The Ages of Life

Healthy Aging Through Smart, Equitable Obesity Care

Though people may pretend otherwise, aging is a great equalizer. Hubris finds humility as age encroaches on presumptions of invincibility. So with varying degrees of success, we chase the goal of healthy aging. But over the last three decades, obesity has become a major stumbling block to healthy aging, for two reasons.

First, the prevalence of obesity has nearly doubled in Americans over 60. In fact, it went from 24 percent in 1990 to 43 percent in 2018. Second, the access to obesity care and options for dealing with it is both poor and inequitable for older adults. Recognizing this, a diverse group of organizations came together late last year to bring better definition to this problem. So they are calling for systematic changes to address it.

A new commentary in the Journal of the American Geriatrics Society summarizes their conclusions. They highlight ten stumbling blocks to addressing obesity for the sake of healthy aging.

1. Heterogeneity

One size fits all simply doesn’t work for older adults. Though everyone experiences aging, the experience can be vastly different for different people. Thus in addressing obesity for older adults, one-size-fits-all thinking – which is prevalent on the subject of obesity – simply doesn’t work. Not even close. Obesity care for older adults requires tailoring for individual needs.

2. Limitations of BMI

BMI is a convenient, but crude, yardstick for assessing obesity. Especially for older adults, more holistic assessments are essential.

3. Unrecognized Complexity

Many complex factors interact in the development and progression of the chronic disease of obesity. Social and biological factors come into play in surprising ways that makes simplistic approaches to obesity counter-productive.

4. Disconnected Healthcare and Community Systems

Obesity care and community systems that can promote better health often do not connect. Stronger connections and coordination between these systems is necessary.

5. Access to Real Care

Most seniors rely on Medicare for health insurance. Yet Medicare denies equitable access to the full range of evidence-based obesity care. In addition, many other aspects of health systems follow Medicare on this inequitable approach to obesity care.

6. Bias and Stigma

Weight bias and stigma is a common experience for people living with obesity. The medical and psychological harm accumulates over a lifetime. The impact is serious for older adults.

7. Aggregation Masking Health Inequities

Aggregate data on health risks often obscures great disparities that racial, ethnic, and gender minority groups experience related to health and obesity. Better data with greater detail can inform more equitable policies.

8. Trauma in Tribal Communities

Experiences of trauma in Native populations contribute to the disproportionate impact of obesity and their related health conditions.

9. Gender-Based Discrimination

Among LGBTQ+ groups, fear of judgment and receiving inferior health care leads to less care-seeking.

10. Remote Communities

In rural communities, access to care, especially obesity care, is poor. This is because of difficulty recruiting providers and issues of distrust.

Without smart, equitable obesity care, hopes for healthy aging across the population will come to nothing. This working group has done a fine job of outlining the issues. Their report, which you can find here, deserves your attention.

The Ages of Life, painting by Georges Lacombe / WikiArt

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March 11, 2022

4 Responses to “Healthy Aging Through Smart, Equitable Obesity Care”

  1. March 11, 2022 at 8:38 am, Carol said:

    Thanks for the insights. Are you able to share the journal citation?

    • March 11, 2022 at 10:16 am, Ted said:

      Thanks for noticing that I neglected to highlight and underscore the link. You should be able to find it above easily now in blue.

  2. March 12, 2022 at 12:51 am, John said:

    I found this very poorly presented and lacking knowledge of the literature. The problems of equity and complexity are well articulated. But the complexity not explained in any meaningful way.

    Perhaps the biggest question is “When is intentional weight loss indicated”?

    There are simply no evidence based guidelines for those over 70 years.

    Perhaps we could ask the sponsor of this study to carefully examine the older members of their many RCTs? Functional outcomes will be important to examine.


    • March 12, 2022 at 7:17 am, Ted said:

      You are raising some very important questions, John. Thanks for your thoughtful comments.

      I found the commentary in JAGS to be very worthwhile because it collected and organized a number of issues related to healthy aging and obesity from diverse stakeholders. As you note, the data to provide answers is lacking. The authors did not presume to have those answers. But to me, providing a good accounting of the issues was helpful.