The importance of arriving at older age a healthy weight

The Scottish Government are currently holding a consultation on developing a health and care strategy for older people in Scotland, to consider the health and care needs of older people going forward and to ensure services are integrated and person-centred. In our response, we highlight the importance of diet and nutrition for older people, and emphasise the need to for a whole spectrum understanding of malnutrition to be taken forward into policy making.

The impact of obesity in older people  

The health risks associated with obesity increase with age, and there are many such risks in older adults, including sarcopenia, slowing metabolism, medication, dental health, low physical activity, and poor diet/nutrition.

Other risk factors include higher incidence of many non-communicable diseases including type 2 diabetes and chronic heart disease. If we take type 2 diabetes as an example, in 2020, adults in the 60-69 age group accounted for 26% of new type 2 diabetes cases, compared to only 6% in the 30-39 age group. Further, in terms of prevalence of type 2 diabetes, 28% of the 60-69-year-old population in Scotland had type 2 diabetes in 2020, compared to only 2% of those aged 30-39ⁱⁱ.

Diet and nutrition continue to be poor into older age and this compounds many of these risk factors. Findings by the Scientific Advisory Committee on Nutrition (SACN) report that older people regularly consume too much high fat, salt and sugar foods, and do not get enough fruit and vegetables and other key nutrients like fibre in their dietsⁱⁱⁱ. Levels of physical activity are also poor. Over 65s are the age group with the lowest physical activity levels in Scotland. These low rates of physical activity, coupled with poor diet and nutrition, increase the risk of overweight and obesity among older adults.

Prevalence of obesity in older people

Within the Scottish population, the older age groups (65+) present the highest proportion of individuals living with overweight and obesity and, conversely, the lowest proportion of individuals of a healthy weight. As of 2020, 73% of people in the 65-74 age group and 66% of people in the aged 75+ were living with overweight, obesity, or severe obesity. This is higher than the national average across all age groups in Scotland, which was 62% in the same year. Importantly, 31% of those aged 65-74 years and 24% of those aged 75+ are living with obesity and severe obesity^iv. These figures are illustrated in the graph below.

Figure 1: Rates of overweight, obesity and severe obesity in older people 

The continuum of malnutrition

Lets now consider obesity in the context of malnutrition. Malnutrition in older adults is a key topic. There has been increasing attention nationally about malnutrition in older adults but often this focuses only on undernutrition. Understanding the whole spectrum of malnutrition across all age groups and life stages is key to effective action to address it. Use of a historical definition of malnutrition, to mean only undernutrition, risks creating confusion and an unnecessary conflict in priorities and actions. In fact, a focus on tackling only one aspect of malnutrition could cause harm.

In this regard, it is helpful to imagine malnutrition as a continuum from undernutrition to overweight and obesity. In recognition of the whole spectrum of diet-related problems, authorities such as the World Health Organization and Global Nutrition Report have been increasingly using the terms of ‘malnutrition in all its forms’ and ‘double burden of malnutrition’^v. It is now recognised that undernutrition and obesity are intrinsically linked through four shared factors: early life nutrition; dietary quality; food environments; and socioeconomic factors. Focusing on progress in these four areas will improve all aspects of nutrition across all life stages.

We published a position statement calling on policymakers to ensure when they use the term malnutrition they are not inadvertently only referring to undernutrition as we have seen this issue arise regularly in policy documents relating to older people.

Our policy asks to tackle overweight and obesity in older people

We call on the Scottish Government to take action to address overweight and obesity in older people and would like to see action in the following areas.

Firstly, we must see action by national government and public sector to promote a healthier weight and prevent weight gain through the life course through improved food and physical activity environments. It is important that adults arrive at older age already a healthy weight as this will help ensure they can avoid the risks associated with overweight and obesity.

Secondly, prevention and population level interventions are the priority issues that we want to see action on, but we know that prevention alone will not resolve the issues discussed in this blog, especially for older people. The Scottish Government should therefore ensure that opportunities for weight management and early detection of type 2 diabetes services are accessible to the older adult.

Finally, in order to ensure that the full spectrum of malnutrition is given proper and full consideration at policy level, we call on the Scottish Government to adopt the WHO definition of malnutrition, and to include the whole spectrum of malnutrition (including overweight and obesity) in any policies targeting malnutrition or diet in older people in Scotland.

We recently published a briefing paper on older people and obesity, where we discuss the issues explored in this blog in more detail. Read the briefing paper here.

References

ⁱ National Records of Scotland. Mid-year population estimates, Scotland. 2021 https://www.nrscotland.gov.uk/files//statistics/population-estimates/mid-20/mid-year-pop-est-20-report.pdf

ⁱⁱ NHS Scotland Scottish Diabetes Survey 2020 https://www.diabetesinscotland.org.uk/wp-content/uploads/2022/01/Diabetes-Scottish-Diabetes-Survey-2020.pdf

ⁱⁱⁱ Scientific Advisory Committee on Nutrition (SACN). SACN Statement on Nutrition and Older Adults Living in the Community.; 2021.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/953911/SACN_Nutrition_and_older_adults.pdf

^iv The Scottish Government. The Scottish Health Survey 2020 Edition - telephone survey, volume 1, main report https://www.gov.scot/publications/scottish-health-survey-telephone-survey-august-september-2020-main-report/documents/

v https://www.who.int/news-room/fact-sheets/detail/malnutrition#:~:text=Combating%20malnutrition%20in%20all%20its%20forms%20is%20one,best%20possible%20start%20in%20life%2C%20with%20long-term%20benefits.