Until recently, weight loss in the elderly obese was feared due to ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older subjects (≥65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese subjects is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations can induce weight loss with improvement in frailty indices. Sustained weight loss in this age can prevent/ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly GLP-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in elderly obese subjects with type 2 diabetes. In our opinion, this option should not be denied to obese subjects with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older subjects as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity and reliance on centers which are highly experienced in the surgical procedure as well as short and long term subsequent comprehensive care and support.
Assaf Buch, Yonit Marcus, Gabi Shefer, Paul Zimmet, Naftali Stern