Sparse but increasing evidence points to a delicate balance between weight loss and weight gain in aging. While malnutrition afflicts a considerable segment of our aging population, the obesity epidemic has also hit Australia’s growing older cohort.
And the health effects are just as damaging. Overweight and obesity amplify risk of chronic diseases like heart disease, diabetes, cancer and even dementia. They increase declining health in aging and can trigger physical and cognitive disability, boosting hospital admissions, health care costs and mortality.
“Sarcopenic obesity” is a new term to describe age-related loss of muscle mass combined with increased body fat. Evidence suggests it may even have worse consequences for disability than sarcopenia without obesity.
Health professionals are wary of prescribing weight loss in older adults for fear of impacting muscles, bones and nutrition status. But evidence suggests that shedding excess weight at an older age, as in younger years, can improve physical function and reduce chronic diseases.
What causes obesity in older adults?
Excess calories and scant physical activity are primary risk factors for obesity at any age. These have also contributed to swelling obesity in advanced years.
“In an affluent country such as Australia,” the National Health and Medical Research Council says, “food is plentiful, easily accessible, often energy dense and heavily promoted, and daily tasks and recreation depend less and less on physical activity.”
Increased love of eating out, computer use, television viewing, labour saving technologies, restricted time, fear of crime, and greater use of cars are likely contributors.
Compounding these factors, age-related declines in hormone production can increase fat accumulation. Aging also reduces muscle mass. It compresses spines and makes people shorter. All this can unfavourably tilt the fat:muscle ratio, so simply stepping on the scales may not reveal increased fat.
Less than half of health professionals advise weight loss in overweight or obese older adults. Yet such advice is a good predictor of efforts to shed weight. In support, governing health bodies now advocate treating obesity in older adults.
In so doing, priority must be given to preservation of muscle mass, bone density and nutrient levels. Individualised care is critical to address any related conditions. The suggested target is a gradual 5% to 10% weight reduction over 6 months, followed by weight maintenance.
A nutritious, well balanced diet is always optimal for healthy weight and healthy body. Plenty of plant foods provide nutrients that support good health and can be eaten in bulk without consulting the calorie counter. Round this out with oily fish like salmon, tuna and mackerel, dairy products, whole grains and healthy fats. Bin highly processed foods and refined carbohydrates.
The golden years demand special attention to consuming adequate protein (1.0-1.2 grams per kg per day) to help maintain muscle mass and bone health. Vitamin D and vitamin B12, notoriously compromised with age, are recommended as supplements. Fibre—from plant foods—and plenty of fluids will help keep things purring along.
Regular exercise is the crowning jewel—it burns energy to help shed kilos, maintains healthy muscle mass and bone density, supports a healthy immunity, reduces chronic physical illness, and helps keep the brain sharp.
Minimum physical activity recommendations are individually, professionally tailored aerobic exercise (increasing heart rate and breathing) 30 minutes a day, 5 days a week, and strengthening exercises at least three days a week.