News women can use

If you’re a woman who’s moved beyond menopause, you may be concerned about the pounds that have naturally crept on over the years. Well, you needn’t be. In fact, your natural, more zaftig shape appears to have notable benefits at this time in your life and be worth celebrating.

A new study published in the American Journal of Public Health a few weeks ago received hush from the media. It’s doubtful the AARP will make so much as a peep about it, either. After all, it has partnered with the American Obesity Association, the lobbying organization for weight loss interests.

This study not only added to the already strong body of evidence to date, but its information could help millions of mature women feel more comfortable with their bodies and avoid making decisions that could compromise their health.

Briefly, they examined 8,029 women from across the country (Maryland, Minnesota, Oregon and Pennsylvania) and measured their height, weight, and percentage of fat and lean mass using bioelectric impedance. (Bioelectric impedance estimates had been validated to correspond well with dual X-ray absorptiometry at all body and age categories, for you docs reading.) The women were aged 65 and older at the start of the study and were followed every four months for eight years. They were participants in the Study of Osteoporotic Fractures, so the researchers also gathered other information that could play a role in their health and cause of death, such as smoking, education, marital status, hormone usage, alcohol, medications, reproductive history, muscular strength and physical activity, and self-reported conditions such as diabetes and hypertension.

Black women were not included in this study because Black women have a much lower risk for osteoporosis or hip fractures, which was their main interest. Body size among Blacks has also been well established to have especially little influence on mortality risks, with optimal body mass indexes falling into the overweight to obese categories for both men and women.

At the end of the study period, the women were well into their 70s and 80s and those who had died were more likely to have had characteristics that reflected lower socioeconomic status or poor socially supportive living situations, and to have had poorer health at the start of the study (unmarried, less well educated, smoke, not walk for exercise and have lower strength, and take nonthiazide diuretics).

In looking at body size and composition, and their association to mortality, the researchers analyzed the data in several different ways to make sure that smoking, age, or any preexisting illnesses weren’t influencing their conclusions. They even tried excluding women who had dieted or lost weight for any reason since the age of 50 because of the well-established health risks of dieting and intentional weight loss at any age. But the results held and “were consistent with several large prospective cohort studies.”

The women with the lowest risks in this study were overweight. There was a wide range of weights and sizes that enjoyed similar mortality risks, with a “U” shape — more accurately described as a reverse “J” shape — correlation at the two extremes. The slightly increased risks seen among the very largest women, however, were still less than the much higher risks seen among women in the smallest quintile. The women with the highest risks were not extremely small, either, but had BMIs starting under 22.38 (about 130 pounds for a 5-4 woman).

Also supporting the body of research to date, the women’s fat — both total fat mass and percentage of body fat — was protective. The more fat a woman had, the lower her risks. Only at the highest fat level did risks begin to rise, but they never approached the even higher risks seen among the least fat women. Like studies on men, the highest levels of lean body mass were also associated with the highest risks. (The popular myth that fat is worse than lean is one for another day.)

The researchers concluded that the lowest risks for older woman were to be fatter than the current government recommended BMIs. Our chances for living longer and healthier improve with some fat on our bones. The researchers specifically said that the National Heart, Lung, and Blood Institute (NHLBI) guidelines, which recommend weight management of “overweight,” were inappropriate in older women because those were the sizes where women have the lowest rates of mortality. In other words, following government guidelines would increase their risks for dying.

As the researchers noted, their results “are consistent with the results of the National Health and Nutrition Examination Survey, which reported that a broad range of BMI values was associated with lower mortality, as well as with other studies that have suggested that women classified as overweight are not at excess risk for mortality, particularly in older age groups.”

This study actually offered little new information, but merely confirmed what decades of studies have shown, among men and women. We’ve talked about some of them here, such as the Framingham study which found that, while our parental genes are the biggest determinants of how long we’ll live and age is still the most signifiant risk factor for dying, increasingly higher BMIs among nonsmokers are associated with longer lives. And how researchers at the University of California, San Francisco, found that except for smoking none of the lifestyle and risk factors popularly believed to be important actually made a difference in how long we live, and that obesity was associated with a 30% lower mortality. And for those who develop heart failure, every 5 units higher the BMI, lowered the risk of dying by 10%. The Cardiovascular Health Study of 5,200 older men and women, recently published in the Journal of the American Geriatric Society, again found that body mass index was inversely related to mortality.

