

attention [100].

Studies from the Netherlands show that obesity was present in 18% of men and 20% of women belonging to the age group of 60 years and above [82]. Also, the increase in waist circumference ranged from 40% among males to 56% among females [82, 83].

In France, studies show that the prevalence of obesity among elderly was relatively stable during early years (1980–1991), 6.4–6.5% in males and 6.3–7.0% among females [83], but studies from recent years [84, 85] have highlighted a sharp increase in obese elderly, 19.5% for both males and females; this prevalence rate decreased gradually after 70 years of age, that is, from 19.5 to 13.2% [86]. The Scottish Health Survey shows that in 10 years (2003–2013), the prevalence of obesity has increased as the body mass index (BMI) continues to rise in people 60–70 years of age, especially among females [87]. In this same period, there was an increased curve shown for the waist circumference (5–10 cm) in both the sexes between 50 and 70 years of age. This inappropriate increase in waist circumference and a slight increase in BMI in the Scottish Health Survey may indicate a substantial gain in visceral fat mass and loss of lean tissue that predisposes to ill health in the obese elderly [88, 89].

In Spain, 35% of subjects aged 65 years or older suffered from obesity (30.6% of males and 38.3% of females) and 61.6% had an increased waist circumference (50.9% of males and 69.7% of females) [88].

#### 5.2. Prevalence of obesity: developing countries

Over the past years, obesity among elderly was considered as a problem only in high-income countries, but the trend is changing now; excess weight, as well as obesity, is dramatically increasing in low-income and middle-income countries as well, particularly in urban settings [90]. Various studies show a significant change in the mean body weight, physical activity and diet along with progressive economic development in developing countries. Possibilities are high that obesity and its co-morbidities will continue to affect an increasing number of populations in these regions. Lifestyle and environmental factors are acting in a synergistic manner to fuel the obesity epidemic. As per WHO estimates, there is a decline in undernourished population across the world, whereas the overnourished population has increased to 1.2 billion [90]. A WHO report shows that more than 1 billion elderly are overweight and 300 million are obese. The problem of obesity is increasing in the developing world with more than 115 million people suffering from obesity-related problems [90]. The obesity rate has increased threefold or more since 1980 in the Middle East, the Pacific Islands and India [91, 92]. However, the prevalence of obesity is not as high in all developing countries, like China and some African nations [93].

As per the WHO report, the prevalence of overweight and obese elderly in China was 19.0 and 2.9%, respectively. However, the prevalence has increased over the past years; in the latest study, the prevalence of overweight and obesity among elderly was 21.0 and 7.4% [94, 95]. There was a slight increase in the prevalence of overweight and obesity among women than among men in China.

According to WHO estimates, among all Gulf regions, Kuwait ranked number one with the highest prevalence of overweight and obesity (78.8%) among elderly (60 years and above) [92]. Worldwide, Kuwait is ranked 11th, that is, the highest in obesity among the Arab countries and the Middle East [93, 96]. Studies from Sri Lanka show a prevalence rate of 25.2% for overweight and 9.2% for obesity. The prevalence of central obesity among elderly was highest at 26.2% [97, 98]. The prevalence of overweight and obesity in Brazil was 41.8% for females and 23.4% for males. According to the prevalence studies of obesity among elderly in Nigeria [99], overweight among elderly ranged from 20.3 to 35.1% and obesity ranged from 8.1 to 22.2%. WHO reported that the prevalence of obesity in Sub-Saharan African countries ranged between 3.3 and 18.0% and that obesity has become a leading risk factor for diabetes mellitus and cardiovascular diseases in the urban areas of Africa [93, 99]. The situation can get worse within a decade if the present trend continues and overweight could emerge as the single most important public health problem in adults. Overweight or obesity may not be a specific disease but it is certainly considered as a major contributory factor leading to various degenerative diseases in adult life. Prevention and control of this problem must, therefore, claim priority attention [100].

As per a study done in Delhi on urban elderly, nearly 14% of men and more than 50% of women belonging to what may be a higher-income group (HIG) were overweight (BMI >25) and obese (BMI >30) [101]. The prevalence of abdominal obesity among the elderly group was also reported as high. Assuming that the HIG in India number is around 100 million (half the number of the middle class), it may be computed that there are roughly 40–50 million overweight subjects belonging to the HIG in the country today. Visweswara et al. [102] studied females of Hyderabad (60 years and above) belonging to the high socio-economic status and reported the prevalence rate of obesity as 36.3%. Gopinath et al. [103] studied urban elderly in Delhi and reported the rate of prevalence of obesity as 33.4%. A study done in the Union Territory of Chandigarh showed an increase in BMI (>25) resulting in the high prevalence rate of overweight (33.14%) and obesity (7.54%) among elderly [104, 105].
