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Nutrition and Weight Control for Older Clients

As people age, their physiological needs change - and so should your fitness and diet recommendations.

"She says her No. 1 goal is to 'lose some weight around my middle,' but I am reluctant to encourage her in this area. She is close to 72 years old, and while she has some extra belly fat, her arms and legs are quite thin, and her fitness is fairly low. I think she should concentrate on building up her strength and muscle, and preventing bone loss. Maybe I can guide her to think about body composition rather than weight loss. She needs to see that weight loss for her would mean bone and muscle loss, which she can't afford to lose."

Many more older people are joining fitness centers. They have read that exercise can help slow the aging process and address their health concerns. Many have questions about weight loss and nutrition. You will need to answer these questions in a different manner from the way you might answer the same questions for your younger clients. Nutrition needs change with age, and weight-control recommendations are complicated by the physiology of the aging process.

Nutrition Needs Of Older Adults

The biggest nutrition problem for older adults is that they generally need fewer calories per day, but their need for several nutrients increases. (These are reviewed in the Client Handout, opposite this page.) This means that they must make calories count by choosing nutritious foods as often as possible, and avoiding empty calorie choices that offer energy but little nutrition.

What about older adults who need or wish to lose weight? Several studies have found that calorie restriction and weight loss result not only in fat loss, but also in loss of muscle tissue and bone mineral. This is true for both young and old, but young people at least have higher levels of anabolic hormones such as testosterone and estrogen, which can help them recover at least somewhat from these losses, given good exercise and nutrition most of the time. In older adults, losses may never be regained, and may speed the course toward osteoporosis and sarcopenia (loss of muscle tissue and strength).

Older adults should be encouraged to improve eating and exercise habits, and to avoid very restrictive diets. A healthful lifestyle may help to address chronic health problems associated with obesity, such as hypertension and diabetes. Body composition may even change slowly, over time, as clients gain a little bit of muscle and possibly even lose a little fat. Older adults who may be at risk for osteoporosis or sarcopenia, like the client in the opening paragraph, should be encouraged in the healthful-lifestyle direction, with a focus on strength training to build muscle. Restrictive diets are especially harmful for adults headed toward frailty.

Fitness professionals should limit their diet advice to general nutrition guidelines that are well supported by current scientific evidence, and endorsed by scientific organizations. For example, you can encourage your clients to eat a variety of nutritious foods, including more fruits and vegetables, lean sources of protein and whole grains. Unless licensed, you should not prescribe specific meal plans to address health problems, such as diabetes. Such counseling is best left to nutrition professionals.

Health And Lifestyle Issues

Eating well can be difficult at any age, and older people are likely to have even more barriers that interfere with plans to follow a healthful diet. Health problems may limit shopping and cooking, and living alone may reduce motivation to cook meals. Sense of taste and smell decline with age, and appetite may decline, as well. Some older adults have dental problems that decrease their ability to chew.

Behavior change requires planning and a conscientious effort to establish new habits. Help your clients make realistic plans to adopt a few of the most important behaviors, such as regular physical activity and eating more fruits and vegetables, which will improve quality of life for years to come.

References
Daly, R.M., D.W. Dunstan, N. Owen, et al. Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes? Osteoporosis International 16 (12): 1703-1712, 2005.
Ensrud, K.E., S.K. Ewing, K.L. Stone, et al. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. Journal of the American Geriatric Society 51 (12): 1740-1747, 2003.
Villareal, D.T., L. Fontana, E.P. Weiss, et al. Bone mineral density response to caloric-restriction-induced weight loss or exercise-induced weight loss. Archives of Internal Medicine 166 (22): 2502-2510, 2006.
Wardlaw, G.M., and A.M. Smith. Contemporary Nutrition. McGraw-Hill: New York, N.Y., 2009.
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