7

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Elderly woman with mid-range BMI, but 'morbidly obese' body fat %. Why, and how to get it down?

Answered on July 17, 2015
Created November 09, 2011 at 6:57 PM

So, my 75-year-old MIL just got her bodyfat tested. At 5'2" and 125 lbs, it's 44%. Her doctor's recommendation is to get her weight between 106-118 lbs; her set-point for many years was about 110 lbs, but she now has osteopenia and almost no muscle mass. I don't think losing pounds is going to help her health.

I'm at a bit of a loss of what to tell her to do (considering the below info).

She lost 45 lbs in 9 months three years ago, after being diagnosed with diabetes and going low-carb, and she's kept it off since - maintained her current weight all this time. She's very good at complying with her diet, her blood sugar is great. She eats until she's full, but doesn't eat much food, and mainly for this reason her diet could surely be more nutrient-dense; but she eats mostly meat and veggies, snacks on nuts and some fruit, doesn't eat low-fat. More 'paleo' than almost anyone else I know.

I can't believe her BF is so high still. She does a lot right. If anyone has an explanation for why this would happen, I'd be curious to know.

She works retail (constant movement) 3-4 days per week and does all her own housework (lives alone in a large 3-bedroom house and cooks every night), so she's pretty active for her age, but I think more structured exercise could help a lot; at least it would build her a little more muscle, even if there was no fat loss. I might try to get her lifting weights/doing bodyweight stuff a couple times per week.

I don't think she'd be down with the 'leptin reset'; she just doesn't eat that much food! I'd be surprised if she got anywhere near 50g protein in an entire day.

If anyone has any other suggestions on how to help her, I'd much appreciate it.

27361737e33ba2f73ab3c25d2699ad61

(1880)

on November 11, 2011
at 05:53 PM

Muscle strength is different than bone mass. Perhaps I misunderstood but I thought "diagnosis" of osteopenia was the issue and the fatty look was secondary. I think some of that so-called fat may be loose skin.

Medium avatar

(19479)

on November 10, 2011
at 01:14 PM

"We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age." http://jama.ama-assn.org/content/263/22/3029.short

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 11:11 PM

Wow, hadn't heard that before. Will buy her some K. Good thing she likes Parmesan cheese.

C00e493393828df34be65ddc25456c7c

(610)

on November 09, 2011
at 10:38 PM

Forget about leptin reset. The priority is to build muscle by lifting weights.

7dc950fc76a046048e683d2a27dced37

on November 09, 2011
at 09:38 PM

She might benefit from some type of exercise program for folks her age ... any chance that's available near you? I'm thinking that working out with her peers might be something she'd do for both social and health benefits.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on November 09, 2011
at 08:16 PM

Nice answer FED!

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 08:07 PM

She probably is leptin resistant. I just don't think I could convince her to follow the leptin reset, it's way too strict and intensive. She listens to what I tell her, but she has little interest in researching or implementing life changes on her own, and also listens to her dr. Probiotics no, antibiotics rarely.

Medium avatar

(19479)

on November 09, 2011
at 07:57 PM

I agree with Travis. Vit D toxicity is generally regarded as a factor of vit K (k2) deficiency.

27361737e33ba2f73ab3c25d2699ad61

(1880)

on November 09, 2011
at 07:54 PM

I question the whole diagnosis of osteopenia as a "disease" or indication that osteoporosis is imminent... http://www.sciencebasedmedicine.org/index.php/osteoporosis-drugs-good-medicine-or-big-pharma-scam/

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on November 09, 2011
at 07:51 PM

And based on her described body profile, are you sure she's not leptin resistant? Isn't is possible doing all the right things hasn't fixed her metabolism? Has she had antibiotics in recent years and does she use probiotics?

24df4e0d0e7ce98963d4641fae1a60e5

on November 09, 2011
at 07:48 PM

I am trying to get my own Mom off statins. I was under the impression that all statins had negative impacts on bone density, and yet here's one that says different. Maybe if she won't kick the statins, make sure she has the right one. http://www.ncbi.nlm.nih.gov/pubmed/20045497

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:45 PM

For reference, I'm a string-bean 105 at 5'5", wear clothes 5-7 sizes smaller than she does, yet I have 86 lbs of LBM.

7dc950fc76a046048e683d2a27dced37

on November 09, 2011
at 07:42 PM

Gotcha. Well, I agree with Evelyn ... best thing to do is just work on gaining LBM. I am a fan of BBS, so FED's recommendation is a great one IF you can find the right person to work with her.

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:37 PM

Her sugar is well-controlled, but she is on statins and will not stop taking them. :( Her lipid panel is okay but her HDL could be higher. She seems to be in good health, honestly, which was why I'm so surprised she only has 70lbs of LBM!

