Excess weight is protective in the elderly? New research says no

Obesity is a known health risk. The number of epidemiological studies that have linked excess weight to cardiovascular disease, cancer, diabetes, other chronic conditions, and increased risk of death is staggering.1,2 In fact, the cutoff points for BMI into overweight and obese were created to reflect increased risk of disease and death due to excess fat.3

Photo of obese man

Then there is the “obesity paradox.” This is the term used to describe the opposite of the usual finding - there are certain groups of people, usually those with severe chronic diseases such as heart failure and kidney disease, in which a higher BMI seems to be associated with a decreased mortality risk.4,5

Elderly persons are another group in which an obesity paradox has been observed in some studies.6 However, this observation is not consistent – other studies have reported an increased risk with higher BMI in adults over age 70 or 75, similar to younger age groups, and others have shown no association at all.7-11 Overall, the relationship between BMI and mortality in the elderly has been unclear.

Several explanations have been proposed to explain the paradox – these are a few examples:

  • BMI is not a true indicator of body fat – older persons tend to have more body fat at the same BMI as younger adults.3 One study found that greater waist circumference in the elderly was associated with increased mortality risk, but greater BMI was associated with decreased risk. In these individuals, greater BMI may reflect greater fat-free mass, rather than greater body fat. Waist circumference and fat-free mass may be more important indicators than BMI for obesity-associated health risks in the elderly.12,13
  • Unintentional weight loss may be involved – many older persons in these studies who are at a low or normal BMI may be there because of disease-related weight loss. Weight loss in elderly has been shown to be associated with negative health outcomes, presumably for this reason.14 So a study of elderly persons that only takes one weight measurement and does not measure weight change over time is inherently flawed.
  • Another issue with the length of studies is that weight gain late in life is probably less dangerous than weight gained earlier in life and then maintained for many years – being obese for 50 years results in more cumulative damage than being obese for 15 years. The earlier you become obese, the greater the risk of death.15,16 Therefore, long-term data (decades, not years) is needed to get an accurate picture of health risks in the elderly due to obesity.

New research has attempted to reconcile the contradictions in previous studies by using long-term data. Although the researchers used BMI rather than waist circumference, they used two weight measurements 17 years apart, and followed subjects for a total of 29 years – importantly, they only included subjects who maintained a similar weight over the first 17 years – this helped to remove any potential effects from late life weight gain or disease-related weight loss.

Men (age 75-99) who maintained a BMI greater than 22.3 had a shorter life expectancy by 3.7 years, and an 88% increased risk of death during the study period compared to men with a lower BMI. Men who maintained a BMI greater than 27.3 had double the risk of death compared to those with a BMI less than 22.3. Women in the same age group who maintained a BMI greater than 27.4 shortened their life expectancy by 2.1 years, and had a 41% increase in risk of death compared to women with a lower BMI.17,18

This new study leads us to conclude: no matter what your age, carrying excess weight for a significant length of time is dangerous – in fact, it can be deadly.

 

References: 

