Barefoot woman stepping up on a scale, wearing black leggings.

According to the National Center for Health Statistics, about 43 percent of women and 38 percent of men 60 and older are obese.

However, some evidence suggests that in older people, defining overweight and obesity is tricky, and a few extra pounds may be healthy.

“It’s kind of a controversial area in terms of where the cutoff points for overweight and obesity should be in older adults,” says Denise Houston, Ph.D., R.D., associate professor of internal medicine at the Wake Forest School of Medicine.

Here's the lowdown on weight as we age. 

Weighty Issues

There’s no doubt that being too heavy is harmful to health. “In the older pop­ulation, carrying too much extra weight makes many chronic conditions worse, including heart and liver disease, osteo­arthritis, and sleep apnea,” says Alexis Eastman, M.D., medical director for the division of geriatrics at the University of Wisconsin School of Medicine and Public Health.

And the higher your weight, the greater the risk of concerns such as type 2 diabetes and high blood pressure.

More on Healthy Weight

But the way overweight is typically measured—BMI, or body mass index—may not be the best indicator of health risks in older people.

A BMI of 25 to 29.9 is considered overweight, while a BMI of 30 or higher is obese. However, BMI can be misleading.

“BMI is correlated with how much fat a person has, but it’s an imperfect measure,” Houston says. For example, it doesn’t account for related factors, such as muscle mass, where fat is located, gender, ethnicity—or age.

Houston says that an older adult perhaps shouldn’t be considered overweight unless BMI is 27 or 28. In fact, a 2014 analysis of 32 studies in the American Journal of Clinical Nutrition found that the lowest mortality risk for people ages 65 and older was seen in those with a BMI of 27 to 27.9.

Other studies have had similar findings. A 2017 research review published in the journal Medicine found that obese older adults had a 6 percent decreased risk of dying early from any cause. And a 2015 study of more than 19,000 nursing home patients, published in Obesity Reviews, also linked overweight and obesity to a longer life.

Extra weight may help protect against illness or falls, or sustain an individual during hospitalizations. Being too lean may decrease your physiologic reserve, Eastman says. “If something happens, like you get pneumonia or fracture a hip, you don’t have as much energy stores to draw on, so you get depleted and can’t recover,” she says.

Who Needs to Gain?

While researchers continue to study the effects of a few extra pounds on older adults, it’s clear that being very thin—a BMI below 18.5—is risky, and those people should try to put on weight.

Appetite loss is common with age, but there are a few ways to combat that. Eat smaller meals more often and choose higher-calorie, nutritionally dense foods, such as avocado, nut butters, or whole milk yogurt. You can also drizzle healthy oils, such as olive oil, on vegetables, meats, fish, or bread.

In addition, make sure you’re getting enough protein—it will help you maintain muscle mass. By some estimates, close to one-third of older adults living independently have sarcopenia—age-related muscle loss.

Muscles help give your body structural integrity, protect joints, and maintain balance. Having too little muscle can lead to abnormal movement patterns and poor posture, which can cause aches and pains and increase fall risk. Even as you try to gain weight, stay active and include resistance training in your exercise regimen to help build muscle.

Who Needs to Lose?

Whether excess weight is harming your health depends on a few things. First, although BMI is not always the best measure, it can guide you to have a discussion with your doctor.

Next, where you carry your weight is important. Visceral fat—the kind around your midsection—is the most dangerous because it surrounds and sometimes accumulates inside the arteries and organs, such as the liver, heart, and pancreas.

“There are studies showing waist circumference may predict chronic conditions better than BMI,” Houston says. For men it should be 40 inches or less and for women 35 inches or less; measure just above the hip bones.

Last, if you’re short of breath or have pain or discomfort when you’re moving around or doing normal daily activities, your weight may be an issue. Talk to your doctor, who will review your health and family history to determine whether you should drop pounds.

Healthy Weight-Loss Rules to Follow

If you’re too heavy, losing as little as 5 to 10 percent of your weight can have a healthy impact on blood pressure, blood sugar, and cholesterol levels, Houston says. Before you try a fad diet, though, keep these essentials in mind:

Opt for real food. For most people, diet is the key to weight loss. Eating whole foods vs. processed and avoiding empty calories (such as crackers or sugary beverages or snacks) will help ensure that you’re getting plenty of vitamins, minerals, fiber, and other nutrients.

Consider adding more protein. It may help keep you fuller longer. Current guidelines recommend 0.36 gram of protein per pound of weight, but older adults may need 0.6 gram per pound to prevent sarcopenia and 0.7 gram for weight loss. (That’s 96 to 112 grams daily for a 160-pound person. A 4-ounce chicken breast has 32 grams.)

Eastman recommends working with a doctor or dietitian to find your right protein intake. Have protein—lean meats, poultry, fish, yogurt, tofu, nuts, or beans—at every meal; spreading it out makes it easier for the body to build muscle.

Get some exercise. “You have to preserve your muscle mass,” Eastman says. “Every older person should engage in some sort of strength and endurance exercise.” You may be able to find workout classes and activities targeted to seniors at a local YMCA, hospital, or community center.

Unexplained Weight Loss

If you’ve lost more than 5 percent of your weight over the last six months to a year—without trying to—always check with your doctor to rule out underlying conditions.

Cancer, diabetes, dementia, and thyroid issues can all lead to unintended weight loss. If there’s no obvious cause, your doctor will explore other factors.

“The body is programmed to seek out food, so if someone’s losing weight, there must be something else happening,” says Cary Kreutzer, M.P.H., R.D.N., with the USC Leonard Davis School of Gerontology.

“In that case, we look at a few things: Are they not eating properly because they lost their sense of smell or taste? Do they have the ability to shop and cook, and have company at mealtime? Maybe they’re depressed or it’s a side effect of medications, or maybe alcoholism is involved.”

Depending on the cause, consider working with a dietitian, who can help you plan meals that have adequate calories and nutrients.

“It may be more palatable to eat frequent but smaller meals and snacks,” says Wake Forest School of Medicine's Denise Houston.

Just remember that food quality is still important. Instead of loading up on junk food to add calories, opt for whole foods. Include fruits and vegetables—especially berries and leafy greens, which in addition to being rich in vitamins are also high in compounds that may help fight inflammation and preserve brain health. 

Editor’s Note: This article also appeared in the January 2020 issue of Consumer Reports On Health