Trying to lose a few pounds? If you’re over 65, your health may be better for remaining at your current weight or actually gaining more, a former health secretary has said.
Dame Patricia Hewitt, 76, who was health secretary from 2005 to 2007, has advised people to have a “buffer zone” of extra weight to prevent frailty and illness in old age.
She shared the advice after being hospitalised with severe dehydration while on holiday in Australia, where doctors told her about the concept of “geriatric BMI” (that a healthy BMI for older people is higher than that of younger people).
Dame Patricia had weighed 7st 11lb (50kg) when hospitalised and counted herself “jolly lucky” in the past that she hadn’t gained weight easily. But doctors told her to gain nearly 2st to protect her health in the future. “What is a healthy weight for you as you grow older, particularly if you’re a woman, is almost certainly higher than you think it is,” she told The Times.
How can you know if you need to gain weight and what are the risks of being skinny as we age? The experts share their insight.
What is ‘old age BMI’?
Body mass index (BMI) is a blunt measure of whether an adult is a healthy weight for their height.
It is calculated by dividing weight (in kilograms) by height (in metres squared). A BMI of below 18.5 indicates someone is underweight, a healthy weight (18.5 to 24.9), overweight (25 to 29.9), obese (30 to 39.9) or severely obese (40 or above). While it provides a useful indication, it has limitations and research suggests that these categories are of limited use to over-65s.
“We rightly hear lots about the health problems related to obesity, and of course, obesity is a very significant challenge for our country, but we also know that people with a low BMI have worse health outcomes,” says Prof Jugdeep Dhesi, a consultant geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and president of the British Geriatrics Society.
“A healthy BMI for older people is between 23 and 30 [which includes overweight and obese BMI categories], rather than the usual 18 to 25 that we’d use for younger people,” she explains.
“Most geriatricians and all those that work with older people know that but it’s not as widely recognised by the wider public,” says Prof Roy Soiza, a consultant geriatrician at Aberdeen Royal Infirmary.
“At a younger age, being thin and sprightly is seen as healthy but when you get to an old age, that’s no longer true. A BMI of around 30, maybe even a little bit over [classed as obese], which we would consider unhealthy in a young person, is OK in an older person.”
This is because of the so-called “longevity paradox”, that overweight older people, especially women, live longer than their slimmer peers, Dame Patricia noted in her letter to The Times.
One paper recommended that older women can benefit from a BMI of 31 to 32 (classed as obese) and men should aim for 27 to 28 (in the overweight category) to reduce their risk of suffering a fall and a decline in muscle mass.
What are the risks of being too slim as we age?
Falls are one of the most common injuries in older people, leading to more than 100,000 hip fractures and 5,000 deaths annually, and carrying extra weight can provide protection against fractured and broken bones.
“The biggest risk with falls is fractured hips. Having more insulation is certainly helpful,” Prof Soiza says. Once in hospital, research shows that older adults can lose up to 10 per cent of their muscle mass within a week, which can cause their health to deteriorate.
Having a low BMI – under 23 for the over-65s – can also increase the risk of disability, reduce your independence and shorten life expectancy, says Prof Dhesi.
Frailty is another concern linked with a low BMI as we age. “If you are frail, it means that a relatively minor illness such as a urinary tract infection or minor fall can have a serious impact on a person’s health and wellbeing,” notes Clare Thornton-Wood, a registered dietitian and spokesperson for the British Dietetic Association.
“At the lower range of a normal BMI, we’ll see people that are unintentionally losing weight and becoming frail and they’ll be very susceptible to things like cancer and infections,” Prof Soiza adds. “They’re more likely to have things like sarcopenia, so the age-related muscle loss. Overall, it’s a feature of being less healthy and robust.”
How to gain weight healthily
“If an older person is noticing their weight going down, then the logical thing to do is to try and eat more to compensate and try to maintain a good weight,” says Prof Soiza, who is also an honorary chair of the Ageing Clinical and Experimental Research (ACER) Group at the University of Aberdeen.
If you need to put on weight, Thornton-Wood recommends turning to snacks. Cheese and crackers, nuts and full fat Greek yogurt are both high in calories and protein, she notes.
There are also some tricks to add calories to your food. “Consider adding cheese or full fat yogurt or crème fraîche as a garnish to soup or butter and cheese to mashed potatoes,” she says. “Stir a teaspoon of olive oil through sauces such as bolognese or on salads.”
“If you can manage slightly bigger portions that is beneficial – increase gradually if you need to,” Thornton-Wood adds.
Don’t turn to foods that are fatty and processed, Prof Dhesi says. “We know that those are not good for you,” she notes.
It’s also vital to eat enough protein to maintain strong muscles, for all over-65s, not just those looking to gain weight, Prof Dhesi says. She recommends 1g of protein for every 1kg of weight, meaning a 60kg woman should eat 60g of protein per day.
“One egg has got 6g, a chicken breast has got approximately 30g, a glass of milk has about 8g and a cheese sandwich has about 20g,” Prof Dhesi says.
However, for people who are of very advanced age, there’s no right or wrong way to go about gaining weight, Prof Soiza says. “The key thing is just to maintain your weight if you possibly can and how you do it matters little – if you like your fish and chips and your chocolate or ice cream, then go for it.”
Though it’s important to pay attention where you carry extra weight, Prof Dhesi notes. “Having a large waist is not good for you and indicates that you’re probably carrying too much fat rather than muscle,” she says. “For women, that’s a waist of over 35 inches, for men, it’s a waist of over 40 inches.”
Prof Soiza recommends against turning to high-calorie drinks or supplements, as there’s “reasonably good evidence that these are no better than just eating more of what you like and just having a healthy, balanced diet is probably better”.
Exercise is also key for gaining weight, Prof Dhesi says. “We know that that helps to build up your muscle mass, and that muscle mass contributes to your weight,” she explains.
If you’re not used to being active, she recommends going from sitting to standing from your chair, multiple times a day, is a good place to start, as is going up and down the stairs or going out for a walk.
“But if you can push yourself a bit harder, try resistance training,” she says. “Use a couple of bags of sugar or a couple of dumbbells, if you have them, to really build up some muscle, both in your arms and in your legs as well.”
“Any exercise is good – it’s the closest thing to a panacea that we have,” Prof Soiza says. He recommends those that involve social interaction, such as team sports and dancing. “But the important thing is to exercise and stay active. Quite how you do that, it doesn’t matter,” he adds.
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