Health for life

Change in Weight More Important Than Where You Start

Some overweight older adults don’t need to lose weight to extend their lives, but they could risk an earlier death if they pack on more pounds.

In fact, the nationwide study found that people who were slightly overweight in their 50s but kept their weight relatively stable were the most likely to survive over the next 16 years.

They had better survival rates than even normal-weight individuals whose weight increased slightly, but stayed within the normal range.

On the other hand, those who started out as very obese in their 50s and whose weight continued to increase were the most likely to die during that period.

Overall, the results suggest that about 7.2 percent of deaths after the age of 51 are due to weight gain among obese people, at least among the generation in this study, said Hui Zheng, lead author of the study and assistant professor of sociology at The Ohio State University.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time,” Zheng said.

While some extra weight seemed protective in this study, Zheng cautioned that these results applied only to people over 50. His previous research, published in Social Science & Medicine, suggests that being overweight may not be helpful for younger people.

“Our other research suggests that the negative effect of obesity on health is greater for young people than it is for older people, so young people especially shouldn’t think that being overweight is harmless,” he said.

This new study was published online this month in the American Journal of Epidemiology. Co-authors are Dmitry Tumin, doctoral student, and Zhenchao Qian, professor, both in sociology at Ohio State.

The researchers used data from the Health and Retirement Study, a nationally representative survey of Americans born between 1931 and 1941. This study analyzed 9,538 respondents who were aged 51 to 61 when the survey began in 1992. They were re-interviewed every two years until 2008, and the researchers had information on how their body mass index (BMI) changed at each interview and whether they died at any point before December 2009.

Body mass index measures weight relative to height and is often used to evaluate obesity.

Zheng and his colleagues classified respondents into six groups, depending on their BMI at the beginning of the study and how it changed over the 16-year period they were surveyed.

While slightly overweight people (BMI of 25 to 29.9) whose weight was steady had the highest survival rate, those who moved from overweight to obese (BMI 30 to 34.9) were close behind.

“This suggests that among overweight people at age 51, small weight gains do not significantly lower the probability of survival,” Zheng said.

The third highest survival rate among the six groups was normal weight individuals (BMI of 18.5 to 24.9) whose weight increased slightly, but stayed within normal range.

Next came the Class I obese (BMI of 30 to 34.9) whose weight was moving upward.

“You can learn more about older people’s mortality risk by looking at how their weight is changing than you can by just looking at how much they weigh at any one time.”

Next to last were normal weight individuals who lost weight. Although the study attempted to control for illnesses among those studied, it may be that many of these individuals dropped weight because of illness.

The most obese individuals (BMI of 35 and over) who continued to add weight had the lowest survival rate of the six groups.

There weren’t enough people who started out as overweight and obese and lost weight to include in this analysis, Zheng said.

“We can’t really evaluate the effectiveness of planned weight loss on mortality. Even in the normal-weight people in this study, there was no way to tell whether weight loss was planned,” he said.

Zheng noted that the study took into account a wide variety of demographic and socioeconomic factors that may play a role in both weight and mortality among Americans. The researchers also controlled for whether the respondents smoked, whether they had a variety of chronic illnesses and even how they rated their own health. The results stood even after all of these factors were taken into account.

Why is being slightly overweight protective for older people?

“It is probably because the older population is more likely to get illnesses and disease, especially cancer, that cause dangerous weight loss,” he said. “In that case, a small amount of extra weight may provide protection against nutritional and energy deficiencies, metabolic stresses, the development of wasting and frailty, and loss of muscle and bone density caused by chronic diseases.”

Younger people are less likely to get many of the diseases that afflict older adults, which is one reason extra weight is not good for them, he said.

But Zheng said the main message for everyone, including older adults, is that packing on the pounds, especially if you’re obese, can be hazardous to your health.

“Continuing to put on weight can lower your life expectancy,” he said.

Ed is a 59-year-old father of three from Queens, New York. Though an avid golfer and fisherman, he struggled with his weight most of his life. Then, in the ‘90s, a complete lifestyle overhaul helped him drop almost 110 pounds, sending him from 287 to his current weight of 179. He’s never joined a gym or a diet program. This is his story.

(Incidentally, for transparency’s sake [and so I will not receive a beating from my mother], I will henceforth er to him as Dad.)

(Also, parts of this interview were edited for length.)

(Also also, thats not his real head in the pictures. But you knew that.)

KRIS: So Dad, when did you weigh the most?

DAD: I weighed 287 pounds in November of 1991.

K: Why do you think you were overweight? What are the reasons?

D: Well, I was always overweight. When I got out of high school I was about 195, and I slowly put on a lot of weight over the years until I got about to 250. It was my steady weight once I was out of the service.

K: And you’re 6-foot-1?

D: I’m 6-foot-1.

K: But you gained more weight after that.

D: I used to smoke. When I was 42, I quit smoking cold turkey and at the time I was about 255. I had trouble once I quit smoking pushing myself away from the dinner table, because there was no cigarette to end the meal. So I would hang around the table and eat just about anything that was left. Whether it was rolls, bread and butter, potatoes, spaghetti, meatballs - anything. And I put on another 32 pounds in that winter of ’91, and wound up at 287.

