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Seniors' Body Weight Dissatisfaction and Longitudinal Associations With Weight Changes, Anorexia of Aging, and Obesity: Results From the NuAge Study
Abstract and Figures
Objective:
We examined longitudinal associations between weight dissatisfaction, weight changes, anorexia of aging, and obesity among 1,793 seniors followed over 4 years between 2003 and 2009.
Method:
Obesity prevalence (body mass index [BMI] ≥ 30) and prevalence/incidence of weight dissatisfaction, anorexia of aging (self-reported appetite loss), and weight changes ≥5% were assessed. Predictors of weight loss ≥5%, anorexia of aging, and weight dissatisfaction were examined using logistic regressions.
Results:
Half of seniors experienced weight dissatisfaction (50.6%, 95% confidence interval [CI] = [48.1, 53.1]). Anorexia of aging and obesity prevalence was 7.0% (95% CI = [5.7, 8.3]) and 25.1% (95% CI = [22.9, 27.3]), whereas incidence of weight gain/loss ≥5% was 6.6% (95% CI = [1.3, 11.9]) and 8.8% (95% CI = [3.3, 14.3]). Weight gain ≥5% predicts men's subsequent weight dissatisfaction (odds ratio [OR] = 6.66, 95% CI = [2.06, 21.60]). No other association was observed.
Discussion:
Weight dissatisfaction is frequent but not associated with subsequent eating disorders. In men, weight gain predicted weight dissatisfaction. Seniors' weight dissatisfaction does not necessarily equate weight changes. Due to its high prevalence, it is of public health interest to understand how seniors' weight dissatisfaction may impact health.
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... Gender and age are the strongest determinants of the way one senses and perceives their body, and they both influence the importance one attaches to these processes (see Ålgars et al., 2009;Davison & McCabe, 2005;Roy, Shatenstein, Gaudreau, Morais, & Payette, 2014;Skultety & Whitbourne, 2004;Striegel-Moore & Franko, 2004;Swami et al., 2010). ...
... Objective changes in appearance that can be observed in seniors refer mostly to skin (particularly, facial skin) covered by wrinkles, forwardflexed posture and weight gain. Beginning at approximately 50 years of age, an average person gains five kilograms of body weight per decade (Roy et al., 2014). This weight gain, along with the altering of the distribution of adipose tissue, results in changes to one's figure (Visser & Harris, 2012). ...
... However, as in younger women, most older women are concerned about weight (see: Roy et al., 2014;Tiggemann, 2004). In a study conducted by Clarke (2002), most women aged 61-92 identified body weight as the most important cause of concerns about their body. ...
Objectives:
To study the attitudes of seniors to their own bodies, specifically subjective body attractiveness and activities aimed at the improvement of body appearance and condition.
Methods:
The study looked at 72 women and 81 men between 60 and 80 years of age. The participants were examined with the Body/Self Relationship Test, Body Esteem Scale and Healthy Behavior Inventory. Anthropometric measures, such as body mass index (BMI) and the index of central obesity (ICO), were also used.
Results:
Older women and men did not differ in terms of subjective attitudes to their bodies. Most seniors were overweight; this problem was more often disclosed and assessed negatively by women, but was not correlated with a higher level of health-seeking behaviors. Despite being clearly overweight, no significant associations were found between objective anthropometric parameters in men, their body attitudes and health-seeking behaviors.
Discussion:
The study confirmed that older women consider their body as an object that is assessed for its appearance, whereas men see it as a process, focusing on its efficient functioning.
... One risk factor for anorexia in healthy older adults is, not surprisingly, ageing itself [113]. Furthermore, body weight dissatisfaction, which might lead to avid dieting, weight loss and eating disorders, is frequent in older adults [114] and has been studied as possible precursor of appetite loss. Ultimately, Nutrients 2021, 13, 2764 9 of 20 anorexia of ageing has even been proposed to be a geriatric syndrome [115] as it significantly and independently affects nutritional und functional status in the old [116,117]. ...
Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.
... In Canada, one study evaluated anorexia of aging in a population of 67-84 years old elderly, and found a prevalence of less than 10% (45). Another study evaluating geriatric unit elderly found 50 (15.8%) ...
This study evaluated the association between anorexia of aging and nutrients intake. It was a cross-sectional study with 130 individuals aged 60 years or older, undergoing outpatient care in the city of Campinas, São Paulo. Anorexia of Aging (AA) was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ), and food consumption was evaluated using the 24-hour recall (24HR). The prevalence of AA was 27.7%, in which 66.7% were women and 38.9% were older than 80 years. Elderly with AA presented lower intake of calories (1172.6 kcal vs 1477.9 kcal; p = 0.003), carbohydrates (158.5 g vs 194.1 g; p = 0.015), proteins (49.9 g vs 68.5 g; p = 0.004) and lipids (34.6 g vs 46.1 g; p = 0.006). They also had lower intake of fibers (12.6 g vs 19.4 g; p < 0.001), iron (6.4 mg vs 8.9 mg; p < 0.001) and zinc (6.0 mg vs 8.5 mg; p = 0.004). Our results show that intake of most nutrients is significantly lower in AA elderly, except carbohydrates, which may point to worse-quality diets. The diagnosis of AA, as well as the evaluation of elderly food intake, are essential to prevent undernutrition, vulnerabilities, and increased morbidity and mortality.