A comprehensive review of more than 400 studies noted most studies show fatness as we age to be especially favorable for longevity. Despite efforts to depict fat as a pathology, most of the claims made over recent years about the deadliness of being fat for any age group have used flawed statistical models to estimate risks or used surrogate endpoints, not actual deaths. As we’ve seen, a wide variety of weights and sizes can be healthy. The CDC National Center for Health Statistics has found that existing studies have shown “little relationship between BMI and mortality.”

And it bears repeating because of the exaggerated fears about even extreme obesity, that based on weight alone, a woman is no more likely to die at a BMI of 50 (about 310 pounds) as at a BMI of 35, and that the most extremely "morbidly obese" women still have a longer life expectancy than normal weight men. Our figures need not be our worry.

Given the protective, fertility, immunological and nurturing benefits of fat stores, it is not surprising that there is no evidence that midlife weight gain is harmful to healthy women. Mother Nature is very wise, it appears, in the natural weight gain that accompanies aging. With age, fat cells have also been shown to become less metabolically active, lessening their role in diseases associated with aging like diabetes. The clinical research of Reubin Andres, M.D., a gerontologist at the National Institute on Aging and a professor of medicine at Johns Hopkins, found that the fewest deaths occurred in those whose weights increased as they aged. “It’s acceptable, possibly even highly beneficial, for normal, healthy adults to gain gradually about a pound a year beginning around age 40, so that by the time they’re in their 60s they weigh about 20 pounds more than the Met Life tables would suggest,” he said in Food & Nutrition Digest.

With all of the focus today on “obesity,” we are led to believe we should all be dieting and watching our weight. We’ve also come to believe that a “poor diet” means eating the “wrong” foods, but malnutrition is primarily due to not eating enough and not enjoying a full variety of foods. In wealthier cultures, undernutrition especially afflicts older people. Lots of things contribute to this sad fact, including transportation problems, living alone, isolation and depression, dental problems, diminished senses of smell and taste, and financial hardships. As emergency room physicians in Minneapolis found, 24% of the patients they saw screened positive for hunger, many forced to choose between medications or food. It’s equally tragic to see mature women still worried about their figures and jeopardizing their health by trying to diet.

As informed geriatric healthcare professionals recognize, as we age, eating well is especially critical for our health, keeping activity and quality of life; and low-fat or any form of dietary restrictions is ill-advised. According to the National Health and Nutrition Examination Surveys, which gathers detailed dietary and health data on a representative segments of the U.S. population, 25 to 40 percent of senior citizens are getting inadequate calories, and as a result, are dramatically short on such nutrients as riboflavin; vitamins B6, A and C; and calcium. Other studies have found that as many as 15 percent of older citizens in the community and 35-65 percent of hospitalized ones suffer from poor nutritional status. The Malnutrition Advisory Group reported in 2001 that one in seven people in the UK were malnourished or at severe risk. The medically-documented consequences of not eating enough (for any age) include functional decline, delayed wound healing, impaired immune system and increased risks of infection, damaged heart and intestinal functions, depression, apathy, loss of muscle strength, falls and increased fractures.

An abundant body of research has shown that undernourished older people have “longer hospital stays, higher rates or rehospitalization, significantly higher total healthcare costs, higher complication rates and higher mortality rates,” as was documented in a 2002 report, “Improving the Care of Older Adults with Common Geriatric Conditions,” commissioned by the trade organization, American Association of Health Plans.

The AAHP report documented an abundance of studies showing people with low BMIs have higher mortality, healthcare costs and functional impairment compared to people with higher BMIs. [Yes, health plans know this stuff, but it’s important to realize that insurance rates are not necessarily driven by evidence, but by what they can get away with charging. So as long as obesity is popularly believed to be bad, they’ll get away with charging fat people more. The creative machinations used to convince the public and politicians of the costliness of obesity are a topic for another time.] While BMI alone is not a precise measure of undernutrition, the National Institutes of Health still recommends using higher BMI cut-offs for older people to help identify those undernourished. In one study, older people just at-risk for undernutrition were found to have longer average hospital stays (six versus four days), have higher average hospital costs ($6,196 versus $4,563), use more home health care services, and require more post-hospital subacute care.

Despite what would seem intuitive — that food enhances life — the report also documented a surprising lack of awareness among healthcare professionals of the dangers of undereating or weight loss for older citizens. (For any age group, too.) And it goes without saying, that a lot of government officials aren’t aware of good science, either, but are driven by other things. But we can arm ourselves with information and help ensure that we and our loved ones eat well and live well and don’t get taken in by fears about being fat or marketing claims for dieting and the need to be thin.

A great shape can be whatever one we naturally have at any age.

© 2007 Sandy Szwarc