Weight Control
Trim Down to Trim Your Disease Risk
When he wasn't acting or directing classic films like Citizen Kane, Orson Welles ate. Reportedly, it wasn't uncommon for him to eat four to five large portions of caviar a day, and three huge steaks and mounds of rich desserts for dinner. His lifetime of gluttony weakened his heart and dangerously elevated his blood pressure. Welles died at age 70 of a massive heart attack.
"To my mind, Orson Welles's health was the antithesis of what you want to experience as you get older," says Michael Klaper, M.D., director of the Institute of Nutrition Education and Research in Manhattan Beach, California.
"I would rather be a lean older person than an obese one because when it comes to heart disease, stroke, and cancer, it's clear that being overweight puts you at high risk for these diseases," Dr. Klaper says. "Overweight people in their sixties or seventies concern me because they're really setting themselves up for many of the same problems that Welles had."
While most of us certainly don't overindulge as much that Welles did, the pounds do seem to creep up on us and threaten to erode our health as we age. But it doesn't have to be this way.
"Even if you go into your sixties a bit overweight and inactive, you definitely haven't written yourself a death sentence," Dr. Klaper says. "I've seen some people at these ages who have made dramatic turnabouts in their weights. If you begin eating a good diet and become leaner and more active in your sixties or seventies, there's a good chance that you'll still be that way when you hit 90 or even 100."
Where Did These Extra Pounds Come From?
As a person strides toward 60, the amount of muscle in the body naturally drops and fat begins to account for a greater percentage of weight. So even if you didn't gain a pound, you would still have more body fat at 70 than you did at age 30.
At the same time, metabolism—the rate at which your body burns calories—slows down. Many people also get less exercise as they age, yet continue eating the same amount of food as they did when they were younger. The result is more pounds. In fact, many people gain about a pound a year after age 35.
By age 60, roughly 40 percent of American men and women are overweight. After age 75, the number of people who are overweight dips to 30 percent because many people who are extremely overweight have died. Furthermore, most of us who survive into our eighties naturally begin shedding pounds because of diminished appetites, says Artemis Simopoulos, M.D., president of the Center for Genetics, Nutrition, and Health in Washington, D.C.
Although excess weight is one of the primary causes of premature death after age 60, how much of an impact being overweight has on your risk of stroke, heart disease, and cancer in these years is a riddle that scientists are just beginning to probe.
"It's a darn good question that we don't fully have an answer for yet," says Edward Saltzman, M.D., a scientist at the U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston. "In the past the diseases associated with being extremely overweight would have precluded many people from living into their sixties or seventies. Now that medical technology is getting better at extending life, we're seeing more people who are overweight living longer. So many of the data for these people are relatively new."
The bulk of the emerging evidence suggests that too much body fat—whether it is caused by overeating, a sedentary lifestyle, or the natural reduction of body muscle and buildup of fat as you age—is just as harmful now as it was when you were 40 or 50, says Walter Willett, M.D., Dr.P.H., professor of epidemiology and nutrition and chairman of the Department of Nutrition at the Harvard School of Public Health. Researchers believe that excessive body fat at any age increases the production of sex hormones such as estrogen that promote colon, breast, and endometrial cancer. Increased body fat also drives up blood pressure, forces the heart to work harder, and raises low-density lipoproteins (LDLs)—the bad cholesterol that contributes to the clogging of arteries and increases your risk of stroke and heart disease.
| Age Alters Your Healthy Weight For years, height and weight charts were based on the assumption that one size fits all, no matter what your age. But researchers are finding that slim and trim takes on a whole new meaning after age 60, says Reubin Andres, M.D., clinical director of the National Institute on Aging Gerontology Research Center in Baltimore. As we age, a greater percentage of our body weight is fat, and that is something that most height and weight charts don't make allowances for, Dr. Andres says. Using the body mass index (BMI), a calculation of body fat based on height and weight, Dr. Andres has found that people older than 60 have lower death rates at slightly higher BMIs than those who are younger. In other words, even if you are carrying around a few more pounds than you used to, you may still be at a healthy weight for your age. Based on his calculations, here's what Dr. Andres says are healthy weight ranges for men and women in their sixties. Although researchers haven't calculated the optimal weight after age 69, these weight ranges are probably reasonable for people in their seventies and eighties as well, says William Hazzard, M.D., chairman of the Department of Internal Medicine at Bowman Gray School of Medicine of Wake Forest University in Winston-Salem, North Carolina. | Height | Weight | Height | Weight | | 4'10" | 115-142 | 5'8" | 158-196 | | 4'11" | 119-147 | 5'9" | 162-201 | | 5'0" | 123-152 | 5'10" | 167-207 | | 5'1" | 127-157 | 5'11" | 172-213 | | 5'2" | 131-163 | 6'0" | 177-219 | | 5'3" | 135-168 | 6'1" | 182-225 | | 5'4" | 140-173 | 6'2" | 187-232 | | 5'5" | 144-179 | 6'3" | 192-238 | | 5'6" | 148-184 | 6'4" | 197-244 | | 5'7" | 153-190 | |
It Isn't As Hard As You Think
Fortunately, losing weight after age 60 is easier than you might suspect. In fact, one study has shown that people in their sixties and seventies who enrolled in a weight-control program were twice as successful in their efforts to lose weight and make lifestyle changes than younger men and women, says Eileen Rosendahl, Ph.D., a geriatric psychologist and assistant professor at the Albert Einstein College of Medicine of Yeshiva University in New York City.
