Edna proudly tells you that without even trying her weight is down from 170 to 155 lbs in just three months. At age 76 and 5’ 1” tall her BMI was in the obese category, but now it’s in the overweight category—and Edna wants to lose more weight. So do you cheer her on? Or do you worry that she may experience some serious health repercussions?
More than 33% of people over age 65 are obese, so it’s likely you’ll see more people like Edna in your practice.1 Research indicates that intentional weight loss in older persons can be beneficial, especially if regular physical activity is included, but the health implications of weight loss in overweight and obese older adults is complicated.2
The “Obesity Paradox”
The Obesity Paradox describes the phenomenon that obesity appears to be protective from disease and death in some, but not all, individuals. A growing body of evidence shows that overweight and obese older adults aren’t at greater mortality risk than their normal weight counterparts.3,4 In acute and chronic heart failure, overweight and mild-to-moderate obesity is associated with improved survival.5 Moreover, obesity can appear protective among individuals with cardiovascular disease (CVD),6 and normal weight adults have higher mortality risk than obese patients with type 2 diabetes.7
In older adults, there may be other protective effects associated with being slightly overweight, such as better survival of acute illness, improved ability to handle stress, and recover more quickly from traumas.
In some cases, maintaining an older adult’s usual body weight is more appropriate than initiating weight loss. For example, weight management in older people with CVD should aim to improve and maintain physical function and quality of life rather than prevent medical problems associated with obesity.8
There’s strong evidence that unintended weight loss leads to increased morbidity and mortality, so RDs should carefully weigh the risks vs benefits of weight loss for each individual.9 The safety of weight reduction must be the priority to avoid the potential for malnutrition and other possible complications such as bone loss, weakness, and falls.
Should Edna Lose More Weight?
Although formerly exercising daily on her stationary bike and using her resistance bands for strength training, Edna has stopped her routine due to pain from progressive arthritis. In her case, this unintended weight loss should send major red flags to you as her RD. She’s likely experiencing sarcopenia with her unintended weight loss, and this may be the beginning of a downward spiral of health issues.
You will want to ask several questions about Edna’s current eating and activity habits so you can complete an accurate nutrition assessment with appropriate nutrition diagnosis, interventions, and a monitoring/evaluation plan. A nutrition-focused physical assessment along with application of the Academy of Nutrition and Dietetics criteria may indicate that Edna has chronic disease-related malnutrition. Her unintended weight loss may have led to muscle weakness, which in turn may lead to decreased abilities to perform daily activities (such as shopping and cooking), falls, and other health problems.
As you assess Edna or any of your obese older patients, many questions must be answered before determining whether weight loss is appropriate: Will weight loss reduce risk factors for other complications? Will weight loss prolong life for the individual? What are the risks associated with obesity treatment? Will a diet that restricts calories reduce the individual’s ability to consume adequate nutrients to maintain health?10 Only after answering these questions can RDs determine the best approaches for clients.
For more information on this topic, refer to Diet and Nutrition Care Manual: Comprehensive Edition and The Obesity Challenge: Weight Management for Adults and Older Adults from Becky Dorner & Associates, Inc.
— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition and long-term health care. Her company, Becky Dorner & Associates, Inc, is a trusted source of valuable resources dedicated to improving quality of life for older adults. For valuable resources for health care professionals, visit www.beckydorner.com and sign up for our free membership.
- Fakhouri THI, Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Obesity Among Older Adults in the United States, 2007–2010. Hyattsville, MD: National Center for Health Statistics; 2012. NCHS data brief 106.
- Darmon P. Intentional weight loss in older adults: useful or wasting disease generating strategy? Curr Opin Clin Nutr Metab Care. 2013;16(3):284-289.
- Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014;99(4):875-890.
- Flicker L, McCaul KA, Hankey GJ, et al. Body mass index and survival in men and women aged 70 to 75. J Am Geriatr Soc. 2010;58(2):234-241.
- Gupta PP, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heart failure. Can J Cardiol. 2015;31(2):195-202.
- Banack HR. Kaufman JS. The obesity paradox: understanding the effect of obesity on mortality among individuals with cardiovascular disease. Prev Med. 2014;62:96-102.
- Thomas G, Khunti K, Curcin V, et al. Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease. Diabetes Obes Metab. 2014;16(4):317-325.
- Dorner TE, Rieder A. Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol. 2012;155(1):56-65.
- Unintended weight loss in older adults. Academy of Nutrition and Dietetics Evidence Analysis Library website. http://www.andeal.org/topic.cfm?menu=5294. Accessed August 12, 2016.
- Houston DK, Nicklas BJ, Zizza CA. Weighty concerns: the growing prevalence of obesity among older adults. J Am Diet Assoc. 2009;109(11):1886-1895.