Handbook for successful ageing - 2. - 2.1.4

2. Reduce possible overweight!
  

"You don not have to eat only with your mouth, but also with your head in order that the mouth’s fondness for sweet things does not ruin you."
- Friedrich Wilhelm Nietzsche -
  

"The human being eats too much. He lives on one quarter of what he eats, the physicians live on the remaining three thirds."
- Egyptian teacher of wisdom -
  

"A person who swallows the medicine, but does not maintain the diet, tasks the doctor for nothing."
- Chinese saw -

"Since the invention of the art of cooking, people eat twice as much as nature requires."

- Benjamin Franklin -

"A slim person outlives ten fat persons."

-J ewish maxim -
 

2.1 General
   

2.1.1 Body mass index and and other methods for the measurement of a healthy weight
 

2.1.1.1

Whether you are overweight (or even obese (corpulent - what an ugly word!)) or whether you are underweight, is nowadays normally calculated from your body mass index (BMI).
  

It is calculated on completition of the sixteenth year (for younger persons the paediatrician calculates it), on the basis of the weight in kilogram, divided by the height in metres multiplied by itself. You do, however, not have to calculate yourself but you can find a BMI calculator, in which you only have to type in your results, on www.nhlbisupport.com/bmi/. It is, however, a controversial, since it does not take into account the percentage of muscle mass and water on the one hand, as well as body fat and fluid on the other hand. A body fat analysis scale gives better results.
  

According to the definition of the WHO, a person is underweight when he has an BMI of less than 18.5. At an BMI from 25.0 a person is overweight, and from 30.0 upwards someone is obese.

2.1.1.2

The relation of the waistline to the height (WHtR= waist-to-height-ratio) is supposed to be more significant. That is because it gives indication of the particularly harmful visceral fat (see below, 2.1.3, key word "visceral fal"). On this website you can learn how it is calculated for different age groups: www.gesundheit.ch/whtr/.

2.1.1.3

Finally, the waistline (abdominal girth) also plays a role in this context. It is measured in the middle between the lower costal arch and the upper edge of the iliac crest, breathing out slightly.
  

Put the measuring tape in a way that the writing faces upwards - this makes it easier for you to read the result.
  

For women the waistline should not be more than 80 cm and for men not more than 94 cm. A waistline of more than 88 cm, respectively more than 102 cm already is considered very dangerous.

The waist measurement as measure for the visceral fat is regarded as a better statistical possibility to forecast exactly the risk to fall ill than the calculation of the body mass index or the waist-to-hip ratio. This is especially the case with thin people (low BMI) with a high waist measurement. You should also do lots of sports in this case. The good news is that if you lose weight, the visceral fat melts first - the fat under the skin melts afterwards.
  

Animals, like for example Rhesus Monkeys, become older when their amount of food is being reduced.The reason: less ingestion means less metabolic activity, hence less free radicals are built. The same seems to be true for humans. Friars and sisters reach relatively high ages.
  

They live on moderate food and have regularly fast days.
  

The worldwide highest percentage of over 100-year-olds live in Okinawa. They eat lots of fruits, vegetables, rice and fish, but little fat and meat, and never eat until they are entirely full. All this indicates that it is better to live closer to being underweight than to being overweight. However, gene variants that have been found in people of old age are also factors contributing to a high age.
  

According to a meta-analysis with 900,000 participants, persons with a BMI between 22.5 and 25 live the longest. Apparently light weighted people die more often of respiratory diseases and lung cancer, all the more if they smoke. However, those seem to be dangers that, apart from respiratory problems, can be avoided easily.
  

In addition I refer to Spektrum der Wissenschaft, issue 4/08, page 16 where it says: "A true holdup of the ageing process could emerge from the scientific approach of a reduced-calorie diet. For decades scientist have been testing this process on animals. In the case of all tested species, including monkeys, on average those animals that get at least a third less calories than they would take in by their own choice die later and stay healthy for longer - provided that they get the nutritients required for the bodily functions. It is assumed that such a diet would have a similar, life prolonging effect on humans. Therefore biologists now examine those metabolic mechanisms that are the basis for this effect. The scientists then want to imitate this, so that humans can benefit from their impact, without being forced to go hungry."
 

