Heart Failure - overweight is better than underweight in later age.

Among older adults with heart failure, there have been a number of studies over the past decade or so that have identified people who are “at risk of malnutrition” or who are malnourished as having a higher chance of three things: dying in hospital, being readmitted soon after discharge and/or suffering greater disability than those who are well nourished. Here is one example of an article discussing these findings.

But, what was also found in this study might surprise you: These researchers found that people who were identified as obese on admission to hospital with a heart failure diagnosis were less likely to die in hospital and less likely to be readmitted soon after discharge. In comparison, those identified as being at risk of, or having, malnutrition were much more likely to die and to end up back in hospital soon after discharge.

This is important work because it is commonly believed that losing weight and aiming to be lean is essential in people facing cardiac issues (or for health more generally). But, while that is certainly true for younger adults, the situation is quite different for those older. For those beyond about 65, a bit of extra bodyweight is thought by many to be protective against frailty - a debilitating condition experienced by many in later age and something that is associated with heart failure in older people.

We need to remember that almost every health message we hear on a daily basis is for people of 30, 40 or 50 and that many of those same messages just don’t apply to older people - in fact, they can be harmful. Weight loss is partly caused by some processes occurring in heart failure and weigh loss at later age, as you will well know if you read my blog, can be dangerous, rather than beneficial.

In the study mentioned here, its not clear how obesity was measured, but there is increasing worldwide agitation for public health advice to set ideal weight ranges for older adults at levels that better reflect ongoing physical capacity and health: those are slightly higher than younger adults. The ideal weight for someone of 70+ is a bit heavier than that for someone of 50. In this study, it may be that at least some of those identified as ‘obese’ would instead be in the healthy weight range for older adults, if we were using more older age-appropriate healthy weight range guidelines. (BMI 23-28 is often suggested in the scientific literature, while the ideal for the 18-65yr olds is 19-25)

Remember that exercise is always key and that weight loss can only safely be achieved at later age by combining good resistance exercise with a high protein diet. For those with heart failure, cardiac rehabilitation programs include exercise components, but exercise for those with heart failure must be carried out under medical advice.

What is clear is that - heart failure or not - eating to maintain weight as much as possible, and maybe even to gain a little if you have lost any is absolutely vital to living as well as possible in the years ahead.