BMJ  2005;331:452 (20 August), doi:10.1136/bmj.331.7514.452

Letter

Prognosis in obesity

Older people should not be misinformed about being overweight

EDITOR—With reference to the editorial by Lean on prognosis in obesity,¹ advising apparently overweight older people to lose weight may do more harm than good. Evidence suggests that the risks of being "overweight" decrease with increasing age. On the basis of mortality, the ideal body mass index (BMI) is higher in older than young adults, with an optimum BMI for people older than 65 in the young adult "overweight" range of 27-30 kg/m².² In a systematic review, Heiat et al concluded that the relation between BMI and mortality in people older than 65 is a flat bottomed, U-shaped curve, with mortality rising only at BMI > 31 kg/m² and perhaps not at any BMI in people older than 75.²

Weight loss is more common than weight gain in older people, and associated with poor outcomes, even when the weight loss is intentional and the person was "overweight" at baseline.^3-5 In the prospective cardiovascular health study of some 4700 community dwelling people older than 65, weight loss of more than 5% over three years was substantially more common than weight gain of more than 5%.³ Weight loss, but not weight gain, was associated with a significantly increased risk of mortality (relative risk 1.67, 95% confidence interval 1.29 to 2.15).³ The association of increased mortality with weight loss persisted even at the highest third of baseline weight.³ In a study of older men with BMI 30 kg/m², intentional weight loss was associated (P < 0.001) with a greater rate of hip bone loss (-1.7%/year) than in men with no weight loss (-0.1%/year) or weight gain (0.5%/year).⁵

The indiscriminate application of evidence from studies in younger adults to the management of older people is hazardous. We believe that many older people are trying to lose weight inappropriately. There is a need to ensure that most of our elders are given appropriate advice: "Keep physically active, eat sensibly, and maintain weight."

renuka.visvanathan{at}adelaide.edu.au
Department of Medicine, University of Adelaide, SA 5011, Australia

Department of Medicine, University of Adelaide, SA 5011, Australia

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Competing interests: None declared.

References

1. Lean MEJ. Prognosis in obesity. BMJ 2005;330: 1339-40. (11 June.)[Free Full Text]
2. Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med 2001;161: 1194-203.[Abstract/Free Full Text]
3. Newman AB, Yanez D, Harris T, Duxbury A, Enright PL, Fried LP. Weight change in old age and its association with mortality. J Am Geriatr Soc 2001;49: 1309-18.[CrossRef][ISI][Medline]
4. Wannamethee SG, Shaper AG, Lennon L. Reasons for intentional weight loss, unintentional weight loss, and mortality in older men. Arch Intern Med 2005;165: 1035-40.[Abstract/Free Full Text]
5. Ensrud KE, Fullman RL, Barrett-Connor E, Cauley JA, Stefanick ML, Fink HA, et al. Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab 2005;90: 1998-2004.[Abstract/Free Full Text]

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