Obesity - Age 65+ in North Carolina

North Carolina

Adults with obesity are at increased risk of developing serious health conditions such as hypertension, Type 2 diabetes, stroke, sleep apnea and other breathing problems, osteoarthritis, certain cancers and mental illnesses like depression and anxiety. Research suggests that the strength of the association between obesity and mortality risk increases with age, making obesity among older adults an area of particular concern. Contributing factors for obesity include behaviors such as poor diet and physical inactivity, certain health conditions, genetic predisposition and environmental elements like neighborhood safety, food access and infrastructure.

While body mass index (BMI) can serve as an easily accessible proxy for population health, it has its limitations. BMI does not distinguish excess fat from muscle or bone mass, and the relationship between BMI and body fat is influenced by sex, age and ethnicity. BMI cannot adequately capture the complexity of human health: Some individuals may have a high BMI and good cardiovascular health, while others may have what is categorized as a “healthy” or “normal” BMI and poor cardiovascular health. The American Medical Association has adopted a new policy recognizing BMI as an imperfect clinical measure of health and recommending it only be used in clinical settings alongside other metrics like body composition or genetic factors. 

Furthermore, weight stigma — also known as weight-based discrimination or weight bias — has harmful effects on health and can lead to mood and anxiety disorders and avoidance of exercise. Weight stigma has been pervasive in health care, with reports of medical professionals spending less time with higher-weight patients, engaging in less education and even being reluctant to perform certain procedures on patients with a higher BMI. Weight stigma in the clinical environment can make patients feel uncomfortable or marginalized, causing many individuals to avoid seeking health care.

According to America’s Health Rankings analysis, the prevalence of obesity is higher among:

• Black, multiracial and Hispanic older adults compared with Asian older adults.
• Older adults with a high school diploma or GED degree compared with college graduates.
• Older adults with an annual household income less than $25,000 compared with those with annual household incomes of $75,000 or more.
• Older adults living in non-metropolitan areas compared with those in metropolitan areas.
• Older adults who have difficulty with self-care compared with older adults without a disability.

Key strategies for decreasing and preventing obesity target individual behaviors as well as environmental factors. Successful interventions include:

• Creating community-based physical activity programs to help older adults maintain regular, multicomponent exercise as recommended by the Department of Health and Human Services.
• Encouraging older adults to eat a healthy diet high in whole grains, fruits, vegetables and lean protein and limit intake of sugary and fatty foods.
• Improving access to healthy foods in neighborhoods and care facilities.
• Tailoring weight loss diets to older adults’ nutritional needs and particular health risks.
• Providing individualized support and dietary suggestions, ideally maintained through a consistent patient-physician relationship.
• Prioritizing safe public outdoor spaces in disadvantaged areas to promote physical activity among older residents and mitigate obesity-related health disparities. 

The Centers for Disease Control and Prevention provides useful strategies for community-level interventions and healthy living tips designed to prevent obesity. The Community Preventive Services Task Force recommends a combined built environment approach to make it easier for people to engage in physical activity. This involves improving land use design by adding pedestrian and cycling paths, ensuring local access to stores and enhancing proximity to parks.

Healthy People 2030 includes several weight-related goals, including: 

• Reducing the overall proportion of adults with obesity.
• Increasing the proportion of health care visits by adults with obesity that include counseling on weight loss, nutrition or physical activity.

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Patsalos, Olivia, Johanna Keeler, Ulrike Schmidt, Brenda W. J. H. Penninx, Allan H. Young, and Hubertus Himmerich. “Diet, Obesity, and Depression: A Systematic Review.” Journal of Personalized Medicine 11, no. 3 (March 3, 2021): 176. https://doi.org/10.3390/jpm11030176.

Steele, C. Brooke, Cheryll C. Thomas, S. Jane Henley, Greta M. Massetti, Deborah A. Galuska, Tanya Agurs-Collins, Mary Puckett, and Lisa C. Richardson. “Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014.” MMWR. Morbidity and Mortality Weekly Report 66, no. 39 (October 3, 2017): 1052–58. https://doi.org/10.15585/mmwr.mm6639e1.

Tomiyama, A. Janet, Deborah Carr, Ellen M. Granberg, Brenda Major, Eric Robinson, Angelina R. Sutin, and Alexandra Brewis. “How and Why Weight Stigma Drives the Obesity ‘Epidemic’ and Harms Health.” BMC Medicine 16, no. 1 (December 2018): 123. https://doi.org/10.1186/s12916-018-1116-5.

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U.S. Department of Agriculture and U.S. Department of Health and Human Services. “Dietary Guidelines for Americans, 2020-2025.” Washington, D.C.: U.S. Department of Agriculture and U.S. Department of Health and Human Services, December 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

U.S. Department of Health and Human Services. “Physical Activity Guidelines for Americans, 2nd Edition.” Washington, D.C.: U.S. Department of Health and Human Services, 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf.