'Fat frail' patients difficult to treat

THE TREATMENT of obese but malnourished older people, known as “fat frail”, is becoming a major challenge for healthcare systems around the world, a conference in Dublin will hear tomorrow.

Dr John E Morley, director of the division of geriatric medicine at St Louis University Medical Center in Missouri, US, said that as global obesity levels rise, levels of sarcopenic obesity in older people are also increasing.

A person with sarcopenic obesity will be seriously overweight but have very low muscle mass.

The condition, which is estimated to affect 5 per cent of the population aged 60 and over, and 30-40 per cent of those aged 80 and over, is on the increase.

“We start losing muscle from the age of 30 at the rate of around 1 per cent per year. If we are sick or do not walk or exercise, we lose more muscle mass,” he said.

“We know that losing muscle is bad for you and being excessively overweight is bad. In overweight older people, fat infiltrates into the muscle, weakening it.

“A person might not have enough functioning muscle to carry the weight of their own body around.”

Dr Morley will be speaking at the inaugural Irish Society for Parenteral and Enteral Nutrition (ISPEN) annual conference at the Royal College of Physicians of Ireland, which takes place in Dublin tomorrow.

According to Dr Morley, sarcopenic obesity is clearly associated with increased hospitalisation and nursing home stays, bad outcomes and increased mortality.

He said that treating patients with this condition was posing a new challenge for healthcare professionals.

“Typically, if we want a patient to lose weight, we put them on a diet, but the problem is that after the age of 60, diets are related to an increase in hip fractures, bad outcomes and death,” he said.

“When somebody loses weight, they are losing 25 per cent of this as muscle and bone, and if they already have low muscle mass, they will really be in trouble.”

The solution for people over the age of 60 with sarcopenic obesity is to eat more protein, walk and do resistance exercise (strength training) daily and stay away from diets, according to Dr Morley.

Some “fat frail” patients were being treated with testosterone but there were side effects, he said.

“The best prevention of sarcopenic obesity is not to put on weight in the first place.

“Everybody who is overweight and losing muscle has some degree of pre-sarcopenic obesity,” he warned.