Caring for older people living with obesity

Obesity in older adults

Care for elderly people with obesity can be helpful in preventing further health issues from developing, such as diabetes. Here, we are exploring what type of care is recommended for older people with obesity, what is involved, nutrition and lifestyle changes that could help, what personal care needs might be a priority, how mental health is impacted, how caregivers can help, and more.

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about care for older adults, we can help.

What causes obesity in older adults? 

Obesity is a complex issue caused by a number of factors outside of simply overeating and under-exercising; people living with obesity may have developed behavioural patterns and habits they struggle to change, have genetic history of obesity in their family, have a related health condition such as an underactive thyroid gland (known as hypothyroidism), are taking certain prescription medications (such as steroids or antidepressants), have poor mental health, or have a combination of these factors. For this reason, it is important to take into account the cause of obesity in order to tailor care to the individual’s needs.

Is bariatric surgery ever recommended for older people? 

According to guidance from the National Institute for Health and Care Excellence and other professional bodies, referral for bariatric care should take place for people with a BMI (Body Mass Index) of over 40 kg/m2 (meaning their weight in kilograms and their height in metres, squared), people with a BMI of over 35 kg/m2 who also have a comorbid condition that can be improved by weight loss, or people with a BMI of over 30 kg/m2 who have already gone through other interventions to address their weight. 

Bariatric surgery (such as gastric bypass) may be recommended as a treatment option for those with obesity who fit the aforementioned criteria, and where all relevant non-surgical treatment options have been attempted but appropriate weight loss has not been achieved. Surgery will also only be recommended if the person can adhere to the post-surgery nutritional requirements and follow-up appointments, and if they are fit enough for anaesthesia and surgery. For this reason, although the National Institute for Health and Care Excellence does not specify an upper age limit for bariatric surgery, older adults are less likely to meet the fitness criteria for weight-loss surgery due to the health risks involved, and may not benefit from surgical outcomes the way other age groups might. Alternative types of obesity care and management may be recommended on a case-by-case basis.

What non-surgical interventions might be recommended? 

Several non-surgical bariatric interventions can assist with weight management, including:

• Medications – Certain prescription drugs can help to aid weight loss by affecting appetite or metabolism. Though lifestyle changes will still be required to maintain weight loss, these medications can be an effective starting point for anyone who has struggled with weight loss in the past.
• Exercise prescriptions – For those who may struggle to stick to a fitness routine on their own, or who would not know where to begin using exercise to lose weight, a doctor may prescribe exercise through a specialised program or gym instruction course to help people on their weight loss journey. You can learn more in our guide to fitness and exercise for the elderly.
• Weight loss groups – Sometimes having accountability and group motivation can help people stick to their weight loss goals, so a doctor may recommend someone attends a free weight loss group through the NHS where they can speak to others, learn more about weight loss, and stay accountable on their journey. 
• Lifestyle modifications – Behaviour change and lifestyle modifications are arguably the most important elements of bariatric care, and this will mainly involve dedicated dietary changes and a consistent exercise routine. In everyday life, this could be more about making healthy choices such as not overindulging on unhealthy foods, doing more movement throughout the day, taking more steps, choosing fruit and vegetables over processed snacks, and more.

How can those with obesity manage their nutrition needs?

The phrase “you can’t outrun a bad diet” is true, meaning no matter how consistent you are with your exercise routine, this will have little impact on health and weight management if you continue to eat unhealthy foods. People who live with obesity might be given a specific eating plan with recommended foods and supplements to help, or they may be referred to a dietician for more tailored advice. 

If you would like to learn more about helpful supplements for older adults, you may find more information in our guide to the best supplements and vitamins for older adults, but always check with your doctor before taking supplements.

Although diet is arguably the most important factor for weight management, it is important to adopt a fitness routine too for a more well-rounded approach to health. 

How can those with obesity manage their personal care needs?

Personal care can be challenging for those with obesity, as their mobility may be affected. For this reason, they (or their carers) may need to consider things like simplifying personal care tasks, making tasks safer with home adaptations, carrying out tasks when energy levels are high, cleaning regularly in areas with skin folds or irritation, and more. 

Studies suggest those with a high body mass index (BMI) often experience changes in their skin, lymphatic system, collagen function and micro/macro circulation. They may also experience excessive sweating which can lead to maceration and microorganism growth between skin folds. These areas may require cleaning, which can be difficult for older adults with obesity who may have reduced mobility. For this reason, home care could support the personal care and hygiene needs of those with these issues. 

How does mental health affect obesity, and vice versa? 

Often, obesity may occur due to mental health struggles that make sticking to a healthy diet feel impossible. When this is the case, therapy interventions may be recommended to provide the comprehensive support needed to address underlying emotional causes and intervene on the negative cycle that can begin to form. In addition, lack of mobility can impact the ability and desire to go out and socialise, which can lead to social isolation, loneliness, and further mental health struggles. 

Some forms of therapy that might support those with obesity and mental health issues include: 

• Cognitive-behavioural therapy (CBT) – This can help address any emotional eating habits, create behavioural change, and promote healthier coping mechanisms when under pressure. Research suggests one in four older adults experiences a behavioural health problem like depression or substance abuse, so addressing this element of obesity could make a big difference. Talking therapies like CBT are available via the NHS, and you can access these options by speaking to your GP. However, it is important to know that wait times for available appointments can vary depending on where you live. You may also be able to refer yourself for this service.
• Nutritional counselling – This is important so the person learns to manage their dietary needs themselves and does not rely on an eating plan long-term.
• Physical therapy – This can help in assisting with safe and effective exercises to improve mobility and support weight management.

You can learn more in our guide to supporting mental health in the elderly.

How can caregivers support those with obesity?  

Caregivers can support those with obesity in a number of ways, including providing nutritional support through healthy meal prepping and cooking, providing emotional support and encouragement for fitness activities, monitoring and tracking progress, assisting them in adherence to weight management medication, facilitating regular medical appointments, offering practical help with daily activities if mobility is impacted, and more.  

If you are looking after a loved one who lives with obesity, you may find more information on the NHS website, or if you would like to learn more about eating well, you can find information on the Age UK website.

Caring for an older person living with obesity can be challenging, so if you believe you need the help of a professional home carer to assist with this, either for yourself or for a loved one, you can reach out to your local Home Instead office to learn more about how we can provide this specialised type of care in the comfort of your own home. 

Our Care Professionals are the best of the best, and highly trained to deliver the services you need. No matter what type of home care you are looking for, we can provide a tailored service that suits you or your loved one. 

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.