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Losing Weight

Author: Helen Dennis, Specialist on Aging

Question:  My mother is 86 years old and healthy.  I recently noticed that she is looking a lot thinner, particularly her arms.  Her clothes are loose and her movements are more tentative.  The doctor says nothing is wrong.  Her friends and I keep telling her that she needs to eat more.  I don’t think she is getting enough calories, although what she eats is healthy.  Any suggestions what I can do?   S.R.

Dear S.R.:

The most important step is to be certain that your mother does not have an underlying medical condition causing the weight loss.

Barring a medical problem, your mother might be dealing with a double whammy:  Losing muscle because of normal aging and loosing muscle because she is not consuming enough calories.    Both may cause her to lose weight.

Let’s start with some background information.

As part of normal aging, each decade older adults lose about 3 percent of lean body mass which is mostly muscle according to Dr. David Haber, Director of the Center for Human Nutrition at UCLA as quoted in a New York Times blog (January 2011).  The problem is that with the loss of muscle tissue is the loss of strength.

This incremental loss of strength is called sarcopenia which is known to increase the risk of hospitalization and even death.  In the U.S., an estimated 53 percent of men and 43 percent of women over 80 are sarcopenic.

Sagging of the skin over normal muscle areas such as legs and arms is a sign that muscle rather than fat is disappearing.

The good news is that strength training, even for those in their 80s, helps muscle cells get bigger. And that means muscles gets stronger.

According to UCLA researcher and geriatrician Jonathan Wanagat, we don’t know why muscles shrink with age.  One popular theory according to his interview on Morning Edition is “… stem cells in the muscle are not able to respond to damage or to aging the way they did when we were younger.  And if damaged muscle cells aren’t repaired, they sort of whittle away and die.”

Involuntary weight loss has consequences even though it can be hard to evaluate according to Grace Booke Huffman in her article published in American Family Physician. Evaluation is critical particularly because this weight loss is associated with not only the wasting of muscle, but also a decreased immune system, depression and complications from diseases.

And calories are the energy powerhouse for our bodies.  Without sufficient calories, one easily can become less energetic.

So why is it that so many adults 80 and over aren’t consuming enough calories?  One reason is that they just aren’t hungry and may feel full all of the time.  This full feeling can lead to “physiologic anorexia of aging,” according to Huffman and may be caused by the increased production of a hormone that makes one feel satiated.  Clearly this does not apply to everyone since many older adults tend to gain weight with age.

What to do?  Suggest to your mother the importance of seeing a nutritionist.  He or she will likely conduct a nutritional assessment that includes calories consumed and nutritional value, the availability of foods, use of nutritional supplements, current medications, physical and mental well-being plus a medical history.

In the meantime, here are some tips to increase calories with healthy foods.

  • Eat small meals more frequently.
  • If taking a nutritional supplement, take it daily; consistency is important.
  • Add avocados to salads and snack on dried fruit.
  • Mix eggs into casseroles, hamburger patties and meatloaf before baking.
  • Add cheese to casseroles, potatoes, bread, beans, rice and pasta.  Melt on hamburgers, fish, tortillas and eggs.
  • Drizzle olive oil over pasta.
  • Add crushed nuts to yogurt, cereal, canned fruits and entrees

Several years ago, I had a conversation with Dr. Walter Bortz, a noted Stanford geriatrician.  He commented that the “real disease” of aging is frailty, a condition that can be prevented.”   And frailty means physical weakness.  Dr. Bortz indicates that one of the best predictors of entering a nursing home is the inability to get up from a chair which requires strength and balance.  Muscle strength is key.

For more nutritional information and a possible consultation, contact the Beach Cities Health District’s nutritionist at 310-375-3426, Ext. 160.

And add some strength training to the mix.

S.R., Thank you for your important question and best wishes in assisting your mother for a life of health and strength.

Copyright 2011 Helen Dennis. All rights reserved.

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