Abstract

Obesity in aging populations has become a pressing global public health concern as demographic shifts increase 
the proportion of older adults worldwide. This narrative review synthesizes current evidence on the epidemiology, 
mechanisms, health consequences, measurement challenges, and management of obesity among older adults. The 
prevalence of obesity continues to rise more rapidly in the elderly than in younger age groups, driven by 
globalization, lifestyle transitions, and physiological changes inherent to aging. Pathophysiological mechanisms, 
including metabolic dysregulation, sarcopenic obesity, chronic inflammation, and insulin resistance, interact to 
accelerate functional decline and biological aging, a phenomenon increasingly described as “obesageing.” Health 
consequences are profound, with obesity exacerbating multimorbidity, disability, cognitive impairment, frailty, and 
mortality. Standard obesity metrics, particularly BMI, remain inadequate for older populations due to age-related 
changes in body composition, necessitating improved classification systems and broader use of alternative 
measures such as fat mass index and muscle-based indicators. Evidence-based management options, lifestyle, 
pharmacologic, and surgical, demonstrate potential benefits but require cautious, individualized implementation to 
avoid exacerbating frailty, sarcopenia, and chronic disease. Barriers across individual, provider, and system levels 
continue to impede optimal treatment, highlighting the need for integrated care models, community-based 
solutions, and supportive policy environments. Significant research gaps persist, especially in longitudinal 
trajectories of aging with obesity, functional outcomes, interventional safety, and the role of emerging 
technologies. As the dual burden of aging and obesity intensifies globally, prioritizing geriatric-specific strategies 
and interdisciplinary research is essential for improving health, independence, and quality of life in older adults.