That is because you probably have more time to devote to the effort than you did when you were younger, and fat cells on the abdomen, the type that is really harmful, melt away more quickly than fat on the buttocks and thighs, says Lodovico Balducci, M.D., program leader of the senior adult oncology program at the University of South Florida College of Medicine in Tampa.
"You don't have to get down to an ideal body weight to get the benefits of intentional weight loss. I'm starting to believe that losing just a few pounds may be very good for you," says David F. Williamson, Ph.D., a researcher at the Centers for Disease Control and Prevention in Atlanta. One way for an older person to lose those pounds is by improving his level of physical activity, he says.
| Overweight? The Shadow Knows Scientists rely on sophisticated formulas and tests to determine if you're overweight. But Sharon Emmons, R.D., a clinical dietitian and geriatric nutrition specialist at the University of South Alabama College of Medicine in Mobile, often uses a more down-to-earth approach. "I tell my clients to stand out in the sun and look at their shadows. For men, if your shadow resembles Alfred Hitchcock—your belly protruding out beyond your chest—then you might want to lose a few pounds. For women, if your shadow looks more like a rectangle than an hourglass, then it may be time to lose weight as well," says Emmons. For a more precise measure, however, Emmons and other weight-control experts turn to body mass index, or BMI—a calculation that takes into account both your height and weight—which has proven to be an excellent predictor of a person's susceptibility to certain diseases like stroke, heart disease, and cancer. To figure your BMI, multiply your weight in pounds by 700. Divide that number by your height in inches. Then divide by your height again. The result is your BMI. So, for example, if you weigh 150 pounds, multiple that by 700. Then divide that number by your height—let's say 66 inches—twice. The result is 24. A healthy BMI for a man or woman over age 60 is below 29, says Jose Morais, M.D., a gerontologist and nutritionist at Royal Victoria Hospital in Montreal. If you're above that, try some of the weight-loss strategies suggested in this chapter or ask your physician during your next checkup about ways to control your weight. |
The Weight of the Evidence
If you're overweight, losing just 10 to 15 pounds (depending on your height) can reduce your risk of life-threatening diseases and improve your overall health. But if you don't make an effort to get your weight under control, you'll be more vulnerable to the big three killers, Dr. Klaper says.
Here's a look at the persuasive arguments that scientists are finding for shedding modest amounts of weight after age 60. Among other things, weight control does the following:
Promotes longevity. In a study of 15,069 overweight women, Dr. Williamson found that those who had lost 20 pounds in the year before the study began were 25 percent less likely to die of heart disease or cancer in the next 12 years than overweight women who didn't lose weight. These women also reduced their overall risk of dying by 20 percent and slashed in half their chances of succumbing to weight-related cancer of the breast, cervix, ovary, and others, as well as reducing their risk of dying with diabetes.
Researchers traced the lives of 19,000 Harvard University alumni men for up to 26 years. Those who weighed 20 percent under the U.S. average for men of similar age and height had the lowest rates of death.
Protects the heart. In the Framingham Heart Study—an ongoing assessment of the health habits of 5,200 people in Massachusetts—researchers showed that men and women in their sixties and seventies who weighed 30 percent more than what is considered a healthy weight were at least twice as likely to develop heart disease.
