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Dangerous Dieting ; to Lose Weight, Start Exercising; Don't Stop Eating

Posted on: Wednesday, 1 December 2004, 03:00 CST

One group of people in America might want to ignore all the warnings about the obesity epidemic: people older than 60.

After that age, stop dieting, experts say. Losing weight by not eating is dangerous for elders, so much so that even nursing homes have stopped serving diets that could promote weight loss, they say. If you want to lose weight, then exercise, but don't stop eating.

A few things to remember: Dropping weight for younger people means an effort to reduce body fat. But for older people, losing weight often means dropping muscle mass and bone mass. Also, the chemistry of weight loss can make illnesses, such as heart disease and other organ diseases, worse.

"The body-mass index that's healthy for young people is shown to be unhealthy for older people," said Sherry Robinson, assistant professor of nursing at Southern Illinois University School of Medicine in Springfield. "In nursing-home work, we're always watching the weights because that's the significant problem: weight loss. We're more concerned about weight loss than we are about older people who are overweight."

As baby boomers rewrite the book on aging, they ought not forget that chemistry can't read; the chemistry of people ages 60 to 65 changes permanently.

Weight loss among older people can come from a variety of sources, many of them physiological, Robinson said.

Among the causes:

*Often, food loses its appeal. As people age, their senses of smell and taste diminish.

*Older people might have dental problems that make eating more difficult.

*Older people who live alone might be plagued by loneliness, depression and paranoia.

*Medications might reduce appetite or change how people taste food.

*Older people might not be able to afford the foods they found pleasurable before they were on fixed incomes.

*People must deal with the infirmities of age: illness, swallowing problems, glands going haywire or wearing out.

"It's a huge problem," said Dr. John Morley, director of the department of geriatrics at St. Louis University School of Medicine. "We're so fixated on obesity at the moment. But the problem is that as we get older, if you start to lose weight, you can't carry your weight anymore because you're losing muscle weight as well. Then you become what's known as the 'fat frail,' and we've shown in studies that, fundamentally, these are the people who have the worse outcomes."

The problem comes from a change in chemistry. In old age, the body produces too much of certain chemicals but too little of certain hormones, so the cells in the muscles and bones are unable to maintain themselves. Although physicians can control the problem with medication, older adults should be aware that dropping muscle and bone mass could occur at a dangerous rate when dieting.

Morley covered the issue extensively in the winter 2004 edition of his magazine, Successful Aging. More studies are available in the October-November 2003 issue of The Journals of Gerontology Series A: Medical Sciences.

About 10 percent of American seniors starting at about 60 to 65 years of age are underweight, and as many as half the residents of nursing homes might be underweight, Morley said. The National Health and Nutrition Examination Survey found that up to 16 percent of Americans over 65 consume fewer than 1,000 calories a day, which adds up to malnutrition.

Pointing to a recent study on weight loss in seniors, Morley said that nearly one-third of elder patients who continued to lose weight died, while more than 90 percent survived after reversing their pattern of weight loss. Another study he cited showed that hip fractures tended to occur not in overweight seniors but among older people who were dropping pounds.

Howard Houghton, assistant professor of clinical psychiatry at the University of Missouri at Columbia School of Medicine, said he has seen malnutrition among the elderly for a long time.

Many of the cases he has seen stem from Alzheimer's disease and anorexia. People with Alzheimer's often forget to eat and lose their ability to use utensils, he said. In addition, "people who got anorexia years ago used to die. Now, they live into old age. The condition is still there, but once they get into old age, they sometimes just stop fighting it."

The experts have tips regarding weight loss in the elderly. For people who are healthy in general:

*Don't go on weight-loss diets unless you are morbidly obese.

*Exercise to increase muscle mass and bone density well into old age.

*Watch for weight stability. In older people, dropping 5 percent of body weight in less than three months signals illness, Morley said. Put them on a scale and see whether they're dropping weight, Houghton said. "Gravity doesn't lie." Watch to see whether their clothes are fitting like they used to, he said. Look at their faces. Sunken cheeks and eyes are a sign.

*Get annual checkups. "Even if they're healthy, they should be seen once a year by a doctor for a complete checkup," Houghton said.

*Beware of heart-healthful diets. Morley said that diets that are heart-healthful for younger people might cause heart problems in older adults. A balanced diet is still the best diet. For someone not eating a lot, add high-density food to other foods cheese, peanut butter and powdered milk, for example.

*Diabetes might be the only exception to the rules. When your blood sugar is out of whack, Houghton said, that's another set of problems. Work with your physician, but still be wary of any radical weight loss by not eating.

If there are problems such as illness or dementia:

*Consider more finger foods for relatives who might be developing Alzheimer's or another form of dementia.

*Serve foods people want to eat. "If you wouldn't eat it, your elderly relative probably wouldn't eat it, either," Houghton said.

*Watch dietary reactions to new medications. Blood-pressure medicines are notorious for reducing appetite. Some heart medications can change the perception of the taste of foods. Appetite loss may accompany any new prescription.

*In old age, treat the disease and its symptoms and resist changing the diet.

*Use caloric supplements between meals.

Source: Richmond Times - Dispatch

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