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Fernández-Rodríguez, J. Casado, F. Formiga, A. González-Franco, J.C. Arévalo, M. Beltrán, J.M. Cerqueiro González, P. Llàcer, L. Manzano, J.L. Morales-Rull, J. Pérez Silvestre, A. Conde-Martel" "autores" => array:12 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Fernández-Rodríguez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Casado" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Formiga" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "González-Franco" ] 4 => array:2 [ "nombre" => "J.C." "apellidos" => "Arévalo" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Beltrán" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Cerqueiro González" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Llàcer" ] 8 => array:2 [ "nombre" => "L." "apellidos" => "Manzano" ] 9 => array:2 [ "nombre" => "J.L." "apellidos" => "Morales-Rull" ] 10 => array:2 [ "nombre" => "J." "apellidos" => "Pérez Silvestre" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Conde-Martel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256523001327" "doi" => "10.1016/j.rce.2023.06.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256523001327?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887423000942?idApp=WRCEE" "url" => "/22548874/0000022300000008/v2_202404080905/S2254887423000942/v2_202404080905/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887423000954" "issn" => "22548874" "doi" => "10.1016/j.rceng.2023.07.009" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "2129" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2023;223:486-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Characteristics of hospitalized patients with hypercalcemia in the province of Malaga: a longitudinal, retrospective, multicenter study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "486" "paginaFinal" => "492" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características de los pacientes hospitalizados con hipercalcemia en la provincia de Málaga: estudio longitudinal, retrospectivo y multicéntrico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1051 "Ancho" => 1675 "Tamanyo" => 99877 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Survival functions in patients with hypercalcemia of neoplastic origin (red, lower curve) and of other origins (blue, upper curve) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Ropero-Luis, A. López-Sampalo, J. Sanz-Cánovas, A. Ruiz-Cantero, R. Gómez-Huelgas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Ropero-Luis" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Sampalo" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sanz-Cánovas" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Ruiz-Cantero" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256523001443" "doi" => "10.1016/j.rce.2023.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256523001443?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887423000954?idApp=WRCEE" "url" => "/22548874/0000022300000008/v2_202404080905/S2254887423000954/v2_202404080905/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Consensus Document</span>" "titulo" => "Approach to obesity in the elderly population: a consensus report from the Diabetes, Obesity and Nutrition Working Group of SEMI (Spanish Society of Internal Medicine)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "493" "paginaFinal" => "498" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Pérez Martínez, Ricardo Gómez-Huelgas, Pedro Pablo Casado Escribano, José Carlos Arévalo-Lorido, María Isabel Pérez-Soto, Juana Carretero Gómez" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Pablo" "apellidos" => "Pérez Martínez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Gómez-Huelgas" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "Pedro Pablo" "apellidos" => "Casado Escribano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "José Carlos" "apellidos" => "Arévalo-Lorido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "María Isabel" "apellidos" => "Pérez-Soto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 5 => array:4 [ "nombre" => "Juana" "apellidos" => "Carretero Gómez" "email" => array:1 [ 0 => "juanicarretero@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 6 => array:1 [ "colaborador" => "En representación del Grupo de Trabajo de Diabetes, Obesidad y Nutrición de la SEMI (Sociedad Española de Medicina Interna)" ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA)/Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario del Vinalopó, Elche, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Propuesta acerca de la obesidad en la población anciana: informe de consenso del Grupo de Trabajo de Diabetes, Obesidad y Nutrición de la SEMI (Sociedad Española de Medicina Interna)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3982 "Ancho" => 2917 "Tamanyo" => 1206437 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Algorithm of obesity in individuals older than 65 years old.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The global burden of obesity is rapidly increasing worldwide. According to the World Health Organization (WHO), more than 650 million people worldwide are living with obesity, which predisposes them to several clinical consequences, including cardiovascular disease, type 2 diabetes, cancer, chronic kidney disease, mental health issues, and musculoskeletal disorders.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Concurrently, the elderly population is growing, and healthcare systems must address the needs of a rising number of individuals over the age of 65 who are affected by obesity and its related complications.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On the other hand, new and effective tools for treating obesity, such as bariatric surgery and drugs like glucagon-like peptide-1 receptor agonists (GLP-1 RA) and novel GIP/GLP-1 receptor agonists, are available. However, their use in older patients is limited due to the lack of robust evidence in this particular population.