... Moreover, obesity threatens the psychophysical health of the elderly. According to the study, abdominal obesity especially widespread among above population, is particularly associated with cardiovascular and metabolic diseases [46,47]. Besides it affects body-esteem and therefore self-esteem of obese people [48]. ...
Among the elderly increases risk of obesity-related disorders so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may motivate elderly people to change their nutrition habits. Might priming different kinds of food influence the attractiveness of the food for people in late adulthood undergoing obesity therapy? Based on priming theories, we analysed the effects of the conscious processing of stimuli associated with dietary habits in individuals aged with BMI ≥ 30 kg/m2. Our experiments confirmed the influence of a higher-priority goal of “slimming” on the perception and internalization of nutrition-related stimuli. In response to such stimuli, individuals who are actively involved in weight reduction and health-oriented programs use strategies for resisting temptation and to effectively “slim”. We present our findings in the context of their theoretical background and practical application.
... The higher percentage of overweight men among athletes can be also explained referring to the claim that the 'optimal' BMI category for older fit individuals could be the overweight one, probably reflecting the maintenance of muscle mass due to chronic exercise. [53,54]. ...
... The higher percentage of overweight men among athletes can be also explained referring to the claim that the 'optimal' BMI category for older fit individuals could be the overweight one, probably reflecting the maintenance of muscle mass due to chronic exercise. [53,54]. ...
Although ageing people could benefit from healthy diet and physical activity to maintain health and quality of life, further understandings of the diet- and physical activity-related mechanisms that may cause changes in health and quality of life perception are necessary. The purpose of the study was to investigate the effect of eating attitudes, body mass and image satisfaction, and exercise dependence in the relationship between physical activity and health and quality of life perception in older individuals. Hundred and seventy-nine late middle-aged, (55-64 yrs), young-old (65-74 yrs), and old (75-84 yrs) senior athletes (n = 56), physically active (n = 58) or sedentary adults (n = 65) were submitted to anthropometric evaluations (body mass, height) and self-reported questionnaires: Body Image Dimensional Assessment, Exercise Dependence Scale, Eating Attitude Test, and Short Form Health Survey (Physical Component Summary [PCS] and Mental Component Summary [MCS] of and health and quality of life perception). Senior athletes, physically active, and sedentary participants subgroups differed (P<0.05) from each other in body mass index (BMI) and several components of body image and exercise dependence. Senior athletes showed, compared to their sedentary counterparts, further differences (P<0.05) in eating attitudes and in both PCS and MCS. Mediation analysis showed that the relationship between physical activity habit and MCS, but not PCS, was indirectly explained by a serial mediation chain composed of objective BMI and subjective body image (dis)satisfaction. Findings confirm the relevant role of physically active life habits for older individuals to perceive good physical and mental health. The novelty of the three-path mediated link between physical activity level and mental health perception suggests that the beneficial effect of a physically active lifestyle on weight control can positively impinge on the cognitive-emotional dimension of mental health by ensuring the maintenance, also at older age, of a satisfactory body image.
... The higher percentage of overweight men among athletes can be also explained referring to the claim that the 'optimal' BMI category for older fit individuals could be the overweight one, probably reflecting the maintenance of muscle mass due to chronic exercise. [53,54]. ...
