If your mental image of an older person is someone frail and thin, it may be time for an update. For the generation currently moving through middle age and beyond, a new concern is, well, growing: obesity. "We're already seeing a large number of obese elderly, and if we don't do something, that figure is sure to rise," laments David Kessler, former commissioner of the Food and Drug Administration and author of The End of Overeating. Government figures show that Americans in their 60s today are about 10 pounds heavier than their counterparts of just a decade ago. And an even more worrisome bulge is coming: A typical woman in her 40s now weighs 168 pounds, versus 143 pounds in the 1960s. "People used to start midlife [at a lower weight] and then lose weight when they got into their 50s, but that doesn't happen as much anymore," Kessler says.
If you're entering that danger zone now, be aware that it's not going to get any easier to lose weight, because people need fewer calories as they age. Blame slowing metabolism and the body's tendency starting in midlife to lose muscle mass—a process known as sarcopenia—and gain fat, especially around the abdomen. (Fat burns fewer calories than does muscle.) "All that conspires to make it harder for people to maintain the same body weight when they eat their usual diets," says Alice H. Lichtenstein, director of the Cardiovascular Nutrition Laboratory at Tufts University. "People have fewer discretionary calories to play with, so they need to make better food choices."
Why do those choices matter? First, carrying an extra 20 or 30 pounds with you into old age doesn't bode well for attempts to head off the myriad diseases that strike in midlife and later and are linked to weight—including diabetes, arthritis, heart disease, and some forms of cancer. (It's probably not a coincidence that one recent study finds that people in their 60s have more disabilities than in years past.)
But paying attention to what you eat isn't only about controlling weight; the need for some vitamins and minerals increases with age. One is calcium, necessary to protect bones. Another is B12, since some older adults make less of the stomach acid required to absorb the vitamin. More vitamin D also is required. "The skin gets less efficient at converting sunlight into this vitamin, so more is needed from other sources," Lichtenstein says. Fewer than 7 percent of Americans between 50 and 70 get enough vitamin D from the foods they eat, and fewer than 26 percent get enough calcium.
Staying lean and eating right are both crucial for maintaining health through the years. (Kessler recalls a fellow researcher at Yale who, upon realizing the panoply of diseases linked to body weight, promptly lost 30 pounds.) If weight is a problem, it is especially important to cut back on the processed foods that combine sugar and fat. Studies with rats indicate that when the two are added to chow, animals can't easily stop eating, says Kessler. This happens in humans, too, he says, and food manufacturers have taken note and added sugar and fat to many products. So what should people eat? A healthful diet at midlife is the same as for younger adults—it's just that the stakes may be higher. The focus should be on fruit, vegetables, whole grains, low- and nonfat dairy, legumes, lean meats, and fish. For someone whose current diet is far from this ideal, Lichtenstein suggests starting small: Swap dark green lettuce for iceberg, load more veggies on the dinner plate, eat more skinless chicken or beans in place of hamburger. And exercise. Walking briskly for at least 30 minutes every day makes it easier to get away with the occasional cookie. With some further fine-tuning of that basic healthful eating plan, you can greatly improve your odds of staving off the major barriers to a vital old age:
Bone loss. No nutrient can stop bones from losing mass over time, but consuming sufficient calcium and vitamin D can slow the deterioration, says Felicia Cosman, an osteoporosis specialist at Helen Hayes Hospital in West Haverstraw, N.Y., and clinical director of the National Osteoporosis Foundation. Once a person reaches age 50, calcium requirements jump to 1,200 mg per day (from 1,000 mg). Cosman recommends adding up the number of dairy and highly calcium-fortified products (such as juice and cereal) eaten in a typical day and multiplying that by the 300 mg each likely supplies. Add another 200 to 300 mg for the combined trace amounts in leafy green vegetables, nuts, and other sources. Then get the remainder in a supplement. By midlife, adults also need at least 800 to 1,000 IU of vitamin D to help the body absorb calcium and, possibly, prevent other diseases, according to the NOF. Sources include fatty fish such as salmon (also important for heart health), egg yolks, and fortified foods, but most people need to supplement.
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Heart disease. By now every American surely knows which foods affect your heart. Good for the ticker: monounsaturated fats like olive oil and the omega-3 fatty acids found in such cold-water fish as salmon and herring and in flaxseed and walnuts. Harmful: too much red meat and full-fat dairy, because of their saturated fat content, and margarine and baked goods, because of the trans fats they contain. Still, troublesome foods can be hard to limit. "Although many supermarket products have removed the trans fats, they're hardly history. Restaurants, especially, continue to use them," cautions Robert Eckel, former president of the American Heart Association and a professor at the University of Colorado–Denver. Plus, some food manufacturers have swapped their trans fats for equally problematic saturated fat, Eckel says. Sat fat should total no more than 7 percent of daily energy intake—about 16 grams for the average, 2,000-calorie diet.