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Age should not be the sole criterion, known as “ageism,” for deciding the therapeutic approach to older patients with obesity. It is crucial to adopt an individualized, person-centered approach based on comprehensive geriatric assessments to accurately evaluate the risk-benefit balance of obesity therapies in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Aging is associated with an increase in abdominal white adipose tissue and fat deposition in skeletal muscle, which significantly affects insulin sensitivity.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Obesity is also strongly linked to a diminished quality of life. In this context, prevention and treatment of obesity become even more relevant in older adults. One major concern in treating obesity in elderly individuals is that many may have sarcopenic obesity, which can worsen with weight loss, inevitably resulting in some degree of lean body mass loss.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Therefore, it is clinically important to identify which elderly individuals with obesity have sarcopenia, and this can be achieved inexpensively and easily using the SARC-F questionnaire.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Additionally, for this population, it is important to identify other barriers to treatment initiation, such as life expectancy, and evaluate other associated comorbidities, including the degree of frailty (FRAIL scale)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and/or cognitive impairment (Pfeiffer test).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Lifestyle interventions that include a reduced but sufficient energy intake, age-appropriate protein and macro/micronutrient intake, combined with a comprehensive resistance exercise program tailored to individual limitations, can induce weight loss while improving frailty indices.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The use of weight loss medications, particularly GLP-1 RA and tirzepatide, provides an additional stage of treatment.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> Their safety and cardiovascular health benefits have been convincingly demonstrated in older obese patients with type 2 diabetes mellitus. This option should not be denied to obese individuals with other obesity-related comorbidities based solely on age. Moreover, recent evidence suggests that bariatric surgery can be safely performed in selected older individuals as a last treatment option.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Risk-benefit considerations should be carefully weighed and disclosed to candidates, taking into account their good presurgical functional status. From a clinical perspective, physicians must balance the potential risks of weight loss in older individuals against the complications of obesity in order to determine the most suitable patient-centered approach.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of this document is to propose an algorithm of recommendations for the management of obesity in the elderly (above the age of 65), based on scientific evidence and the expertise of members from the Diabetes, Obesity, and Nutrition Workgroup of the Spanish Society of Internal Medicine. It is important to note that this document does not serve as a clinical practice guideline or review. For that purpose, you can refer to the guidelines and recommendations provided by different scientific societies.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The methodological structure of the algorithm comprises two distinct parts. The first part aims to assess certain essential aspects (functional status, sarcopenia, and cognitive status) when considering possible treatment recommendations for elderly patients. This will include the following.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Frailty</span><p id="par0035" class="elsevierStylePara elsevierViewall">Frailty is an emerging global health burden with significant implications for clinical practice and public health. It refers to a state of decreased physiological reserve and increased vulnerability to negative health outcomes. Frail individuals face an increased risk of adverse outcomes such as falls, hospitalization, and mortality.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The FRAIL scale assesses five components: Fatigue, Resistance (inability to climb stairs), Ambulation (inability to walk a certain distance), Illnesses, and Loss of weight.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This simple questionnaire consists of five self-reported YES/NO items.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> A patient is considered frail when they score equal to or higher than 3 on the FRAIL scale. Frailty is a significant determinant when determining therapeutic strategies for elderly patients due to its prognostic implications.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Sarcopenia</span><p id="par0040" class="elsevierStylePara elsevierViewall">Sarcopenia refers to the loss of muscle mass and strength that occurs with aging. It is a major cause of disability and frailty among the elderly population. Sarcopenia leads to disability, falls, and increased mortality. Growing evidence has shown that sarcopenic obesity is associated with accelerated functional decline, increased risks of cardiometabolic diseases, and mortality. Therefore, identifying sarcopenic obesity is crucial for clinicians working with the elderly.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> The SARC-F questionnaire has been developed as a rapid diagnostic test for sarcopenia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although the screening sensitivity of SARC-F is poor, recent evidence indicates its high specificity, making it an effective tool for selecting subjects who require further testing to confirm a diagnosis of sarcopenia.