It may be okay to gain weight as we age

If you, like me, have been saying for years that you’d like to lose 10 to 15 pounds, wouldn’t it be nice to hear that it might be healthier not to?

A number of research studies have found that it’s healthy for older adults to have a Body Mass Index of between 25 and 27, in the overweight category of the widely used weight assessment tool. Having more padding might protect those of us with thinning bones from fractures. Some researchers have also found that being supposedly overweight is not associated with a higher risk of mortality, but being underweight is.

“Oftentimes in a healthcare setting, those with a BMI of 25 or greater are encouraged to lose weight, “ Katie M. Dodd wrote on her website The Geriatric Dietitian. “However, making such a recommendation for an older adult could be detrimental to their health.”

Note that we’re talking about people with BMIs categorized as overweight and not those in the obese category of BMIs over 30.

Dodds cited a meta-analysis led by Australian dietitian Jane Winter and published in the American Journal of Clinical Nutrition in 2014. The assessment of 32 studies found that adults with BMIs of 27 to 27.9 have the lowest mortality rates and thin folks with BMIs of less than 23 have a higher risk of death.

Studies led by epidemiologist Katherine Flegal, formerly of the Centers for Disease Control and Prevention, have also found that an overweight BMI is not associated with higher mortality for elderly people and may even provide some survival advantage.

Looking at Winter’s research, Dodds created a chart that shows BMIs of 23 to 30 as normal for older adults. Depending on height, people can weigh 24 to 41 pounds more than on standard BMI charts before being considered overweight.

Weight guidelines that take age into consideration include Halls’s BMI Calculator and the Smart Body Mass Index. Halls’s calculator returns a weight percentile for one’s age and sex, with Dr. Steven Halls advising that “the 45th percentile weight is a good estimate of your ideal weight.” The SBMI informed me that my weight “is at a level that should be good for your health . . . contrary to the ‘overweight’ classification.”

“At older ages, we really need to rethink what’s a desirable weight,” Mayo Clinic cardiologist Francisco Lopez-Jimenez, who researches the health effects of obesity, has said. “If it turns out that BMI between 25 and 30 might actually be normal and protective in [older] people, then we should not be labeling these people unhealthy.”

Before you grab a sweet treat to celebrate permission to hold on to excess pounds, note that Lopez-Jimenez said, “If it turns out.” Not all health experts agree that an overweight BMI is desirable for older adults. It’s a contentious topic still being debated.

“A pile of rubbish” is how Walter Willett, Harvard professor of epidemiology and nutrition, damned Flegal’s research. Willett said that Flegal and her colleagues failed to control for people who had lost weight due to illness, putting sick people in the normal-weight category. Research by Willett and others concluded that the risk of premature death increases with each pound above normal.

A researcher in Willett’s camp, Boston University demographer Andrew Stokes, led a study published in 2017 in the Annals of Internal Medicine. His study excluded people who lost weight due to illness. It found that people with a history of being overweight had a 6 percent greater risk of dying from any cause.

Flegal says that her detractors analyzed studies favorable to their preferred answers and used unreliable self-reported data. Moreover, hers is not the only research that concluded that being somewhat overweight has benefits, and her opinions are shared by many scientists.

As the experts debate their conflicting findings, how should we decide for ourselves?

The Mayo Clinic’s Lopez-Jimenez says that weight is only part of the picture. Fitness matters. Noting that “it’s much easier to make a person fit than to make a person lose 40 pounds,” Lopez-Jimenez advises patients to focus on improving aerobic fitness and strength through exercise. Extra weight that is lean muscle and not fat is less likely to increase cardiovascular risk. In fact, elite athletes have been wrongly categorized as overweight.

The Smart BMI also pushes fitness as we age. “An elevated weight is far less important than it may have been earlier in your life,” the SBMI notes. “Fitness, on the other hand, is all the more crucial for your health.”

In an interview with NPR’s All Things Considered, Dr. Steven Heymsfield, an obesity researcher at Louisiana State University, focused on the health problems associated with excess weight rather than weight itself. Weight-related health problems, such as high blood pressure, blood sugar, or cholesterol, need attention, he said.

The higher-weight-is-okay argument makes some sense in my case. I don’t have cardiovascular risk factors but I do have osteopenia, the bone-loss stage before osteoporosis. I walk 30 minutes most days. My doctor says I’m healthy.

Sad to say, however, health isn’t the main reason I’ve wished to lose 10 pounds. Like legions of American women, I’ve been brainwashed into wanting to be thinner. That desire may be harder to shed than pounds.

Filed under: Health and fitness

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