There is an “obesity paradox” raging in the medical community. You may be surprised to hear this hot debate revolves around an unlikely group: our elders. Childhood and young adulthood obesity seem to always be in the headlines. But what about people ages 65 and older? Thanks to some new research, the debate of obesity in older people has been thrust into the medical spotlight.
In January, a meta-analysis by U.S. Centers for Disease Control and Prevention senior scientist Katherine Flegal caused a stir when she concluded that being older than 65 and overweight helps people to live longer than their skinnier peers. The findings also claimed that obesity becomes less dangerous with age, and obese adults with a grade 1 obesity BMI of 30 to 34.9 did not have a greater mortality risk than someone of a healthy weight.
In response to this controversial study, the American Journal of Epidemiology published research in March contradicting Flegal’s findings. Using data from the U.S. National Health Interview Survey, Ryan Masters and his colleagues argued people ages 75 to 84 with a grade 1 obesity have a 59 percent higher chance of mortality than their healthy peers. They also stated that mortality risks in obese people increase with age.
A follow-up study was recently released in the American Journal of Public Health, in which Masters and his colleagues found that obesity accounts for 18 percent of deaths in people ages 40 to 85. This estimate is more than four times higher than researchers previously thought. Due to environmental factors—more sedentary lifestyle, processed foods—the study says each generation is obese for a longer period than the former, a factor not considered in previous estimates.
While this research paradox carries on, obesity in our elders can’t be ignored. Being overweight or obese can be exacerbated in some people after retirement because they have more free time to sit around and aren’t as active as when they were younger or worked. On the other hand, baby boomers are being forced to delay retirement because of the economy. So many of those people are at desk jobs all day instead of being able to retire and be active.
Although people can control what they eat and how much they exercise, age comes with certain uncontrollable factors. For instance, you lose lean body mass as you age. “The more lean body mass we have, the higher our metabolic rate is and the more efficiently we burn calories,” says Carmen Roberts, clinical dietician specialist with Johns Hopkins Bayview Medical Center. Therefore, reduced lean body mass lowers your metabolism, thus, lowering the amount of calories needed and increasing the amount of physical activity needed.
The imbalance between calories in and calories out doesn’t need to be large to gain weight, says Dr. Lawrence Cheskin, director of the Johns Hopkins Weight Management Center and associate professor of Health Behavior and Society at Johns Hopkins Bloomberg School of Public Health. As little as 50 extra calories a day can lead to weight gain. So it all adds up quickly, particularly when you’re older. Even if you eat the same amount of food at age 50 as you did at 25, your body will gain weight.
So what can be done to help combat weight gain and improve weight loss when you’re older?
Older people have to be careful when they implement a weight-loss plan. They key is to focus on what kind of weight you want to reduce. An article in The Online Journal of Issues in Nursing stated it’s important to hone in on minimizing muscle and bone loss.
Walking is a great starting point for people who are elderly and overweight or obese. It’s gentler on the joints because it’s low impact and is equally as effective as a workout. “For burning calories and weight control, that’s just as valuable as going for runs or going to the gym,” says Dr. Cheskin. What matters most is how long you go for and how far, not how fast. If you go for a walk, even at a leisurely pace, you will still burn a good amount of calories, explains Dr. Cheskin.
Strength training targets two vital components that gain vulnerability with age: bones and muscles. Dr. Cheskin recommends beginning with a set of light weights, such as 5 lb. weights. Legs, arms, and core are the key areas to work.
Physical or occupational therapy
Some obesity diagnoses justify physical or occupational therapy and some insurance will cover it. If applicable, this is an excellent option. There’s nothing better than doing targeted exercises with a trained professional.
“From a nutritional perspective, starting at age 30, our metabolic rate (meaning the calories we need) declines by 10 percent per decade,” explains Roberts. It comes down to the number of calories consumed versus the number of calories burned. Remember: You don’t want to break down lean body mass; you only want to burn stored body fat.
What to eat
Roberts recommends an adequate amount of daily protein: 1 gram of protein for each kg of body weight per day, minimum. Also try to up your protein intake a little more than the average person. Choose a diet that is low in fat and limited in starchy carbs to ensure you’re getting enough calories from the right kinds of foods.
What you need
Bone loss is a factor of aging, so get the right amount of calcium. Roberts recommends 1,200 mg of calcium a day, either through low-fat dairy products or a supplement.
Antioxidants — vitamins A, C, D, E — are all crucial for older people (and all adults in general). They help with sight and fight free radicals that can cause cancer.
Consult with your doctor
Compared to younger populations, elderly people tend to be on more medications. It’s critical that you talk to your doctor or health care professional before beginning a new diet regimen. There are a multitude of food and drug interactions that can be detrimental to your health, especially for blood thinners or cholesterol and blood pressure medications. Your physician knows your prescription history and can forewarn you on which foods to avoid.
The Takeaway: It’s Never Too Late
For older people, losing weight is about disease prevention, staying healthy, and feeling good. One of the biggest misconceptions people have, says Roberts, is someone thinks they have to be an ideal weight to be healthy. She says even modest weight loss, such as 10 percent of excess body weight, has significant improvements in someone’s health. If you get down one weight classification and are still overweight, Roberts says, you’re already decreasing your risk for disease. Losing weight has a positive snowball effect: It gets easier as you continue to shed pounds, and it improves your overall mood and outlook.
The Online Journal of Issues in Nursing, http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Obesity-in-Older-Adults.html
American Journal of Public Health, http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301379