February 7, 2024

"Until recently, the very notion of prescribing any form of weight loss whatsoever to an elderly patient—i.e., someone 65 or older—was considered suspect, even dangerous."

"'Advising weight loss in obese older adults is still shunned in the medical community,' the geriatric endocrinologist Dennis Villareal and his co-authors wrote in a 2013 'review of the controversy' for a medical journal. More than a decade later, clinicians are still struggling to reach consensus on safety, Villareal told me.... When a person addresses their obesity through dieting alone, as much as 25 percent of the weight they lose derives from loss of muscle, bone, and other fat-free tissue. For seniors who, through natural aging, are already near the threshold of developing a functional impairment, a sudden drop like this could be enfeebling...."

From "Older Americans Are About to Lose a Lot of Weight/People over 65 make up a sizable portion of Americans on GLP-1 drugs. That might be trouble" (The Atlantic).

39 comments:

tim maguire said...

I don't know if it's age-related or I because just started paying attention as I got older, but I find it impossible to lose weight without losing muscle mass.

I put on about 30 lbs after an injury a couple years ago and am trying to drop 20 of that. I have a scale that also checks body fat, muscle mass, bone mass, etc. I'm losing weight slowly (1 or 2 lbs a month) and I lift weights and take protein supplements. Despite all that, I never lose weight without losing at least some muscle.

Howard said...

Resistance training is the Mother's Milk of old age. Healthy skeleton muscles store glucose. This is why the Asian skinny fat people with no muscle get diabetes at a higher rate than the American morbidly obese.

Planet Fitness is only $10/month. No judgement zone.

Skeptical Voter said...

Getting older is not for sissies--says this now 80 year old. OTOH I can remember a lot of folks who were friends at various stages in life who are now looking up at the grass instead of down at it. So there is that. Would I take a weight loss drug? Maybe.

Big Mike said...

If you’re going to diet, you have to hit the gym and take long walks. Hitting the gym and taking long walks is good even if you don’t diet.

tim in vermont said...

Sleep apnea is a major contributor to dementia, and obesity is a major contributor to sleep apnea.

Original Mike said...

I've never been fat, but when I switched to a low carb diet 2 years ago my weight dropped, unintentionally. to the bottom of the "healthy" BMI range. My physician told me to gain some weight. "Overly thin at your age is not good", he told me. It's actually not been easy, but I've added 10 pounds. It's enough, I think.

Still, I can't imagine that obese is good at any age.

n.n said...

We are conceived as lightweights in the womb and evolve as lightweights to seniority, and throughout our diets sustain our viability.

Iman said...

Fat!

Leland said...

Why is it better for them to be diabetic? After all, the class of drugs was created to lower type-2 diabetes.

Oh this is “The Atlantic”: https://www.theatlantic.com/international/archive/2016/04/canada-assisted-suicide/478257/
“Americans interested in ending their lives through medical-assisted suicide will not be allowed to take advantage of new Canadian legislation introduced Thursday that would legalize the practice.” (Emphasis mine)

Yancey Ward said...

“Americans interested in ending their lives through medical-assisted suicide will not be allowed to take advantage of new Canadian legislation introduced Thursday that would legalize the practice.”

A pity- I was hoping we could send Biden, Schumer, McConnell, Pelosi, and Gavin Newsom to Canada for treatment.

mikee said...

I am one of those elderly fat people losing weight via diet, exercise and Mounjaro. The drug is working, at least I am experiencing appetite suppression, and I am eating more healthily than I did the last time I lost a lot of weight, on Optifast liquid protein diet for 4 months.

My doctor emphasizes working out and counting calories. If it works, it works. .

Aggie said...

Related topic, my wife watches Fox news a little, at night, on occasion. And as someone affected by second-hand smoke-blowing, I can't help but notice (as I sit in my office) how many of those really, truly obnoxious pharmaceutical ads play, during the news. Good God, one after the other, and then, the first again. There's a theme: Some pre-purposed Boomer anthem plays in the background, with lyrics cleverly devised to stir nostalgic memories of youthful (healthy) abandon as the Silver-tips on screen cavort with healthy leisure activities and live the Good Life. Meanwhile, the announcer drones on about seemingly endless side effects: Suicidal thoughts and violent allergic reactions and so on.

I'm coming around to the point of view - I think I read about Tucker Carlson mentioning this - that this relentless advertising revenue is the Big-Pharma way of keeping the News Industry from looking too hard at some of the unanticipated side effects of these chemical cocktails. And now, as the semaglutides work their magic and all the unanticipated nasty complications come to light, as well as consequences from all the off-label recreational use, I'm even more convinced.