Recent research points to another potential heart danger: high-fructose corn syrup, commonly found in soda. The decades-long, 88,000-women Nurse's Health Study found that, even controlling for weight and other unhealthy habits, drinking one 12-ounce can of regular soda daily boosts a woman's risk of later having a heart attack by 24 percent; two or more servings raise the risk by 35 percent. "We don't know exactly why this is, but fructose does increase uric acid and triglycerides in the blood, which are known contributors to hypertension and heart disease," says study coauthor Teresa Fung, associate professor of nutrition at Simmons College in Boston.
Hypertension. Lowering high blood pressure before it contributes to the development of heart disease is vital for people in midlife. It can be accomplished with an eating plan known as the DASH (Dietary Approaches to Stop Hypertension) diet. "The DASH diet has the same effect as taking a blood-pressure-lowering medication," Eckel says; the DASH-Sodium version, which subtracts salt, works as well as up to two medications. The plan is rich in fruits and vegetables (eight to 10 servings a day for someone on a 2,000 calorie diet), grains (six to eight servings daily, with most being whole grains), and low-fat protein sources. And it's low in saturated fats and added sugars. The biggest difference from standard healthful eating advice is DASH's focus on lowering sodium, which can damage artery walls in people sensitive to the nutrient. The diet limits sodium to 2,300 mg a day, while DASH-Sodium slashes it to 1,500 mg—just two thirds of a teaspoon. It's not enough to go easier on the salt shaker; the National Institutes of Health recommends looking for low- or no-salt labels, limiting salty foods like bacon and sauerkraut, and rinsing canned foods. (Here's a sample menu of a DASH eating plan.)
Insulin resistance. Research has repeatedly demonstrated that type 2 diabetes and insulin resistance (a precursor to the disease in which the body begins to respond less well to the hormone that clears glucose from the bloodstream) can often be prevented or postponed with a healthful diet, exercise, and weight loss. That combination, in fact, actually has proved to be more effective than medication. An eating plan aimed at minimizing the risk of insulin resistance does not have to be complex. "I coach people to mentally divide their lunch and dinner plate in thirds, with one third protein, one third nonstarchy vegetables, and the final third a starch like brown rice, whole wheat pasta, potatoes, or corn," says Nora Saul, a dietitian and diabetes educator at Harvard's Joslin Diabetes Center in Boston. It's also a good idea to get serious about cutting back on sugar and white flour, both of which can spike blood glucose levels.
Memory problems. Alas, there's no magic bullet that will guarantee protection from dementia. But researchers are finding that a Mediterranean diet—similar to a conventional healthful diet but with an emphasis on fish and olive oil—seems to lower the odds of developing cognitive problems. Scientists at Columbia University followed more than 1,300 people for up to 16 years; those most closely adhering to this diet developed Alzheimer's at half the rate of those who didn't. One caveat: Alcohol (particularly in the form of wine), one element of the Mediterranean diet that has been suggested as a memory function enhancer, has not been proven as such, says Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York.
Joint disease. Although age is a risk factor for arthritis, the breakdown of cartilage in the joints is not inevitable. Minimizing weight gain goes a long way toward avoiding this problem, because every extra pound translates to three pounds of pressure on the knees while walking. It is also a good idea to limit foods that encourage inflammation in the body, particularly omega-6 fatty acids (found in corn and soybean oils and many snack and fried foods), the Arthritis Foundation says.
Cancer. Some 45 percent of colon cancers, 38 percent of breast cancers, and 69 percent of esophageal cancers would never occur if Americans ate better, controlled their weight, and stepped up their exercise, estimates the American Institute for Cancer Research. "It's not just cancers of the digestive tract. What you eat and what you weigh affect certain other cancer types as well," says Alice Bender, AICR's nutrition communications manager. The organization recommends limiting red meat to 18 (cooked) ounces per week and loading up on plant-based foods, which are high in the phytochemicals and antioxidants known to inhibit cancer cell growth in lab animals. Those with the deepest colors—like purple grapes, blueberries, and leafy green vegetables—have the most beneficial compounds. One recent study, for example, showed that eating foods with the antioxidant sulforaphane, found in broccoli and kale, reduces the amount of a bacteria linked to stomach cancer.
At least for now, people should plan on getting as many as possible of their healthful nutrients from food rather than supplements. "Numerous studies on supplements—of vitamin C, lycopene, beta-carotene, and even fiber—have all proved disappointing," Bender says. Another reason to swap that cookie for a carrot.