"I strongly feel that an overweight person who is age 60-plus should lose weight. Excess weight magnifies the risk factors of hypertension, diabetes, and high cholesterol levels that are associated with heart disease. Developing diabetes, for example, increases cardiac risk by more than 100 percent. But all these things are reversible to some extent if you lose those extra pounds," says Robert Di Bianco, M.D., associate clinical professor at Georgetown University School of Medicine and a Washington, D.C., cardiologist.
Slashes stroke risk. In another ongoing phase of the Framingham study, researchers have been tracking the weights and blood pressures of men and women up to age 94 for 30 years. Every pound of excess weight, according to William Kannel, M.D., professor of medicine and public health at Boston University Medical Center, causes you to retain more sodium in your bloodstream, increases your risk of diabetes, and drives your systolic blood pressure (the top number in a blood pressure reading) up 4.5 millimeters. Combined, these weight-related risk factors may quadruple your chances of a heart attack or stroke, Dr. Kannel says.
"Weight control is very important for preventing stroke," says Philip Wolf, M.D., professor of neurology at Boston University School of Medicine. "Being overweight doesn't seem to be an independent risk factor for stroke. But if you look at the main risk factors for stroke—high blood pressure, high blood sugar, and high cholesterol levels—losing weight will lower every one of them."
| Body Fat: Where You Have It Matters Apples are a food to admire. You just don't want to be shaped like one. Doctors have long known that people who have extra weight around their bellies (apple-shaped bodies) are at greater risk of heart disease, stroke, and cancer than those who are trimmer. The danger increases after age 60 because more men and women develop that shape. "Body shape—fat distribution—becomes more important as we age because weight, which relects both muscle and fat mass, becomes a less reliable guide to fat stores after age 60," says Walter Willett, M.D., Dr.P.H., professor of epidemiology and nutrition and chairman of the Department of Nutrition at the Harvard School of Public Health. If you're shaped like a pear—with more fat on your hips and thighs—you still have an increased risk of these diseases, but not as much as an apple-shaped man or woman, says David V. Schapira, M.D., director of the Stanley S. Scott Cancer Center at Louisiana State University Medical Center in New Orleans. To accurately assess your body fat distribution, measure your waist at its narrowest point and your hips at the widest point (over the buttocks). Divide your waist measurement by the number of inches around your hips. If you're a woman, a number greater than 0.75 suggests that you are at greater risk of health problems. For men, a number higher than 1 is a warning sign. The best way to diminish an apple shape is through exercise. Even as little as walking 30 minutes a day, three times a week, can be an important beginning, Dr. Willett says. |
Pounds Add to Your Cancer Risk, Too
Although scientists believe that extra pounds have more impact on heart disease than on cancer risk, slimming down may decrease the possibility that you'll develop some tumors, says Rachel Ballard-Barbash, M.D., an epidemiologist at the National Cancer Institute in Bethesda, Maryland. Specifically, avoiding midlife weight gain can help you:
Stifle breast and endometrial cancer. Dr. Barbash has found that women with more upper-body fat, the so-called apple-shaped bodies, are at 70 to 100 percent greater risk of developing breast cancer than women whose fat is on their lower bodies—the so-called pear shape in which fat clings to the hips and thighs.
Other studies involving women up to age 83 have found that the heaviest women who were apple-shaped have a 5 to 6 times greater risk of breast cancer and had 15 times greater incidence of endometrial cancer than women who were trimmer, says David V. Schapira, M.D., director of the Stanley S. Scott Cancer Center at Louisiana State University Medical Center in New Orleans.
"Theoretically, breast cancer risk can be reduced by 45 percent just by losing 10 to 15 pounds," Dr. Schapira says.
In addition, if a woman who weighs 25 percent or more over her ideal weight develops breast cancer, she is 60 percent more likely to have a recurrence of the disease in the next 10 years than does a woman who has her weight under control at diagnosis.
"Weight control is one of the few modifiable lifestyle behaviors that may reduce a woman's risk of diagnosis and death due to breast cancer," says Ruby Senie, Ph.D., associate attending epidemiologist at Memorial Sloan-Kettering Cancer Center in New York City.
Corral cancer of the esophagus. Men in their sixties who are 20 percent over their recommended healthy weight are at three times greater risk of developing adenocarcenoma, a cancer of the esophagus, than men who tip the scales right on, according to researchers at National Cancer Institute who studied 174 men who had the disease and 750 who didn't.
Fight off colon cancer. In a six-year follow-up study of 47,723 male dentists, pharmacists, and other health professionals up to age 74, Harvard University researchers found that men who had waist circumferences of 43 inches or more were 2½ times more likely to develop colon cancer than those whose waists were less than 35 inches.