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:34 PM

It was a DEXA (to check her bone mass as well), so probably fairly accurate. To my eye, she has a lot of both subcutaneous AND visceral fat. Carries most of her weight in her torso, upper hips and arms, fairly slim legs. 'Beer belly' evident. Her daughter is nearly the same height and weight, but several clothing sizes smaller and with no extra fat.

Medium avatar

(39821)

on November 09, 2011
at 07:29 PM

If it were me, I'd take gram quantities for at least a few months and then lower it down to 200mcg or so.

Medium avatar

(39821)

on November 09, 2011
at 07:28 PM

Taking calcium and D3 without K2 is really dangerous. It would calcify her soft tissues and *greatly* increase the chance of heart attack/stroke. She absolutely must take K2.

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:25 PM

She is supposed to be taking calcium and D3 twice per day, but she's spotty. I nag her. Couldn't hurt to give her some K2, also

Medium avatar

(19479)

on November 09, 2011
at 07:18 PM

I have tested people that look "thin" yet have ridiculously high bodyfat percentages. This can still be the case with "active" individuals. General movement does not preserve muscle mass although it does help maintain other health parameters

Medium avatar

(19479)

on November 09, 2011
at 07:18 PM

I have tested people that look "thin" yet have ridiculously high bodyfat percentages. The can also be "active" individuals. General movement does not preserve muscle mass although it does help maintain other health parameters.

7dc950fc76a046048e683d2a27dced37

on November 09, 2011
at 07:16 PM

Also, what can you notice from visible distribution of her fat? Is it visceral/abdominal?

24df4e0d0e7ce98963d4641fae1a60e5

on November 09, 2011
at 07:11 PM

I'm with Beth here. I suspect skin-fold tests on a woman her age who lost significant weight just a few years ago are gonna be off.

7dc950fc76a046048e683d2a27dced37

on November 09, 2011
at 07:08 PM

How was her bodyfat tested? It seems unlikely to me it's really that high if she's still as mobile as you say!

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8 Answers

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15
Medium avatar

(19479)

on November 09, 2011
at 07:10 PM

The answer is "sarcopenia", the age-related loss of muscle mass that happens starting around the age of 30 if you don't actively work to preserve your muscle mass.

At 125, your mother-in-law is not overweight, she is "over-fat" because her muscle mass, organs, bones, and other "lean" tissue have deteriorated.

General movement is not going to maintain her lean mass (as evidenced by the fact that it hasn't helped thus far). I recommend starting her on a resistance training program along the lines of that proposed in the book Body by Science. I would also do this as soon as possible because her current level of independence is very much at risk. Without muscle and organ reserves, a single fall, hospital stay, and the resultant imposition of sedentary recovery time would send her health into a downward spiral.

Body by Science is the standard Arthur Jones/Nautilus protocol, but it is suitable for seniors and those who don't want to spend a ton of time in the gym. Basically, all you need is a fitness center that has a at least a leg press, chest press, and lat pull-down/pull-over. Equipment like a shoulder press, seated row, leg extension, leg curl, bicep curl, tricep extension, can be helpful too.

Starting off, she would only really need to do 1-2 sets of 8-12 reps per machine 1-2x per week. Keep the weight low at first just to make sure she is using proper form (slow speed of movement, proper settings to the seat, correct mechanics). You may also want to hire a trainer to work with her for the first few sessions, just make sure that they are on board with the program so that you don't end up with her falling off a BOSU ball.

Her strength should increase fairly rapidly, so you do want to progress the weights in order to keep the rep range around 8-12 (assuming form stays perfect) and you should see her body composition improve after just a few months.

I would also make sure that she is properly hydrated. The sensitivity of the thirst response degrades with age and many seniors are chronically dehydrated with affects all metabolic processes.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on November 09, 2011
at 08:16 PM

Nice answer FED!

4
24df4e0d0e7ce98963d4641fae1a60e5

on November 09, 2011
at 07:14 PM

How are her metabolic markers? I think this is way more important than if she even has (see comment below Beth's) excess fat. If blood lipids/sugars are good, then her "obesity" is not problematic.

No matter what, I would focus on lean muscle weight gain if that's really the case, and addressing the osteopenia and not worry one wit over fat. At the very least, any approach should be centered on maintaining LBM.

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:45 PM

For reference, I'm a string-bean 105 at 5'5", wear clothes 5-7 sizes smaller than she does, yet I have 86 lbs of LBM.

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:37 PM

Her sugar is well-controlled, but she is on statins and will not stop taking them. :( Her lipid panel is okay but her HDL could be higher. She seems to be in good health, honestly, which was why I'm so surprised she only has 70lbs of LBM!

