Mobility Over Metrics: A New Take on Senior Obesity

For older adults living with obesity, the goal of treatment should not just be shedding pounds — it should be improving physical function, preserving independence, and enhancing quality of life. 

That was the central message from a group of experts who presented on patient-centered approaches to obesity care at the American Geriatrics Society (AGS) 2src25 Annual Scientific Meeting in Chicago. 

Rather than defaulting to weight loss as the primary measure of success, clinicians should focus on what matters most to each patient, said Julianna Marwell, MD, geriatrician and assistant professor of medicine at the Duke University School of Medicine in Durham, North Carolina. 

“We can’t afford to be weight-centric,” she said. 

Marwell framed obesity management using the 5Ms of geriatrics, which include mind, mobility, medication, multicomplexity, and what matters most. 

Through the case of a 73-year-old woman with a body mass index of 38 who had multiple chronic conditions, Marwell explained how functional goals like fall prevention, sleep improvement, and managing depression should drive treatment decisions. 

Research shows intentional weight loss in older adults can lead to better mobility, reduced medical complications, and improved quality of life. Marwell said clinicians have to integrate nutrition, physical activity, behavioral support, and medication review to achieve these benefits. 

Many medications commonly prescribed to older adults like antidepressants and pain medications can contribute to weight gain or hinder weight loss efforts, underscoring the need for routine medication reassessment, she said. 

Structural inequities such as not having access to healthy food options, limited access to exercise spaces, and lack of transportation can make weight loss guidance unrealistic for many patients without broader systems-level support, said Anna Pendrey, MD, primary care physician at Indiana University Health in Indianapolis. 

“We can’t recommend diet and exercise without acknowledging the social and economic realities our patients face,” Pendrey said. 

Pendrey and her colleagues at the Indiana University Student Outreach Clinic are addressing these barriers through community partnerships, free clinic services, transportation support, and embedding pharmacists, dieticians and physical therapists to support underserved older adults. 

Pendrey said obesity treatment requires “tackling structural obstacles to care, not individual willpower.” 

That same level of intentionality is important when considering newer pharmacologic treatments, she added. While incretin mimetics drugs, including glucagon-like peptide 1 receptor agonists like semaglutide, offer promising results for both obesity and diabetes management, they must be used cautiously in older adults, given side effects, high costs, and limited long-term data in this age group, panelists said. 

The expert panel members did not report any relevant disclosures.

Lara Salahi is a health journalist based in Boston.