A geriatrician's approach to managing the complex older adult with obesity

The prevalence of obesity in older adults is rapidly increasing due to the demographic shift occurring globally. Older adults with obesity face health care challenges due to multimorbidity, functional dependency, and disability. This population often has prior history of struggles through weight-loss attempts during the middle years of life. Therefore, weight-loss intervention needs a personalized approach, taking into consideration weight-loss attempts, relapse, and life events, including bariatric surgery, functional limitations, psychosocial status, and current residential environment. Racial and ethnic and systemic disparities based on gender, sexual orientation, rurality, zip code, and income merit attention, as they are barriers to obesity management. Intensive lifestyle intervention with dietary changes and physical activity remains the cornerstone of obesity management, with pharmacotherapy and bariatric surgery as adjuncts in the armamentarium. With the revolutionary influx of antiobesity medications, geriatricians face the challenge to treat obesity with limited evidence-based interventions in older adults. The goal of this review is to guide geriatricians with current evidence of obesity management in older adults. This review highlights the need for a tailored weight-management approach to be delivered to this fast-growing segment of the population with complex needs, which is predicted to impact health care economics due to the related comorbidities and disabilities.