What's Going On?
Doctors suspect that excessive body fat sparks increased production of sex hormones like estrogen and testosterone that are thought to promote breast and endometrial cancer. At the same time high amounts of body fat slash levels of a protein that binds to these sex hormones and deactivates them. The result is a greater risk of developing these cancers, Dr. Schapira says.
Extra weight also triggers gastric reflux, bathing the esophagus with excessive amounts of acid that may promote precancerous growths, says Linda Morris Brown, an epidemiologist at the National Cancer Institute in Bethesda, Maryland.
Researchers are less certain how excess weight contributes to cancer of the esophagus and colon. They do know, however, that some of the same things that cause excess weight—high-fat foods and lack of exercise—also increase the risk of colon cancer. So being overweight may not directly cause colon cancer, but it could be a potent warning that other aspects of your lifestyle are endangering your health, says Tim Byers, M.D., professor of preventive medicine at the University of Colorado School of Medicine in Denver.
You Can Make a Big Difference Now
For many of us, controlling weight has been like trying to catch a live trout with bare hands. But, as discussed, making another effort even after age 60 can have an immense impact on your health and well-being.
"The safety of being thin is huge. There are 300,000 excess deaths in the non-thin population each year, and we spend $100 billion a year to treat diseases like heart disease, stroke, and cancer that are related to not being thin," says George Blackburn, M.D., Ph.D., associate professor of surgery at Harvard Medical School and chief of the nutrition/metabolism laboratory in the Cancer Research Institute at Beth Israel Deaconess Medical Center West in Boston.
In most cases diet alone won't do the job for you. Your best bet is to use dietary changes as part of a comprehensive effort that includes exercise, Dr. Balducci says.
Remember that the pounds may come off more slowly than in the past, says Sharon Emmons, R.D., a clinical dietitian and geriatric nutrition specialist at the University of South Alabama College of Medicine in Mobile. If you lose a half-pound to a pound a week at this age, you're doing great, she says.
Usually, losing weight at that rate means shaving only 150 calories a day from your menu, Dr. Blackburn says. That's about the equivalent of a slice of cheese pizza, a 12-ounce beer, a ½-cup serving of vanilla ice cream, or five gingersnaps.
Shoot for losing no more than 10 pounds or 5 percent of your body weight (whichever is less) in 12 weeks, Dr. Blackburn says. Then try to maintain that weight loss for three months before attempting to lose more weight. The body, particularly after age 60, is willing to lose weight for about three months, he says. Then it doesn't want to budge for quite a while. If you push yourself too much, you're more likely to start overeating and regain the weight that you have dropped, Dr. Blackburn says. With these goals in mind, here's a look at the nuts and bolts of weight control, beginning with motivation.
Feed Your Head First
Weight control begins in the mind.
"I don't think that you'll seriously be able to get your weight under control without considering what is going on between your ears," says Maurice Larocque, M.D., a bariatric physician in Montreal and author of Slim Within, a 21-day, audiocassette weight-loss program. "The thoughts that you plant in your mind will determine if you succeed or fail."
Here are some ways to help you think more positively about weight control so that you can achieve your goal and permanently reduce your risk of stroke, heart disease, and cancer.
