August 6, 2008

More Evidence That Weight Loss After 65 is Dangerous To Your Health

We already knew from analysis of NHANES data that after age 70 any weight loss, including weight loss from intentional dieting, correlates with a higher risk of death. This was true even when controlling for the presence of diseases that might have caused weight loss like cancer. You can review some of the research that established this in this earlier blog post: Overweight is Healthiest Weight.

Now an intriguing finding about the hormone adiponectin may hint at why this is. The study is described in this week's issue of Diabetes in Control. Read the summary here:

Adiponectin May Increase Risk of Heart Attack.

Diabetes in Control's article reports: "This study examined a sample of 1,386 participants of the population-based Cardiovascular Health Study from 1992 to 2001. Participants consisted of adults aged 65 to 100 years and were recruited from four field centers in the United States. Subjects underwent physical examinations and laboratory testing. Of these participants, 604 experienced a heart disease event. Those with the highest levels of adiponectin were most likely to suffer a heart attack."

The kicker is this: Weight loss causes adiponectin to rise.

The researchers from this study speculate that "higher adiponectin concentration may reflect underlying disease processes in the body, or even have direct harmful effects, which may be amplified in the elderly. Adiponectin has been shown to increase energy expenditure through direct actions in the central nervous system in mice, and if this effect were also present in humans, it could be significantly harmful in older adults by accelerating the loss of skeletal muscle, a condition called sarcopenia."

Given that repeated analysis of the huge volume of NHANES research found a similar increase in death with weight loss even when people's underlying health conditions were screened out, I doubt that underlying conditions are the explanation for the correlation here. Indeed, there may very well be a reason why our bodies start to pack on weight at middle age and that reason may be that the fat we pack on helps keep us alive.

It is worth noting, again, that despite all the demonization of obesity in the media, Dr. Nir Barzilai's research about people who lived to be 100 years old or older found that fully one third of them were obese in their 50s.

So what does this latest finding mean for you? My guess is that it means that the best time to work on your weight is long before you hit your 60s. From then on your focus should be on blood sugar control and that your dieting efforts should be directed to maintaining your current weight rather than losing weight.

Certainly the body helps us out on this one. It gets tougher and tougher to drop a pound with each passing year and just maintaining our weight may take more self-restraint than we expended dropping 30 lbs in our 30s.

Vanity fanned by a media culture that makes people believe that we all should have bodies like liposuctioned, breast-augmented 20-year-old actresses makes it very hard to accept the idea that a healthy older person is a plumper older person.

Perhaps the next radical step the Baby Boom generation will have to take is to publicly challenge the fat-phobic media culture and start demanding that health authorities tell the truth about the relationship of weight and health in older people. That truth is simple: LOSING WEIGHT KILLS OLDER FOLKS.

Ignore it at your peril.

4 comments:

Jenny said...

Well, Jenny, (I should post here as Jennytoo as I do at TYP, to avoid the confusion of sharing your name) this is certainly somewhat alarming. I am 62 and am low-carbing. I have eaten a somewhat low-carb diet for several years, but over the last year, my thyroid replacement, which had been stable for several years, became unstable, and I gained about 12 lbs. while hypothyroid, without realizing what was going on. I got stricter with the low-carb at the same time I started trying to get a handle on my TSH, and have lost 18 pounds since March, not from eating less than I want, but strictly from eating less carbohydrate. It has had a good effect on my Blood Pressure, and the labs I had most recently are the best ever (Triglycerides 50, HDL 88). I feel that to really be at my ideal weight I would need to be somewhere between 10-15 pounds lighter even, (judging by the amount of abdominal fat I still carry), and in many ways I feel better than I have felt in years. I wonder if the method of losing weight matters--if being sure to keep up fat and protein requirements and cultivating a fat-burning metabolism is at all protective?

Jenny said...

Jennytoo,

That's the kind of question we don't have any way of answering, unfortunately.

I draw attention to these kinds of studies because they cast doubt on the accepted wisdom. But they also point out just how little we really know.

I just knocked off some weight I gained last winter during my trial of Lantus and yes, I like being skinny better than the alternative. But I don't feel great if I keep my carbs extremely low for more than a month or so.

My guess is that a diet that leaves us feeling energetic over a long term is probably the best diet.

But we shouldn't fool ourselves that we can control everything and live forever if we just eat the right foods. No one does!

Anne said...

Oh dear, I am 65 and I have heart disease. I recently lost 15 lbs on the low carb diet in an effort to get my blood sugar under control. The weight dropped without trying. I am not depriving myself of healthy low carb food.

In the recent study in NEJM "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet" it says:

"During both the weight-loss and the maintenance phases, the level of high-molecular-weight adiponectin increased significantly (P<0.05) in all diet groups, with no significant differences among the groups in the amount of increase."

Darn, I am trying to reduce the possibility of more heart problems.

In the table, the adiponectin level rose the most with the low carb diet. Of course we know the maintenence diet used 120 carbs - not very low. At least the CRP dropped the most in the low carb group.

I read one study where it was found that overweight people fared better than thin people after cardiac bypass.

Anne

ItsTheWooo said...

I am skeptical of any findings showing intentional healthy weight loss increasing risk of death. I think this is along the lines of the findings that aggressive lowering of blood sugar correlates with mortality, you know? It may be true statistically speaking but the conclusions implied are invalid.

For example, a lot of people who lose weight do so via intense physiologic stressors - high exericse, strict calorie restriction - these can really hurt an old person who's body is already damaged. The usual way of losing weight: low fat diets, unnecessarily low calories (many people just arbitrarily pick a starvation calorie number and stick to it), and the stupidity of excess exercise may be more harmful than good for someone with an aged body.

That doesn't mean to say using carb reduction as a means for weight loss has the same outcomes, you know? If someone reduces carbs, and starts losing weight, and feels better, how can that be bad at any age?

I suspect the real issue here is the methods of weight loss and not necessarily the loss itself.

Also, keep in mind weight loss correlates with weight cycling, a well known physiologic stressor. Those who lose weight in old age may have a history of weight fluxing.

As for adiponectin increasing heart attack risk - it's also true adiponectin is absolutely necessary for normal glucose control and metabolism. Low adiponectin is abnormal and well known to be associated with diseases of glucose metabolism and insulin excess that befall the obese.
It could be that adiponectin, as a nervous system stimulant, makes heart attack more likely in those who tend toward unnatural starvation and excessive exercises (all stressors, all of which can damage the heart). In this case, the elevated adiponectin only encourages the development of a condition that the individual was vulnerable for at the start (because the damage from stressful exercise and stressful restriction made development of plaques and clots more likely). I don't see how a normalizing fat hormone necessary for normal metabolism could possibly cause health problems.

Basically I'm highly skeptical of these conclusions.

In general it is probably a good idea for the elderly to avoid abusing their bodies just to lose a few pounds. They should avoid excessive exercise and strict calorie restrictions. THis is probably true of all people, but the elderly are more vulnerable to succumbing to death from such stressors, as elderly people are more vulnerable to stress in general.

However if an elderly person eats healthier, reduces their insulin via low carb and starts losing weight I can't imagine anything but good things coming from that kind of weight loss - the non starvation/stress kind.