Every organ system is impacted by obesity. Obesity is a chronic inflammatory condi-
tion. This chronic inflammation can lead to significant other diseases. That’s why, by the way, obesity is such a
risk factor for both sickness and death re- lated to COVID-19. That chronic inflam- mation is present for individuals who have the chronic disease of obesity, who then develop that acute inflammation associated with COVID-19.
Q. As obesity is a disease, is there a cause—and a treatment? A. We say it’s a multifactorial disease: The causes can be maternal and fetal issues, psychological reasons, food and beverage behavior and environment—everything, basically, is a potential trigger. We’ve been focusing on having people
eat fewer calories or get moving more—yet we see rates continue to increase, even as so many people increase their activity and try to eat healthier. That’s because causes and treatment is so much more complex than “calories in, calories out.” My goal when I’m working with a patient
is to figure out the variety of potential fac- tors that led to that person having obesi- ty—and then, determining how I develop treatment strategies that help them get to their healthiest and happiest.
Q. Many people in senior living are taking medications that can affect their weight—is this an issue? A. Absolutely. I take an assessment of what patients are taking and see if they might be on a medication that’s no longer necessary or can be adjusted. For instance, Lyrica and gabapentin can cause weight gain; I’ve had patients gain up to 80 pounds from these medications.
Q. Senior living culinary services have started using evidence-based diets such as the MIND and the Mediterranean diets—do these types of diets help? A. In treating obesity, we always start with the lifestyle. Food does matter. We want to focus
on less processed foods, because the body stores highly processed foods very differently than foods that are less processed. We want lean protein, whole grains, fruits, and vege- tables to be our predominant food sources. Dieticians and menus are very helpful. Physical activity is also key. The goal for humans, adults older or younger, is to have at least 150 minutes of moderately intense physical activity per week. If you have obe- sity, the target is 300 minutes. “Moderate intensity” means you can talk
during the activity, but you cannot sing, be- cause your breathing should be too labored for you to carry a tune.
Q. Are older adults candidates for surgery? A. Absolutely; 100 percent. People are often shocked when I say that. One patient I had was 69, and she thought she would be too old for surgery. I told her: I’ve listened to you talk about the struggles with weight you’ve had over 69 years of your life. You have severe obesity. You have obesity-related diseases. If surgery is the most effective tool to generate the greatest weight loss, and it’s going to lead to the greatest resolution of other diseases, why not utilize that? Interestingly enough, we’ll send older
people for total knee and total hip re- placements, spinal surgeries, open heart surgery—these are much more invasive. But with bariatric surgery, we can some
RESOURCES
• The report, “Obesity in Older Adults: Succeeding in a Complex Clinical Situation” is available free at the Gerontological Society of America’s website,
geron.org.
• Dr. Stanford recommends those seeking obesity treatment check the American Board of Obesity Medicine website, at
abom.org. It has a physician finder button that also helps verify provider credentials.
• As patients begin treatment, Dr. Stanford asks them to watch a lecture on YouTube: “Obesity: It’s More Complex Than You Think.” It’s an hour long, but fascinating and fast-moving, and can help anyone understand the evidence about different treatments and the importance of stopping weight bias.
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sometimes send you home on the same day. Right now, the U.S. mortality rate from bariatric surgery is 0.7 percent—not zero, but very low.
Q. The GSA report says one barrier to treatment is the persistent idea that obesity is about individual choices rather than a disease, and that people with obesity face bias from health care providers. How can people in senior living help change this? A. Remember that it’s not about the weight itself: It’s how that excess weight affects a person—their overall health, their mental state, their well-being, the chronic diseas- es they have, and the risk for additional diseases. My goal is to help change the narrative— to help people recognize that if they’ve struggled so long, that this is not their fault, and that there are those of us that are out here that are willing, ready, and able to treat them. With some people that are older, what
I’m saying to them deviates drastically from everything they’ve heard about weight, all their lives. For older people, I’m now trying to undo
every negative thing they’ve been told about themselves, or that they’ve been taught to believe about themselves, or all the nega- tive language over their lives. All that comes with them to that first appointment.
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