Time to Shifting Senior Obesity Care to Focus on Function, Not Weight
New research urges a move beyond BMI to prioritize mobility, independence, and nutrition in older adults
Topline
A growing body of evidence shows that older adults with obesity or malnutrition are underserved by traditional weight-focused diagnostics. Experts urge a shift toward patient-centered goals that prioritize mobility, nutrition, and team-based care.
Study Details
At the American Geriatrics Society (AGS) 2025 Annual Scientific Meeting in Chicago, clinicians and researchers presented compelling evidence that obesity and malnutrition care for older adults needs a fundamental shift. The presentations challenged the long-held reliance on weight metrics like BMI and instead advocated for a broader, more personalized framework centered on preserving function, autonomy, and nutritional resilience in aging populations.
Experts drew on clinical experience, data from geriatric clinics, and implementation models from underserved communities to highlight how current practices overlook critical indicators of health and often fail to engage the multidisciplinary teams required for effective intervention.
Methodology
Geriatricians and primary care researchers used both case-based frameworks and retrospective medical record analysis to identify gaps in care. One case involved a 73-year-old woman with a BMI of 38 and several chronic conditions, serving as a representative scenario for how clinicians could reframe goals toward functional outcomes. Simultaneously, medical records from 159 outpatient visits at a geriatric clinic were reviewed to evaluate how often malnutrition was identified and addressed. Clinicians' notes, diagnostic codes, and follow-up plans were cross-checked against established malnutrition criteria from the Global Leadership Initiative on Malnutrition (GLIM).
Key Findings
BMI is not enough: Despite being a common diagnostic tool, BMI failed to identify the majority of older adults at nutritional risk. Only 4% of patients had a BMI below 18.5, the conventional malnutrition threshold, yet over 15% met criteria for further evaluation when assessed using GLIM’s more comprehensive indicators.
Malnutrition often missed or miscoded: Diagnostic terms like “abnormal weight loss” or “poor appetite” were frequently used, yet only 17% of those who qualified for a malnutrition diagnosis based on objective criteria were correctly coded. Alarmingly, only one patient was referred to a dietitian during the review period.
Function over weight: Clinicians emphasized that the primary objective in obesity management for older adults should not be weight reduction alone. Functional outcomes such as reducing fall risk, improving sleep, and managing depression were shown to have a stronger impact on quality of life than body weight changes.
Medications and weight dynamics: Many medications commonly prescribed to older adults, including antidepressants, corticosteroids, and certain pain medications, can contribute to weight gain or hinder weight loss efforts. Routine medication reviews were highlighted as essential for achieving sustainable functional improvements.
Social factors limit success: Lack of access to healthy food, transportation, safe exercise environments, and professional nutrition support make traditional advice around diet and exercise difficult to implement for many seniors. Structural issues, not individual willpower, often drive poor outcomes.
Team-based care improves outcomes: Embedding pharmacists, dietitians, and physical therapists into primary care teams especially in community clinics serving underserved populations has proven effective in managing both obesity and malnutrition holistically.
Caution with new drugs in older adults: While incretin-based therapies like GLP-1 receptor agonists (e.g., semaglutide) show promise for weight loss and diabetes management, panelists urged caution when prescribing these to seniors due to side effects, cost, and limited long-term data in aging populations.
Implications for Practice
For Clinicians:
A shift away from BMI-centric care is overdue. Older adults benefit more from interventions that improve balance, strength, energy, and emotional well-being. Clinicians should adopt functional goals as core metrics of success and ensure medications are optimized to support not undermine those goals. Screening for malnutrition should go beyond body weight and involve observable clinical signs, recent changes in intake, and overall frailty.
For Care Teams and Clinics:
Primary care settings should implement standardized malnutrition screening protocols like GLIM and ensure proper documentation and coding. Dietitian referrals must be routine when nutritional risks are identified. Integrating multidisciplinary professionals into routine care especially for older adults with complex needs is no longer optional but essential.
For Healthcare Systems and Policymakers:
To truly support older adults, health systems must address the upstream social factors that affect access to healthy aging. Investments in transportation, food security, and integrated care delivery are necessary to close the gap between clinical advice and real-world feasibility. Reimbursement models should also evolve to reward function-focused, team-based care rather than weight loss alone.