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The SARC-F questionnaire consists of five components: Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls. Each component is scored from 0 to 2, resulting in a total score ranging from 0 to 10. A score equal to or greater than 4 predicts sarcopenia and poor outcomes.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Cognitive decline</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cognitive decline refers to a range of conditions, from mild cognitive impairment to dementia, which represents a severe decline in abilities that interferes with daily life. Clinicians working with elderly patients require a brief and reliable instrument to detect the presence and determine the degree of cognitive impairment. The Pfeiffer test, a 10-item Short Portable Mental Status Questionnaire (SPMSQ), has been designed, tested, and validated for this purpose.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The score ranges are as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">0−2 errors: Intact intellectual functioning</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">3−4 errors: Mild intellectual impairment</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">5−7 errors: Moderate intellectual impairment</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">8−10 errors: Severe intellectual impairment</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Note:</span> Assessing body composition is not essential for the routine clinical management of obesity. Often, devices and equipment for accurately measuring body fat are not readily available.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The second part of the algorithm presents different treatment recommendations for obesity based on the initial assessment of the patient's functional, sarcopenia, and cognitive status. Treatment should be grounded in good clinical care and evidence-based interventions, while also being individualized, multidisciplinary, and focused on realistic goals, weight maintenance, and prevention of weight regain.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Two distinct scenarios are considered:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">1</span><p id="par0085" class="elsevierStylePara elsevierViewall">For patients identified with frailty, sarcopenia, or cognitive impairment during the initial assessment, the aim of the recommendations is to prioritize non-pharmacological interventions and preserve quality of life, avoiding restrictive diets <a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2</span><p id="par0090" class="elsevierStylePara elsevierViewall">For patients who maintain a preserved overall status after the initial assessment, recommendations will be stratified based on the severity of obesity as determined by body mass index (BMI, kg/m<span class="elsevierStyleSup">2</span>):</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">2.1. Patients with a BMI between 30–34.9 will be encouraged to adopt a healthy lifestyle, including a balanced eating pattern, appropriate physical exercise, tobacco cessation, and good sleep hygiene.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> These recommendations are applicable to all subjects, regardless of their BMI.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">2.2. For patients with a BMI between 35 and 39.9, accompanied by comorbidity and/or an Edmonton Obesity Staging System (EOSS) score >2 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), pharmacological recommendations will be introduced. Options may include liraglutide 3.0 mg (subcutaneous injection of 3 mg/24 h) (no dose adjustment based on age; limited therapeutic experience in patients ≥75 years), semaglutide 2.4 mg (subcutaneous injection once weekly) (when available; no dose adjustment based on age; limited therapeutic experience in patients ≥75 years), tirzepatide 5/10/15 mg (subcutaneous injection once weekly) (when available; weight reduction associated with clinically meaningful improvement in body composition across age groups, including those ≥65 years), or orlistat (oral administration of 60−120 mg every 8 h). GLP1RA is recommended as the initial option due to its efficacy. Re-evaluation should be conducted after 12 weeks, and if a weight loss of at least 5% is not achieved, discontinuation should be considered.</p><p id="par0105" class="elsevierStylePara elsevierViewall">2.3. For patients with a BMI over 40, in addition to potential pharmacological treatments, the possibility of bariatric surgery would be evaluated on an individual basis for selected cases.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Obesity in the elderly not only has a significant impact on morbidity and mortality but also on quality of life. However, the treatment recommendations for this population remain a subject of research and debate due to the lack of sufficient evidence.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The objective of this document is to propose a set of recommendations for the management of obesity in individuals above the age of 65, based on scientific evidence and the expertise of the members from the Diabetes, Obesity, and Nutrition Workgroup of the Spanish Society of Internal Medicine.</p><p id="par0120" class="elsevierStylePara elsevierViewall">When dealing with possible treatment recommendations for older adults with obesity, it is crucial to assess certain essential aspects, including functional status, sarcopenia, and cognitive status. Additionally, it is important to have a comprehensive understanding of the risks associated with weight loss on muscle and bone health.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Lifestyle interventions, such as following a Mediterranean diet pattern and engaging in physical exercise, particularly strength training, are considered the best weight loss plan for the elderly. However, it should be noted that pharmacotherapies that are approved by the FDA and/or EMA for adults have not been extensively studied in the elderly population. Bariatric surgery may be an option for selected candidates.