2.1.2 Reasons for gaining weight
   

Here I quote first of all from the brochure of the Landesseniorenrat Baden-Württemberg: "Verbraucher 60+ Aktiv und Selbstbewusst": With increasing age we use less energy and therefore we automatically gain weight if we maintain our lifestyle.
 

The reason for this is that the metabolism is changing with the age and gets slower. Furthermore, muscle and bone mass decreases and the body fat percentage increases. Those changes have an impact on our energy demand. Therefore we need less calories when we rest of when we are active, as our muscle mass has decreased. At a higher age our body also needs less energy to keep up its vital functions."
 

It has to be added that in time a hypothyroidism can develop, which can, however, be easily treated.
 

Some people eat more when they are stressed, bored, frustrated, when they feel lonely or when they are grieving. If this is caused by the death of a beloved person, you should rather join self-help group, write down the experiences you had together, entrust your grief to a diary, go outside into the nature, intensify your friendships and relationships with relatives and search for internet forums where you can get it off your chest (you should do the same if you are heartbroken or similar).

A lack of sleep causes particularly people between 16 and 24 years of age, and especially women, to crave for sweets and fat snacks.
 

Ask yourself what usually causes your attacks of ravenous appetite, and avoid these situations. Consider beforehand what you can do during an attack of ravenous appetite in order to take your mind off things, instead of pitching eagerly into something eatable. Instead you could call someone, read an exciting book or watch a video, do some exercises from my gymnastics programme (see below 3.3.2), drink a glass of water to fill your stomach temporarily or eat

- in small pieces a slice of wholemeal bread or some wholemeal zwiebacks; you really can take five minutes to eat a quarter of a slice or a zwieback, if you only take small pieces

- a quartered wholemeal cookie, one quarter after another

- quartered meat balls (turkey)

- one almond, one peanut, one dried banana slice or one cranberry after another (see above 1.3);

- fresh vegetables cut into pieces, for example cabbage turnips, carrots, cauliflowers or peppers (see above, 1.7)

- a dried black olive and move its pit in your mouth until it doesn’t taste like olive anymore,

- a half of a dried cherry tomato, which you move in your mouth until it doesn’t taste like tomato anymore

- chew a sugarfree chewing gum or eat a sugarfree bonbon.
  

The ravenous appetite will probably soon abate and you will have the vitalising feeling of having gained a victory over yourself.
  

Attacks of ravenous appetite can, however, also be morbid (binge eating disorder). If this is also the case with you and if you, nevertheless, cannot overcome your hunger attacks with the tips described above, you need psychiatric or psychotherapeutic help.

A person who sleeps too little becomes more easily fat, maybe because he eats more in late evenings or probably since the nightly release of leptin, which regulates the metabolism and blocks the feeling of hunger, is reduced. Also in this case it can be said: the less you sleep, the higher the risk of becoming overweight. On the other hand, too much sleep - more than 8 hours - can also lead to overweight. Around 7 hours seem to be ideal for the shape. According to a study with 1,214 adults aged between 30 and 54, those test persons, who sleep less than 6 or more than 8 hours had 45 percent higher risk to fall ill from the metabolism syndrome (see below, 9.3.1 and 2) and therefore also to become overweight.
  

Eat slowly, because then you will have eaten less when after 20 minutes the feeling of satiety sets in, which is independent from the size of the portion.
 

Fat friends can likewise make others fat. Try to get such friends to lose weight contrariwise.
 

Overweight and obesity can also be a consequence of being a good "food utiliser". This can be due to the genes or the gut flora. For affected people there is nothing else for it but to eat even more disciplined and to do even more sports in order to replace body fat and body fluid by muscle mass and body water.
  

The same may apply for overweight caused by the adenovirus type Ad-36 (cold virus). In this respect we can only hope that there will be a therapy or a vaccination some day.
  

Hypothyroidism can also lead to overweight. However, it can be treated medicinally.
 

Inflammations of the middle ear can also cause overweight, if the gustative nerve is impaired by them. Due to this the appetite for flavour enhancers, especially fat, in the food is increases.
  

There are also drugs, which increase your weight by taking them. Therefore check the list of side effects and talk to your doctor about counter-measures.
  

