The Journal of Nutrition Health and Aging

, Volume 12, Issue 7, pp 487–491 | Cite as

The danger of weight loss in the elderly

  • S. L. Miller
  • R. R. WolfeEmail author


Aging is generally accompanied by weight loss made up of both fat mass and fat-free mass. As more people, including elderly, are overweight or obese, weight loss is recommended to improve health. Health risks are decreased in overweight children and adults by dieting and exercise, but the health benefits of weight loss in elderly, particularly by calorie restriction, are uncertain. Rapid unintentional weight loss in elderly is usually indicative of underlying disease and accelerates the muscle loss which normally occurs with aging. Intentional weight loss, even when excess fat mass is targeted also includes accelerated muscle loss which has been shown in older persons to correlate negatively with functional capacity for independent living. Sarcopenic obesity, the coexistence of diminished lean mass and increased fat mass, characterizes a population particularly at risk for functional impairment since both sarcopenia (relative deficiency of skeletal muscle mass and strength) and obesity have been shown to predict disability. However, indices of overweight and obesity such as body mass index (BMI) do not correlate as strongly with adverse health outcomes such as cardiovascular disease in elderly as compared to younger individuals. Further, weight loss and low BMI in older persons are associated with mortality in some studies. On the other hand, studies have shown improvement in risk factors after weight loss in overweight/obese elderly. The recent focus on pro-inflammatory factors related to adiposity suggest that fat loss could ameliorate some catabolic conditions of aging since some cytokines may directly impact muscle protein synthesis and breakdown. Simply decreasing weight may also ease mechanical burden on weak joints and muscle, thus improving mobility. However, until a strategy is proven whereby further loss of muscle mass can be prevented, weight loss by caloric restriction in individuals with sarcopenic obesity should likely be avoided.