</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is the responsibility of physicians to recognize obesity as a disease and provide appropriate prevention and treatment measures for obese patients. By addressing obesity, healthcare professionals can contribute to improving the overall health and well-being of their patients.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">Pablo Pérez-Martínez has received fees for lectures and educational activities from Ferrer, Novo-Nordisk, Boehringer Ingelheim, Amgen, Esteve, Menarini, Servier, and Viatrix.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Ricardo Gómez-Huelgas has received fees for lectures and educational activities from Novo-Nordisk, Lilly, Boehringer Ingelheim, AstraZeneca, Esteve, and Menarini.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Pedro Pablo Casado-Escribano has received fees for lectures and educational activities from Novo-Nordisk, Boehringer Ingelheim, Menarini, AstraZeneca, Sanofi, and Lilly.</p><p id="par0150" class="elsevierStylePara elsevierViewall">José Carlos Arévalo-Lorido has received fees for lectures and educational activities from Boehringer Ingelheim and AstraZeneca.</p><p id="par0155" class="elsevierStylePara elsevierViewall">María Isabel Pérez-Soto6 has received fees for lectures and educational activities from Novo-Nordisk, Boehringer Ingelheim, Nestlé, and Menarini.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Juana Carretero-Gómez5 has received fees for lectures and educational activities from Novo-Nordisk, Boehringer Ingelheim, Menarini, and AstraZeneca.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2120200" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1806202" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2120199" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1806201" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Frailty" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Sarcopenia" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Cognitive decline" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-16" "fechaAceptado" => "2023-05-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1806202" "palabras" => array:5 [ 0 => "Obesity" 1 => "Elderly" 2 => "Mediterranean diet" 3 => "Glucagon-like peptide-1 receptor agonists" 4 => "Sarcopenia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1806201" "palabras" => array:5 [ 0 => "Obesidad" 1 => "Ancianos" 2 => "Dieta mediterránea" 3 => "Agonistas del receptor del péptido glucagonoide 1" 4 => "Sarcopenia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Obesity in the elderly not only impacts morbidity and mortality but their quality of life. This phenomenon has sparked extensive research and debate regarding treatment recommendations, primarly due to the lack evidence in this specific population. When addressing possible treatment recommendations for older adults with obesity, it is crucial to assess certain essential aspects such as functional status, sarcopenia, cognitive status, and others. Intentional weight loss in this population can be both effective and safe. The best weight loss plan for the elderly revolves around adopting a healthy lifestyle, which includes following a Mediterranean diet pattern and engaging in physical exercise, particularly strength training. Additionally, the use of weight loss medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RA) and novel glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, can provide an additional stage of treatment. In selective candidates, bariatric surgery may also be considered. The objective of this document is to propose a comprehensive algorithm of recommendations for the management of obesity in the elderly (above the age of 65), based on scientific evidence and the expertise of members from the Diabetes, Obesity, and Nutrition Workgroup of the Spanish Society of Internal Medicine.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La obesidad en los ancianos no solo influye en la morbimortalidad, sino también en su calidad de vida. Este fenómeno ha suscitado una amplia investigación y debate sobre las recomendaciones terapéuticas, debido principalmente a la falta de datos en esta población específica. Cuando se abordan las posibles recomendaciones terapéuticas para adultos mayores con obesidad, es fundamental evaluar ciertos aspectos esenciales, como el estado funcional, la sarcopenia, el estado cognitivo y otros. La pérdida de peso en esta población puede ser tanto eficaz como segura si es intencionada. El mejor plan de pérdida de peso para los ancianos gira en torno a la adopción de unos hábitos de vida saludables, que incluyen seguir una dieta mediterránea y hacer ejercicio físico, especialmente el entrenamiento de fuerza. Además, el uso de medicamentos para adelgazar puede proporcionar una fase de tratamiento adicional, en concreto los agonistas del receptor del péptido glucagonoide-1 (AR GLP-1) y nuevos polipéptidos insulinótropos dependientes de la glucosa (GIP)/agonistas del receptor del GLP-1. Y en determinados candidatos también se puede plantear la cirugía bariátrica. El objetivo de este documento es proponer un completo algoritmo de recomendaciones para el manejo de la obesidad en las personas de edad avanzada (mayores de 65 años), basado en datos científicos y en la experiencia de los miembros del Grupo de Trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Contributed equally as joint first authors.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3982 "Ancho" => 2917 "Tamanyo" => 1206437 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Algorithm of obesity in individuals older than 65 years old.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHOO. <a target="_blank" href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight</a>. 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