I have to admit that as strange as it may sound coming from someone who has spent his entire adult life over 300 pounds, I am eating less and less every day. The prevalence of reduced food intake (also called anorexia of aging) among seniors is a very real phenomenon. According to studies, approximately 15-20% of older adults living independently experience significant decreased food intake. The percentage rises to 30-40% among those living in assisted living facilities. The rate increases even further to 50-60% for seniors in nursing homes. Furthermore, while this phenomenon begins as early as 60 years old, these rates tend to increase with age, getting noticeable after 70 and particularly so after 80.
I recall that when I was in college and the dorms were closed for some holiday, I would stay with my Aunt Aggie and Uncle Art at their house on West Hill in Ithaca. It was always pleasant there and as a childless older couple, what they didn’t understand about kids they made up for in sweetness. When it was lunchtime, Aggie would set out three places at their little kitchen table made for two. On my plate would be something like half an egg salad sandwich on white bread and two pieces of celery. I remember it took all my 18-year-old tact to please ask for a bit more gruel after I had inhaled that small repast. She was genuinely amazed that I could eat so much. I guess at the time they were in their late 60’s and retired. They were both healthy and active, but I guess not eating so much.
The demographic patterns that have emerged are that women are generally more affected by anorexia of aging than men. Those living alone show higher rates of it than those living with family. The prevalence is higher among those with multiple chronic medical conditions, and, strangely enough, lower socioeconomic status correlates with higher rates (which would seem to be a complete reversal of the obesity correlation with lower socioeconomic class). The most obvious major contributing social factors of all this include: loss of a spouse who previously handled meal preparation, fixed incomes limiting food choices, reduced mobility affecting grocery shopping, and social isolation leading to less motivation to cook and eat. Let me be clear here, none of these factors (those some may think me as belonging to a lower socioeconomic class in general) apply to me. Kim still cooks for me, though she eats those meals less and less herself, I don’t recall ever being unable to afford food or being unable to shop for food (unwillingness not withstanding) and there is no social isolation that causes me to being unmotivated to cook, I have always said that if I had to cook for myself I would weigh 120 pounds.
The health impact on aging people of all this is significant. About 1 in 3 seniors admitted to hospitals show signs of malnutrition, which can complicate their recovery and increase healthcare costs. An analysis of food consumption typically shows changes in older adults, particularly after age 70. Appetite and food intake most often decrease with advancing age, especially after 70 for very similar reasons. There are the physical changes like decreased metabolism (my metabolism has always been as slow and steady as a freight train) and energy needs due to reduced muscle mass and physical activity (OK, probably a bit more relevant to me), reduced sense of taste and smell (probably exacerbated recently by COVID, but not so I have noticed in myself or Kim), which makes food less appealing, changes in hormone levels that regulate hunger (I’m actually glad to have a lower T level, as Steve Coogan said, it’s nice to have fewer visits from that particular idiot younger brother) and satiety and slower digestion and feeling full more quickly (a definite issue with me thanks to 19 years with a LapBand installed). Let’s not forget other things like dental issues (I have near perfect and fully functional teeth) that may make eating certain foods difficult, medications that can affect appetite (perhaps), and even something as simple as reduced social eating opportunities (well, Mike will never go to lunch with me, so maybe).
They say that this anorexia of aging situation has the effect of leading to unintended weight loss, reduced immune function, increased risk of falls and resultant fractures and generally a slower recovery from illness and injury. I seem to be in a different place on much of those concerns. I think we can all agree that I benefit from anything that causes weight loss, intended or not, and that I have enough excess weight onboard to give the medical profession ample time to figure out if my weight loss is being caused by something particularly harmful so that they can address it before I starve. From what I can tell, my immune response is very little or at all compromised yet since I seem to get colds and flu much less frequently than others. This has always been so and I tend to attribute it to my six years living in Latin America and three years in the Rome of the 60’s before hygiene was a priority. In general, I think I fought off all sorts of bad germs in those bad old days and what didn’t kill me definitely made me stronger. And then there’s the slip and fall risk. I’ve done my share of yard sale falls on the ski slopes and doing various chores and goofy things on my travels (there was the time I injured my left knee trying to mount a donkey in Spain…don’t ask), but I am generally very cautious about NOT falling. I take great care to avoid those pains. And yet, my bulk has given me the advantage of strengthening and thickening my bone structure, so that I am a long way from having a frail or brittle skeleton. It may be one of the only identifiable advantages I have ever found to my bulk other than being more noticeable than most.
But the fact remains that I do want to eat less and less and I am seeing it on the scale. I have recently lost about 25 pounds (In the last two months or so) and am quite happy so far with that outcome. In fact, I have told Kim I would like to lose another 10-15 in the next 60 days before our Patagonia cruise. I could joke that I want to be fit enough to get around the Viking World Cafe buffet quicker than the other passengers, but the truth is I want to be fit enough to enjoy the “moderate” activity excursions we have signed on for. Less weight will help and I’ve already seen a difference. On a normal day I have an English muffin with peanut butter for breakfast (est. 250 cal.), something like a small (King’s Hawaiian roll) turkey and cheese sandwich with a few spoonfuls of macaroni salad for lunch (400 cal.) and then a small rice and chicken dish, salad, curry soup or pasta dish for supper (average 750 cal.). I rarely snack at night for some lucky reason. I figure I am consuming an average of less than 2,000 calories per day (+/- 200). Based on my weight, age and activity level, I need about 3,000 calories to maintain my weight (+/- 300). At worst I have a caloric deficit of 500 calories and at most 1,500. That translates into a weekly range of 3,500 – 10,500 (average 7,000), which means I should be losing 2 pounds per week at this time. I’ve been in this place for 8 weeks, and if I have lost 25 pounds, then I am averaging more like 3 pounds a week or an average caloric deficit of 11,000 calories per week….so on the high side of my estimate. Assuming I reduce that deficit to 7,000 calories per week (wither by eating a bit more or increasing my activity level), In the eight weeks until I leave for the cruise, I should lose about another 16 pounds give or take. Let’s see how my math works out. I can tell you one thing already, just focusing on this topic is already causing me to eat less as part of the achievement game. We’ll see if that keeps up and if anorexia of aging continues to take hold.