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BMI and the Elderly

Posted by tim1028 @tim1028, Oct 2, 2023

I recently read an article by a dietitian who specializes in geriatric nutrition that a higher BMI than the standard 20-25 is healthier for the elderly. Up until I hit age 65 (I'm 74 now), my weight was within the standard BMI range. Now I have a BMI of 26-27. I maintain a healthy lifestyle, managing stress, eating a heart-healthy diet, exercising according to current recommendations, and sleeping well. I feel ok at this weight, except that it does give me a slightly distended stomach (not a beer belly) I also asked a dietitian my wife saw at our medical clinic and she confirmed that a higher BMI is beneficial for older people. Any comments or thoughts you have?

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turberg | @turberg | Oct 3, 2023

Did the article explain why it is healthier and give any examples? I know that the older we get, our appetite goes down and many elderly lose weight. I've seen this in my mother-in-law. She was very overweight most of her adult life, do this weight loss is beneficial. However, had she been at a healthy weight, the weight loss would've been detrimental. I've also read that a little extra weight is healthy for bone loss.

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Mentor
Sue, Volunteer Mentor | @sueinmn | Oct 3, 2023

Both my mother's trusted internist in the early 200's and my primary physician have said not to be worried about a little extra weight if you are otherwise fit and eat a healthy diet. That unexpected illnesses, injuries and surgeries can change things in a heartbeat, and those fat stores are protection for your bones and organs.

This certainly was true in my mother's final years. She was always what I called middle-sized - muscular and slightly padded. By her final year, after a number of illnesses and strokes, she was frail and much smaller.

I stressed a bit over weight when I was in my early 60's, then I had 4 major surgeries in less than one year, and lost all of the "extra" weight plus some more due to complications. I would have been a skeleton if I started at my "ideal" weight. Five years after that, having regained my former weight, I got a severe long-term lung infection and lost 20% of my body weight - since I started at 125#, you can imagine how gaunt I was.

So there is truth behind this - and you can probably observe examples among your family and friends. The only caution I have is, too much weight stresses bones, joints, muscles, heart and lungs, so there is a fine line to walk, especially if you have a family or personal history of hypertension, heart disease or stroke.
Sue

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2 replies
tim1028 | @tim1028 | Oct 3, 2023
In reply to @sueinmn "Both my mother's trusted internist in the early 200's and my primary physician have said not..." + (show)
@sueinmn

Both my mother's trusted internist in the early 200's and my primary physician have said not to be worried about a little extra weight if you are otherwise fit and eat a healthy diet. That unexpected illnesses, injuries and surgeries can change things in a heartbeat, and those fat stores are protection for your bones and organs.

This certainly was true in my mother's final years. She was always what I called middle-sized - muscular and slightly padded. By her final year, after a number of illnesses and strokes, she was frail and much smaller.

I stressed a bit over weight when I was in my early 60's, then I had 4 major surgeries in less than one year, and lost all of the "extra" weight plus some more due to complications. I would have been a skeleton if I started at my "ideal" weight. Five years after that, having regained my former weight, I got a severe long-term lung infection and lost 20% of my body weight - since I started at 125#, you can imagine how gaunt I was.

So there is truth behind this - and you can probably observe examples among your family and friends. The only caution I have is, too much weight stresses bones, joints, muscles, heart and lungs, so there is a fine line to walk, especially if you have a family or personal history of hypertension, heart disease or stroke.
Sue

Jump to this post

The main reason for a little extra weight, as Sue mentioned, is to have a reserve against unexpected illness, injuries or surgeries. I haven't read that it has a beneficial effect on bone loss or other problems. The article said that extra protein, to help slow muscle mass loss with aging, is helpful. As recommended, I aim for about 1.2 grams of protein per kg of weight. The nutritional experts suggest that this should be spaced out over the day, because the body cannot absorb over 20 to 30 grams of protein at a single meal.

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1 reply
sisyphus | @sisyphus | Oct 4, 2023

First BMI is a measure to compare healthy weight, overweight and obese conditions in Populations. I know doctors and dietitians may also use this as a guide but for Individuals, it can be EXTREMELY faulty. WHY?

