The worldwide epidemic of obesity is recognized as a serious health threat, contributing to a higher risk of diabetes, heart disease, cancer, severe osteoarthritis and back pain, physical disability at a younger age and a shorter life expectancy. Furthermore, obesity is linked to poverty, poor education and lack of access to care, which certainly aggravates the problem.
The Body Mass Index (BMI), although not perfect, is the way in which obesity is evaluated. It adjusts the weight of individuals for their height. Clearly a 150-pound person who is 5 feet tall is more likely to be overweight than a person of the same weight who is 6 feet tall. The BMI is calculated by dividing the weight by the height squared. A BMI between 19 and 25 is considered to be of normal weight, and over 30 is obese. Between 25 and 30 includes individuals who are overweight but not obese.
It would seem likely that life expectancy would be longest in normal weight individuals. However, this is not the case as the longest lived are those in the overweight but not obese group. This particularly applies to anyone over 75 where the greater your weight the longer the life expectancy. And weight loss whatever the cause must be taken seriously as it is always a major predictor of poorer health and shorter life expectancy.
Often weight loss is the first and only manifestation of an illness. But in frail older persons over the age of 80 and despite an extensive evaluation, no cause for the weight loss can be found. This condition is often referred to as "failure to thrive" and virtually no intervention leads to weight gain. It also indicates a substantially shorter life expectancy.
Only if a correctable cause for weight loss can be identified is there hope for significant improvement. The most common causes are drugs, depression and disease. It is remarkable how many medications can lead to weight loss. These include medications used to treat depression, heart disease, Alzheimer's disease, and many other common conditions. Medications causing weight loss are so common that a physician or pharmacist must review every medication taken and discontinue those affecting appetite.
Depression is a common cause of loss of appetite leading to weight loss. Symptoms can be difficult to identify, and if there is even the slightest impression that the patient is depressed, therapy with antidepressants and psychotherapy can be greatly beneficial. Interestingly, even though many of the drugs used to treat depression suppress appetite, addressing the root cause of the depression can help patients readily gain back any lost weight.
Many diseases are associated with weight loss. These include serious infections, immune diseases and cancers. A careful history, physical examination, laboratory tests and appropriate X rays and imaging studies are required to identify illness, such as tuberculosis, various illnesses associated with joint pains and many cancers.
If a specific illness is identified and treated weight gain will frequently occur spontaneously. However, in patients diagnosed with chronic conditions that are not curable, gaining weight becomes a challenge. Every effort must be taken to increase calorie and fat intake. In general, this means a high-fat, high-protein diet. This includes full cream ice cream, fatty meats, bacon and eggs or chocolates. Fried foods are better than grilled, and always avoid "empty calories," such as candy or sodas. Nutritional supplements can be of value as well. The supplement chosen should have the highest fat and calorie content possible.
Another important recommendation is to graze rather than have big meals. Slowly sipping a supplement or milkshake over a few hours will not lead to satiety as quickly as consuming 12 ounces in a few minutes. The slower you eat over time, the more calories consumed over 24 hours.
And finally, there is compelling evidence that without exercise and physical therapy aimed at increasing muscle, effective weight gain will never occur. And sadly to date, there are no medications that help stimulating appetite that are effective.
Many of my overweight patients over the age of 75 still are willing to try anything to lose weight. Sadly, at this age it is better to be pleasantly plump than shedding pounds that are likely to lead to ill health.
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at: DrDavidHealth.com
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