Tag: food

Weight Loss After 65: Treating Obesity in Older Adults

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

Obesity in older adults is a clinical problem about mobility, independence, and quality of life, and the number on the scale is the least interesting part of it. The problem is growing as the population ages. In the NHANES data, 38.9% of adults 60 and over meet criteria for obesity (Emmerich SD, NCHS 2024).

Between 2010 and 2050 the U.S. population over 65 will nearly double, from 40 million to more than 80 million (U.S. Census Bureau). Aging brings multimorbidity, frailty, and loss of independence with it, and excess adiposity adds a layer on top. Older adults with obesity are more likely to experience disability, reduced gait speed, and earlier institutionalization (Batsis JA, Eur J Intern Med 2014; Elkins JS, Obesity 2006). Body composition also shifts with age, with sarcopenia and visceral adiposity together making BMI a much less trustworthy measure than it looks (Batsis JA, Int J Obes 2016).

So the question is not really whether weight loss is safe in older adults. It is how it gets done. Intentional, structured weight loss helps when it is handled carefully. Randomized trials show that combining diet with exercise improves physical performance even when the weight loss itself is modest (Villareal DT, NEJM 2011; Batsis JA, J Am Geriatr Soc 2016). The danger sits with weight loss that is unintentional or too aggressive, which costs lean mass and bone density and raises fracture risk (Ensrud KE, J Clin Endocrinol Metab 2005). That is why the intervention has to protect muscle: resistance training, and protein intake of at least 1.0 to 1.2 g/kg/day, with leucine-rich sources where possible (Porter Starr K, J Gerontol Med Sci 2016).

Function is the goal, not the scale. Better mobility, more independence, better quality of life. Which means starting with an assessment of baseline function and cognition before recommending weight loss at all, and factoring in food security, transportation, and whether the patient is also caring for someone else. Physical therapists, dietitians, and care managers earn their place in this (Batsis JA, JAMDA 2011).

Medications are an option and they need care here. GLP-1 receptor agonists like semaglutide and liraglutide, and combinations like bupropion/naltrexone, are promising, but older adults have been poorly represented in the trials (Hollander P, Diabetes Care 2013; Grunvald E, Gastroenterology 2022). In practice hypotension, hypoglycemia, GI intolerance, and lean mass loss all carry more weight in a frail patient than they would in a younger one (Volpe S, Nutrients 2023; Batsis JA, Nat Rev Endocrinol 2018). I go slower on titration with these patients than the labeling suggests, and I ask about falls before I ask about weight.

What works is tailored and multidisciplinary. DASH or Mediterranean patterns are reasonable starting points. Activity should be gradual, supervised, and matched to ability, along the lines of the LIFE trial (Pahor M, JAMA 2015). Behavioral support delivered through community programs or telemedicine works in this population, which matters given how much harder it is for older patients to get to an office (Alberts SM, Gerontologist 2021; Batsis JA, BMC Geriatrics 2021). And sarcopenia, osteoporosis, and medication side effects all need watching throughout.

Treating obesity in older adults means preserving mobility, strength, and vitality rather than chasing an ideal weight. Done carefully, it buys people independence and dignity, which is what they came in for.

Scott Rennie, D.O.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Childhood Food Insecurity: What Doctors and Families Can Do

On By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Food insecurity means the lack of consistent access to enough food for a healthy, active life. Hunger is part of it. The rest reaches into development, school performance, behavior, and long-term health, and millions of children in this country live inside it.

In pediatrics it surfaces quietly. A child who can’t concentrate at school. A family that skips meals at the end of the month. A growth curve that looks off and doesn’t fit the usual explanations. Treating it as a clinical problem rather than a social one is where the work starts.