Although ageing people could benefit from healthy diet and physical activity to maintain health and quality of life, further understandings of the diet- and physical activity-related mechanisms that may cause changes in health and quality of life perception are necessary. The purpose of the study was to investigate the effect of eating attitudes, body mass and image satisfaction, and exercise dependence in the relationship between physical activity and health and quality of life perception in older individuals. Hundred and seventy-nine late middle-aged, (55-64 yrs), young-old (65-74 yrs), and old (75-84 yrs) senior athletes (n = 56), physically active (n = 58) or sedentary adults (n = 65) were submitted to anthropometric evaluations (body mass, height) and self-reported questionnaires: Body Image Dimensional Assessment, Exercise Dependence Scale, Eating Attitude Test, and Short Form Health Survey (Physical Component Summary [PCS] and Mental Component Summary [MCS] of and health and quality of life perception). Senior athletes, physically active, and sedentary participants subgroups differed (P
Although there is substantial evidence of visual attentional biases in processing weight-related information among individuals with weight dissatisfaction, few studies have examined auditory attentional biases in these individuals. The identification of attentional biases may provide an impetus for interventions to reduce distress, negative body image, and pathological eating patterns among weight-dissatisfied individuals. Therefore, the present study aimed to investigate the attentional biases, as well as the neural consequences, toward auditory weight-related information among weight-dissatisfied young females. In this experiment, young female participants were assigned to an experimental group with high weight dissatisfaction (HWD) and a control group with low weight dissatisfaction (LWD) according to the levels of weight dissatisfaction. Using a spatial cueing paradigm, auditory fatness-related, thinness-related, and neutral household words were presented laterally as cue stimuli, followed by visual stimuli presented at either the cued or uncued location. The results revealed that auditory fatness-related words elicited significantly larger N2ac amplitudes than auditory thinness-related and neutral words in the HWD group. However, for the LWD group, thinness-related words elicited a significantly larger N2ac than fatness-related and neutral words. These results suggest an orienting attentional bias toward auditory fatness-related body words among females with HWD and an orienting attentional bias toward auditory thinness-related words among females with LWD.
The ingestion of food has at least three functions: to (a) satisfy hunger and promote survival (physiologic hunger), (b) offer pleasure to satisfy an emotional attachment to food (hedonic hunger), and (c) perform a social obligation with family and friends (social dining or social hunger). The demographic shift globally, in which we see a rapid increase in the number of older adults, comes with a responsibility for the society to keep older adults healthy while satisfying the three functions of a meal mentioned above. Although preventable in most cases, malnutrition in older adults is a growing problem even in affluent nations. Even short durations of poor eating in older adults can lead to protein energy-wasting, frailty, and multiple nutritional deficiency disorders. Undernutrition and malnutrition of older adults are often missed by clinicians who are currently more concerned about obesity, a major epidemic receiving much attention. Although neglected, malnutrition in older adults is a real problem with varying severity and prevalence. Weight loss in the older adult has a greater impact on the overall health, immunity status and quality of life, compared to the younger adults. The consequences of malnutrition in older adults are frailty, falls, immunodeficiency, and worsening of other comorbidities decreasing the life span. The combination of hunger, taste, appetite, and satiety is inter-related and regulated by the hypothalamus with stimuli arising from the brain as well as from an elaborate enteric hormonal system. Anorexia of aging (AOA) plays a major role in the pathogenesis of nutritional deficiency states. Multiple mechanisms individually or more often collectively influence the incidence and severity of AOA. In this chapter, the authors have brought to light the hidden problem of malnutrition in the older adult as a result of AOA, discussed the pathophysiological basis of regulation of taste, appetite, and satiety, and address the clinical implications of AOA with potential preventive measures.
Objective:
To examine associations between energy/nutrient intakes and frailty in older migrant women, and to explore perceptions of body weight, dietary intake, and physical function.
Design:
Cross-sectional, mixed-methods study.
Setting:
Birmingham, United Kingdom.
Participants:
Seventy-six first-generation migrant women ≥ 60 years of age.
Main outcome measures:
Energy/nutrient intakes (assessed by 24-hour dietary recall), frailty (using the frailty phenotype), and links between perceptions of body weight, dietary intake, and physical function (via semi-structured interviews).
Analysis:
Bivariate and logistic regression analyses examined associations between frailty and low energy/nutrient intakes. Interviews were analyzed using inductive thematic analysis.
Results:
Seventy-six women completed a 24-hour dietary recall; 46 participated in a semi-structured interview. Low energy intake was associated with frailty (odds ratio [OR], 11.71; 95% confidence interval [CI], 2.36-57.97). After adjusting for energy and other confounders, a low intake of > 3 nutrients was associated with frailty (OR, 6.58; 95% CI, 1.01-43.08). Qualitative data suggest that dietary intake was influenced by concerns about body weight and perceptions that unhealthy foods reduce mobility.
Conclusions and implications:
Among older migrant women with high prevalence of overweight/obesity, an inadequate dietary intake may be a stronger predictor of frailty than weight loss. Dietary interventions should focus on healthy weight maintenance and optimization of nutritional adequacy and physical function.
Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and the NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.
Body composition in older adults can be assessed using simple, convenient but less precise anthropometric methods to assess (regional) body fat and skeletal muscle, or more elaborate, precise and costly methods such as computed tomography and magnetic resonance imaging. Body weight and body fat percentage generally increase with aging due to an accumulation of body fat and a decline in skeletal muscle mass. Body weight and fatness plateau at age 75-80 years, followed by a gradual decline. However, individual weight patterns may differ and the periods of weight loss and weight (re)gain common in old age may affect body composition. Body fat redistributes with aging, with decreasing subcutaneous and appendicular fat and increasing visceral and ectopic fat. Skeletal muscle mass declines with aging, a process called sarcopenia. Obesity in old age is associated with a higher risk of mobility limitations, disability and mortality. A higher waist circumference and more visceral fat increase these risks, independent of overall body fatness, as do involuntary weight loss and weight cycling. The role of low skeletal muscle mass in the development of mobility limitations and disability remains controversial, but it is much smaller than the role of high body fat. Low muscle mass does not seem to increase mortality risk in older adults.
