If you are overweight or obese your chances of dying of any cause are raised.
If you were one of the nearly four million people in this study the best weight to be was the one that put your Body/Mass Index under the red arrow. As it goes up or down so too do your chances of dying. It’s a J curve.
If you are young and obese you have the most to gain from losing weight. It is not easy but some succeed. You can give it a go or you can shriek about fat shaming and stuff another ice cream in your face.
If you’re obese and really lucky you may be metabolically healthy. It’s true for a minority. On the other hand some people of normal weight fall prey to those ills we associate with obesity, the dreaded metabolic syndrome. It does rather complicate the decision regarding the ice cream.
But wait it gets worse.
If you are a baby boomer or, my goodness, even older there are a number of confounding issues. Declining muscle mass being replaced with fat can bring all the disadvantages of obesity at a normal or not greatly elevated BMI. Add to that the fat distribution – middle aged spread tends to go around the middle where it does more harm than subcutaneous fat. You may be in more trouble than you think … or less.
I’m still exactly the same height I was lying about when I was 18 but some people have shrunk. This would increase their apparent BMI even if they haven’t put on a gram in the meanwhile. (Do I get extra consideration for bow legs?).
Next thing to consider is the obesity paradox. If BMI is plotted against all cause mortality in the elderly a different picture emerges than the one above. A higher BMI can appear to be protective. The simplest explanation for this is that death is fairly common in this age group and is often preceded by a period of wasting. Alternatively it may be because those most susceptible to the ills of obesity have already been eliminated from the cohort.
So if unintentional weight loss clouds the picture is intentional weight loss safe or not?
Intentional weight loss, even when excess fat mass is targeted also includes accelerated muscle loss which has been shown in older persons to correlate negatively with functional capacity for independent living. Sarcopenic obesity, the coexistence of diminished lean mass and increased fat mass, characterizes a population particularly at risk for functional impairment …. Miller & Wolfe.
Failed weight loss in a sedentary population invites the worst of both worlds – lose fat and muscle regain only fat. Weight loss in the elderly regardless of intentionality also carries an increased risk of subsequent hip fracture.
No surprise then that health care professionals are divided on whether weight loss should be recommended to their elderly patients.
This little essay draws heavily on a review paper by Gill, Bartels & Batsis. Their conclusion is fairly positive …
The number of older adults is projected to increase substantially in the coming decades and addressing obesity is essential for the health of this rapidly growing population. Though the “obesity paradox” has contributed to a lack of attention to addressing obesity as a major health problem in older adults, weight loss and improved fitness in obese older adults has been shown to improve function and multiple health indicators. Though physical activity and diet alone can improve outcomes, randomized controlled trials showed better outcomes when they were combined. The process of activity prescription should be patient-centered in order to develop a plan that is relevant to the older adult’s goals and achieve the overarching purpose of improved quality of life.
If you’re no spring chicken and thinking of shedding some weight it’s worth a read. A chat with your doctor would also be a good idea. Diet and exercise beats either alone.
My choice was to start cycling coupled with resistance training and a low-carb diet taking care to keep the protein intake up. All appears to be going well, the hips are still intact (you’d need oxy-acetylene equipment to get through one of them).
Previous failure has taught me that it ain’t over until the fat lady is singing about how much weight she’s lost but cycling is low impact compared to running and the keto diet involves little will power compared to calorie restriction diets. Confidence remains high.