The scope is wide. In 2024, 13.7% of U.S. households experienced food insecurity at some point during the year, and among households with children the figure was 18.4% (1). That is up sharply from the 10.5% recorded in 2020. Children carry the heaviest burden. The literature links food insecurity to iron-deficiency anemia, delayed motor and cognitive development, poor school performance, and behavioral problems including depression and inattention (Cook et al., J Nutr, 2004; Casey et al., Pediatrics, 2006).

Food insecurity and obesity travel together, which surprises most parents. Economic pressure pushes families toward calorie-dense, low-cost food. Scarcity itself can trigger binge eating when food becomes available. Stress and parenting under pressure add another layer. Children get urged to clean their plates, or food becomes the tool for soothing. Children aged 10 to 15 in food-insecure households are more likely to carry higher BMI and adiposity (Tester et al., Curr Obes Rep, 2020).

Geography tells its own story. The Southeastern U.S. carries some of the highest rates of both food insecurity and childhood obesity. Mississippi, Arkansas, Louisiana, New Mexico, and Texas rank among the hardest hit for food insecurity. Mississippi, West Virginia, Kentucky, Alabama, and Oklahoma consistently report the highest pediatric obesity rates. The overlap is no coincidence. Rural areas, tribal lands, and parts of Appalachia function as food deserts, where grocery stores are scarce and convenience stores and fast food fill the gap. Poverty and underinvestment in health infrastructure compound it.

So how do we find it? Most pediatric settings use the Hunger Vital Sign, a two-question screener drawn from the USDA’s 18-item scale and endorsed by the American Academy of Pediatrics. Against the full scale it runs 97% sensitive and 83% specific (Hager et al., Pediatrics, 2010; AAP Council on Community Pediatrics, Pediatrics, 2015). It asks families to respond to two statements:

“We worried whether our food would run out before we got money to buy more.”

“The food we bought just didn’t last, and we didn’t have money to get more.”

An answer of “often true” or “sometimes true” to either one signals risk. It is short, it embeds cleanly in an EMR, and it has been validated across languages. Longer tools exist, including the USDA’s full 18-item module, its 6-item short form, and the 9-item youth survey, but the time cost usually rules them out.

Screening is harder to implement than it sounds. Time, competing priorities, and plain discomfort discussing money are real barriers. Self-administered forms, EMR prompts, and universal framing all help. Telling every family “we ask everyone about food, because it’s central to health” takes the sting out of the question. When a screen comes back positive, the referral pathway has to already exist, whether that means SNAP and WIC enrollment, food pantries, or school meal programs.

Federal nutrition programs remain the strongest safety net. SNAP provides grocery support. WIC offers food vouchers, nutrition education, and breastfeeding support. The National School Lunch and School Breakfast Programs cover the school year, and the Summer Food Service Program covers the gap when school is out. The evidence doesn’t support the worry that these programs worsen obesity risk. WIC participation tracked with a decline in obesity among children aged 2 to 4 across 2010 to 2016 (Pan et al., MMWR, 2019). Stable SNAP benefits reduce the time children spend with obesity compared with non-participants (Au et al., J Nutr, 2019).

For clinicians the task splits in two: identify and connect. Screening is the first half. The impact comes from linking families to something real, which might mean a referral list built into the EMR, a relationship with a local enrollment center, or a standing partnership with a community food bank. Even asking “would it help if I connected you with resources that provide healthy food?” moves something.

Food insecurity is a health problem, and it shows up in front of us constantly. Naming it, screening for it, and acting on it protects children from consequences that reach a long way forward.

Scott Rennie, D.O.