In order to examine whether the double standard of aging exists in self-perceptions of body attitudes, 144 men and women aged 20 to 80 years were tested. Variables that might moderate the relationship between body attitudes and aging, including self-esteem, health, masculinity, appearance orientation, and exercise participation were also examined. No age, gender, nor Age × Gender differences in body attitudes were found. Self-esteem, health, and masculinity were positively related to body attitudes, but these relationships did not vary according to age or gender. An Age × Gender × Exercise interaction indicated a positive relationship between age and body satisfaction among women exercisers but a negative relationship among women nonexercisers. Finally, appearance orientation was unrelated to body attitudes among all participants. The results of this study do not support the double standard of aging in self-perceptions but do suggest the similarity and importance of body attitudes across the adult life span.
The authors examined factors prospectively associated with age of onset of partial syndrome eating disorders over a 4-year interval in a community sample (N = 877) of high school-age adolescent girls. Four percent developed a partial syndrome eating disorder over the interval. A measure of weight concerns was significantly associated with onset in a multivariate Cox proportional hazard analysis (p <.001). Girls scoring in the highest quartile on the measure of weight concerns had the highest incidence ( 10% ) of partial syndrome onset, whereas none of the girls in the lowest quartile developed eating disorder symptoms. This finding is consistent with both theoretical and clinical perspectives and may represent a useful step toward the establishment of a rational basis for the choice ofa prevention intervention target.
Background.
—During the first decade since the recognition of the acquired immunodeficiency syndrome (AIDS), new therapies have been introduced and the frequency of clinical manifestations has changed. The impact of these changes on AIDS survival, however, has not been well characterized.Design.
—A prospective cohort study of the outcomes of human immunodeficiency virus (HIV) infection.Setting.
—Homosexual and bisexual men residing in San Francisco, Calif, recruited in 1983 and 1984 for two prospective studies and followed up for more than 9 years with clinical examinations.Participants.
—A total of 761 HIV-positive homosexual and bisexual men.Main Outcome Measures.
—Survival time from a CD4 lymphocyte count at 0.20×109/L (200/μL and from a clinical AIDS diagnosis to death.Results.
—Median survival time from a CD4 lymphocyte count at 0.20× 109/L increased from 28.4 months in the October 1983 to November 1986 period to 40.1 months in the November 1986 to November 1988 period and is estimated at 38.1 months in the November 1988 to February 1993 period. Patients diagnosed with Pneumocystis carinii pneumonia (PCP) accounted for most of this increase with a gain in median survival time of 9.7 months (P=.0009), compared with a nonsignificant decline in the survival time of those patients without a PCP diagnosis. Multivariate analysis showed that rate of CD4 lymphocyte loss (P<.001) and receipt of both PCP prophylaxis and antiretroviral therapy (P=.04) were significantly associated with longer survival time, whereas antiretroviral therapy alone was not (P=.81). Time to death from a clinical AIDS diagnosis was 14.7 months in the 1983 to 1986 period, 19.1 months in the 1986 to 1988 period, and an estimated 15.7 months in the 1988 to 1993 period.Conclusions.
—Survival time from a CD4 lymphocyte count at 0.20×109/L has improved significantly by about 1 year; yet survival time using the 1987 AIDS case definition has shown small improvement. The largest increase in survival time from a CD4 lymphocyte count at 0.20×109/L was in patients diagnosed with PCP, suggesting that PCP prophylaxis and treatment were more important factors in longer survival time than antiretroviral therapy.(JAMA. 1994;271:1083-1087)
In order to examine whether the double standard of aging exists in self-perceptions of body attitudes, 144 men and women aged 20 to 80 years were tested. Variables that might moderate the relationship between body attitudes and aging, including self-esteem, health, masculinity, appearance orientation, and exercise participation were also examined. No age, gender, nor Age × Gender differences in body attitudes were found. Self-esteem, health, and masculinity were positively related to body attitudes, but these relationships did not vary according to age or gender. An Age × Gender × Exercise interaction indicated a positive relationship between age and body satisfaction among women exercisers but a negative relationship among women nonexercisers. Finally, appearance orientation was unrelated to body attitudes among all participants. The results of this study do not support the double standard of aging in self-perceptions but do suggest the similarity and importance of body attitudes across the adult life span.