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Added weight: The challenge of obesity in older patients

The combination of overweight and comorbid conditions takes a serious toll on older Americans. Addressing the problem requires sensitivity and specific strategies.

By Stephanie Stapleton, amednews staff. Nov. 15, 2004.

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The patient is a 78-year-old woman with severe osteoarthritis in her knees, hypercholesterolemia and hypertension. She is severely overweight. And her physician has been working with her to address her excess bulk.

Has the effort resulted in any success?

"Yes and no," said Melvyn Sterling, MD, an internist in Orange County, Calif. He has been able to stop the progressive rise in her weight. But as of yet, the scales haven't started registering downward momentum.

Like Dr. Sterling, many physicians are well aware of the hard-fought nature of such small victories when treating older, overweight patients who often present with a lifetime of bad habits and a range of complex chronic conditions. After all, the problems related to obesity are both widespread and insidious.

About two out of three Americans are overweight or obese. Incidence rates for older Americans follow close behind. According to the National Heart, Lung and Blood Institute, an estimated 18% of U.S. adults older than 65 are obese. Another 40% are overweight, putting them at substantially increased risk for diabetes, hypertension, heart disease and other illnesses.

In July, the Centers for Medicare & Medicaid Services announced a change in Medicare rules designed to remove barriers to covering anti-obesity treatments. The agency changed language that had stated that obesity was not a disease. As a result, coverage decisions now can be made on treatments, with the exception of weight loss drugs, if an advisory panel determines that enough evidence exists to demonstrate effectiveness in improving beneficiaries' health outcomes. Many doctors hope that this step ultimately will enable Medicare to be more proactive in paying for interventions before comorbidities take hold.