2.1.3 Consequences of overweight/ obesity
  

Many people suffer from overweight. According to the National Study for consumption in 2008, two thirds of the male and more than the half of the female Germans are overweight. Roughly one in five Germans is even adipose (obese). Adiposity diminishes the life expectancy of women by up to six years, the life expectancy of men even by up to eight years. For people with a BMI of more than 40 it can even be 10 years for both genders. Physicians forecast a considerable increase in our medical costs, in case all this doesn’t change.
  

Overweight women suffer from menstrual irregularities and infertility more often than women with a normal weight.

Pregnant women that are obese have a higher risk to deliver a child suffering from a heart condition than women with a normal weight or slight overweight.
  

Make sure that gestional diabetes is detected early. It harms you and your child. You should not be content with a urine test but you should also have done a glucose tolerance test.
 

Overweight parents often have overweight kids; overweight mothers have overweight daughters and overweight fathers have overweight sons.
  

They suffer increasingly from adult onset diabetes, and all the dangers resulting from it, (see below 9.3.13), an early form of arteriosclerosis, damages on the spine, the hip joints and the feet, high blood pressure, lipid metabolic disorder and fatty liver, which can lead to cirrhosis and cancer of the liver, asthma and renal calculi. Make sure that your child will be examined precautionary, if the paediatrician recommends it, in view of the BMI of your child. In general, overweight children stay overweight as adults; as, once built, the number of fat cells remains the same for a whole life. They can fill up again, even if they have been emptied before.
  

As a result of sleep apneas (dropout of breath while sleeping), fat children are often additionally overtired at daytime and suffer from lack of concentration. In many cases their self-confidence and self-trust are disturbed and they feel segregated by other children. This may even lead to depressions. Talk to your children about a healthy diet, take them with you when you go food shopping and set an example in order that they mind it somewhere else, too. Do not force your children to finish their meal, but give them smaller portions instead. You should, however, not allow them to eat between meals.
 

Sweetened drinks are particularly dangerous for them. A portion of lemonade (330 ml) contains 40-50g sugar, which is about 10 tea spoons. You should also be aware of the fact that lemonade reduces the mineral content of the bones and harms the teeth. Give your children, apart from water, mainly sugar reduced whey or low-fat milk to drink, which both contain the calcium needed (see above, 1.9.2).
   

Children under 10 should sleep 10 hours. The shorter the sleep, the greater the danger of becoming overweight. The same is valid for teenagers who sleep less than eight or nine hours, since they then nibble more often.
  

The arteries of fat kids can already be as narrow as those of 45 year old persons. Hence such kids have a higher risk of heart attacks and strokes.
   

A person who is too heavy at the age of 14-19, has a high risk of dying early from CHD, colorectal cancer or other illnesses.
   

The main immediate problems of overweight persons are, above all, a low level of fitness, getting tired very fast, combined with excessive sweating and short-windedness.
  

The more women gain weight when they get 18 years old and older, the more they tend to get breast cancer, in addition their chance to become older than 70 is decreasing significantly. During the first pregnancy overweight often leads to premature births or stillbirths, and infants of overweight mothers are more vulnerable to diseases and they die more often. For women overweight can also be a reason for urinary incontinence as well as for unwanted growth of hair (facial hair). Middle aged overweight women suffer twice as much from depressive disorders than women with normal weight. Adiposity also reduces the efficiency of the pill.
 

Men with a high BMI or a big waist measurement (see below) have to fear diverticulitis and erectile dysfunction, have less seminal fluid and a greater part of abnormal sperms.
   

Furthermore overweight raises for adults the overall risk of arteriosclerosis, atrial fibrillation due to a dilation of the left auricle, high blood pressure, hence heart attack and stroke, diabetes and the illnesses resulting from it (see below, 9.3.13), blood clotting disorder, chronic migraine, osteoporosis, rheumatoid arthritis, arthrosis, backache, varicose veins, flat feet, bile complaint, heart burn, liver damages (fatty liver), asthma, articular gout, skin diseases, health troubles caused by heat, "Restless Legs Syndrome" (RLS), gum diseases, various types of cancer and depression.
  

If you are overweight, you should be particularly cautious with alcohol, since drinking alcohol increases the risk of liver damages considerably. Snoring can also be due to overweight. Overweight distorts the repair of blood vessels and the creation of new ones, and can also damage the renal function, in particular lead to kidney stones, cause leukaemia and enlarged lymph nodes as well as loss of brain tissue, and thus a reduction of the memory and finally Alzheimer dementia.
  

