Clinical practice guidelines for older adults living with overweight and obesity: A scoping review

Summary: Background & Aims: Age-related changes in body composition and the apparent protective effects of being overweight suggest that specific guidance is required for the clinical management of overweight and obesity for older adults (≥65 years). This study aimed to synthesise content on older adults from clinical practice guidelines for the management of overweight and obesity in adults. Methods: Twenty-three clinical practice guidelines on the management of overweight and obesity in the general adult population were identified from a recent scoping review. These guidelines were analysed for content relating to older adults. Data extraction focused on the assessment, diagnosis, and management of overweight and obesity in older adults, and specific guidance/recommendations on the management of overweight and obesity in older adults. Data were synthesised narratively. Results: Of the 23 guidelines, nine included text specific for older adults. Of these guidelines, four contained cautions regarding relevance of body mass index (BMI) cutoffs for older adults, and an additional two guidelines contained statements that BMI is a poor predictor of mortality. Information on waist circumference was inconsistent across five guidelines. Five guidelines cautioned against pursuing weight loss goals with older adults. Age-related considerations for diet, exercise, use of pharmacological interventions for weight management, and bariatric surgery were identified in several guidelines. Guidance to encourage older adults to participate in diet and exercise interventions was the most common recommendation. Recommendations on pharmacological interventions for weight management and bariatric surgery were inconsistent. Conclusions: Few guidelines incorporate content and recommendations for older adults, and there are inconsistencies between guidelines regarding the management of overweight and obesity. With evidence showing body composition and mortality risk associated with overweight change with age, there is a need to provide recommendations for older adults within clinical practice guidelines for the management of overweight and obesity.