References:

1. Rabbitt MP, et al. Household Food Security in the United States in 2024. USDA Economic Research Service, ERR-358, December 2025. https://www.ers.usda.gov/publications/pub-details?pubid=113622

2. Cook JT, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr. 2004;134(6):1432-1438. https://pubmed.ncbi.nlm.nih.gov/15173408/

3. Casey PH, et al. Child health-related quality of life and household food security. Pediatrics. 2006;118(5):e1406-e1413. https://pubmed.ncbi.nlm.nih.gov/17079542/

4. Hager ER, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26-e32. https://pubmed.ncbi.nlm.nih.gov/20595453/

5. Council on Community Pediatrics, Committee on Nutrition. Promoting Food Security for All Children. Pediatrics. 2015;136(5):e1431-e1438. Reaffirmed 2021. https://publications.aap.org/pediatrics/article/136/5/e1431/33896/

6. Tester JM, Rosas LG, Leung CW. Food Insecurity and Pediatric Obesity. Curr Obes Rep. 2020;9(4):562-570.

7. Au LE, et al. J Nutr. 2019;149(9):1642-1650.

8. Pan L, et al. Trends in Obesity Among Participants Aged 2 to 4 Years in WIC, United States, 2010 to 2016. MMWR Morb Mortal Wkly Rep. 2019;68(45):1057-1061. https://www.cdc.gov/mmwr/volumes/68/wr/mm6845a2.htm

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

How Should Parents Limit a Child’s Food? Finding Balance

On By Dr. Scott RennieIn Weight Loss & Metabolic HealthLeave a comment

As a physician, I’ve seen how difficult it can be for families to set healthy eating patterns for their kids. Parents often ask me how to keep children from eating too much junk food without turning it into a daily battle. Research points to two main strategies: overt restriction and covert restriction. How they play out at home differs enormously.

Overt restriction is the one most people think of first. It’s when a parent sets clear rules like “No candy after dinner” or “You can only have one cookie.” Simple, on paper. In practice it often backfires: studies show that when kids are told they can’t have a certain food, that food becomes more appealing, and they get curious and start craving it more. I’ve had parents tell me that their child, once away from home, goes overboard on the very foods that were restricted. The literature backs this up, linking overt restriction to a higher risk of overeating and weight gain once children get access on their own (Ogden J, Reynolds R, Smith A. Appetite. 2006;47:100-106).

Covert restriction works differently. It doesn’t rely on direct rules; instead it shapes the environment. A parent might stock the pantry with fruits and vegetables, limit the chips and sweets that come into the house, and skip the frequent fast-food runs, so the child never feels denied anything even though the choices available are quietly healthier than they’d otherwise be. Research suggests this method reduces cravings and lowers the pull of high-sugar, high-fat foods (Boots SB, Tiggemann M, Corsini N. Appetite. 2019;135:54-60).

Between the two, covert restriction seems to have the better long-term track record. When the home is set up so the easiest option is also the healthiest, children develop preferences that last. That said, overt restriction isn’t always avoidable, since food allergies, medical diets, or severe obesity can make firm rules necessary. When that happens, pairing restriction with positive reinforcement and supportive communication limits the damage.

Another useful approach I’ve seen is what some call a junk food budget. Parents allow a set number of treats each week, maybe two or three small items, and the child decides when to spend them. Once they’re gone, that’s it until the following week. This gives kids some autonomy and teaches self-regulation. Research suggests it helps prevent binge eating or overvaluing restricted foods later in life (Ogden J, Reynolds R, Smith A. Appetite. 2006;47:100-106). Parents often tell me it lowers family conflict too.

The big picture: food habits are shaped more by environment and tone than by rigid control. When families make healthy foods visible and easy to reach, involve kids in cooking, and give them some freedom to manage their own indulgences, the results are usually better. For providers, guiding parents toward motivational interviewing, and helping them balance overt and covert strategies, supports healthier eating without adding to the power struggles.

Scott Rennie, D.O.

