Written by Anne Jacobson, MD, MPH | Reviewed by Katie E. Golden, MD
Key takeaways:
A healthy weight for older adults is higher than it is for younger people. Too much weight loss may lead to weak bones and other health problems.
Losing weight without trying may be a sign of an illness. Or that an older person needs help with getting enough healthy foods.
Nutrition, exercise, and social support are important for older adults to maintain a healthy weight and keep muscles strong.
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Every stage of life brings change. That includes what happens to our bodies. Many people live big, full lives well into their older years. But some may find they’re doing it in a smaller body.
For some, shedding a few pounds without trying may be a welcome surprise at first. But weight loss when you’re older doesn’t mean the same thing for your health than it did when you were younger. So when is weight loss in older adults a cause for concern?
Is it normal for older adults to lose weight?
Metabolism is how fast or slow our bodies use energy. It doesn’t change much until around the age of 60. And then it tends to slow down.
If you’re eating about the same, and doing the same amount of activity, a slower metabolism often leads to weight gain. So if an older adult is losing weight instead, there might be a medical condition that’s using up extra calories. Or a person may not be eating enough to keep their weight steady.
Older adults also experience changes in muscle mass. We tend to lose muscle as we age. And the fat in the body often settles more around the belly. This process begins a little earlier for women than it does for men. But losing muscle sometimes means that you weigh less, too.
If an older adult is aiming for a healthy weight with nutrition and exercise, they’re probably on the right track. But if they lose weight without trying, or if it’s more than expected, that’s often not healthy.
Losing 5% or more of your usual weight within 6-12 months — especially without trying — may mean that something more serious is happening in the body. And even if there isn’t, too much weight loss in older adults can have other health consequences.
What is a healthy weight range for older adults?
A healthy weight for older adults is a little different than it is for younger people. Knowing your body mass index (BMI) is one place to start. Older people who have a BMI between 25 and 29.9 seem to have the fewest health complications. That’s higher than the recommended BMI for younger people.
But BMI alone won’t tell you how much of your weight is muscle versus fat. Knowing your waist size can add more to the story. For women, a healthier waist size is less than 35 inches. For men, it’s less than 40 inches.
If your waist size and BMI are higher than what’s recommended, you may be at greater risk for things like high blood pressure, diabetes, and cardiovascular disease. But a low BMI increases your risk for osteoporosis (fragile bones) and anemia. And it may be harder to recover after you’ve had an infection or some other illness.
Most people reach their highest weight around the age of 60. After the age of 70, many people lose small amounts of weight. But only around 0.2 lbs to 0.4 lbs each year.
What causes unexplained weight loss in older adults?
Maybe your weight is changing a little faster than you’re used to. Or you might be concerned about an older family member or friend. Let’s take a look at some causes of unexplained weight loss in an older adult.
Cancer
Weight loss is a common early sign of cancer. About 40% of people with cancer say they had unexplained weight loss when they were first diagnosed. Often, people with weight loss from cancer have lost more muscle than fat. That contributes to some other common symptoms of cancer like feeling tired and weak.
Problems with digestion
Changes happen in the digestive system with age. Those changes can happen anywhere from the mouth to the rectum. That affects how much a person eats, as well as how much nutrition they’re absorbing.
Changes in the digestive system that are common in older people include:
Dental cavities or dentures that don’t fit well
Weaker chewing muscles
Less saliva
Trouble swallowing
More time for food to move from the stomach to the intestines
Ulcers in the stomach or small intestine
Intestine problems like diverticulosis or diverticulitis
Constipation
Other chronic conditions
Weight loss can happen with other chronic health conditions, too. People with heart failure often lose muscle mass, which results in weight loss. The same thing can happen in people who have:
Chronic kidney disease
Chronic lung disease like chronic obstructive pulmonary disease (COPD)
Autoimmune diseases like rheumatoid arthritis and lupus
Endocrine conditions like thyroid problems, diabetes, and adrenal insufficiency
Infectious diseases like tuberculosis and HIV
Medication effects
Some medications are meant to help people lose weight. But other medications have side effects that lead to unintentional weight loss. As people age and have more health conditions, they take more medication. Some side effects from medications that could lead to weight loss include:
Changes in smell and taste
Not feeling hungry
Dry mouth
Trouble swallowing
Feeling sick to your stomach
Depression and dementia
Most older people aren’t depressed. But depression becomes more common when people have more health conditions or feel isolated. Not eating enough may be a symptom of depression, especially in older people.
