Millions of people enter later life 10 to 15 pounds extra, gain weight after having children, joint problems, become less active or make food the center of their social lives.
Lose this modest extra weight to optimize their health? This question has arisen as a new class of diabetes and weight-loss drugs offers hope that people can shed extra pounds.
For years, experts have debated what advice to give the elderly in this situation. On the one hand, weight gain is associated with fat accumulation. It can have serious health consequences for heart disease, diabetes, arthritis and many other medical conditions.
On the other hand, several studies suggest that carrying a little extra weight can sometimes be protective later in life. For people who fall, fat can act as padding, protecting against fractures. For people who are critically ill with conditions like cancer or advanced kidney disease, that padding is a source of energy that helps them endure demanding treatments.
To maintain muscle mass, the US Centers for Disease Control and Prevention recommends muscle-strengthening exercises at least twice a week.
Of course, it depends on how heavy one is to begin with. People who are already obese (body mass index 30 or higher) and put on extra pounds are at greater risk than those who are underweight. Rapid weight gain in later life is always a cause for concern.
Understanding the scientific evidence and expert opinion surrounding weight issues in adults is not easy. Here’s what I learned from reviewing dozens of studies and talking to nearly two dozen obesity doctors and researchers.
Our bodies change with age. As we age, our body composition changes. We lose muscle mass — a process that begins in our 30s and accelerates in our 60s and beyond — and gain fat. This is true even when our weight remains constant.
Also, fat accumulates under the skin, and more is distributed in the middle of the body. This belly fat is associated with inflammation, insulin resistance, and a higher risk of cardiovascular disease, diabetes, and stroke, among other medical conditions.
“The distribution of fat plays an important role in determining how harmful excess weight is in the form of fat,” said Mitchell Lazar, director of the Institute for Diabetes, Obesity and Metabolism at the Perelman School of Medicine at the University of Pennsylvania. “It’s the visceral (abdominal) fat around the waistline that we’re really concerned about, rather than the peripheral fat (in the hips and buttocks).”
Activity level declines with age. Also, as people age, they become less active. When older adults maintain the same eating habits (energy intake) and cut back on activity (energy expenditure), they tend to gain weight.
According to the US Centers for Disease Control and Prevention, 27% of 65- to 74-year-olds are physically inactive outside of work. This rises to 35% in those aged 75 or older. For older adults, the health agency recommends at least 150 minutes a week of moderate-intensity activity, such as moderate walking, and muscle-strengthening activities, such as lifting weights, at least twice a week. According to various surveys, only 27% to 44% of older adults meet these guidelines.
Concerns about muscle mass. Experts are more concerned about lack of activity in older adults who are overweight or mildly obese (body mass index in the low 30s) than about weight loss. With little or no activity, muscle mass deteriorates and strength declines, “increasing the risk of disability or functional impairment” that interferes with independence, said John Batsis, an obesity researcher and associate professor of medicine at North University. Carolina School of Medicine at Chapel Hill.
Weight loss causes muscle wasting because muscle is lost along with fat. On average, 25% of each pound shed comes from muscle and 75% from fat.
Because older adults have less muscle to begin with, “if they want to lose weight, they have to be willing to increase physical activity at the same time,” said Anne Newman, director of the University’s Center for Aging and Population Health. Pittsburgh School of Public Health.
Ideal body weight may be higher. Epidemiological research suggests that the ideal body mass index (BMI) may be higher in older people than in younger people. (BMI is a person’s weight, in kilograms or pounds, divided by the square of their height in meters or feet.)
A large, well-considered study found that people at both ends of the BMI spectrum — those with a low BMI (under 22) and those with a high BMI (over 33) — were more likely to die earlier than those with no BMI. Middle range (22 to 32.9).
Older adults with the lowest risk of early death have a BMI of 27 to 27.9. According to WHO standards, this is above the “overweight” range (29.9 of 25) and above the “healthy weight” BMI range (18.5 to 24.9). Also, many of the older adults found in the study to have the highest risk of death — those with a BMI below 22 — would be classified by the WHO as having a “healthy weight.”
The study’s conclusion: “The WHO healthy weight range may not be appropriate for the elderly.” Instead, being overweight can benefit older people, while being thin can be problematic, contributing to the risk of frailty.
Indeed, the optimal BMI for adults may be in the range of 24 to 29, suggested renowned obesity researcher Carl Lavey in a separate study reviewing the evidence surrounding obesity in the elderly. LaVey is the medical director of cardiac rehabilitation and prevention at Ochsner Health, a large health care system based in New Orleans, and the author of “The Obesity Paradox,” a book that explores weight problems in the elderly.
Expert recommendations. In our conversations, obesity doctors and researchers offered several key recommendations:
- For overweight adults (those with a BMI of 25 to 29.9), maintaining fitness and muscle mass is more important than losing weight. “Does losing a few extra pounds significantly improve their health? I don’t think the evidence shows that,” LaVey said.
- Unintentional weight loss is associated with many serious illnesses and is always a red flag to watch out for. “See your doctor if you’re losing weight without trying,” said Newman of the University of Pittsburgh. She is a co-author of a new paper that finds that “even in obese adults, unexpected weight loss is associated with increased mortality.”
- Ensuring food quality is essential. “The elderly are at risk for vitamin deficiencies and other nutritional deficiencies, and if you’re not getting enough protein, that’s a problem,” said Batsis of the University of North Carolina. “I tell all my older patients to take a multivitamin,” said Dinesh Edem, MD, director of the Medical Weight Management Program at the University of Arkansas for Medical Sciences.
- Fat loss is more important for older adults with a lot of fat around the middle (apple shape) than for those with lower weight (pear shape). “For patients with a high waist circumference, we’re more aggressive in reducing calories or increasing exercise,” said Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan.
- Maintaining weight stability is a good goal for healthy adults who are overweight but not moderately or severely obese (BMI of 35 or greater). By definition, “healthy” means that people do not have serious metabolic problems (excessively high cholesterol, blood sugar, blood pressure, and triglycerides), obesity-related disorders (mobility problems are common), or serious obesity-related diseases such as diabetes. or heart disease. “No big gains and no big losses — that’s what I recommend,” said Katie Dodd, a geriatric dietitian who writes a blog about nutrition.
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