Imagen corporal y estilo de vida en adultos mayores con sobrepeso y obesidad

Abstract

Overweight and obesity do decrease quality of life, while they also increase the risk of developing chronic conditions. Unfortunately, weight excess is currently a world-wide epidemic. In addition, the world’s population is aging rapidly and life expectancy is increasing. Most health problems that affect older people are chronic non-communicable diseases. Accordingly, the prevalence of obesity increases with age. Obesity in older people specifically increases the risk of suffering from metabolic syndrome, cardiovascular diseases, cognitive impairment or some types of cancer, among others. Obesity also causes functional limitations, chronic pain and reduces quality of life of older people. The first strategy for weight management consists on following healthy lifestyles. The Mediterranean lifestyle is a healthy lifestyle, mainly consisting on doing physical activity daily and following the Mediterranean Diet. It improves general well-being, prevents cardiovascular incidence and reduces mortality. Nevertheless, lifestyle changes are sometimes tricky to implement. People, especially older adults, tend to underestimate the importance of their weight as a risk factor for their health, either due to an incorrect perception of body image or because its importance is not very well understood. Body image can therefore affect the way in which actions to improve weight, lifestyle and health are taken. Body image has been widely studied in young people, especially when linked to eating disorders. However, scientific evidence tackling body image in older adults with extra weight is limited. The present Doctoral Thesis aims to increase the evidence on this topic. Therefore, the main objective of this Doctoral Thesis is to evaluate the relationship among several body image parameters, lifestyle and health in a population of older adults over 55 years of age with overweight and obesity, as well as their changes after the first year of a healthy lifestyle promotion programme. Data obtained from the PREDIMED-Plus study have been used to respond to the objective of this Doctoral Thesis. Overweight self-perception is related to spontaneous weight management in overweight adults, usually done by dieting, exercising or a combination of both. However, aging is associated with a lower perception of weight excess and a decrease in weight concerns. Nevertheless, when weight perception in overweight older adults is accurate, it is associated with weight control, in the general adult population. Body image concerns improve as body weight decreases. The Body Mass Index (BMI) is closely related to desired weight loss (DWL), and its evolution through time. DWL is related to adherence to a Mediterranean lifestyle. High DWL, as compared to low DWL, are related to a lesser healthy dietary pattern, richer in processed foods and sugary sweetened beverages, and poorer in fruits and vegetables. High DWL are also related to lower levels of physical activity than low DWL. Nevertheless, high DWL have a positive impact on lifestyle, health and perceived quality of life when a healthy-lifestyle promotion program is provided. On the other hand, improvements on lifestyle, health and, perceived quality of life might decrease DWL among older adults with overweight. Hence, older adults could settle for a higher ideal BMI, which could still fall within the overweight or obese categories. While long term weight loss efforts are related to better spontaneous dietary pattern, they also related to moderate effects of a precise healthy-lifestyle promotion program. Compared to weight loss maintainers, those who started the healthy-lifestyle promotion program at their higher lifetime weight improved more significantly their dietary quality in the short term. Diabetic subjects report higher ideal weights and had higher maximum weights during their adulthood than pre-diabetic or non-diabetic subjects. Older Mediterranean individuals with metabolic syndrome and diabetes had better nutrient adequacy and adherence to the Mediterranean Diet than those with pre-diabetes or had no diabetes. It is noteworthy that all the above-mentioned differences in diet quality occurred under similar caloric intakes, underscoring the importance of dietary patterns and food selection. Consequently, both previously achieved maximum weight and satisfaction with body image should be considered when initiating and selecting a weight management strategy. Offering cognitive-behavioural therapies alongside diet and physical activity therapy is advisable to ensure long-term satisfaction and success.