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Rethinking BMI for Older Adults: The Obesity Paradox

The body mass index, BMI, is one of the epidemiological indicators that define the population’s health status, but it has been criticized for not being able to take into consideration such factors as gender, age, and level of physical activity. From this, BMI is determined as the subject weight on a scale of kilograms divided by the square of height in meters.

In a BMI, that is not within the range of “normal” weight, which is 18, different health issues and risks are occurred. 5-24. Nine is generally regarded as unhealthy, but such is not the case with elderly people according to the recent findings. Moreover, if talking about BMI from 25 to 30 kg/sq m, which means being slightly overweight, the BDA’s analysis of available research seems to indicate that it is healthy for people in the age range of 70-80 years.

“Factors like exercise play a more significant role,” said Mary Hickson of the BDA’s review of the guidelines. The information gathered shows that subjects in their 7th and 8th decades have less hazard of dying than if they are slightly overweight as compared to other age brackets.

Such observation is labeled the “obesity paradox,” which means that excessive weight is potentially related to an increased life expectancy of certain groups of the populace. Naiara Fernández of the SEGG mentioned that the current parameters to distinguish between different weight classifications are based on one’s youth, and in older people, what would be regarded as obesity, namely a BMI between 28 and 30, would be normal weight.

For his part, Jesús Romá, president of the SEDCA, considers that to consider BMI as the only reference for overweight is a mistake. It means that an elderly person with a “normal” BMI is skinny, and such a condition is not healthy.

“Sarcopenic obesity,” is common among this age group, which means their body fat rises while the muscles’ size reduces. To Fernández, it is imperative to perform a detailed geriatric assessment to address issues related to the older adult’s body composition and health status.

When the elderly try to achieve weight loss by adopting very low-calorie diets, they not only reduce their fat stores, but also lose their precious muscle mass, says Román, which causes more frailness, decreases the range of motion of the elder individuals, and raises the likelihood of falls and subsequent injuries.

The suggestions made by Dr José Antonio Serra, a geriatric and head of the geriatrics section in the Gregorio Marañón hospital in Madrid, would be to increase people’s physical activity to decrease the calories they consume. To my mind, Fernández points out that for elderly people, the main goal is not slimming but possessing rather well-toned muscles that would help elderly people remain independent and free from most of the problems that are connected to age limitations.

There is also a need to establish the distribution of body fat with special reference to aged persons. According to Serra, if fat is spread out, he replaces it, in a way, it is “less harmful” than fat that accumulates in the belly, leading to metabolic problems.

Also, Fernández highlighted the fact that dental and/or gastrointestinal health problems, misinformation about nutrition, weakness, or fatigue can negatively impact the older adult’s ability to have proper nutrition by buying poor quality proteins that are processed and constitute the basis of the unhealthy overreliance on ultra-processed foods.

The BDA study also regards forced weight loss, which older people may undergo, as more dangerous than being overweight. Unintentional weight loss may occur due to factors such as; lack of social interaction, diseases that persistivly accompany the patient, bereavement, severe depression, poor oral hygiene, or the effects of certain medications.

To implement the recommendation of Fernández, several interventions across disciplines should be incorporated such as having a support person, beginning a physical exercise program, and considering an assessment of the usage of medications with adverse effects. Education on diet or supplementation may also become required.

The research shows that it is high time to reconsider the efficiency of BMI as a unique parameter of health, particularly with the elder generation. Hickson feels that more emphasis should be placed on strength training to increase muscle mass, and not just to lose weight furthermore, factors such as glycemia should be depicted to get a better meaning of what obesity results in.

The strategy that Fernández underlined is to stop focusing on weight and diets and switch to functionality and eagerness to exercise. Thus, by taking this more general view we can assist elderly people to remain as self-sufficient as possible and, consequently, experience a far higher quality of life.


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