Obesity Muscle Mass Lean Mass Coronary Heart Disease Risk Factor Excess Death 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Hedley AA, Ogden CC, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1992–2002. JAMA 2004;291:2847–2850.PubMedCrossRefGoogle Scholar
  2. 2.
    2005 Dietary Guidelines for Americans. 6th ed. Washington DC: US Department of Health and Human Service, 2005.Google Scholar
  3. 3.
    Sichieri R, Everhart JE, Hubbard VS. Relative weight classifications in the assessment of underweight and overweight in the United States. Int J Obes Relat Metab Disord 1992;16(4):303–12.PubMedGoogle Scholar
  4. 4.
    Bales CW, Ritchie CS. Sarcopenia, weight loss and nutritional frailty in the elderly. Annu Rev Nutr 2002;22:309–23.PubMedCrossRefGoogle Scholar
  5. 5.
    Ensrud KE, Cauley J, Lipschutz R, Cummings SR. Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Int Med 1997;157(8):857–63.CrossRefGoogle Scholar
  6. 6.
    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(7):968–79.PubMedCrossRefGoogle Scholar
  7. 7.
    Heiat A; National Institutes of Health (NIH: the NIH Consensus Conference on Health Implications of Obesity in 1985); United States Department of Agriculture (the 1990 Department of Agriculture’s Dietary Guidelines for Americans); National Heart, Lung, and Blood Institute. Impact of age on definition of standards for ideal weight. PrevCardiol 2003;6(2):104–7.Google Scholar
  8. 8.
    Landi F, Zuccala G, Gambassi G, Incalzi RA, Manigrasso L, Pagano F, Carbonin P, Bernabei R. Body mass index and mortality among older people living in the community. J Am Geriatr Soc 1999 47(9):1072–6.PubMedGoogle Scholar
  9. 9.
    Rossner S. Obesity in the elderly — a future matter of concern? Obes Rev 2001; 2(3):182–8.CrossRefGoogle Scholar
  10. 10.
    Lennie TA, Moser DK, Heo S, Chung ML, Zambrowski CH. Factors influencing food intake in patients with heart failure: a comparison with healthy elders. J Cardiovasc Nurs 2006;21(2):123–9.PubMedGoogle Scholar
  11. 11.
    Doherty TJ. Invited Review: aging and sarcopenia. J Appl Physiol 2003;95:1717–27.PubMedGoogle Scholar
  12. 12.
    Paddon-Jones D, Short KR, Campbell WW, Garlick PJ, Volpi E, Wolfe RR. Dietary protein and sarcopenia. J Nutr (in press)Google Scholar
  13. 13.
    Zamboni M, Zoico E, Scartezzini T, Mazzali G, Tosoni P, Zivelonghi A, Gallagher D, De Pergola G, Di Francesco V, Bosello O. Body composition changes in stableweight elderly subjects: the effect of sex. Aging Clin Exp Res 2003;15(4):321–7.PubMedGoogle Scholar
  14. 14.
    Gallagher D, Ruts E, Visser M, Heshka S, Baumgartner RN, Wang J, Pierson RN, Pi-Sunyer FX, Heymsfield SB. Weight stability masks Sarcopenia in elderly men and women. Am J Physiol 2000; 279:E366-E375.Google Scholar
  15. 15.
    Gallagher CS, Gates J. Obesity: Changing the face of geriatric care. Ostomy Wound Manage 2006; 52(10):36–8, 40–4.Google Scholar
  16. 16.
    National Center for Health Statistics, Health, Unites States, 2004, with Chartbook on trends in the Health of Americans. Hyattsville, MD. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.Google Scholar
  17. 17.
    Elia M. Obesity in the elderly. Obes Res 2001;9:244S-248S.PubMedCrossRefGoogle Scholar
  18. 18.
    Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res 2005;13(11): 1849–1863.PubMedCrossRefGoogle Scholar
  19. 19.
    Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer X, Eckel RH. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circ 2006;113:898–918.CrossRefGoogle Scholar
  20. 20.
    Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr 2006;84:475–82.PubMedGoogle Scholar
  21. 21.
    Department of Health and Human Services, Centers for Disease Control and Prevention. BMI-Body Mass Index: About BMI for Adults. Accessed October 2007 Scholar
  22. 22.
    1999 Metropolitan Height and Weight Tables for Men and Women. Accessed October 2007 at Scholar
  23. 23.
    Kyle UG, Genton L, Hans D, Karsegard VL, Michel JP, Slosman DO, Pichard C. Total bosy mass, fat mass, fat-free mass, and skeletal muscle in older people: crosssectional differences in 60-year-old persons. J Am Geriatr Soc 2001;49(12):1633–40.PubMedCrossRefGoogle Scholar
  24. 24.
    McTigue KM, Hess R, Ziouras J. Obesity in older adults: A systematic review of the evidence for diagnosis and treatment. Obesity 2006; 14(9):1485–1497.PubMedCrossRefGoogle Scholar
  25. 25.
    Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293(15):1861–1867.PubMedCrossRefGoogle Scholar
  26. 26.
    Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM (for the Study of Osteoporotic Fractures Research Group). Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 2007;62(7):744–51.PubMedGoogle Scholar
  27. 27.
    Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Int Med 2001;161:1194–1203.CrossRefGoogle Scholar
  28. 28.
    Wedick NM Barrett-Connor E, Knoke JD, Wingard DL. The relationship between weight loss and all-cause mortality in older men and women with and without diabetes mellitus: the Rancho Bernardo Study. J Am Geriatr Soc 2002;50(11):1810–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007;335(7612):166–7.CrossRefGoogle Scholar
  30. 30.
    Groessl EJ, Kaplan RM, Barrett-Connor E, Ganiats TG. Body mass index and quality of well-being in a community of older adults. Am J Prev Med 2004;26(2):126–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Galanos AN, Pieper CF, Cornoni-Huntley JC, Bales CW, Fillenbaum GG. Nutrition and function: is there a relationship between body mass index and the functional capabilities of community-dwelling elderly? J Am Geriatr Soc 1994;42(4):368–73.PubMedGoogle Scholar
