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How thin is too thin when you get older?


This story is sponsored by University of Utah Health. Learn more about University of Utah Health.

It’s safe to say that Americans spend a lot of time and money on weight-loss efforts. About two-thirds of the adult population in America is overweight or obese, according to the Centers for Disease Control and Prevention and Americans spent about $66 billion on weight loss products in 2016 alone.

While being thin is often equated with being healthy, that’s not necessarily the case as you get older. An elderly person needs to maintain a healthy (and sometimes more robust) body weight to prevent some of the health risks that come from frailty.

“Frailty, in general, is the inability for someone to be able to respond to acute stressors. They have decreased physiologic reserves, and therefore are in a state of increased vulnerability,” says Dr. Natalie Sanders, a board-certified geriatrician with University of Utah Health. Being thin can exacerbate some of the risks that come with frailty.

Unfortunately, being frail is not like other diseases such as high blood pressure, where you can measure it and compare it to a set number, Sanders says. Instead, most doctors use five criteria to determine whether a person is frail or at risk of becoming so:

  • Unintentional weight loss, without any changes to a person’s diet or exercise routine.
  • Decreased strength, which can be measured as grip strength, or observing whether a person can get in and out of a chair easily.
  • Slow gait speed, measured by whether a person can walk five meters in six seconds or less.
  • Low energy expenditure, spending most of the day being inactive.
  • Poor endurance, often expressed as feeling tired or fatigued even with basic daily activities.

Because frailty cannot be specifically measured, and the process for diagnosing someone varies throughout the medical community, it’s hard to know exactly how many people suffer from this condition. It’s estimated that about 10 to 25 percent of adults over 65 are frail, and that number increases to around 45 percent or more of adults 85 and older.

Maintaining a healthy body weight is one way to prevent frailty for as long as possible, Sanders says. But the recommendations for someone who is older don’t differ much from those given to younger adults: keep your body mass index, or BMI, in the healthy range of 18.5-25.

“Thinner than that, or BMI lower than 18.5, can come with problems,” Sanders explains. “But greater bodyweight also comes with its own set of problems.”

It’s not necessarily looking at the exact weight or BMI numbers, but instead observing the trajectory—is this person maintaining their usual body weight, or are they rapidly losing weight? The latter is a sign that you should talk to a healthcare professional.

While all frail patients are at an increased risk of falling, suffering from delirium, and developing osteoporosis, these things can be exacerbated when a person is also exceptionally thin. Eventually, it will become hard to perform basic daily tasks, such as walking, transferring weight, keeping track of medications, bathing and eating. Being very thin and frail can also lead to a higher risk of mortality from diseases such as influenza because your body is not as capable of fighting off illness and recovering.

Unfortunately, even when someone shows signs of frailty, they are not always properly diagnosed.

“People are not always being told that they are frail by a care provider,” said Sanders. “[But telling them can] alert them and their primary care providers that this is someone who might need additional support,” Sanders says.

In addition to having adequate support, it’s also important for patients to take their own health seriously as they get older. Be sure you’re eating enough food every day and getting all the nutrients your body needs, especially eating enough protein.

“Exercise is really still our best medicine,” Sanders says. “The recommendations for older patients are not any different from younger patients—do some kind of cardiovascular exercise getting the heart rate up for 30 minutes, five times a week, and incorporate strength exercises in there. You don’t have to hire a personal trainer. You can do something as simple as getting in and out of a chair without using your arms to stand up.”

Other things patients can do to reduce the chances of becoming frail include taking medications as prescribed and eating a healthy, balanced diet to maintain your weight.

“If you’re having trouble getting access to healthy food, or you don’t really know where to start in terms of an exercise program, talk with your doctor about getting some resources to help.”