The extra costs of extra weight for older adults

Lifelong obesity, now common in the U.S., is beginning to change how Americans age. Along Alabama's Gulf Coast, one in three adults is obese, and many who have lived with the negative health effects of excess weight are entering their senior years. Special correspondent Sarah Varney of Kaiser Health News reports on the added costs, disabilities and challenges for older obese patients.

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    Two major trends are on a collision course in the United States: The aging of the U.S. population and a decades-long surge in obesity.

    The elderly population is projected to double to 80 million by 2050. And, as that's happening, obese individuals are far more likely to become sick or disabled as they age.

    Special correspondent Sarah Varney has the story from Alabama, produced in collaboration with our partners at Kaiser Health News.


    Bayou La Batre calls itself "The Seafood Capital of Alabama." Residents here depend on fishing and shrimping for their livelihood. And when they sit down to eat, they like most things fried.

    Former Surgeon General Dr. Regina Benjamin has been trying to reverse the nation's obesity epidemic one patient at a time at her Bayou clinic.

  • REGINA BENJAMIN, Former U.S. Surgeon General:

    Bake, boil, and broil. Say that again.


    Bake, boil, and broil.


    So no more fried shrimp.


    Gari Qualls is 69 years old and a retired crab picker. She spent most of her life seriously overweight and was diagnosed with diabetes at age 39.

    As obesity became commonplace around the U.S., health care providers like Benjamin began seeing the impacts of the disease all around them.


    We saw our patient population get heavier. We also saw chronic diseases start to rise — hypertension, strokes, diabetes. We're now called the Stroke Belt, where we are. So we saw all those things start happening. And if we continued, our entire community would totally be crippled, basically, based on chronic diseases and chronic illnesses.


    That grim assessment stretches beyond Bayou La Batre.

    Here along Alabama's Gulf Coast and elsewhere in the South, one in three adults is obese and many who have lived for decades with excess weight, diabetes, and heart disease are now heading into their senior years.

    The problem has been deepening everywhere. As you can see, the obesity rate grew in many states from 10 to 15 percent, shown in blue, to more than 30 percent, shown in red. That is going to have profound effects as the country ages.

    Dr. Virginia Chang, a demographer at New York University, says lifelong obesity, now common in the U.S., is poised to undermine improvements in disability rates among older adults.

  • VIRGINIA CHANG, New York University:

    We're potentially going to have a larger older population that's more likely to be obese, surviving longer with cardiovascular disease and other chronic conditions. I think the primary fallout from increasing obesity is probably not going to be some huge hit to mortality, right? It's going to be disability.


    At the University of Alabama at Birmingham, biology Professor Steven Austad is studying the effects of diet and nutrition on aging, using mice.

    STEVEN AUSTAD, University of Alabama at Birmingham: What aging researchers used to think is that aging was all of these different processes and — your heart aged, your brain aged, something… feet aged.

    But now, what we've realized, there's a handful of processes that are involved in aging all parts of your body. And it turns out that one of the processes is inflammation.


    Inflammation naturally increases as we age, but that process is exacerbated by belly fat, which secretes chemicals that cause further inflammation around the body.


    If you're obese, then your system-wide levels of inflammation are higher, particularly when you get to be older.

  • WOMAN:

    My mother had vascular dementia.


    That's one reason scientists think men and women who are obese are more likely to develop dementia, Alzheimer's disease, and certain cancers as they age.

    Birmingham resident Bob Parker says his own weight is starting to catch up with him. As a realtor and Democratic Party activist, he often attends meetings at restaurants. He says all those nights dining out make it hard to eat well. Now at age 60, he's being treated for diabetes, high blood pressure, high cholesterol and sleep apnea. He's lost 90 pounds twice, and gained it back.


    There's no question. I mean, I can just feel it. I get tireder. When I do projects around the house or something like that, I can't do them as long. And I find myself resting more when I am doing it. I like to do things out in the yard and have a couple of various little projects going on that have stopped for the winter.

    And I can't — I just can't work on them as much. So that's pretty galling, to be honest.


    To get help he's been coming here, to the university's weight loss clinic to see Dr. Tarnay Solamani.


    Tell me what is making it challenging for you to adhere to the diet plan that we discussed last time.


    The choices are things, frankly, that I don't much like.


    Obesity is an expensive diseases, especially for aging seniors. One study found that while obese 70-year-olds live as long as healthy weight 70-year-olds, they will spend $39,000 more on health care.

    DAVID ALLISON, University of Alabama at Birmingham: Obese people have higher health care costs than non-obese people. This is true virtually throughout life.


    David Allison directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham.


    As one gets into the age where health care spending goes up — 25-year-olds don't spend that much on health care, but as you progress through age, that difference is going to be bigger and bigger and more and more important.


    Two hours from Birmingham, in the northwest corner of the state, Generations of Red Bay is one of the only nursing homes in the region willing to take on the added expense of caring for heavier patients. Patients come from as far away as Texas.

    Surveys show more obese people are heading into nursing homes at younger ages and staying longer than non-obese residents.

  • WOMAN:

    Are you feeling OK?


    Yes, I'm fine.


    Margaret Hill Douglas arrived two years ago at age 47 after she broke her knee. Surgery was considered too risky because of her congestive heart failure, so she languished in the hospital for weeks while a social worker looked for a nursing home that would accept her. Patients like Hill Douglas require additional staff and costly equipment, says Aundrea Fuller, the nursing home's chief operating officer.

    That includes everything from specialized beds and lifts to larger blood pressure cuffs.

    AUNDREA FULLER, Generations of Red Bay: There are two certified nursing assistants for eight to 10 residents and that's about twice the staffing that you would have for the general population of a skilled nursing facility.


    Fuller says most of the people that move in, even the younger ones, will need this type of care for the rest of their lives.

    Back at the weight loss clinic in Birmingham, Bernard Rayford, age 55, says he wants to avoid that fate.

  • BERNARD RAYFORD, Birmingham:

    I have always prayed, 'Lord, before I be a burden, just take me.' So I saw myself being a burden and me being a major problem. So the end was for me not to make it, or me… for being — end up being an invalid. And that's a direction I don't want to be in.


    Rayford is working hard now on his diet and in the clinic's gym. He says there is much at stake. He wants to be around to enjoy retirement with his wife and years with his grandson.

    For the PBS NewsHour, I'm Sarah Varney in Birmingham, Alabama.

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