Normal weight is defined between BMI values of 18.5 and 24.99. Now think for a moment: Can a person have Normal weight even when the BMI is varying from a low point of 18.5 to an upper limit of nearly 25 , Of course not. Actually, if you are 1.80 meter tall, is your weight Normal at 60 kg (based on 18.5) or at 80 kg (based on 24.5) or somewhere in between? (BMI equals weight in kg divided by the square of your height in meters.)

Your healthiest weight is at which you feel and observe optimal physical fitness. No no one HAS to be optimally fit, there are things in life that are also equally (or more) important that physical health. Generally you would want to be functionally healthy and fit. In my 80 year old body I can do brisk walk for 30 mins each way, one and a half full pull-up or walk continuously 12 floors in my building with the last few at highest heart/pulse rate. Enjoy sound sleep and have no pains, surgeries, meds, tho sight is getting weaker. I think I am (never really measured) at right BMI with waist a few inches smaller than hip level. I don't see flab on my body any place and have good balance and flexibility. Actually I just fell on four tonight in a darker area stumbling over a raised curb but was back walking.

So eat well -- No Ultra Processed Foods (UPF) and lots of veggies fruits, legumes, whole grain, seeds nuts. Yes soda is a UPF. have been same waist for all my adult life.

You will FEEL too-- besides LOOKing -- fit and healthy. Good luck

REPLY
1 reply
tim1028 | @tim1028 | Oct 4, 2023
In reply to @sisyphus "First BMI is a measure to compare healthy weight, overweight and obese conditions in Populations. I..." + (show)
@sisyphus

First BMI is a measure to compare healthy weight, overweight and obese conditions in Populations. I know doctors and dietitians may also use this as a guide but for Individuals, it can be EXTREMELY faulty. WHY?

Normal weight is defined between BMI values of 18.5 and 24.99. Now think for a moment: Can a person have Normal weight even when the BMI is varying from a low point of 18.5 to an upper limit of nearly 25 , Of course not. Actually, if you are 1.80 meter tall, is your weight Normal at 60 kg (based on 18.5) or at 80 kg (based on 24.5) or somewhere in between? (BMI equals weight in kg divided by the square of your height in meters.)

Your healthiest weight is at which you feel and observe optimal physical fitness. No no one HAS to be optimally fit, there are things in life that are also equally (or more) important that physical health. Generally you would want to be functionally healthy and fit. In my 80 year old body I can do brisk walk for 30 mins each way, one and a half full pull-up or walk continuously 12 floors in my building with the last few at highest heart/pulse rate. Enjoy sound sleep and have no pains, surgeries, meds, tho sight is getting weaker. I think I am (never really measured) at right BMI with waist a few inches smaller than hip level. I don't see flab on my body any place and have good balance and flexibility. Actually I just fell on four tonight in a darker area stumbling over a raised curb but was back walking.

So eat well -- No Ultra Processed Foods (UPF) and lots of veggies fruits, legumes, whole grain, seeds nuts. Yes soda is a UPF. have been same waist for all my adult life.

You will FEEL too-- besides LOOKing -- fit and healthy. Good luck

Jump to this post

You have spoken well and I agree with you. Individualizing BMI is fraught with problems. I use it as a very general indicator, but also base my health on other measures, including, as you pointed out, how I feel. Functional fitness is essential the older we get.

Congratulations on your excellent health! I bike with a friend who is 85, ten years older than me. He prizes physical fitness and has maintained this despite surgeries for Afib, stomach issues and prostate cancer. On our moderately paced two-hour rides, he easily keeps up with me and at times I have to push to keep up with him. He is a model for me of a fitness and health.

REPLY
rsfcowgirl | @rsfcowgirl | Oct 4, 2023
In reply to @sueinmn "Both my mother's trusted internist in the early 200's and my primary physician have said not..." + (show)
@sueinmn

Both my mother's trusted internist in the early 200's and my primary physician have said not to be worried about a little extra weight if you are otherwise fit and eat a healthy diet. That unexpected illnesses, injuries and surgeries can change things in a heartbeat, and those fat stores are protection for your bones and organs.

This certainly was true in my mother's final years. She was always what I called middle-sized - muscular and slightly padded. By her final year, after a number of illnesses and strokes, she was frail and much smaller.

