For many the New Year brings new resolutions around weight loss. My training as a clinical psychologist requires rotating through various clinical settings—hospitals, inpatient facilities, community and university health centers—to hone my skills. In my current capacity as a behaviorist at a weight loss medicine clinic, I work alongside patients to identify their weight loss goals and modify the behaviors sabotaging them.
The clinic sees people of all shapes and sizes, but typically attracts overweight and obese middle-aged and older adults. Many of these patients have struggled with their weight their entire lives, and consequently, often have impressive insight into the reasons for gaining it. “I eat too much and exercise too little”; “I use food to fill up an emotional hole”— “Our culture bombards us with food cues and temptations that I can’t seem to resist,” they say. But far and away, these patients blame aging the most.
I hear things like this daily: “When I hit 30, I couldn’t even look at a carb without gaining five pounds,” or “I could’ve lost this weight with one intense gym session back in my 20s.”
Convenient falsities, or inconvenient truths?
The epidemiology of adult obesity
The rising global trends in generalized obesity have been well described. In the United States, rates of obesity continue to grow progressively among older age groups across sex, race, and education levels (Zamboni et al., 2005), with adults over 60 more likely to be obese than their younger counterparts (Ogden et al., 2012). Prevalence of obesity among 65-to-74-year-old men, for example, increased from 10.4% in 1960-1962 to 41.5% in 2007-2010. In women, the prevalence increased from 23.2 to 40.3% during the same period (Chan et al., 2013). In older folks especially, excess weight predicts morbidity related to cardiovascular and other chronic diseases—including type II diabetes and osteoarthritis— increased functional limitation, and all-cause mortality (Samper-Ternent et al., 2012).
Why the increase in weight with aging?
“For the public, it is important to reiterate that many factors contribute to obesity,” explains Michelle M. Bohan Brown, PhD and postdoctoral trainee in the Department of Nutrition Sciences at the University of Alabama Birmingham (UAB).
“On an individual basis, what contributes more or less to obesity depends on many factors including, but not limited to genetics, physiology, behavior including intake and expenditure, culture, and environment,” she continues.
“But among older adults especially,” emphasizes Laura Rogers, MD and Senior Scientist in the UAB Nutrition Obesity Research Center (NORC), “metabolic and physiological changes explain a great deal.”
Physicians, nutritionists, and dietitians typically conceptualize body composition in terms of fat (adipose tissue) and lean (muscle, bone, water) mass. Of the several age-related body composition changes that can negatively impact overall health, an increase in fat mass, admittedly, is one of them.
“With aging,” says Amy Ellis, PhD, RD, LD in the department of Human Nutrition at the University of Alabama, “lean mass progressively lessens as fat mass accrues, which tends to redistribute deeper within the abdominal cavity.”
The changes in body composition accompanying aging also affect resting metabolic rate (RMR)—or the energy (calories) it takes, at rest, to maintain basic bodily functions such as respiration.
“RMR typically accounts for about 60-70% of total energy expenditure in most people,” adds Ellis, “but researchers have shown that on average, RMR declines approximately 2% per decade after age 20, complicating weight loss.”
What you can do and what you shouldn’t do
“The decline in metabolism is unavoidable—so individuals should be prepared for this and proactive about preventing weight gain,” explains Rogers.
Fortunately, because RMR only accounts for about 2/3 of average total energy expenditure, older adults can increase their expenditure through physical activity.
“Some folks may see these statistics and adopt a fatalistic perception that nothing can be done to offset the decline,” admits Ellis. “However, it is well known that lean body mass is the biggest determinant of RMR, so efforts to maintain as much lean mass as we can will concordantly help maintain RMR as much as we can.”
Rogers echoes this: “Physical activity, particularly resistance (strength training), can help prevent bone loss and promote muscle, which metabolizes glucose and burns energy better than fat,” she says.
But no matter what you do, do something—anything.