1. Guh DP, Zhang W, Bansback N, et al: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC public health 2009;9:88.
2. McGee DL: Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 2005;15:87-97.
3. U.S. Centers for Disease Control and Prevention: About BMI for Adults. http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Accessed
4. Oreopoulos A, Padwal R, Kalantar-Zadeh K, et al: Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 2008;156:13-22.
5. Schmidt D, Salahudeen A: The obesity-survival paradox in hemodialysis patients: why do overweight hemodialysis patients live longer? Nutr Clin Pract 2007;22:11-15.
6. Oreopoulos A, Kalantar-Zadeh K, Sharma AM, et al: The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009;25:643-659, viii.
7. Calle EE, Thun MJ, Petrelli JM, et al: Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999;341:1097-1105.
8. Janssen I, Mark AE: Elevated body mass index and mortality risk in the elderly. Obes Rev 2007;8:41-59.
9. Grabowski DC, Ellis JE: High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc 2001;49:968-979.
10. Kuk JL, Ardern CI: Influence of age on the association between various measures of obesity and all-cause mortality. J Am Geriatr Soc 2009;57:2077-2084.
11. Stevens J, Cai J, Pamuk ER, et al: The effect of age on the association between body-mass index and mortality. N Engl J Med 1998;338:1-7.
12. Janssen I, Katzmarzyk PT, Ross R: Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 2005;53:2112-2118.
13. Zamboni M, Mazzali G, Zoico E, et al: Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005;29:1011-1029.
14. Woo J, Ho SC, Sham A: Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatr Soc 2001;49:737-746.
15. Adams KF, Schatzkin A, Harris TB, et al: Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763-778.
16. Sun Q, Townsend MK, Okereke OI, et al: Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study. BMJ 2009;339:b3796.
17. Singh PN, Haddad E, Tonstad S, et al: Does excess body fat maintained after the seventh decade decrease life expectancy? J Am Geriatr Soc 2011;59:1003-1011.
18. Contrary to Earlier Findings, Excess Body Fat in Elderly Decreases Life Expectancy. 2011. ScienceDaily. http://www.sciencedaily.com/releases/2011/08/110811151325.htm. Accessed September 29, 2011.

 

Gaining 1 pound per year increases breast cancer risk

Overweight/obesity is a significant risk factor for breast cancer.1 The American Institute for Cancer Research estimates that 17% of breast cancers (this equates to 33,000 new cases per year) are due to excess weight alone, and women who are obese when diagnosed are more likely to die from breast cancer after diagnosis.2

Obese womenA study of 72,000 postmenopausal women presented at this year’s American Association for Cancer Research annual meeting took into account body mass index (BMI) at age 20 and at their current age (55-74), and compared breast cancer risk between those who gained weight and those who did not. They found that a 5 point increase in BMI during these years doubled the likelihood of postmenopausal breast cancer compared to women whose BMI remained stable.3

Although excess weight has been consistently associated with breast cancer risk, the scientists undertook this study because previous studies investigating BMI or body weight during early adulthood were not conclusive. Rather than look simply at BMI at age 20, they looked at the change in BMI over time. Their results clearly indicate that weight gain puts women at risk for breast cancer, and confirms the importance of maintaining a healthy weight for cancer protection.

How much weight gain is risky?

Weight gain of 30 lbs. in a 5’4” woman would produce a 5 point increase. This may seem like a large amount of weight, but over thirty years, it would be a barely noticeable amount – a steady weight gain of 1 pound per year. This study suggests that even 1 pound per year is a dangerous amount of weight gain. And it turns out that this dangerous amount of weight gain is quite common - 60% of the women in the study had increased their BMI by at least 5 points since age 20.4  This tells us that most American women likely do gain this much weight during adulthood, doubling their risk of breast cancer.

Read more about Dr. Fuhrman’s strategy for breast cancer prevention.



References:

1. Cleary MP, Grossmann ME. Minireview: Obesity and breast cancer: the estrogen connection. Endocrinology. 2009 Jun;150(6):2537-42.

2.  Abrahamson PE, Gammon MD, Lund MJ, et al. General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1871-7.

3. Sue LY, Genkinger JM, Schairer C, Ziegler RG. Body mass index (BMI), change in BMI, and postmenopausal breast cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; 2010. Abstract number 4823

4. U.S. News & World Report blog: Weight Gain Ups Breast Cancer Risk: 7 Ways to Avoid the Bulge. Deborah Kotz. http://health.usnews.com/health-news/blogs/on-women/2010/04/21/weight-gain-ups-breast-cancer-risk-7-ways-to-avoid-the-bulge

Glucosamine supplements fail to improve knee osteoarthritis

knee x-ray

A previous meta-analysis of clinical trials had suggested that the benefits of glucosamine supplements were exaggerated, and noted that most of the studies had been carried out by manufacturers of the supplements.1

Now, a recent study called “Joints on Glucosamine,” presented at the annual meeting of the American College of Rheumatology has concluded that glucosamine has no beneficial effects on osteoarthritis of the knee. The 201 participants, given either glucosamine or placebo, were subject to MRI at baseline and after 6 months to structurally assess arthritic conditions. The odds of worsening of the cartilage were the same in the control and treatment groups, indicating that glucosamine did not slow the damage to the cartilage.2

