Obesity paradox: obese older people live better and longer

But all this applies to centenarians over 90 years old.

Today, no one doubts that being overweight entails a whole bunch of health problems. Obese people have a higher risk of developing all known “diseases of old age” and unpleasant outcomes from them.

But still. Russian scientists from Sechenov University came to sensational conclusions by conducting research among super-centenarians. It turned out that most of them have very decent body fat.

The obesity epidemic is called one of the most urgent problems of the XXI century. According to the forecasts of experts from the World Federation against Obesity, by 2030 the number of adults suffering from various forms of obesity in the world may be about 1.5 billion (more than 25% of the world’s population). The negative contribution of excess weight to the state of health is beyond doubt and does not need extra evidence. “Getting fat means getting old,” scientists and doctors like to repeat. And yet, as it turned out, sometimes obesity can play a positive role.

The population of centenarians in the world is growing, so scientists are trying to understand their main secrets. Russian scientists from the Department of Hospital Therapy No. 2 of the First Moscow State Medical University. I.M. Sechenov of the Ministry of Health of Russia made the body composition of centenarians the object of their study in order to understand what helped them live so long.

“Aging means numerous changes in body composition,” says Svetlana Topolyanskaya, Associate Professor at the Department of Hospital Therapy No. 2 at Sechenov University. – With age, the components of lean tissue decrease; bone mineral density decreases, but the volume of adipose tissue, on the contrary, increases. Perhaps the reason is the imbalance of energy consumption and its expenditure – older people move less. In addition, there is an age-related restructuring of the endocrine system and metabolism. Due to bone loss, the risk of osteoporosis increases dramatically. An increase in adipose tissue also leads to osteopenia (depletion of bone mineral density). Reduced muscle mass, which leads to sarcopenia (muscle weakness). As we age, the body accumulates more visceral fat, which leads to the development of diabetes and cardiovascular disease.”

However, all the described changes in centenarians (people over 90) may also have protective properties. The medical literature has already described the “obesity paradox” among centenarians: it turns out that in obese people in old age, all prognosis for the future improves dramatically, compared with people with normal or reduced body weight! The optimal body mass index (BMI) associated with the lowest mortality in the elderly is considered to be overweight or first degree obesity! In other words, this is where the folk saying “While the fat one dries, the thin one dies” comes into play.

In addition, there are differences in the body composition of older people depending on gender. So, women have more adipose tissue, by definition, than men. At the same time, women have more subcutaneous fat in the lower extremities, and men have more visceral fat (in the abdomen). An important effect on adipose tissue is the level of sex hormones. Estrogen levels decline with age, and the longer a woman goes through menopause, the more visceral fat she has.

… Approximately from the age of 40, a gradual decrease in muscle mass begins in a person, and by the age of 80 its amount reaches 30–50% of the initial volumes. This increases the risk of mortality, disability, senile asthenia and, in general, worsens the quality of life. Sarcopenia leads to fractures, depression, and even insulin resistance. The reasons for the development of sarcopenia are a decrease in physical activity, a decrease in protein intake, vitamin D deficiency, a decrease in testosterone, growth hormone, a decrease in muscle blood flow, etc. “The mismatch between muscle mass and muscle function is part of the aging process,” says Svetlana Topolyanskaya. – Muscles synthesize substances myokines, which reduce visceral fat. If there are not enough of them, cognitive functions, the cardiovascular system, the pancreas and the liver suffer.

Sarcopenia is diagnosed today on the basis of a qualitative and quantitative analysis of muscle tissue (including bioimpedance studies, CT and MRI). These studies were carried out in a group of centenarians over 90 years old, who were studied by our scientists from Sechenov University. Scientists observed more than 200 centenarians (70% women) under the age of 106 years (average age – 92 years). The composition of their body was studied, primarily the percentage of adipose tissue and its content in each part of the body. Significant differences between men and women were taken into account (weight, height and bone density in men are higher; lean tissue density is also higher in them). Only one woman did not have senile asthenia; among men, such strong men turned out to be 11%.

But only 30% of centenarians had normal body weight. In 70%, it was overweight or obese was established (it concerned every third participant in the study). In women, there was significantly more fat, and more in the lower extremities. 40% had osteoporosis, but a third of the group had none at all. In women, bone mineral density in all parts of the skeleton was lower than in men. At the same time, in 72% of the participants, the indicators of the musculoskeletal index were normal. Scientists suggest that special substances are produced in adipose tissue with age that help strengthen bone tissue. “We found in the group of centenarians who have crossed the 90-year mark, a lot of people with overweight, but at the same time with normal indicators of bone tissue. We need to continue to study the obesity paradox,” Sechenovka scientists say.

Published in the newspaper “Moskovsky Komsomolets” No. 29014 dated April 19, 2023

Newspaper headline:
I love you fat