“I never worry about diets. The only carrots that interest me are the number you get in a diamond.”~Mae West
Well, that attitude may have worked for the undisputed sexual symbol of frankness, fascination and controversy of the 20th century, but for the rest of us, and especially those over 50, watching what we eat is an all-too-familiar activity that determines not only how we look but, as the research suggests, how we feel.
In a recent study at Dartmouth Centers for Health and Aging at Dartmouth College in New Hampshire, older men and women who were overweight or obese at age 65 spent up to 17% more on healthcare throughout their lifetimes.
Research has told us again and again that excess weight can put people at risk for numerous health issues, and the data is even more compelling for older Americans who aren’t moving as much as they once were and who may already be facing health issues for other reasons.
According to the Centers for Disease Control and Prevention (CDC), “Obesity is common, serious and costly,” affecting about 93.3 million U.S. adults in 2016. The estimated annual medical cost of obesity in the United States was $ 147 billion in 2008 and the medical cost for people who have obesity was $ 1,429 higher than those of normal weight.
“Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death,” the CDC states.
According to data from the National Health and Nutrition Examination Survey in 2015–2016, the prevalence of obesity was higher among middle-aged adults (42.8%) than among younger adults (35.7%).
In its evidence report “Managing Overweight and Obesity in Adults,” the U.S. Department of Health and Human Services (HHS) contends that the “biomedical, psychosocial, and economic consequences of obesity have substantial implications for the health and well-being of the U.S. population.” They hold that “obesity raises the risk for death from hypertension, elevated cholesterol, type 2 diabetes, coronary heart disease (CHD), stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems and some cancers.” In fact, according to their report, obesity is also associated with increased risk of death from all cardiovascular disease, HHS reports.
In “Obesity in the Elderly,” Nadia B. Pietrzykowska, MD—a board certified and fellowship-trained obesity medicine specialist, physician nutrition specialist and health coach—states that while obesity may affect anyone, young or old, “…as we grow older, both the characteristics of obesity and the way it affects individuals are sometimes different compared to younger adults. This is very important to know as it may determine if and how obesity should be treated in older adults.”
She says that the commonly used BMI measurement for obesity isn’t always completely accurate when used in screening overweight and obesity in older adults, as “it doesn’t differentiate between the type of excess body weight, it cannot determine if the excess weight consists of muscle or fat.”
“When we grow older, especially if ill and not really physically active, we tend to lose our muscle mass. It gets replaced with fat. Our BMI may not change, but in reality, our fat-stores increase and so does the chance of being affected by obesity and its related diseases,” Pietrzykowska writes. “BMI can also be inaccurate in the elderly for another common reason. As we grow old, we often get shorter. This is due to osteoporosis and spinal vertebral issues that take away inches in older age.”
Pietrzykowska said this is just the first hurdle encountered when trying to evaluate and treat obesity in the elderly. “It’s important to know where one stands with their weight, as it is extremely relevant not only for the treatment, but also for the prevention of many chronic diseases…just screening for overweight or obesity isn’t a simple task, and obesity can be missed or overestimated in the elderly population even more so than in younger adults.”
Pietrzykowska said most organs and body systems are negatively affected by obesity, so determining whether an older adult is overweight is important. Still, she cautions about a phenomenon scientists have described called “the obesity paradox. Although at younger age, overweight and obesity are clearly associated with a shorter lifespan, it seems that at older age, this is not always true. Some studies have shown that the ‘ideal’ protective weight might be higher in the older population.”
Elderly patients with some diseases seem to survive longer when they are affected by excess weight or obesity, she writes. “The debate is ongoing in the scientific world about whether this is a real phenomenon and if so, what could explain it. Some suggest that the statistics are such only due to the fact that as adults age, those ‘susceptible’ to the harmful effects of obesity may have already succumbed to diseases. Therefore, the elderly population affected by obesity is represented by people that are ‘resistant’ to the negative effects of obesity.
The obesity paradox is comparative to grandpa who has smoked all of his life and is still thriving. “It doesn’t mean that smoking does not affect people’s health. While everybody else has died from cancer or other lung diseases at a younger age, grandpa is now older and doing well while still smoking like a chimney, as he may just happen to have a sort of resistance to the harmful effects of smoking.” In any event, she writes, more studies are needed on whether overweight and obesity are protective in the older population.
Nevertheless, Pietrzykowska says along with the laundry list of diseases that can be caused or exacerbated by obesity including a lesser quality of life, it has even been proven to affect cognition, which includes the way we process information, memory, comprehension, problem solving and decisions.
In fact, she writes on WebMD, “new research from Sweden found the odds of a heart attack jump nearly 40 percent on Christmas Eve. ‘Traditional holidays were associated with increased risk of heart attack. The risk overall during Christmas/New Year’s was 15 percent higher than a regular December day,’ said study senior author Dr. David Erlinge. He’s the head of the office of cardiology at Skane University Hospital in Lund. Erlinge noted that the 15-year study of more than 300,000 heart attack patients suggested that the risk was highest at 10 p.m. on Christmas Eve.”
Sharon Roth Maguire, RN and chief clinical quality officer at BrightStar Care®, a national homecare and medical staffing agency, said that because older adults are often more susceptible to gaining weight than their younger counterparts, it’s especially important for them to watch what they’re eating at this time of year. “With the holidays here, it’s easy to fall in the trap of eating binge-worthy foods that are high in sugar and calories and forgot about these extreme risks,” she said. “As individuals age it’s especially important to pay more attention to the food that is consumed. Elderly individuals are more susceptible to put on weight due to many underlying factors.”
According to Maguire, some of those factors as well as strategies to deal with them include:
- Many elderly individuals become more sedentary, which will in turn affect physical activity. “As individuals age, and potentially become more sedentary, one of the important contributors to overall health and well-being—physical exercise—may become more difficult,” she said. “It’s important that seniors continue to make physical movement a part of their daily routine. This can be anything from working out at a local gym, taking a walk around the block, or even doing chair exercises. The benefits of physical activity not only include weight loss but also keeping muscles, bones and joints limber to reduce the risk of falling. Additionally regular physical activity has been shown to improve mood and general sense of overall well-being.” Maguire suggests considering the wide variety of apps and electronic “wearables” (eg. Fit Bit, Apple Watch, etc.) that can motivate older adults to track their activity, log their intake and monitor weight loss. Some of the wearables even display larger font size making them a better choice for an older adult.
- The issue of loneliness has become an important focus in overall health for seniors, including issues of both obesity and weight loss. “Older adults tend to become more isolated and less social as their closest circle of friends and family begin to change due to death or relocation,” Maguire said.
- Research supports the importance of community involvement and having an exercise partner or “buddy” to dine, exercise, or simply get out and engage in life with.
- An important component of losing weight has to do with food choices. Both in quantity as well as quality, food choices will influence overall weight loss efforts. As individuals age food choices can become a challenge due to several variables including changes in taste buds, the effect of medications on taste and appetite and even the lack of desire to cook when there is no one else to cook for. In these instances, Maguire said older adults may begin eating “easy” foods that tend to have higher sodium, fat and sugar which add additional calories that have little overall health benefit. Make better choices at Christmas and all year long, Maguire said. “The elderly need to incorporate more vegetables, fresh fruits and choose lower sugar, and fat options.”