K: 287 was your top weight.

D: 287 was my top weight.

K: So, you were eating a lot of starches.

D: I was eating everything.

K: Did you have a particular food that you really kind of …

D: All food. I love bread and butters, pastries. Sunday was practically an all-day eating experience. I would go out to the bakery in the morning and pick up a bunch of rolls and pastries and sit down with the paper for an hour-and-a-half or so, eating continually, and then break for a couple of hours and then watch a couple of football games in the afternoon on Sunday and continue eating. So, there was a lot of eating and it was always two large meals, sometimes three.

K: So you’re 42-years-old, you have three wonderful children and a lovely wife. Why do you decide to lose weight at that point? Why do you go on a diet?

D: Well, when I quit smoking I told the doctor I was worried about gaining a lot of weight. And he said, “Don’t worry. If you have the willpower to quit smoking, you can lose weight.” So I kind of took him at his word. And when I got up to 287, I couldn’t fit into most of my clothes anymore. I had outgrown extra large shirts and all my pants. My waistline was between 44 and 46 inches, and I was in XXL shirts. I felt huge. And I decided I had to do something about this, and I started on a diet in early 1992.

K: How did your weight affect your everyday life? Did you have limitations?

D: Well I was still relatively young…

K: Hee. Relatively.

D: Well, when you’re 59, 42 sounds great. I used to work on the car a lot, and it was difficult to get up and down, move around. You lose a lot of agility because you’re carrying this extra person, really. 287 is a good weight for two people. It’s just a huge amount of weight, and you just don’t feel right at all. I still did what I liked. I played some golf. I still went fishing. But everything was an extra burden. It was harder.

K: So what kind of changes did you make in your diet when you decided to start losing weight?

D: Well, I decided I was going to try to get by on 1500 calories a day. So, I was working at [redacted] at the time, and I used to eat practically non-stop all day there. I would come in with a couple of bagels and I’d say, “Well, I don’t have any butter on them, so it’s okay.” And then at break time I’d have something, and then go out for a full lunch. And then I’d have a snack in the afternoon. And then I’d go home and eat a big dinner. I was probably taking in about 5000 calories a day.

K: Wow.

D: I decided I was going to try to cut down to 1500 calories. To do that I cut out my snack in the car on the way to work – I forgot to mention that. And I cut it down to two rice cakes, which comes to 100 calories. And then at break time I’d have two more rice cakes. The caramel kind. Quaker.

K: Delicious.

D: Delicious. As rice cakes go, it doesn’t get much better than that. So, by the time lunch came around, I’d had 200 calories so far for the day. And I’d try to keep lunch between 500 and 600 calories, and then dinner about the same. And at night I’d have 100 calorie snack before I went to bed.

K: What did you have for lunch and dinner?

D: For lunch– maybe if I’d have a hamburger, it would be without cheese. Maybe a couple of hot dogs. No French fries. If I had a sandwich on a bagel, it would be a low-calorie meat like boiled ham. One slice of cheese for flavor, but not loaded up on cheese. Dinner in those days, we always had two vegetables, meat, and usually a piece of bread. And I cut almost all the butter out of my diet. We used to have spaghetti and meatballs every Tuesday night and I’d have two meatballs and some spaghetti, but instead of four or five slices of bread with butter, I cut it down to two slices of Italian bread with no butter. So, cutting back all around.

K: What kind of changes did you make to your exercise plan?

D: I just played golf. I wasn’t into walking for its own sake back then. I lost ten pounds a month for seven months. I went from 287 to 217 in seven months. It felt good.

K: How did you keep track of the calories?

D: I would read the labels on the food, and I also had a little booklet I bought at the checkout at the supermarket. It was a little pocket book that had about 30 or 40 pages, and it had a nice index of foods and calories in it. … Basically I was cutting about 35,000 calories a month out of my diet.

K: That’s a lot.

D: Yeah. Doing the math, I was losing 2-1/2 pounds a week.

K: Hunh.

D: Right. And that’s how I lost the weight. I strictly believe in counting calories and exercising for losing weight. I don’t think there’s any fad diets that work over any length of time.

K: Did you find you were eating less meat or more vegetables? It sounds like you definitely cut out the dairy part of it, but what about those two?

D: Well, I watched the quantities more than the types of food. But one thing I insisted on any diet is I had to have pizza once a week. Any diet I’ve ever been on because I absolutely love pizza. But it would be two slices. My days of three, four, five slices of pizza at a meal are over.

K: So it was a portion control issue.

D: It was portion control. I believe you have to have things you like. You just can’t be continually eating rice cakes. Once in awhile you have to treat yourself.

K: Are there any other big changes you made to your lifestyle? You mentioned you had quit smoking.

D: That was it. It was seven months at ten pounds a month, and it just worked out.

K: At this point, when you were losing 70 pounds, did you ever consider joining a gym or Weight Watchers or anything?

D: No. I’m not a joiner. I don’t like the crowd aspect of joining things. I can’t see myself at a gym.