| Do You Use Food to Quell Emotions? Loneliness, frustration, boredom, anger, grief, anxiety, guilt, and other emotions are savage beasts. If you regularly soothe them with food, like many people over 60 do, you may be packing on pounds without really solving the underlying problem. Here is a simple test, developed by Stephen P. Gullo, Ph.D., author of Thin Tastes Better, that will help you analyze how emotions affect your eating habits and determine what to do what about it. Rate each of the following statements on a scale of 1 (rarely true) to 5 (always true). Scoring follows. 1. There is no problem that can't be solved by chocolate. 2. I like to treat myself to a nice dinner or some other food treat to celebrate accomplishments. 3. On previous diets I've sometimes cheated because I just felt that I deserved a little treat. 4. When I'm stressed or upset, I feel better after I've eaten. 5. I have a favorite restaurant where my friends and I go to celebrate or just get together. 6. I have a particular food that I always crave when I'm under stress. 7. I always gain weight when I'm under pressure. 8. Whenever I've gone off a diet plan, there was something unpleasant going on in my life. 9. I always overeat when my children or grandchildren visit me. 10. I always overeat after I fight with friends or family. Scoring: Add up your total. If you scored 21 or less, you're doing pretty well—you may occasionally turn to food for solace, but it isn't your first line of defense. If you scored 22 to 36, you may be using food to pacify your emotions, but you're just as likely to use other ways of dealing with feelings—such as talking it out with friends, taking a bath, or exercising—that are less fattening. If you scored 37 or more, you may be relying too much on food to cope with stress. Here are alternatives to help relieve emotional strain without resorting to food. Think, then act. Before you open the refrigerator, ask yourself if eating is really going to relieve your anger, boredom, depression, or other emotional need, says Eileen Rosendahl, Ph.D., a geriatric psychologist and assistant professor at the Albert Einstein College of Medicine of Yeshiva University in New York City. Try to find something else to do—take a walk, garden, or visit an ill friend—that will make you feel gratified or happy instead of guilty. Beware the "comfort" trap. "I often tell groups of older people, 'Maybe you've lost someone recently and are seeking comfort in food. But keep in mind that your loved ones are at peace and watching over you. So please don't let them down. They only want what is best for you, and being overweight simply isn't healthy,' " says Maria Simonson, Sc.D., Ph.D., director of the Health, Weight, and Stress Clinic at the Johns Hopkins Medical Institutions in Baltimore. Sneak in a nap instead of a snack. When you're tired, emotions can overwhelm you and tempt you to seek comfort from food, says Edith Howard Hogan, R.D., a spokeswoman for the American Dietetic Association in Washington, D.C. Get at least 6 hours of sleep a day. If you feel an urge to eat, lie down, close your eyes for a few minutes, and the emotional tug to chow down should pass. |
Find new reasons to like yourself. "We know that 80 percent of people who are overweight don't like themselves. They can't find any pleasure within themselves that would encourage them to care for their bodies. So you need to learn to love yourself before you can make any progress toward slimness," Dr. Larocque says. Twice a day, take a moment to focus on some aspect of yourself that you like such as your legs, nose, or eyes. As you begin to lose weight, take pride in the features that are improving. Tell yourself, "I'm 70, but look at me. I really like how my belly is trimming down. I'm starting to get back the shape that I had when I was 45."
Write 'em down. Jot down on an index card your three most important motivators for losing weight, such as more stamina, more energy, and lessening your risk of heart disease. Read and think about what those motivators mean to you for 5 minutes when you awaken and just before you go to bed, suggests Peter Miller, Ph.D., executive director of the Hilton Head Health Institute in Hilton Head, South Carolina. Doing that will keep your mind locked on your goal.
Take a picture. Once a month, have a friend or a spouse take pictures of you from front, side, and back views. Focus on the parts of your body where you are making progress, like your shrinking tummy or your strengthening arms and legs. Take a couple of minutes each day to imagine how much better you'll look next month, Dr. Larocque says.
Let go. The more relaxed that you are, the more open you'll be to positive thoughts that will help keep your weight under control, Dr. Larocque says. Try the following relaxation exercise twice a day: Get into a comfortable position—either lying or sitting—in a darkened room. Close your eyes and begin breathing very slowly and deeply. Relax the muscles of your forehead and jaw. Part your lips slightly. Now relax the muscles of your mouth, neck, arms, and legs. Now breathe more deeply, inhale slowly. Then push your shoulders upward until it seems as though they are touching your ears. Hold your breath for a count of five, then exhale slowly and drop your shoulders. Push your shoulders up again and repeat the breathing sequence. Sense yourself beginning to feel relaxed. Your arms are very heavy and limp.
Feel the sun's warmth on your arms. They are getting warmer and warmer. Now let your legs go limp and feel the sun's warmth on them. Repeat the sun imagery with your eyelids, jaw, forehead, and finally with your entire body. Feel the sun's energy inside your whole body. See yourself and smile. You are full of energy, and you use it. You appreciate each step that you are taking on your road to weight control. Now count to three, then open your eyes and get on with your day.
Mirror, mirror on the wall . . . Like the queen in Snow White, you can be the fairest one of all. Just use your imagination, says Barbara Morse, an imagery counselor and recreational therapist in San Diego who works with men and women over age 60.
Imagine yourself in a hall of mirrors, each one reflecting a different image of you, Morse says. Try to see as many perspectives in the mirrors as you can. One may make you look short and fat, another tall and skinny. See reflections of yourself as a child, as a person older than you are now, and as you see yourself today. Now look in a mirror and give yourself whatever type of body you would like. Change your hair color or style. Work with the image in the mirror until it reflects