I stressed a bit over weight when I was in my early 60's, then I had 4 major surgeries in less than one year, and lost all of the "extra" weight plus some more due to complications. I would have been a skeleton if I started at my "ideal" weight. Five years after that, having regained my former weight, I got a severe long-term lung infection and lost 20% of my body weight - since I started at 125#, you can imagine how gaunt I was.

So there is truth behind this - and you can probably observe examples among your family and friends. The only caution I have is, too much weight stresses bones, joints, muscles, heart and lungs, so there is a fine line to walk, especially if you have a family or personal history of hypertension, heart disease or stroke.
Sue

Jump to this post

So perfect, Sue.
I'm sad to learn you've been thru so much.
I think we also need to talk about the types of tissue in our weight. BMI does not distinguish between fat and muscle. As we age, we lose muscle and tendon tissue. (That is what I'm fighting at the moment.) Often, loss of muscle tissue is replaced with fat. So ideally we should be fortifying our muscle and tendon tissue regardless of whether we're also putting on some extra fat weight. But sometimes we just have more fat while remains within the standard annual muscle loss with aging or even if we maintain muscle well.
The most current just emerging determinants for condition is the waist- hip ratio. It is a new indicator in weight assessment. It indicates whether weight may be a problem in regards to cardiovascular health, primarily.
Further, doctors are now putting forth the suggestion that a new vital sign should be added. That is "grip strength." Studies have shown that this measurement is a significant + critical predictor of true conditioning, especially in seniors.

REPLY
rsfcowgirl | @rsfcowgirl | Oct 4, 2023
In reply to @tim1028 "The main reason for a little extra weight, as Sue mentioned, is to have a reserve..." + (show)
@tim1028

The main reason for a little extra weight, as Sue mentioned, is to have a reserve against unexpected illness, injuries or surgeries. I haven't read that it has a beneficial effect on bone loss or other problems. The article said that extra protein, to help slow muscle mass loss with aging, is helpful. As recommended, I aim for about 1.2 grams of protein per kg of weight. The nutritional experts suggest that this should be spaced out over the day, because the body cannot absorb over 20 to 30 grams of protein at a single meal.

Jump to this post

I just saw a great presentation that showed thru specialized radiology and biopsies that bone loss does occur concurrent with large muscle and tendon loss in sarcopenia, even early. The finding was also that resisting muscle+ tendon loss does not also prevent the associated bone loss. That is a separate effort.
I was reading about this in the medical literature because I've experienced frightening muscle loss over two weeks of respiratory illness. I'm now trying to rebuild. Not an easy task. I'm doing it the medically recommended way. I cannot afford to be at such risk as not having adequate muscle mass for functioning and fracture prevention.
Aahhhh....it's always something....

REPLY
1 reply
rsfcowgirl | @rsfcowgirl | Oct 5, 2023
In reply to @rsfcowgirl "I just saw a great presentation that showed thru specialized radiology and biopsies that bone loss..." + (show)
@rsfcowgirl

I just saw a great presentation that showed thru specialized radiology and biopsies that bone loss does occur concurrent with large muscle and tendon loss in sarcopenia, even early. The finding was also that resisting muscle+ tendon loss does not also prevent the associated bone loss. That is a separate effort.
I was reading about this in the medical literature because I've experienced frightening muscle loss over two weeks of respiratory illness. I'm now trying to rebuild. Not an easy task. I'm doing it the medically recommended way. I cannot afford to be at such risk as not having adequate muscle mass for functioning and fracture prevention.
Aahhhh....it's always something....

Jump to this post

Sentence should read "replacing" muscle and tendon loss does not replace (associated adjacent ) bone loss.

REPLY
Sirref | @sirref | Oct 6, 2023

Good read from the Doctors on Twitter.
Beverly G. Tchang, MD
@BevTchangMD
Just want to remind all of my lovely wizened >80 year old tweeters here that a BMI in the "overweight" range is perfectly acceptable and in fact, ideal.
https://x.com/BevTchangMD/status/1687851454701125634?s=20

Eugene Lucas, MD
@elucasmd
·Aug 7
This study (http://t.ly/odP2C) divided patients into < 60yo and > 60yo and accounted for muscle mass & chronic conditions. The lowest HR for death occurred at BMI 22-25, lower for patients < 60yo, but still < 1.0 if > 60yo if muscle mass is preserved.
Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894968/#pone.0194697.s008

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