In a news story covering this study, Eric Matteson, MD, chair of rheumatology and professor of medicine at the Mayo Clinic, commented:

"We do know that glucosamine therapy does not appear to be harmful, but there is no evidence it is helpful."3

In October, in a review of the literature on glucosamine and chondroitin supplements, the Center for Science in the Public Interest reported that the evidence for each of these supplements (and combined glucosamine and chondroitin) were inconclusive.4 They also note that for arthritis symptoms, the placebo effect is particularly strong – the author of the article, David Schardt states:

“Studies show that a sugar pill relieves arthritis pain in up to 60% of patients.”

This fact highlights the importance of the results of this new study – the scientists quantified cartilage damage via MRI, rather than relying on the subjects’ reports of knee pain.

Like so many other diseases, the best way to prevent and treat osteoarthritis is to remove the cause. A recent meta-analysis of 85 studies on the risk factors for osteoarthritis found that being overweight posed the greatest risk.5 For most of us, reaching and then maintaining a healthy weight with nutritional excellence is the best protection against osteoarthritis.

 

References:

1. McAlindon TE et al. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000 Mar 15;283(11):1469-75.

2. http://acr.confex.com/acr/2009/webprogram/Paper15123.html

3. http://www.medpagetoday.com/MeetingCoverage/ACR/16561

4. Schardt, David. “Do arthritis supplements work? Don’t bet your joints on it.” Center for Science in the Public Interest: Nutrition Action Healthletter, October 2009

5. Blagojevic M et al. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2009 Sep 2. [Epub ahead of print]

 

Kentucky is the Saddest State

Printed in the upcoming issue of the American Journal of Preventive Medicine, researchers claim Kentucky residents have the highest level of distress and prolonged mental health problems, but not surprisingly, people living in Hawaii were the least likely to experience mental health issues. Experts defined mental distress as 14 or more days of emotional discomfort and 14.4% of Kentuckians clocked in with difficulties. For the study, the Centers for Disease Control and Prevention surveyed 2.4 million adults; via National Geographic.

Not good news for Kentucky. Dr. Fuhrman insists a satisfying emotional environment is an important part of good health. For example, a stressful job can cause angina and heart-related chest pain, and eating comfort food, i.e. bad stuff, for emotional fulfillment may lead to weight gain and obesity, both aren’t doing your mood or health any favors.

In November, the CDC named Burlington, Vermont the healthiest city in the United States, with 95% of citizens in good or great health. So take your pick, Vermont or Hawaii.

Image credit: kenny_lex

More Obese Americans than Overweight Americans

Well, its official, we’re doomed! According to the National Center for Health Statistics, the number of obese Americans now outweighs the total number of overweight people, 34% of Americans are obese, compared to 32.7% of people who are overweight. In 2005-2006, researchers say one-third of Americans were obese, a startling 72 million people, and the prevalence of obesity has more than doubled since 1980, however the trend of overweight has remained stable during that time; via Reuters.

We shouldn’t be proud of this milestone, especially since obesity has been linked to poor health and migraines, cancer, thyroid inflammation and other diseases. So, based on this research, we’ve got a wave, scratch that, a tsunami of sick people on the horizon.

But, oddly enough, a recent study actually claims obesity protects against heart disease. It’s cuckoo!

Too Fat to Fly, You're Fired!

This week, 9 female flight attendants for Air India, who could not meet the company’s weight standards, were fired. The crew members were said to be significantly overweight and had been given time to lose weight, but did not. The airline cites fitness and efficiency concerns for the weight standards, but the lawyer for the flight attendants calls the firings illegal and plans to file paperwork with the Supreme Court; CBS News reports.

No doubt, this is unfair, but I wonder. Is having slim employees on a plane, something I imagine has weight limits, a necessary requirement. If so, going forward, the company probably should print this on the job application.