Weight loss is also a common sign of dementia. Sometimes people lose weight even before noticing memory problems. Some reasons that people lose weight with dementia include:
Forgetting to eat or not wanting to eat
Repetitive actions, like wandering, that use more energy
Changes in taste and smell
Swallowing problems
Changes in hormones and metabolism
Social factors
Where and how we live affects nutrition, weight, and every aspect of health. For some older adults, social factors may affect how much and what kinds of food they eat.
For an older adult who’s losing weight and you don’t know why, it can be helpful to think about:
The availability of social support and whether a person is eating alone
Limited income that affects food options
Living with a caregiver or in an environment that gives less control over food choices
Troubles with transportation to a grocery store
Mobility or thinking challenges that make it harder to prepare food
Living in a community with limited access to nutritious food
When is weight loss in older adults a problem?
If an older adult has lost weight, it helps to take a look at the big picture. If someone has lost small amounts of weight slowly because they’re walking more or made healthy diet changes, that’s a good sign.
But fast weight loss, even if it’s on purpose, can put older adults at risk for conditions like weak bones and fractures. And losing weight without trying is always something that needs a closer look.
The first step is to try to figure out how much weight a person has lost, and over what period of time. If they haven’t been weighing themselves, ask about how well their clothes fit. Or get the input of a few family members or friends.
Then, talk with a healthcare professional about other symptoms like:
Changes in thinking or memory
Mood changes
Feeling tired, weak, dizzy, or short of breath
Changes in bowel habits or appetite
Less muscle strength
Ability to do usual activities
New body pains
A physical exam is the next step in finding out what’s going on. Blood tests, urine tests, and sometimes imaging exams like X-rays will provide even more information.
What is the best way for an older adult to gain weight?
The following steps can help you or someone you know find a healthy weight for their age.
Gather a team
If an older adult needs to gain weight to be healthy, it’s best to focus on the reason they lost weight in the first place. Besides family and friends, it helps to have the right people on a team to provide support. That might involve healthcare professionals like:
Doctors and nurses
A dietician or nutritionist
Dentists
Social service professionals
Occupational, physical, or speech therapists
Community support organizations
Know your goal
Everyone’s calorie needs are different. But knowing how much most people need can be a good starting point.
For women age 60 and older:
Not active: 1,600 calories a day
Moderately active: 1,800 calories a day
Very active: 2,000 to 2,200 calories a day
For men age 60 and older:
Not active: 2,000 to 2,200 calories a day
Moderately active: 2,200 to 2,400 calories a day
Very active: 2,400 to 2,600 calories a day
For some serious health conditions, a healthcare professional may recommend medications to boost appetite, or certain kinds of high-calorie supplements. But the American Geriatrics Society recommends against using these things for most older adults. Instead, it’s better to focus on getting the right foods and activities in place.
Focus on nutrition
A nutritionist may be helpful for some people, especially those with certain health conditions like diabetes or cancer. But there are also some tips that will benefit most people who are trying to gain weight in a healthy way:
Try foods with healthy fats like avocados, nut butter, and olive oil.
Eat small, frequent meals, especially if you feel full sooner than you used to.
Drink plenty of fluids — this helps with digestion.
Add healthy snacks between meals, like nuts, cheese, and fruits or veggies.
Stay connected with family and friends. Eat meals with other people when you can.
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