According to the National Centre for Health Statistics, approximately 43 percent of women and 38 percent of men aged 60 and over are obese.
However, some data suggest that among the elderly, it is difficult to define overweight and obesity and that a few extra pounds can be good for health.
“This is a fairly controversial area when it comes to defining thresholds for overweight and obesity in the elderly,” says Denise Houston, PhD, R.D., Associate Professor of Internal Medicine at Wake Forest Medical School.
Here’s the decline in weight as we age.
There is no doubt that being too heavy is harmful to your health. “In the elderly, excess weight aggravates many chronic diseases, including heart and liver disease, osteoarthritis and sleep apnea,” says Dr. Alexis Eastman, medical director of the Division of Geriatrics at the University of Wisconsin School of Medicine and Public Health.
And the higher your weight, the higher your risk of problems such as type 2 diabetes and high blood pressure.
But the way overweight is usually measured – BMI, or body mass index – may not be the best indicator of health risks for older adults.
A BMI of 25 to 29.9 is considered overweight, while a BMI of 30 or more is considered obese. However, BMI can be misleading.
“BMI correlates with the amount of fat in a person, but it is an imperfect measure,” says Houston. For example, it doesn’t take into account related factors such as muscle mass, location of fat, gender, ethnicity or age.
According to Houston, an older adult should perhaps not be considered overweight unless his or her BMI is 27 or 28. In fact, a review of 32 studies published in 2014 in the American Journal of Clinical Nutrition found that the lowest risk of death in people 65 and older was found in those with a BMI between 27 and 27.9.
Other studies have reached similar conclusions. A review of research published in 2017 in the journal Medicine found that obese older adults had a 6% risk of dying prematurely from any cause. And a 2015 study of more than 19,000 nursing home patients, published in Obesity Reviews, also linked overweight and obesity to longer lives.
Being overweight can help protect against illness or falls, or support an individual during hospitalization. Being too thin can decrease physiological reserves,” Eastman explains. “If something happens, like pneumonia or a hip fracture, you don’t have as many energy reserves to draw on, so you exhaust yourself and can’t recover,” she says.
Who Needs to Gain?
As researchers continue to study the effects of a few extra pounds on older people, it’s clear that being very thin – a BMI of less than 18.5 – is risky, and that these people should try to gain weight.
Loss of appetite is common with age, but there are some ways to combat this. Eat smaller meals more often and choose higher calorie, nutritionally dense foods such as avocados, nut butters or whole milk yogurt. You can also sprinkle vegetables, meat, fish or bread with healthy oils, such as olive oil.
Also, make sure you get enough protein, as it will help you maintain your muscle mass. Some estimates suggest that up to one-third of older adults living independently have muscle loss related to sarcopenia.
Muscles contribute to the structural integrity of your body, protecting joints and maintaining balance. A lack of muscles can lead to abnormal movements and poor posture, which can cause pain and increase the risk of falling. Even if you’re trying to gain weight, stay active and build resistance training into your exercise program to help build muscle.
Who Needs to Lose?
Whether excess weight is detrimental to health depends on several factors. First, while BMI is not always the best measure, it can guide you in discussing it with your doctor.
Second, where you carry your weight is important. Visceral fat – the fat that surrounds the middle part of your body – is the most dangerous because it surrounds and sometimes accumulates inside the arteries and organs, such as the liver, heart and pancreas.
“Studies show that waist circumference can better predict chronic disease than BMI,” says Houston. For men, it should be 40 inches or less and for women 35 inches or less; it should be measured just above the hip bones.
Finally, if you’re short of breath or experience pain or discomfort when moving around or performing normal daily activities, your weight can be a problem. Talk to your doctor, who will review your health and family history to determine if you need to lose weight.
Healthy Weight-Loss Rules to Follow
If you’re too heavy, losing only 5-10% of your weight can have a beneficial effect on blood pressure, blood sugar and cholesterol levels,” says Houston. But before you try a fad diet, keep these essentials in mind:
Opt for real food. For most people, dieting is the key to weight loss. Eating whole foods rather than processed foods and avoiding empty calories (such as crackers or sweetened drinks or snacks) will help ensure that you get plenty of vitamins, minerals, fibre and other nutrients.
Consider adding protein. It can help you stay full longer. Current guidelines recommend 0.36 grams of protein per pound of body weight, but older adults may need 0.6 grams per pound to prevent sarcopenia and 0.7 grams to lose weight. (That’s 96 to 112 grams per day for a 160-pound person. A 4 ounce chicken breast contains 32 grams of sarcopenia).
Eastman recommends working with a doctor or dietician to find the right protein intake. Eat low-protein meats, poultry, fish, yogurt, tofu, nuts or beans at every meal; by spreading them out, you help build muscle.
Exercise. “You need to preserve your muscle mass,” Eastman says. “Every elderly person should engage in some sort of strength and endurance exercise.” You may find classes and training activities for the elderly at a local YMCA, hospital or community centre.
Unexplained Weight Loss
If you have unintentionally lost more than 5% of your weight in the last six months to a year, always consult your doctor to rule out an underlying condition.
Cancer, diabetes, dementia and thyroid problems can all lead to involuntary weight loss. If there is no obvious cause, your doctor will look at other factors.
“The body is programmed to search for food, so if someone is losing weight, there must be something else going on,” says Cary Kreutzer, M.P.H., R.D.N., of the USC Leonard Davis School of Gerontology.
“In this case, we’re looking at some things: Aren’t they eating properly because they’ve lost their sense of smell or taste? Do they have the ability to shop and cook, and do they have company at mealtimes? Perhaps they are depressed or it is a side effect of medication, or perhaps alcoholism is to blame”.
Depending on the cause, consider working with a dietician, who can help you plan meals with enough calories and nutrients.
“It may be more enjoyable to have frequent but smaller meals and snacks,” says Denise Houston of the Wake Forest School of Medicine.
Remember that food quality is still important. Rather than filling up on junk food to add calories, choose whole foods. Include fruits and vegetables, especially berries and leafy greens, which, in addition to being rich in vitamins, are also rich in compounds that can help fight inflammation and maintain brain health.