RigelDog said...

Well I have been in the "overweight but not quite obese" category ever since my mid-forties, after a lifetime of being slender and athletic. Was pre-diabetic but we didn't talk about such things at that time so I didn't know that my glucose was high and that carbs were a problem---therefore I didn't have a chance to head Type II off at the pass.

I've been on the 'Zempic for seven months now and I have yet to experience this amazing weight loss. I've lost maybe fifteen pounds total but could use to lose another twenty to be at a comfortable, agile, and attractive weight---NOT thin, just losing the bulk of the abdominal fat would be life-changing. Tired of looking like I'm six months pregnant.

I think I made a mistake trying this medication. Tales of rebound weight-gain abound. I never thought that I would have to be on something this strong for life; I thought I would improve my glucose and lose an appropriate amount of weight and then gradually wean off the medication now that I would have gotten used to eating less and feeling better, lighter. I also hoped that getting rid of abdominal fat would bring about its own metabolic change for the better, eliminating the inappropriate hunger that causes the desire to overeat in the first place.

ronetc said...

Unintended weight loss is danger signal for geriatics. One good piece of advice is, "if you love your grandmother, take her a milk shake every day." I am 77, probably on the moderately-obese scale but feel really great and have no activity loss. I eat and drink as I please. I ain't foolin' with nothin' in my diet.

gilbar said...

When a person addresses their obesity through dieting alone, as much as 25 percent of the weight they lose derives from loss of muscle, bone, and other fat-free tissue.

you hear this.. a LOT! and, from "experts".. so it MUST BE TRUE!
but..
is this As True for a morbidly obese person, as an obese person, as an overweight person?

I've lost (so far), about 105 lbs in the last 20 months..
Y'all REALLY think i lost 26 lbs of of bones and muscle? How much bones and muscle did You think i had?
It's NOT that i'm implying that you are comparing Morbidly Obese apples and mildly overweight Oranges..
I'm EXPLICITLY STATING it.

What ARE these "studies"? WHO are they studying?

mezzrow said...

I lost about 40% of my body mass after 60 through no virtue of my own.

Lots of that was muscle - the only treatment is regular strength training. Anaerobic + the aerobic for heart and lungs. It gets neglected if you don't have someone to lift with.

I luckily found a knowledgeable friend.

NKP said...

Got rid of over 100 lbs in my early 70s. It starts with making a DECISION. Not the same as a wish or even a goal.

Take on as much physical activity as you can, TODAY. Take on a tiny bit more - day-after-day. No gym membership or special equipment required. Turn off TV. Get off couch. Walk ( a lttle bit farther - a litle bit faster every day). Wash, dry and put away the dishes. Make your bed. Cook everything you eat from scratch. Start a garden.

Age will slow us down and take us away, eventually. We do not have to cooperate. Keep doing what you can and what you like. People will think you're crazy but you'll enjoy life a lot more than those people.

When doctors give advice you should listen but you should also question. If your doc's not cool with that, get another doctor.

All too ofter the doctor's medical knowledge and judgement is tainted by protocols adopted by his group practice, hospital privileges, and professional accreditations and associations. All, of course, vetted by lawyers and bean-counters.

Oligonicella said...

Exercise. Don't stop exercising. But don't over-exercise.

Life's a conundrum.

gilbar said...

Original Mike said..
my weight dropped, unintentionally. to the bottom of the "healthy" BMI range. My physician told me to gain some weight. "Overly thin at your age is not good", he told me. It's actually not been easy, but I've added 10 pounds.

Exactly!
BIG difference between losing weight when you don't have ANY fat, and losing weight when you're MOSTLY fat.

OM? 10 lbs would be what? about 7% of your total weight?
for me (NOW!) 10 lbs would be about 3.5%.. 20 months ago, 10 lbs would have been little more than 2%

gilbar said...

ps.. I have NO desire to get Under 200lbs..
I'd be ecstatic to get down to 225 (which would be "only" overweight).
Shooting for below 250lbs by mid June.. Which would be another 15 lbs lost in 18 weeks

Jupiter said...

"clinicians are still struggling to reach consensus on safety"

Could we get some video of that?

ccscientist said...

My strategy has been to approach old age already trim and fit. No risk then.

Freeman Hunt said...

All people, but especially older people, should be doing resistance training. That should be part of any weight loss drug plan.

Freeman Hunt said...