  32. 32.
    Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, Fantin F, Bissoli L, Bosello O. Health Consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 2005;29(9): 1011–29.CrossRefGoogle Scholar
  33. 33.
    Villareal DT, Banks M, Siener C, Sinacor DR, Klein S. Physical frailty and body composition in obese elderly men and women. Obes Res 2004;12(6):913–920.PubMedCrossRefGoogle Scholar
  34. 34.
    Baumgarten RN, Waynde SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004;12(12):1995–2004.CrossRefGoogle Scholar
  35. 35.
    Schrager MA, Metter EJ, Simonsick E, Ble A, Bandenelli S, Lauretani F, Ferrucci L. Sarcopenic obesity and inflammation in the InCHIANTI Study. J Appl Physiol 2007;102:919–925.PubMedCrossRefGoogle Scholar
  36. 36.
    Roubenoff R. Catabolism of aging: is it an inflammatory process? Curr Opin Clin Nutr Metab Care 2003:6:295–299.PubMedCrossRefGoogle Scholar
  37. 37.
    Daviglus ML, Liu K, Yan LL, Pirzada A, Manheim L, Manning W, Garside DB, Wang R, Dyer AR, Greenland P, Stamler J. Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. JAMA 2004;292(22):2743–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Krumholz HM, Seeman TE, Merrill SS, Mendes de Leon CF, Vaccarino V, Silverman DI, Tsukahara R, Ostfeld AM, Berkman LF. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 1994; 272(17):1335–40.PubMedCrossRefGoogle Scholar
  39. 39.
    Yarnell JW, Patterson CC, Thomas HF, Sweetnam PM. Comparison of weight in middle age, weight at 18 years, and weight change between, in predicting subsequent 14 year mortality and coronary events: Caerphilly Prospective Study. J Epidemiol Community Health 2000; 54(5):344–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Villareal DT, Miller BV 3rd, Banks M, Fontana L, Sinacore DR, Klein S. Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults. Am J Clin Nutr 2006;84(6):1317–23.PubMedGoogle Scholar
  41. 41.
    Kuller LH, Kinzel LS, Pettee KK, Kriska AM, Simkin-Silverman LR, Conroy MB, Averbach F, Pappert WS, Johnson BD. Lifestyle intervention and coronary heart disease risk factor changes over 18 months in postmenopausal women: the Women On the Move through Activity and Nutrition (WOMAN study) clinical trial. J Womens Health 2006;15(8):962–74.CrossRefGoogle Scholar
  42. 42.
    Nicklas BJ, Dennis KE, Berman DM, Sorkin J, Ryan AS, Goldberg AP. Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese, postmenopausal, African-American and Caucasian women. J Gerontol A Bio Sci Med Sci 2003;58(2):181–9.Google Scholar
  43. 43.
    Yang G, Shu XO, Gao YT, Zhang X, Li H, Zheng W. Impacts of weight change on prehypertension in middle aged and elderly women. Int J Obes (Lond.). 2007;Jul 24 [Epub ahead of print].Google Scholar
  44. 44.
    Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, Ettinger WH Jr, Pahor M, Williamson JD. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 2004;50(5):1501–10.PubMedCrossRefGoogle Scholar
  45. 45.
    Dawson-Hughes B. Interaction of dietary calcium and protein in bone health in humans. J Nutr 2003;133(3):852S-854S.PubMedGoogle Scholar
  46. 46.
    Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 deficiency — an update. Haematologica 2006;91(11):1506–12.PubMedGoogle Scholar
  47. 47.
    Newman AB, Lee JS, Visser M, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Nevitt M, Harris TB. Weight change and the conservation of lean mass in old age: the Health, Aging and Body Composition Study. Am J Clin Nutr 2005;82:872–8.PubMedGoogle Scholar
  48. 48.
    Evans W. Functional and metabolic consequences of sarcopenia. J Nutr 1997;127:988S-1003S.Google Scholar
  49. 49.
    Cahill GF Jr. Starvation in man. N Eng J Med 1970; 282(12) 668–75.Google Scholar
  50. 50.
    Biolo G, Flemming RYD, Maggi SP, Nguyen TT, Herndon DN, Wolfe RR. Inverse regulation of protein turnover and amino acid transport in skeletal muscle of hypercatabolic patients. J Clin Endocrinol Metab 2002;87:3378–84.PubMedCrossRefGoogle Scholar
  51. 51.
    Kadar L, Albertsson M, Arebert J, Landbert T, Mattsson S. The prognostic value of body proteins in patients with lung cancer. Ann NY Acad Sci 2000;904:584–91.PubMedCrossRefGoogle Scholar
  52. 52.
    Anker SD, Steinborn W, Strassburg S. Cardiac cachexia. Ann Med 2005;36:518–29.CrossRefGoogle Scholar
  53. 53.
    Ducher G, Jaffre C, Arlettaz A, Benhamou CL, Courteix D. Effects of long-term tennis playing on the muscle-bone relationship in the dominant and nondominant forearms. Can J Apply Physiol 2005;30:3–17.Google Scholar
  54. 54.
    Pang MY, Eng JJ. Muscle strength is a determinant of bone mineral content in the hemiparetic upper extremity:implications for stroke rehabilitation. Bone 2005;37:103–11.PubMedCrossRefGoogle Scholar
  55. 55.
    Rimbert V, Boirie Y, Bedu M, Hocquette J-F, Ritz P, Morio B. Muscle fat oxidative capacity is not impaired by age but by physical inactivity:association with insulin sensitivity. FASEB J 2004;18:737–9.PubMedGoogle Scholar
  56. 56.
    Catenacci VA, Wyatt HR. The role of physical activity in producing and maintaining weightloss. Nat Clin Pract Endocrinol Metab 2007;3(7):518–29.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France and Serdi Éditions 2008

Authors and Affiliations

  1. 1.Little Rock
  2. 2.Center for Translational; Research in Aging and Longevity, Donald W. Reynolds Institute on AgingUniversity of Arkansas for Medical SciencesUSA

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