6. Causes of obesity among elderly

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

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 circumfer-

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

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%

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

ence ranged from 40% among males to 56% among females [82, 83].

increased risk of NCDs [78, 80, 81].

12 Gerontology

elderly [88, 89].

of females) [88].

African nations [93].

5.2. Prevalence of obesity: developing countries

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

preparing food in the home, the development of high-rise buildings that often lack sidewalks and a deficit of readily accessible recreation areas are some of the common environmental

Ageing Process and Physiological Changes http://dx.doi.org/10.5772/intechopen.76249 15

Poverty and low education level also appeared as a reason for obesity among elderly. Studies state that the lack of nutritional knowledge, purchase of low-cost fat and organ meat are also associated with overweight and obesity. Poor hygienic conditions also appeared as a major

Other health issues and illnesses that are associated with obesity and weight gain are hyperthyroidism, polycystic ovary syndrome, Cushing's syndrome and depression [2]. Obese elderly are more likely to report symptoms of depression, such as hopelessness, sadness or worthlessness [115]. Sleep plays a major role. Lack of sleep contributes to obesity [106]. Certain drugs, such as antidepressants and steroids, may stimulate appetite or cause water retention or reduce the metabolic rate [82], causing an increase in weight. Health issues like arthritis and joint pain decrease mobility and activity intolerance, contributing to obesity [116]. Joint pain decreases mobility, and activity intolerance may lead to weight gain because of a decreased activity. Older adults are more likely than younger adults to experience functional limitations associated with chronic illnesses that may begin a stress-paindepression cycle that can result in lifestyle patterns leading to obesity [117]. Finally, the complex relationship between lifestyle pattern and functional ability merits attention as a

In developing countries, as compared to developed countries, gerontology has drawn comparatively lesser attention. This is because the increased life expectancy of elderly resulting in a demographic transition which developing countries are witnessing today has already been faced by developed countries, several decades back. However, in recent years with a rising percentage of elderly population, epidemiologists, researchers, demographers and clinicians have focussed their attention towards elderly care health issues and various problems associ-

Elderly face various problems and require a multi-sectoral approach involving inputs from

ated with ageing and numerous implications of this demographic transition.

various disciplines of health, psychology, nutrition, sociology and social sciences.

factors associated with obesity.

6.3. Other causes of obesity

contributor to obesity [93].

7. Conclusion

Conflict of interest

There is no conflict of interest.

reason [114].

Figure 6. Possible causes of obesity. Source: La Berge [108].

changes cause an accumulation of fat. Ageing is associated with a decline in the secretion of growth hormone, serum testosterone, resistance to leptin and a reduced responsiveness to thyroid hormone [107]. Studies show that resistance to leptin could cause a decrease in the ability to regulate appetite downward [74]. Several other genetic, environmental and social factors contribute to obesity among elderly.

#### 6.1. Genetic factors

Science does show a link between obesity and heredity [109]. Various studies indicate that obesity is related to the inherited genes and there is a link between obesity and heredity [110–113]. According to a study, visceral fat is more influenced by the genotype than subcutaneous fat [114].

#### 6.2. Environmental and sociological factors

Like genetics, environment also has a major role to play in obesity. The food we consume, physical activity and lifestyle behaviour are all influenced by the environment. For example, the adoption of modern diet over traditional diet, the trend towards 'eating out' rather than preparing food in the home, the development of high-rise buildings that often lack sidewalks and a deficit of readily accessible recreation areas are some of the common environmental factors associated with obesity.

Poverty and low education level also appeared as a reason for obesity among elderly. Studies state that the lack of nutritional knowledge, purchase of low-cost fat and organ meat are also associated with overweight and obesity. Poor hygienic conditions also appeared as a major reason [114].

#### 6.3. Other causes of obesity

Other health issues and illnesses that are associated with obesity and weight gain are hyperthyroidism, polycystic ovary syndrome, Cushing's syndrome and depression [2]. Obese elderly are more likely to report symptoms of depression, such as hopelessness, sadness or worthlessness [115]. Sleep plays a major role. Lack of sleep contributes to obesity [106]. Certain drugs, such as antidepressants and steroids, may stimulate appetite or cause water retention or reduce the metabolic rate [82], causing an increase in weight. Health issues like arthritis and joint pain decrease mobility and activity intolerance, contributing to obesity [116]. Joint pain decreases mobility, and activity intolerance may lead to weight gain because of a decreased activity. Older adults are more likely than younger adults to experience functional limitations associated with chronic illnesses that may begin a stress-paindepression cycle that can result in lifestyle patterns leading to obesity [117]. Finally, the complex relationship between lifestyle pattern and functional ability merits attention as a contributor to obesity [93].
