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Good News About Weight Loss: In Older Adults, a Little Excess Weight Isn’t Such a Bad Thing

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Most of us know the feeling of stepping on the bathroom scale and shaking our heads in frustration. For some reason – especially as we age – that extra 10 or 15 pounds we’re carrying around just never seem to go away. At best, if we do lose a few pounds through extra effort and willpower, it’s not long before they come slipping right back.

Frustration and guilt over weight loss, or the lack of it, is something millions of us older adults share. But there may be some genuine good news in the “extra poundage” department. Multiple research studies now seem to have demonstrated that a moderate amount of extra weight actually helps aging adults live longer. What’s more, these studies appear to suggest that the medical community might need to re-think the standards by which they have judged many of us as “overweight.”

Make no mistake, this isn’t an excuse to ignore healthy weight control guidelines. But if you, like us, have worried about modest amounts of extra weight accumulating over the years, you might find this recent Kaiser Health News article encouraging. It was written by a reporter whose work we appreciate, Judith Graham.

Medical Dilemma Over Losing Moderate Extra Weight

Entering later life carrying an extra 10 to 15 pounds is very common, the Kaiser article observes. With the rise of new weight loss drugs putting weight loss back into the public conversation, it’s worth asking: should we be trying to lose that excess weight? The answer isn’t as clear as we thought.

“For years, experts have debated what to advise older adults in this situation,” Graham writes. “On one hand, weight gain is associated with the accumulation of fat. And that can have serious adverse health consequences, contributing to heart disease, diabetes, arthritis, and a host of other medical conditions.”

She adds, “On the other hand, numerous studies suggest that carrying some extra weight can sometimes be protective in later life. For people who fall, fat can serve as padding, guarding against fractures. And for people who become seriously ill with conditions such as cancer or advanced kidney disease, that padding can be a source of energy, helping them tolerate demanding therapies.”

But Graham is quick to note that this depends on how much excess weight we’re talking about, here. People who are already obese (defined as having a body mass index of 30 or over) could be put at greater risk when they gain an extra several pounds, versus someone who weighs less. And no matter what, rapid weight gain in later life is always something to pay attention to.

“Making sense of scientific evidence and expert opinion surrounding weight issues in older adults isn’t easy,” Graham writes. “Here’s what I learned from reviewing dozens of studies and talking with nearly two dozen obesity physicians and researchers.”

Body Composition, Activity Levels Change with Age

Aging changes the composition of our bodies. Namely, we lose muscle mass starting in our 30s and accelerating in our 60s, and we gain fat. This is true whether or not our weight changes.

“Also,” Graham notes, “less fat accumulates under the skin while more is distributed within the middle of the body. This abdominal fat is associated with inflammation and insulin resistance and a higher risk of cardiovascular disease, diabetes, and stroke, among other medical conditions.”

Mitchell Lazar, director of the Institute for Diabetes, Obesity and Metabolism in Pennsylvania, says, “The distribution of fat plays a major role in determining how deleterious added weight in the form of fat is. It’s visceral [abdominal] fat [around the waist], rather than peripheral fat [in the hips and buttocks] that we’re really concerned about.”

This is exacerbated by the lessening of physical activity that some people experience as they get older, while maintaining the same eating habits.

Inactivity Leads to Alarming Loss of Muscle Mass

The lack of activity in older adults who are overweight or mildly obese (who have body mass index in the low 30s) is worrying to experts, more so than weight loss. “With minimal or no activity, muscle mass deteriorates and strength decreases, which raises the risk of developing a disability or a functional impairment that can interfere with independence,” says John Batsis, an obesity researcher and associate professor of medicine at the University of North Carolina School of Medicine.

In these cases, weight loss doesn’t help, because muscle mass is lost along with the fat. “Since older adults have less muscle to begin with, if they want to lose weight, they need to be willing at the same time to increase physical activity,” says Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh School of Public Health.

Research Shows Ideal Body Weight Higher for Seniors

“Epidemiologic research suggests that the ideal body mass index (BMI) might be higher for older adults than younger adults,” Graham writes. “One large, well-regarded study found that older adults at either end of the BMI spectrum — those with low BMIs (under 22) and those with high BMIs (over 33) — were at greater risk of dying earlier than those with BMIs in the middle range (22 to 32.9).”

She adds, “Older adults with the lowest risk of earlier deaths had BMIs of 27 to 27.9. According to World Health Organization standards, this falls in the ‘overweight’ range (25 to 29.9) and above the ‘healthy weight’ BMI range (18.5 to 24.9). Also, many older adults whom the study found to be at highest mortality risk — those with BMIs under 22 — would be classified as having ‘healthy weight’ by the WHO.”

The study’s conclusion: “The WHO healthy weight range may not be suitable for older adults.” Instead, being overweight may be beneficial for older adults, while being notably thin can be problematic, contributing to the potential for frailty.

“Indeed, an optimal BMI for older adults may be in the range of 24 to 29,” says Carl Lavie, a well-known obesity researcher.

Here’s What the Experts Recommend

Graham concludes her article with a list of recommendations from the experts she consulted. We’ve abridged it below, but recommend checking out the original article for the full unabridged list.

  • Maintaining fitness and muscle mass is more important than losing weight for overweight older adults (those with BMIs of 25 to 29.9).
  • Unintentional weight loss is associated with several serious illnesses and is a danger signal that should always be attended to.
  • Ensuring diet quality is essential.
  • Losing weight is more important for older adults who have a lot of fat around their middle (an apple shape) than it is for people who are heavier lower down (a pear shape).
  • Maintaining weight stability is a good goal for healthy older adults who are carrying extra weight but who don’t have moderate or severe obesity (BMIs of 35 or higher). By definition, “healthy” means people don’t have serious metabolic issues (overly high cholesterol, blood sugar, blood pressure, and triglycerides), obesity-related disabilities (problems with mobility are common), or serious obesity-related illnesses such as diabetes or heart disease.

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(originally reported at https://kffhealthnews.org)

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