K: Okay. So you stopped at 217, but you still lost around 40 pounds after that.

D: No. What happened was, over a period of about 12 or 13 years, I slowly put on about 20 pounds. A pound one year, a couple of pounds the next, and when we went on vacation to Spain, when I came back, I was 237.

K: Were you really?

D: Well, I was 217, and over those years I gained 20 pounds. So, I said, “This is not good. I’m well into my 50s, and I’m only 13 pounds from being 250 again.” So I decided it was time to start a diet again. And the first couple of months I lost quit a bit of weight, as you do on most diets. Maybe 15 or 16 pounds. And then I decided … I want to change my lifestyle so I don’t have to constantly be worried about losing all this weight and then putting it back on. … So, I would start losing, get down three pounds a month, two pounds a month. Sometimes there would be something special going on, like a vacation, and I might put on a couple of pounds or only lose a pound or break even that month. But slowly, over the course of a couple of years, I got down to my low weight, which was 179, which is about where I am now.
K: What about your eating habits now?

D: [On] weekends [I eat] two meals a day instead of three. I have brunch and dinner – maybe a light snack during the middle of the day. … And then it’s certainly a more structured environment at the office, and I think it’s easier to lose weight. I bring in some dry cereal in the morning. I like dry cereal because I think you get more flavor out of it, and I think it takes longer to eat. … And then I have a little snack in the middle of the morning. Always 100 calories or less. At lunch I have either a sandwich or soup.

K: But we’re not talking pastrami with mayonnaise.

D: No. … And then in the evening a normal meal. And I have my pizza once a week, and on the weekends I eat two good meals each day. I mean, they’re hearty meals. Sometimes I go for pancakes. Sometimes I go for Polish food. Whatever I feel like – but only two meals. … [Also] I do a lot of walking. I walk about 30, 35 miles a week. So, that helps, too.

K: Whoa.

D: Well, I get off the subway in the morning, about a mile from the office. I leave the house a little earlier to do that. In the afternoon I walk to a different station, and another mile. And then at lunchtime, whenever I can, I walk up to the promenade in Brooklyn, which is almost another mile to and from – a mile each way. So, just in those four things, I’ve already walked four miles for that day. And on the weekend I play golf and I go fishing at night. I always walk a mile or two. And it adds up quickly. It doesn’t have a lot of stress on my joints. At my age, I’m not into – I never was a jogger. I never saw somebody jogging who was smiling, so I figured it can’t be too pleasant an experience. They always look kind of pained. So … it’s kind of a lazy man’s exercise, but what I don’t have in quality, I make up in quantity.

K: Okay. So were your diets difficult to maintain? Did you ever feel deprived or anything?

D: Well … when I’m into a diet, it becomes a way of life. … Once you get used to it, it’s fine. … And this latest one, where I altered my lifestyle and still had big meals when I feel like it - it’s almost a guilty pleasure you don’t have to pay the price for all the time.

K: So it’s easier now.

D: It’s easier in that I kind of changed the way I manage my intake. I don’t go to the bakery and sit at the breakfast table for two hours anymore either. That doesn’t happen. And I don’t eat those massive quantities of pizza. I went from having pizza twice a week to having it once a week. So, it’s definitely a cutback, but that’s okay. I still get my pie.

K: What have been the benefits of the weight loss?

D: Well, I’m a lot more agile. I can, despite my bones starting to creak and stiffen up a little, I can get up and down relatively easily. I have a bad back, and the weight loss certainly helps my agility and my mobility. And of course, with all the walking, I can walk a pretty good distance. I walked to your office tonight from Downtown Brooklyn, which is about four miles. I did that in a little over an hour, so that’s a good pace. Good for someone my age.

K: Okay. So here’s a question: Grandma, your mom, was a big woman.

D: Yes.

K: Did you ever look at her and say to yourself, “That can’t happen to me when I’m that age”? Was that part of it at all?

D: Well, what I did notice – my mother lived to 88.

K: Oh yeah. I missed that.

D: There’s that. But I noticed that you don’t see a lot of big, old fat guys. They tend to die off relatively early. And I’ve been blessed with pretty good blood pressure and a good heart from what I understand, a strong heart. So, I didn’t want to make it any worse. I wanted to have a long, happy, healthy retirement, and part of that was not being overweight.

K: And with Grandma, she lived until 88, but she was not mobile for the last …

D: Listen, if I can get to 83 and suddenly not get too mobile…

K: Good point. So, for the diet and the lifestyle change, what was your support system like? Did anyone help you?

D: No.

K: Oh no.

D: Well, people say positive things. “Oh, you look great.” “Oh, you lost weight.” That’s certainly – that’s supportive. So, it’s a positive thing that you’re doing and people remark on it. And a lot of people have trouble losing weight, [but] you know, I guess for me, it hasn’t been … extremely difficult to do. But for some people it’s a real struggle, and I understand that. Positive feedback is always appreciated.

K: Got it. What are your plans for the future?

D: Retire, fish, golf, sex, drugs, rock and roll. Not necessarily in that order.
~~~

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