Compared with other age groups, older adults over 60 take the cake for sedentary behavior, spending nearly 80% of their waking time— 8-12 hours— engaged in sedentary activities (de Rezende et al., 2014). Many accept sedentary behavior as a risk factor for chronic diseases and disabilities largely afflicting older folks, including cardiovascular disease, cancer, and diabetes.
“Exercising at a sufficiently vigorous level becomes more of a challenge when facing age-related physical limitations,” admits Rogers, “but physical inactivity tends to beget more physical inactivity. So, it is important to stay as physically active as possible even if you are unable to do so as vigorously as you did when younger,” she explains.
Do not get intimated, warns Ellis. “Physical activity can certainly include exercise, she says, “but other activities such as gardening, cleaning the house, etc., also count.”
(Yes, that includes sex).
And even if you do not meet criteria for obesity, reminds Rogers, staying physically active should still make the top 10 on your daily to do list. “Doing so allows us to engage in and enjoy our daily activities for as long as possible,” she says.
Other behavioral hacks for managing weight in later life
Of course, the combination of physical activity, lifestyle, and dietary changes maximizes weight loss. But in addition to reducing your carb intake and getting your daily dose of 30 minutes of moderate-to-vigorous-physical activity, these other behavioral tweaks can also help:
- Commit to getting a good 7-9 hours of sleep. The National Sleep Foundation recommends 7-9 hours of sleep for adults between the ages of 26-64, and 7-8 for adults 65+. How many are you getting?
Insufficient sleep alters the levels of hormones— including leptin, ghrelin, and cortisol—involved in regulating appetite and body fat. Sleep deprivation spikes production of cortisol and ghrelin, which contribute to feelings of hunger, but reduces leptin— which signals satiety. Plus, people who stay awake longer simply have more opportunities to eat—and late-night eating often involves highly caloric foods like cookies, ice cream, and other carbohydrates.
- Change your environment to change your behavior. Implement strategies to prevent temptation and promote physical activity, like removing all junk foods from the home and stocking it with healthier options, or laying out exercise clothes in the morning to start your day with a brief exercise routine. Psychologists call this stimulus control. Other exercises of stimulus control could include:
- Refraining from leaving food lying around in candy dishes or on the counter to avoid mindless grazing;
- Using smaller plates at mealtime to reduce the tendency to overfill an already large plate; and,
- Immediately brushing your teeth after dinner to combat the urge to snack.
- Pause to examine your ‘hunger’. Are you physically hungry in the stomach-growling, head-spinning, hand-trembling sort of way? Or are you emotionally hungry? When you can differentiate between these and identify the true underlying feeling (e.g. boredom, loneliness, anxiety), you can better meet your own needs.Bored? Go do something that engages you, like garden or sketch. Lonely? Call a friend or play with your pet. Anxious? Go for a power walk or take a warm, candle-lit bath. Remind yourself that feeling feelings doesn’t mean you’re hungry.
Hopefully you didn’t spend too much time in your chair reading this. Now get up, and get moving! Even small steps get you somewhere.
Chan et al. (2013). The impact of obesity and exercise on cognitive aging. Frontiers in Aging Neuroscience, 5, 97.
de Rezende et al. (2014). Sedentary behavior and health outcomes among older adults: A systematic review. BMC Public Health,14, 333.
Ellis et al. (2013). Obesity-related inflammation: Implications for older adults. Journal of Nutrition in Gerontology and Geriatrics, 32(4), 263-290.
Ogden et al. (2012). Prevalence of obesity in the United States, 2009-2010. NCHD data brief, no 82. Hyattsville, MD: National Center for Health Statistics, 2012.
Samper-Ternent et al. (2012). Obesity in older adults: Epidemiology and implications for obesity and disease. Reviews in Clinical Gerontology, 22, 10-34.
Zamboni et al. (2005). Health consequences of obesity in the elderly. International Journal of Obesity, 29, 1011-1029.