Furthermore fleshy tissue at the posterior keeps medicine and vaccines from reaching the muscle the way they are supposed to in order to be efficient. If you are affected by this, point it out to your doctor.
  

In addition overweight and all the more adiposity cause the brain to shrink. The only way to face this is to take enough exercise.
  

The "visceral fat" (intra-abdominal fat) is particularly dangerous. It encloses the internal organs, especially the digestive system in the abdominal cavity. It causes LDL and triclycerides to increase and HDL to sink. Furthermore, in contrast to the fat of hips, it produces messenger substances, which stimulate inflammations. Besides the mechanic burden it contributes to knee joint arthrosis, leads to arteriosclerosis and increases the risk of thrombosis, adult-onset diabetes and all its consequent diseases (see below, 9.3.13), bowel cancer and dementia, and for men the risk of prostate gland cancer and for women the risk of breast and uterus cancer.
      

The same is true for persons with normal weight who have lots of visceral fat.
  

Furthermore these messenger substances disturb the hormonal regulation of appetite and the utilisation of food: the usual sense of having eaten enough vanishes, the appetite increases and the body demands increasingly more food. The thicker someone is, the greater is this person’s hunger. In the end the visceral fat reduces the capacity of the lung. It can grow or shrink. The reason for its growth is a wrong diet and especially the intake of products with hardened fats (see above, 1.4.3) and probably permanent stress too, since stress hormones like cortisol activate its growth.
  

It is assumed that chewing thoroughly contributes to possible fat not sticking to the tummy but elsewhere.
    

Overweight people more often experience complications after long operations. In that case they can suffer from bedsores or they can have problems with their wound healing, thrombosis, pneumonia and even organ failure. Sometimes overweight patients even don’t fit in the magnetic resonance tomograph. There is also the problem in dosing medicine, since there haven‘t been any surveys, yet, about the right dose of various drugs for overweight people.
   

Especially overweight smokers are in danger.
  

I don’t want to comply with the opinion that fat pad is the best life insurance for elder people, since they have to "add" something in "case of illness". If someone nowadays needs to "add" something, there will be sufficient restorer at any time.
  

2.1.4 Underweight
       

However, underweight people have a particularly low risk of heart attack. This resulted from the evaluation of 40 studies by the College of Medicine of the Mayo-Clinic. And underweight is generally not dangerous, if it is not due to malnutrition or an illness and if you do lots of sports to keep the bones strong.
   

On the other hand underweight, especially in the old age, can lead to loss of efficiency, Alzheimer dementia, tiredness, exhaustion, lower body temperature, freezing, oedemata at the extremities, muscle weakness and immunodeficiency. When underweight is a result of the fact that someone in the old age eats too little - this can have several reasons -, he/ she also does not assimilate enough minerals, vitamins and secondary metabolites. This person is especially reliant on nutritional supplement (see above 1.9). In addition he/she has to do exercises for the entire body (see below chapter 3) in order to increase his/her energy consumption and therefore also his/her appetite.

In addition underweight will increase the risk of pressure ulcers (decubitus ulcers), if someone has to lay in bed permanently and can’t turn on its own (see below 9.4 keyword "decubitus ulcers").
   

On top of that, underweight will raise the risk of hypothermia and a subsequent pneumonia, if someone is endangered to fall and remains lying on the ground either because of longer unconsciousness or a fracture of the femoral neck. This person should avoid underweight by all means and should be rather at the maximum line of normal weight than at the minimum line!
   

The same is valid for persons who suffer from a cardiac insufficiency, even though the reason for this is so far unknown.
   

A young person, who is underweight, might suffer from an eating disorder. Talk to this kind of people about this. If you have parental authority, ask for professional advice of somebody.
   

For underweight women the risk of a miscarriage in the first three months of the pregnancy is by 72% higher than for others. This risk can however be reduced if the diet is enriched with fresh fruit and vegetables, respectively Juice Plus (see above, 1.7).
   

If you weigh relatively little, it is possible that your knees will ache in the morning, when you sleep on your side. In this case you should put a pillow between your knees.
   

I am not aware of other risks caused by underweight, even though underweight is often considered as dangerous by overweight persons. Underweight persons take this as a sign of jealousy.

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