Surgery for obesity in older women

Abstract

The global epidemic of obesity continues to grow, with over 1.7 billion people worldwide classified as obese (body mass index; BMI ≥ 30 kg/m²). Of special concern is the population of older women, since women are more obese than men and gain weight early during menopause. Obesity with co-morbidities is the leading threat to women's health and longevity. Specific female co-morbidities, such as reproductive failure, urinary stress incontinence and disproportionate prevalence of serious diseases such as diabetes, cardiovascular disease and cardiopulmonary failure in addition to breast cancer and gynaecologic malignancies, reduce the fitness benefits grandmothers provide to the species by ensuring reproductive success of their children and health and survival of grandchildren. In fact, female life-expectancy is decreasing in industrialized nations. Non-surgical treatment for obesity itself is ineffective; currently there is not enough evidence to recommend weight loss medications for routine use in the elderly and calorie-burning exercise is problematic. Conversely, antiobesity surgery has been shown to be both effective and safe in the older adult population in studies that predominantly enrol women. Although the risks and benefits of antiobesity surgery performed in high-volume dedicated centres must be carefully weighed for each individual patient, the strong evidence for its safety and efficacy in reducing obesity-related co-morbidities and improving quality of life, with the potential to increase healthy life-expectancy, makes antiobesity surgery a viable treatment option for older obese women.