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This article is sponsored by the University of Utah Health.  It’s safe to say that a great majority of Americans spend a lot of time and money on weight-loss efforts.  About two-thirds of America's adult population is overweight or obese.  Americans spent about $66 billion on weight loss products in 2016 alone.

While being thin is often equated with being healthy, that’s not necessarily the case as we get older.  An elderly person needs to maintain a healthy body weight to prevent some of the health risks that come from frailty.

“Frailty, generally, is the inability for someone to be able to respond to acute stressers. They have decreased physiologic reserves, and therefore are in a state of increased vulnerability,” says Dr. Natalie Sanders, a board-certified geriatrician with University of Utah Health. "Being thin can exacerbate some of the risks that come with frailty."

Unfortunately, being frail is not like other diseases such as high blood pressure, where you can measure it and compare it to a set number. Instead, most doctors use five criteria to determine whether a person is frail or at risk of becoming so:

- Unintentional weight loss, without any changes to a person’s diet or exercise routine.
- Decreased strength, which can be measured as grip strength, or observing whether a person can get in and out of a chair easily.
- Slow gait speed, measured by whether a person can walk five meters in six seconds or less.
- Low energy expenditure, spending most of the day being inactive.
- Poor endurance, often expressed as feeling tired or fatigued even with basic daily activities.

Because frailty cannot be specifically measured, and the process for diagnosing someone varies throughout the medical community, it’s hard to know exactly how many people suffer from this condition. It’s estimated that about 10 to 25 percent of adults over 65 are frail, and that number increases to around 45 percent or more of adults 85 and older.

"Maintaining a healthy body weight is one way to prevent frailty," Sanders says. "but the recommendations for someone who is older don’t differ much from those given to younger adults: keep your body mass index, or BMI, in the healthy range of 18.5-25.  Thinner than that, or BMI lower than 18.5, can come with problems,” Sanders explains. “But greater body weight also comes with its own set of problems.”

It’s not necessarily looking at the exact weight or BMI numbers, but instead is this person maintaining their usual body weight, or are they rapidly losing weight? The latter is a sign that you should talk to a healthcare professional.

While all frail patients are at an increased risk of falling, developing osteoporosis, and even suffering from delirium,  these things can be exacerbated when a person is also exceptionally thin.  Eventually, it will become hard to perform basic daily tasks, such as:  walking, transferring weight, keeping track of medications, bathing and eating. Being very thin and frail can also lead to a higher risk of mortality from diseases such as influenza, because your body is not as capable of fighting off illness and or recovering.

“People are not always being told that they are frail by a care provider,” said Sanders. “but telling them can alert them and their primary care providers that they might need additional support.” 

In addition to having adequate support, it’s also important for patients to take their own health seriously as they get older.  Be sure you’re getting enough food every day and all the vitamins your body needs.   Eat enough protein.

“Exercise is really still our best medicine.” Sanders says. “The recommendations for older patients are not any different from younger patients—do some kind of cardiovascular exercise getting the heart rate up for 30 minutes, five times a week, and incorporate weight lifting and strength exercises.  You can do something as simple as getting in and out of a chair without using your arms to stand up.”

Other things patients can do to reduce the chances of becoming frail include taking medications as prescribed and eating a healthy, balanced diet to maintain your weight.  "If you’re not sure about getting healthy food, or you don’t know where to start in terms of exercise, talk with your doctor about getting some extra resources to help.”