Weight Loss a 'Slippery Slope' for Seniors

Source: Tufts University
January 11, 2002 (Reviewed: January 26, 2004)

How much weight loss is 'too much' in an older patient? A study in Journal of the American Geriatrics Society suggests that loss of as little as 5% of body weight during a person's later years can have a negative impact on health.

The 4,000 study participants, all at least 65 years old, were part of the multi-center Cardiovascular Health Study conducted in the USA. The men and women weighed in at a medical facility once a year for 3 years; they also provided extensive data on socioeconomic, behavioral, and health factors known to affect weight status in seniors. The outcome of interest was mortality during the 4-year follow-up period.

The effect of weight loss

During the 3-year weigh-in period, about 16% of the men and 18% of the women lost at least 5% of their baseline body weight. These individuals were more than 60% more likely to die than those whose weight remained stable (RR=1.67, 95% CI 1.29-2.15). This association held even when the researchers excluded those who had suffered an interim event (hospitalization, diagnosis of cancer, or loss of a spouse) known to affect weight status (RR=1.66, 95% CI 1.18-2.33).

(There was no association between a gain of at least 5% over baseline bodyweight and increased mortality).

Combination of factors

It's possible that the weight loss itself was responsible for some participants' poor outcomes; the authors point to studies showing that older individuals who lose weight tend to lose muscle mass as well as fat, which increases their risk of disability. More likely, though, gradual weight loss is a marker of some other factor - such as poor dentition or reduced mobility - that limits an older person's ability to eat well.

In fact, those whose weight remained stable during the course of the study were, on average, in better physical and emotional shape overall. People who maintained a stable weight had higher incomes and were generally younger and better educated, more physically active, and less likely than those who lost weight to suffer from a chronic illness or life-changing event like the loss of a spouse.

Defining a healthy weight

The authors acknowledge the health burden posed by obesity, but point out that standard guidelines used to assess weight in young and middle-aged adults don't necessarily apply to older individuals. The average Body Mass Index (BMI) of those who lost more than 5% of their body weight was 27, a level considered to be slightly overweight by conventional guidelines. The researchers say that even a small amount of weight loss in elderly patients should be investigated, even in those who are not categorized as thin or frail.

Clinicians often use a worksheet such as the DETERMINE checklist to evaluate an older person's nutrition status. It assesses the risk of malnutrition based on medical, social, and other factors such as a history of chronic illness, and whether a person eats alone or has access to a grocery store. Such a tool can help clinicians assess the reasons for weight loss and can help them plan a treatment strategy. An interactive version of the DETERMINE checklist is posted on a website (see link below) sponsored by the New York State Office for the Aging.

Source

• Weight change in old age and its association with mortality. AB. Newman, D. Yanez, T. Harris,  et al., J Am Geriatr Soc, 2001, vol. 49, pp. 1309--1318

Related Links
Determine Your Nutritional Health (DETERMINE checklist)
International Academy Nutrition and Aging
Basel Geriatrics Corner
To quickly access additional accurate information on this and other nutrition-related topics, visit Tufts University's Nutrition Navigator

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.