Sources:

  • 1. Ogden J, Reynolds R, Smith A. Expanding the concept of parental control: a role for overt and covert control in children’s snacking behaviour? Appetite. 2006;47(1):100-106. https://pubmed.ncbi.nlm.nih.gov/16682098/
  • 2. Boots SB, Tiggemann M, Corsini N. Pumpkin is “yucky”: correlates of avoidant/restrictive food intake in preschool children and their mothers. Appetite. 2019;135:54-60. https://pubmed.ncbi.nlm.nih.gov/30599153/

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Norovirus Illness: What Patients and Doctors Need to Know

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Every winter we brace for an uptick in norovirus, often dismissed as the “stomach flu.” For many, it’s just a miserable few days of vomiting and diarrhea. In reality, norovirus is a major public health issue: it spreads quickly, it’s hard to kill, and outbreaks can overwhelm entire communities.

Norovirus is part of the Caliciviridae family and is the leading cause of acute gastroenteritis worldwide. A single infected person can trigger dozens of cases. It doesn’t take much. Just 10 to 20 viral particles. The virus survives on surfaces for days, resists alcohol-based sanitizers, and tolerates a wide range of temperatures, which is why schools, nursing homes, cruise ships, and restaurants are common hotspots.

Symptoms and Impact

Illness usually starts suddenly. Patients may complain of nausea, stomach cramping, watery diarrhea, or repeated vomiting. Children often vomit more, adults tend to have more diarrhea, and fever, fatigue, and body aches can happen but aren’t always present.

For most people, symptoms last 1 to 3 days. But dehydration can become serious, especially in infants, older adults, or those with weakened immune systems. Years ago, in hospital-based practice, I admitted patients who couldn’t keep fluids down and needed IV hydration after only 24 hours of illness.

How It Spreads

Norovirus has been called the “perfect pathogen” because it finds so many ways to move from person to person. Direct contact with someone sick, eating contaminated food like undercooked shellfish, drinking contaminated water, or simply touching a door handle can all spread infection, and even vomiting can aerosolize tiny droplets of virus into the air, which is why outbreaks in crowded dining halls or cruise ships often expand so rapidly.

The incubation period is short: just 12 to 48 hours. That means someone can be exposed at a group gathering and have symptoms by the next day. Diagnosis is usually clinical during outbreaks, though lab confirmation with RT-PCR testing is reserved for severe cases or public health investigations.

Treatment

There is no antiviral medication for norovirus. Management is entirely supportive. Oral rehydration is the first step, with IV fluids for those who can’t keep liquids down, and ondansetron can help control vomiting in children and adults, though it doesn’t shorten the course of illness. A bland diet and gradual return to regular foods is usually recommended. Antibiotics don’t help, since this is viral.

Prevention

Preventing norovirus is about breaking the chain of transmission, and handwashing with soap and water works better than alcohol-based sanitizers. Surfaces contaminated with vomit or stool should be cleaned with bleach-based disinfectants, because many common cleaners aren’t effective. Shellfish should be cooked thoroughly and produce rinsed before eating.

Infected people should stay home for at least 48 hours after symptoms end, since viral shedding can continue. During outbreaks in schools or long-term care facilities, early recognition and strict cleaning protocols are what actually stop the spread, not treatment after the fact.

Why It Matters

Norovirus keeps proving how disruptive a “simple” virus can be. Cruise ships diverted from ports, schools shutting down for deep cleaning, long-term care facilities under quarantine, these are all real-world consequences. Each outbreak is a reminder that prevention matters as much as treatment.

For patients, the focus is on hygiene, hydration, and staying home when sick. For healthcare providers, it’s about rapid recognition, supportive care, and education, and for public health officials, the job is surveillance and outbreak response. Together these steps limit how far norovirus reaches.

—

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

  • Centers for Disease Control and Prevention. Norovirus. https://www.cdc.gov/norovirus
  • Hall AJ, et al. Norovirus disease in the United States. Emerg Infect Dis. 2013;19(8):1198-1205. PMID 23876403.
  • Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. 2009;361:1776-1785. PMID 19864676.
  • Atmar RL, Estes MK. The epidemiologic and clinical importance of norovirus infection. Gastroenterol Clin North Am. 2006;35(2):275-290. PMID 16880066.