I have been rabbiting on about my PhD, so I thought I would put the premise of my study out there to my readers.
I am a consultant geriatrician – I specialise in the illnesses affecting older people. Dementia, Falls, Incontinence, Complex medical issues, functional impairment etc.
My PhD will be on obesity in the elderly, and treatments for it.
The baby boomer generation has the highest rate of obesity. They will be heading into my age bracket (age > 65) from now on.
As you age, you lose muscle mass, hence the frail, weak, previously thin old person. Your caloric burn also goes down, as you will all know muscle burns fat.
Frailty is usually associated with weight loss. However, if you have an extra 20, 30, 50kg of excess body fat, then your shrinking muscle mass will have difficulty carrying you around, hence the onset of functional impairment – difficulty walking, moving around and being able to do things for yourself. The more weight you carry, the worse it can be.
The other thing is that obesity and the diabetes syndrome can actually work to further eat away at muscle mass by causing a low-grade inflammatory state. Hence a vicious circle of fat gain, muscle loss, low caloric burn etc.
There is evidence that obese elderly have a lower mortality rate than expected, but have a high rate of disability. Live, disabled people put a great demand on health services.
There has not been much research into managements for this – there is a general reluctance to put elderly on reducing diets, though there is evidence that this can improve function (and quality of life). There is also fear that dieting can eat away at lean mass (which it also does in younger people)
I will be trialling various measures of weight loss in elderly obese subjects, and measuring their effects on various parameters such as weight, physical function and other things.
So that is that.
So me – I feel a bit better for having started. I still have periods of “I can’t do it”, and am easily overwhelmed. I am fighting through it though, am making contact with the psychologist soon. Just doing my best.