I think it's odd that there has been so much negative press about these drugs and seemingly so little positive. Given the number of obese people and people with Type 2 diabetes in this country, aren't these basically "miracle drugs?" It's a pretty big deal to have effective drugs for these conditions. I know more than one older person who has found these medications life-changing.

Original Mike said...

"OM? 10 lbs would be what? about 7% of your total weight?"

Good guess. Bottomed out at 129. Am 140ish now. Height 5'9".

Leland said...

It is interesting how much zeal there was in the media to support the Covid vaccine that was based on novel science on how a vaccine might work genetically to fight an emerging disease. Now, we have a medicine that had the normal process of qualification to fight long existing and chronic disease, yet the media is questioning its safety. Generally, I think it is good to question medicine, but Semaglutides have been approved for use since 2017. Was the media too busy fabricating the Russian Hoax to cover these drugs then?

Iman said...

I’m 71 years old, 6’2” and have held steady at 215lbs. for a couple of years now. I would like to get below 200, down to 185 if possible. So getting more serious about cutting carbs is the next challenge. And maybe bumping up the number of 2.75 mile walks (around a lake) from 4 to 6 per week.

On zero drugs of any kind and my desire is to keep it that way!

Dude1394 said...

Maybe, just left my docs office he prominently stated that insurance no longer covers any of this stuff. So it might not be as pervasive as thought.

Dude1394 said...

Blogger Iman said...
I’m 71 years old, 6’2” and have held steady at 215lbs. for a couple of years now. I would like to get below 200, down to 185 if possible. So getting more serious about cutting carbs is the next challenge. And maybe bumping up the number of 2.75 mile walks (around a lake) from 4 to 6 per week.

On zero drugs of any kind and my desire is to keep it that way!

Walks are very good, do not forget to lift some heavy weights, I believe they are the other key.

Howard said...

Good luck to everyone who is trying to lose weight. It isn't easy and temptation is everywhere.

If you can't lose it he weight, keep working out. Exercise is the absolute best medicine known to man. Weight lifting is just as important as cardio. And you don't need to do hard cardio to get most of the benefits.

Peter Attia, Rhonda Patrick and Andrew Huberman are fantastic resources on diet, exercise and life habits to increase health span.

Old and slow said...

Barbell squats and deadlifts plus running will go a long way toward keeping healthy.

Iman said...

Thanks, Dude!

Iman said...
This comment has been removed by the author.
Original Mike said...

"Sleep apnea is a major contributor to dementia, and obesity is a major contributor to sleep apnea."

I have a friend who's dementia is progressing. He's had sleep apnea for decades and has always had a big pot belly. n of 1, I know, but it's hard not to put the pieces together into a tidy little story.

tim in vermont said...

I got the sleep apnea thing from a video from a guy who does studies of brain scans, and he says that the oxygen drops from the choking episodes leaves the brain looking pretty ragged, and that dementia is often the result. On the bright side, he said that addressing it with CPAP leads to improvements.

" just left my docs office he prominently stated that insurance no longer covers any of this stuff. "

Thanks Obamacare!

walter said...

"Blogger tim in vermont said...
Sleep apnea is a major contributor to dementia, and obesity is a major contributor to sleep apnea."
--And this..
https://www.rondeauseminars.com/wp-content/uploads/2018/07/TMJ.pdf

"c) Aggravation of Respiratory Disturbances by Use of Flat
Plane Occlusal Splints (Nightguards) in Apneic Patients:
The problem is the upper flat nightguard causes the lower jaw to go
back and the tongue to go back, which blocks the airway at night.
The result is illustrated in an article published in the
International Journal of Prosthodontics. Snoring increased 40% using this upper
nightguard, and AHI increased more than 50% in 5 out of 10
patients.4
Clearly, it is not advisable to use upper flat plane maxilary splints in patients who snore or have sleep apnea.
Sadly, this flat plane upper occlusal splint is the most popular one that is taught in dental schools around the world."

Rusty said...

gilbar said...
"ps.. I have NO desire to get Under 200lbs..
I'd be ecstatic to get down to 225 (which would be "only" overweight).
Shooting for below 250lbs by mid June.. Which would be another 15 lbs lost in 18 weeks"
I'm trying to save my knees. If you've ever fished Agate Falls you'd know what I mean.

Rich said...

The US junk food industry makes a 'sizable' proportion of obese Americans super-obese and here is a Nordic company Novo Nordisk making fat profits.

Johnula said...

I'm just upset that at 64,I'm considered elderly... Well, almost.