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Some extra weight may not be a major health concern for older people

By Abigail Trafford
Tuesday, September 21, 2010

Ten pounds. Maybe 15! Twenty pounds? If only I could lose those 10-plus pounds -- this is the lifelong obsession of scale-watchers.

These men and women are usually not obese. They may be slightly overweight, according to current body-mass tables, but their preoccupation with the bathroom scale weighs heavily on their psyche.

And then, at a certain age, you let it go. You accept yourself as you are. You throw out the size 6 dress that's been in your closet for decades and ignore the scale. You give up on weight loss and focus on other things such as . . . wind power and grandchildren.

Are you deluding yourself?

Pounds matter. Being obese is a serious medical problem. But what about being a little overweight? Can you ignore the weight-loss police and live with a small flesh bonus as you get older?

The answer is a qualified yes. Recent studies suggest that more important than what you weigh is how healthy you are. How do you score on the fitness scale?

"I think having some excess weight and being healthy is just fine," says physician Andrew Weil, director of the Arizona Center of Integrative Medicine and author of several books on health and aging. "An accumulating body of research shows that an excess weight of 10 to 20 percent may be just fine."

Just fine to be a little fat as long as you're fit. The fit-and-fat forces scored a victory five years ago when the Harvard Medical School's Family Health Guide e-mail newsletter said that "it's possible to be heavy and fit, cardiovascularly speaking."

More recently, a 2008 report in the Archives of Internal Medicine found "a high prevalence of overweight and obese individuals who are metabolically healthy." The study followed 5,440 participants over age 20 in the National Health and Nutrition Examination Survey. More than half of the overweight adults were healthy, according to tests that measured such factors as blood pressure and cholesterol levels. A significant proportion -- almost a quarter -- of so-called normal-weight people were found to have risk factors for heart disease.

The key, according to the Cooper Institute in Dallas, is physical activity. A Cooper study published in the Journal of American Medical Association concluded that "fitness was a significant mortality predictor" independent of weight. The study followed 2,603 adults, ages 60 and older, 80 percent of them men.

Other studies are more cautious. While physical activity can reduce the risk of heart disease in overweight and obese women, "the risk is not completely eliminated, reinforcing the importance of being lean and physically active," concluded a 2008 Women's Health Study of nearly 39,000 women.

Yet overall, the research is supportive. Some studies even suggest that while the obese have the highest death rates, overweight people may have longer life expectancies than the folk who are ideally slim.

But before you reach for the cheesecake, you must remember this:

People lie to themselves about their weight. Are you 10 pounds overweight -- or 40? Without a scale, it's easier to delude yourself about what seems to be an inevitable creepage of pounds with age. Metabolism slows as you get older and lose muscle mass, which means you need to eat less.

People also fudge how much exercise they get. Walking from the house to the car to drive to work is not the same as 30 minutes daily of sustained exercise.

In addition, many people have already developed high blood pressure or arthritis by the time they are 50. Losing weight -- along with exercise -- is usually part of the treatment regimen. If you have joint pain, shedding 10 pounds can ease the burden on your knees, for example.

At the same time, the pursuit of a long, healthy life involves much more than counting calories and doing push-ups. "This is about how we deal with our age. How do we deal with managing our lives as we get older?" says physician Arthur Frank, medical director of the George Washington University Weight Management Program.

There are no shortcuts: Follow a healthy diet, get daily exercise, relieve stress, undergo appropriate medical tests, engage in loving relationships and wake up each morning with a purpose, whether it's running an office or sending a birthday card to a friend.

If you do all these things, "then relax," says Weil.

© 2010 The Washington Post Company



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