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Defining Obesity in Middle-Aged and Older Adults


 

The Body Mass Index (BMI) has long been the standard measure for categorising individuals' weight status, influencing clinical and public health interventions.

However,  research recently presented at the European Congress for Obesity challenges the traditional BMI cut-off points, especially for middle-aged and older adults (Di Renzo et al., 2022). The study offers a fresh perspective on how we should define obesity in these age groups, considering different types of body mass rather than just the total weight of people.


x-ray image of human body with muscles and veins and skeleton showing

Why New Cut-Off Points?

As we get older, our body composition does change. Muscle mass/ lean mass tends to decrease while fat mass/ adipose tissue increases, even if our weight remains stable (St-Onge & Gallagher, 2010). As there is typically a correlation between these body composition changes and increasing metabolic (and associated) health risk (Alberti & Zimmet, 1998; Shah et al., 2014; Leenders et al., 2013; Kim & Park, 2018), traditional BMI cut-offs may not accurately classify individuals in accordance with their health status. Recognising these nuances, the study aimed to establish more accurate BMI thresholds for diagnosing obesity in older adults.


Key Findings

The cross-sectional study involved a comprehensive analysis of middle-aged and older adults in clinical nutrition settings across Italy. Their findings suggest that the current BMI thresholds for obesity (a BMI of 30 or above) may be too high for older adults, potentially underestimating the prevalence of obesity and associated health risks in this population.


Implications for Clinical Practice

Adjusting BMI cut-off points has significant implications for clinical practice and public health. More accurate thresholds can lead to better identification of obesity prevalence and risk, allowing for better allocation of resources, early diagnosis and targeted interventions. This is particularly crucial for older adults, who are at higher risk for obesity-related conditions such as cardiovascular diseases (Rodgers et al., 2019) and osteoporosis (Zanker & Duque, 2019).


A Step Towards Personalised Health

The study underscores the importance of updating personalised health metrics. By refining BMI cut-offs, healthcare providers can offer more tailored advice and interventions, enhancing the quality of care for middle-aged and older adults. This approach aligns with a broader medical trend towards more individualised treatment plans that consider a patient's unique physiological and demographic characteristics.



older man exercising with small weights and a personal trainer


 


Conclusion

The evidence on the benefits of new BMI cut-off points is a valuable contribution to our understanding of obesity in different age groups. Challenging conventional thresholds and proposing these age-specific adjustments highlights the need for more nuanced health assessments based on more than just height and total weight. As our population ages, such insights are crucial for improving health outcomes and ensuring that clinical practices evolve to meet the needs of all age groups.


In essence, this study encourages us to rethink how we measure and address obesity, paving the way for more effective health interventions and a better quality of life for older adults.



References


Alberti, K. G. M. M., & Zimmet, P. Z. (1998). Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabetic medicine, 15(7), 539-553.


Di Renzo, L., Itani, L., Gualtieri, P., Pellegrini, M., El Ghoch, M., & De Lorenzo, A. (2022). New BMI Cut-Off Points for Obesity in Middle-Aged and Older Adults in Clinical Nutrition Settings in Italy: A Cross-Sectional Study. Nutrients, 14(22), 4848.


Kim, K., & Park, S. M. (2018). Association of muscle mass and fat mass with insulin resistance and the prevalence of metabolic syndrome in Korean adults: a cross-sectional study. Scientific reports, 8(1), 2703.


Leenders, M., Verdijk, L. B., van der Hoeven, L., Adam, J. J., Van Kranenburg, J., Nilwik, R., & Van Loon, L. J. (2013). Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. Journal of the American Medical Directors Association, 14(8), 585-592.


Rodgers, J. L., Jones, J., Bolleddu, S. I., Vanthenapalli, S., Rodgers, L. E., Shah, K., ... & Panguluri, S. K. (2019). Cardiovascular risks associated with gender and aging. Journal of cardiovascular development and disease, 6(2), 19.


Shah, R. V., Murthy, V. L., Abbasi, S. A., Blankstein, R., Kwong, R. Y., Goldfine, A. B., ... & Allison, M. A. (2014). Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study. JACC: Cardiovascular Imaging, 7(12), 1221-1235.


St-Onge, M. P., & Gallagher, D. (2010). Body composition changes with aging: the cause or the result of alterations in metabolic rate and macronutrient oxidation?. Nutrition, 26(2), 152-155.


Zanker, J., & Duque, G. (2019). Osteoporosis in older persons: old and new players. Journal of the American Geriatrics Society, 67(4), 831-840.



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