Obesity in the elderly-does it matter?

I have just returned from a cruise. Cruises are exciting holidays that are often favoured by  older people, especially those who are widowed, because they are safe and there are many opportunities for connection that you will not find in an hotel. Being of a curious mind, and  a watcher of the behaviour of other people, I noticed many things about my fellow guests.

The food available on a cruise ship (and in holiday hotels) is vast. Many people use eating as a form of recreation. It has nothing to do with staying alive. Holiday food is like being in a sweet shop, with no one there to stop us from putting our hands in the cookie jar. If you add the cocktails and if you are on a package where all you can drink is included, it is even better.

Many people on holiday eat and drink as if there is no tomorrow. Our enjoyment of a holiday is often conditional on letting go of all the rules and constraints of everyday life. Our Palaeolithic brain drives us to gorge on anything that is placed in front of our nose and the tastier it is, the more we want it. But; Palaeolithic man spent much of his life in starvation mode as well, and we have not learned how to adjust.

Many older people are infirm, they are using walking sticks and the elevator rather than the stairs. They have problems with their hips and their knees and they have trouble getting up or sitting down. Some are riddled with arthritis, that is an inflammatory condition. They sit with their morning coffee, watching the exercisers on the walking deck that every cruise ship boasts. The average deck extends for between quarter and a third of a mile around the ship. The older walkers are not particularly thin but – none are at the other end of the scale.

Health in the elderly is Not At Every Size. Obesity in older people is significantly associated with a range of infirmities that affect health and quality of life. Thinness is not a good idea either. I am told that longevity is best in people with a BMI in the “just overweight” category.

Obesity rates have increased enormously recently, even in more elderly age groups,” said Eva Kiesswetter, PhD, from the Institute for Geriatric Biomedicine at the University of Nuremberg, Germany, at the DGE conference.

In addition to the other well-known consequences, excess weight in the elderly can affect falling risk, pain, cognitive performance, and above all, one’s independence. The infirm elderly can live for a long time, but often in a state of pain, dependency and depression. Some of my companions – most if not all in larger bodies went on a trip, but could not get out of the tour bus and walk around– that is not much fun for them.

The need for vigilance in ageing

Research tells us that increases in BMI are normal through the lifespan partly due to changes in muscle mass and metabolism. To avoid weight gain in ageing is effortful and would require vigilance regarding diet and activity. Vigilance is not the same as dieting. Also, there are concerns about weight loss, even in the elderly. This is because weight loss leads to a decrease in muscle mass or bone density that can be particularly risky for elderly people. Dieting alone is thus unhelpful for older people.

Kiesswetter and her colleagues in Germany investigated which weight-loss interventions had a positive effect on elderly people’s physical functionality. The team incorporated 49 studies into their evaluations. They found that a combination of nutritional and activity interventions produced the best results. This combination can improve functional status and moderately reduce body weight without causing a loss in muscle mass, according to the findings.

Gerontologists also tell us that eating extra (complete) protein is helpful for the average older person, helping to sustain muscle mass particularly if someone also spends a little time moving on their feet. Sugar is unhelpful to older people. This isn’t dieting, it is self-care.

Elderly people with a normal BMI can also become ill but are less likely to be “inflamed”. Difficulty moving makes old age FEEL much older than it is; apart from what we know to be the associated health risks.

QOL in the elderly is being able to stand up gracefully, move about flexibly, sit down softly, get dressed easily and to go for long rambles with family and grandchildren. Age has its challenges but our body is a companion to the mind and both need care.