The annual meeting of the American College of Physicians took place in San Diego this past week. Alas, I was not able to attend but through the magic of the internet I was able to catch up with some of the more important discussions. Dennis Sullivan, MD of the University of Arkansas spoke about weight loss in the elderly.
Weight loss in the older patient is different than in the younger person. From the ACP Internist summary: “A group of healthy young and old people were deliberately underfed for 21 days. Not surprisingly, all lost weight. But when the participants were taken off the diet and encouraged to eat anything they wanted, the young people gained back all the weight they had lost and then some, while the older participants did not. “The older individuals, even when they were encouraged to eat more, were unable to increase their food intake to regain the weight that they had lost,” said Dr. Sullivan.”
Dr. Sullivan also pointed out that in the elderly a weight loss of 5-10% in the prior year is associated with an increased risk of death in the present year. Late life weight loss is both linked to illness (infection, gastrointestinal disorders, metabolic problems) and inadequate intake. Poor intake may be due to prior medical advice to limit certain foods as well as social isolation, lack of exercise and depression.
Difficulty swallowing and dental problems can also limit food intake. The best approach is to modify the consistency of food – NOT to substitute products such as Ensure or Boost. A variety of real food is the best option. Older patients need more protein in their diet, but some treats can be included to increase the calories. Ice cream is a favorite – delicious and easy to eat.
A patient that does not feel well may enjoy grazing more than three large meals. Dr. Sullivan does not recommend vitamin supplements with the exception of vitamin B12 (cheap and effective). Dr. Sullivan’s recommendation for the elderly: eat like a teenager – frequently and enjoy some junk food.
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