[PMID: 30542016 DOI: 10.3143/geriatrics.55.464]

[Diagnosis and treatment of obesity disease in older adults]

In Japan, the proportion of older adults with obesity is rising, highlighting the need for specialized medical care for older adults with obesity. The Japan Society for the Study of Obesity (JASSO) defines 'obesity' as excessive fat storage in adipose tissue with body mass index (BMI) ≥ 25 kg/m2, and "Obesity Disease" as a condition with health disorders associated with obesity and/or visceral fat accumulation.The term 'high-degree obesity' applies to those with BMI≥ 35 kg/m2, and "Obesity Disease" with high-degree obesity is defined as "high-degree Obesity Disease".While the diagnostic criteria for "Obesity Disease" are same regardless of age group, older adults have unique problems. For example, BMI may not accurately reflect fat mass due to age-related height changes and other factors like edema. There's also an 'obesity paradox' in the older adults, where higher BMI may correlate with reduced mortality, though visceral fat is a risk factor.Weight reduction goal is 3% or more of body weight in 3-6 months for "Obesity Disease" and 5-10% or more for "high-degree Obesity Disease" . Management may include calorie-controlled diets and resistance exercises to prevent bone and muscle loss. Advanced treatment options like bariatric/metabolic surgery are also available for "high-degree Obesity Disease" .Recent guidelines from the Japan Geriatrics Society and JASSO provide insights into managing "Obesity Disease" among older adults, considering specific issues like dementia and functional decline. Future therapy need to evolve and provide individualized approaches to manage obesity for older adults.

Era of geriatric medical challenges: Multimorbidity among older patients

The number of older adults is increasing worldwide, including in Asian countries. Various problems associated with medical care for older adults are being highlighted in aging societies. As the number of chronic diseases increases with age, older adults are more likely to have multiple chronic diseases simultaneously (multimorbidity). Multimorbidity results in poor health-related outcomes, leading to increased use and cost of healthcare. Above all, it leads to deterioration in older adults' quality of life. However, it is unclear whether any medical interventions are effective for multimorbidity, which means medical practitioners currently offer medical care "in the dark." It is therefore necessary for researchers and medical professionals involved in geriatric medicine to establish ways to manage multimorbidity among older adults. This means that the development of research in this field is essential. Geriatr Gerontol Int 2019; 19: 699-704.