Effective Weight Management for Older Adults

Weight management is a crucial aspect of health and wellness for people of all ages. In one of my research studies published in Cell Metabolism, we showed that longitudinal trajectories of body weight changed dynamically through the life course. Typically, people show their highest body weight around midlife which is followed by a natural decline in towards later life. Unintentional or sudden weight loss could also signal serious underlying issues in older adults. Maintaining a healthy weight at each life stage can help prevent chronic diseases, improve mobility, and enhance overall quality of life. With the recent excitement surrounding GLP-1 agonists for weight loss, a lot of older adults have been asking me about how safe it is for them. Weight management in older adults comes with unique challenges and considerations which must be considered carefully.

The Obesity Paradox

The obesity paradox refers to the observation that, in some older adults, being overweight may be associated with improved survival rates compared to those with normal or lower weight. This phenomenon suggests that a higher body mass index (BMI) might offer some protective benefits against certain illnesses and mortality in older age. This benefit likely comes from preservation of lean mass in older adults. Obviously, this should not undermine the importance of a balanced diet and regular physical activity, as excessive weight can still contribute to several health issues. There’s still quite a bit we don’t fully understand about how body weight, body fat and lean mass change through the life course and how exactly it contributes to aging-related diseases.

Why should older adults pay attention to weight management?

Maintaining a healthy weight can help reduce the risk of chronic conditions such as heart disease, diabetes, hypertension, and certain cancers. In the United States, being overweight or obese is strongly associated with colorectal cancer, according to a recent analysis conducted by us. Weight management can also improve outcomes for those already living with chronic conditions. A healthy weight supports better mobility, reducing the risk of falls and enhancing the ability to perform daily activities. It contributes to muscle and bone health, which is essential for maintaining physical function and independence. Proper weight management is linked to better mental health, by reducing the risk of depression and anxiety. Positive self-esteem and body image are also associated with a healthy weight. In a recent analysis conducted by us, metabolic factors such as obesity were a significant risk factor for all-cause dementia – a life-threatening condition commonly affecting older adults.

Points to consider when trying to manage weight as an older adult

The most common reason for loss of body weight in older adults is Sarcopenia, or the age-related loss of muscle mass. This can lead to a decrease in overall body strength and an increase in fat mass percentage. According to research, loss of muscle mass becomes prominent from the7th decade onwards, with men losing approximately 0.5% to 1% muscle mass per year. Women also lose muscle mass but to a slightly lesser extent according to this study. It is important to maintain muscle mass and a certain amount of fat mass (in other words, a healthy lean to fat ratio) as you get older. This becomes even more relevant because of age-related changes in fat distribution. These changes, including loss of muscle mass can be measured through chemical composition and imaging (computed tomography; magnetic resonance; dual-energy x-ray absorptiometry, DXA). Currently, DXA is the preferred technique commonly available at most clinics and hospitals around the world.

Some chronic illnesses and medications can affect appetite, metabolism, and physical activity levels. Similarly, some medications may cause weight gain or loss as a side effect. Therefore, it is important for older adults to evaluate the effects of their medication or co-morbidities on their body weight with healthcare providers before taking any action.

Reduced physical activity due to retirement, health issues, or social factors can contribute to weight gain. This could be offset by engaging in regular and safe physical activity – especially strength training. Nutrition also plays a critical part in weight management in older adults where changes in taste, smell, and digestive efficiency can affect dietary choices. We have covered nutritional needs of older adults in a 2-part series previously. You can check it out here.

It’s also very important to set realistic and practical weight management goals. Tracking your weekly or monthly body weight using a bathroom scale, maintaining a food diary and physical activity logs can help you quantify areas that need improvement. Overeating and undereating can both be driven by emotional factors so it helps to have accountability from a support system regarding eating habits, e.g., family members, friends, community members. Lastly, it is very important to regularly speak with your doctor about your weight management strategies, progress and struggles. Sudden or unintentional weight loss must be discussed with your doctor immediately.

Weight loss medication for older adults?

Recent advancements in prescription anti-obesity medications, e.g., semaglutide (Ozempic or Wegovy) have resulted in drastic weight loss in obese patients. This class of drugs, also known as glucagon-like peptide-1 (GLP-1) agonists, have been used to treat type 2 diabetes for a long time and has the ability to result in weight loss through suppressing appetite. They are not meant to be used by healthy people to shed a few pounds. The safety and efficacy of these drugs in older adult populations is not fully known yet. Some experts caution against loss of muscle and bone, nutrient deficiencies resulting from suppressed appetite as well as unintended ongoing weight loss even after stopping medication, which could be detrimental in older adults. Another consideration is that most older adults might not be able to make the financial commitment to go on these drug regimens which are currently pricey and not covered for weight loss by Medicare or private insurance.

Conclusion

Weight management is a vital component of healthy aging. Even though weight loss is remarkably beneficial for younger age groups, older adults must exercise caution before losing weight. By understanding the unique challenges faced by older adults and implementing tailored strategies, it is possible to achieve and maintain a healthy weight, which also means a good lean to fat ratio – to offset effects of age-related loss of muscle or sarcopenia which is a very common issue faced by older adults. Talking to your doctor is important, especially if you are an older adult considering losing weight – either through lifestyle changes or prescription drugs.