24df4e0d0e7ce98963d4641fae1a60e5

on November 09, 2011
at 07:48 PM

I am trying to get my own Mom off statins. I was under the impression that all statins had negative impacts on bone density, and yet here's one that says different. Maybe if she won't kick the statins, make sure she has the right one. http://www.ncbi.nlm.nih.gov/pubmed/20045497

3
Medium avatar

on November 09, 2011
at 07:02 PM

Seems like she'd be a good candidate for vitamin D3 and K2 supplementation in order to address the osteopenia. That alone might make a substantial difference.

Medium avatar

(39821)

on November 09, 2011
at 07:28 PM

Taking calcium and D3 without K2 is really dangerous. It would calcify her soft tissues and *greatly* increase the chance of heart attack/stroke. She absolutely must take K2.

Medium avatar

(39821)

on November 09, 2011
at 07:29 PM

If it were me, I'd take gram quantities for at least a few months and then lower it down to 200mcg or so.

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 07:25 PM

She is supposed to be taking calcium and D3 twice per day, but she's spotty. I nag her. Couldn't hurt to give her some K2, also

Medium avatar

(19479)

on November 09, 2011
at 07:57 PM

I agree with Travis. Vit D toxicity is generally regarded as a factor of vit K (k2) deficiency.

26b7615ef542394102785a67a2786867

(7967)

on November 09, 2011
at 11:11 PM

Wow, hadn't heard that before. Will buy her some K. Good thing she likes Parmesan cheese.

0
D71d417b7adfb093aaecb98951b2d8d6

on July 17, 2015
at 08:21 AM

Her doctor is an idiot!!!

If she tried to lose weight she'd likely lose more muscle. And for her age, muscle is the one thing she really needs to make it through any illness.

How was her body fat % actually calculated? 

Calipers will not be accurate or work (skin is loose in the elderly due to collegen breakdown) 

Measurement of the waist? (was ascites assessed?)  

 

Absolutely she should not go on a diet to lose weight. She should start resistance training, and eat a higher protien diet. It's possible she may have malabsorption of protien so definitely include both regular food, and protien shakes. 

Get her up to 0.8- 1.0gm of protien per pound of body weight. 

Get her doctor to assess for ascites, liver, kidneys, blood protien like globulin & albumin and oddly testosterone levels (if too low, supplementation might be extremely helpful). 

 

Goodluck! 

 

0
F6b28b8f67467af0337a0381a6857f4f

(203)

on November 21, 2012
at 05:08 AM

I second the resistance training suggestion

0
3900e514b708d53e2b725ceb5750c8e9

on November 21, 2012
at 03:19 AM

Hey like you said about people who have small bones and others have medium/large bones. But like you said about this body type, the endomorph body type, you was saying that they don't have big, wide/broad, strong/sturdy bones with high body fat%. I mean ectomorphs have small bones while mesomorphs have medium/large bones. But trully, do most endomorphs really have just medium bones other than large bones? Please explain this to me.

0
6c6ff7607b2c5ae0a307f131e881fc86

on April 05, 2012
at 03:21 AM

Any grains will keep weight on. certain foods put weight back on, for instance, I am CRAVING banana smoothies right now, however, everytime I eat them i put on about two lbs (for two bananas). wish i could help more, good luck

0
27361737e33ba2f73ab3c25d2699ad61

(1880)

on November 09, 2011
at 08:25 PM

Re: strength training -- excellent perhaps for being more self-sufficient but doubt it will do anything to increase bone mass. I heard interesting interview with biomed researcher Dr.Clinton Rubin (Stony Brook -- developing vibrational plates) on Dr. Ronald Hoffman's podcasts (free at WOR station web site). This guy says that while exercise is great when one has the hormones necessary to build back bone/muscle - the reality is that in those who don't - menopausal and older women and also elderly men -- jarring exercise can accelerate bone loss. He says there appears to be a sweet spot vibration which signals bone increase without undue tear down/stress/risk of other injuries -- all things the elderly are prone to. They are beta testing on seniors now and want this plate designed for home use to be the size of a typical bathroom scale and affordable -- not the multi thousand dollar monsters some gyms have. This was supposed to be available very soon from what I recall. He says you just stand on it for prescribed amount of time per day. This makes much sense to me. So does tanning in the sunlight or low/med intensity tanning beds and maintaining adequate vitamin d levels. High calcium diets; calcium supplements and drugs do not. I personally am going to look into the consumer vibration plates because there is tons of osteoporosis in my Italian side of the family and eating plenty of unpasteurized dairy did not prevent it. Dairy tastes divine but it's a crave maker, can be a fat maker and I don't believe it prevents osteoporosis.

Medium avatar

(19479)

on November 10, 2011
at 01:14 PM

"We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age." http://jama.ama-assn.org/content/263/22/3029.short

27361737e33ba2f73ab3c25d2699ad61

(1880)

on November 11, 2011
at 05:53 PM

Muscle strength is different than bone mass. Perhaps I misunderstood but I thought "diagnosis" of osteopenia was the issue and the fatty look was secondary. I think some of that so-called fat may be loose skin.

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