Let's be honest. You're trying to do everything right. You work out, you watch what you eat, you've been doing it for years, but slowly, almost silently, the number on the scale is creeping up. Your body composition is changing and your old playbook just isn't working anymore. It's frustrating and it can make you feel like a failure. I'm here to tell you, you're not failing, your body's just playing by new set of rules. Today, we pull back the curtain on the science of midlife weight gain. We're not gonna talk about willpower, we're gonna talk about the physiology. We'll uncover the big things that slowed down your metabolism, the powerful hormonal shifts that happened to all of us, and most importantly, I'll give you an evidence-based plan on how to take back control and keep your weight under control. Let's dive into it. Welcome back, team, to the Building Life Long Athletes podcast. Thanks so much for stopping by. I really appreciate it. If we haven't had a chance to meet yet, my name is Jordan Reineke. I'm a dual-board certified physician in sports and family medicine, and the goal of this podcast is to keep you active and healthy for life through actionable evidence-informed education. Today, we're gonna tackle a common, often frustrating experience, unexplained weight gain during middle age, especially for those who've been active and maintained consistent eating and exercise habits for years, but they're still continuing to see that creep up on the scale. We'll move beyond the simplistic advice, right, of most people say, "Eat less, move more." That's it. It's largely unhelpful for all things weight-related, but we're gonna dive into the kind of intricate, physiologic, and lifestyle changes that happen as we age and talk about how those contribute as well, and the goal here is to kind of unravel the complexities of why this tends to happen to a lot of people and give you some tangible takeaway, so let's dive into it right now. So first things first here, we're gonna talk about, do you have to gain weight as you move? That's not necessarily the question. Is it inevitable, right? Is it inevitable that's gonna happen? And this is the fundamental question, is when we get older, is this what's gonna have to happen to everyone? And the answer is kind of nuanced, right? While it's true that certain physiologic changes are universal part of aging, right, like everyone's aged, that just happens, the extent of weight gain is not entirely predetermined, right, so the aging process creates a strong predisposition towards gaining body weight, so like just getting older in itself leads you at a higher chance for having that happen. This is due to factors we'll explore shortly, but there's lots of different reasons for that. However, this predisposition does not automatically translate into significant inevitable weight gain for every person out there, that's not necessarily the case. Research consistently shows and kind of brings out that there are lots of modified risk factors that we can also impact this as well, so we can do these things and make a difference on this, so it's not like you're just destined, right? I think I'm a big fan, I'm not saying, oh, you're destined, but genes and lots of factors can play a role as well, so we have to kind of figure that out. So while the challenge increases with age, right, so it is a challenge, you're at a higher risk of that happening, significant weight gain doesn't have to necessarily happen, so that's one thing I wanna say is no, it's not like, oh, I'm just gonna give up as I age, I have to gain weight, that's not necessarily the case, but we're gonna talk why it's a little more nuanced than that so first thing first, how does this begin? It's kind of this calorie creep thing, so the weight gain most people experience doesn't happen overnight, right? People don't just wake up and, oh, I just gained 30 pounds, no, it's kind of this creep, right, over time you say, I'm just gaining on some weight here, I mean, how many times do we hear the story of, you know, back in high school, I was this way, now I'm up to here, it's 30 pounds up and I don't know when it happened, it just happened, it happens all the time and a lot of times it's kind of this, what I call calorie creep, so I kind of think this is a result of subtle physiologic changes, right, so they gradually tilt your body's energy balance equation, meaning to storing more calories and you're not burning quite as much, so that's kind of the big thing, this creates this small, oftentimes imperceivable calorie surplus, so let's just say, for example, you are, you don't know this, but physiologically you start burning less and you start consuming maybe just a little more and just a little bit, we're talking 50 to 100 calories per day, maybe, that's a super small amount, you won't notice it right away and in terms of you won't feel like more hungry, you won't feel like you're consciously eating more, doing anything like that, but the effect is cumulative over time, right? Over the months and years, this minor daily surplus accumulates, it kind of gets built and building, it translates into weight gain of, honestly, about five to 10 pounds per year if left on address, that's the big thing I see is, you know, if, as we continue to age, there's no set age range where this happens, but we see that if you continue to go, most people on average gain some weight every year, that's kind of how we do it here in the Western world, but if you just kind of slowly over time have 100 extra calories a day, that definitely starts to add up and have something we have to think about there. And another thing that we wanna talk about is slowing down, right? So the first and most significant of this calorie creep, what is playing into this calorie creep is essentially your gradual metabolic slowdown and so I do wanna, first thing I wanna say is, this is not like, see, I knew it, I knew it was my metabolism just plummeted right away as soon as I hit 40, that's not the case, you know? There's some data that actually it may not change that much until you're like in your 60s and so there's definitely some leeway here, but generally the trend is as you age, starts to decrease a little bit, but I'm saying that I don't want someone to be like, see, like that's it, once I hit 40, it's all over, no, that's not what I'm saying at all. But this is kind of the first one I talk about is gradual slowdown, so you have something called your resting metabolic rate or RMR and it's the number of calories your body burns that just rests, so just living life, so pretty much physiologic functions like breathing and circulating just like existing is kind of what I say, this is your resting and metabolic rate and it naturally declines as you get older. A general decrease of about five and you're between five and 25% in your BMR is estimated to occur across your adult life, which makes gaining weight easier even if your habits don't change at all and so let me step back there, I say five to 25%, that's a huge range, right? And then as I talked about before, sometimes you're predisposed to it and why is this happening, that's a whole other podcast, probably have a dive in a little deeper, I didn't necessarily come across that in this research, but there's some very, very different things. So, some people increase this percentage higher, meaning they have a bigger decrease in their RMR and do I know why? No, not necessarily, but it's kind of different people, but over lifetime, that's what happens and so if you start to decrease your RMR but you're doing the same thing and you're like, oh, I don't notice anything different, well, you're gonna start putting on weight and so that's kind of what I think about. To put a specific number on it, one study I looked at compared older adults to younger ones and after adjusting for differences in muscle and fat, the researchers still found that the older groups and metabolic rate was significantly lower by approximately 154 calories per day and once again, we talked about 100 calories, it doesn't seem like a lot, but you put that over years and years, that's definitely going to add up and so the first one here is kind of this slowing down of this resting metabolic rate. The second one we're gonna talk about here is this age-related muscle loss, a condition known as sarcopenia. So I just wanna put some caveats here, people always talk about sarcopenia, meaning like, oh my gosh, sarcopenia is just this frail person, technically sarcopenia means age-related muscle loss, which we all have some and the goal is to have as little as humanly possible and so when I say sarcopenia in literature, they kind of refer to it, that just means like some muscle loss as we age, I'm not saying necessarily clinical, quote-unquote definition of sarcopenia where it's affecting your daily function, you can't do things, you're really catectic, all these things, so, but that's, we'll just say muscle loss, it's interchangeable there, but it's critical to think of your muscle tissue as essentially your body's primary engine for burning calories, it's significantly more metabolically active at rest compared to fat tissue and so that's why having a lot of muscle is very beneficial. Starting at around age 30, we naturally begin to lose muscle mass at an estimated rate of about three to 8% per decade and this process really kind of accelerate after the age of 50 and so once again, after 30, we start to lose it and now I'm not here to say you can't ever gain muscle after 30, that is definitely not the case at all, you can definitely gain that, especially if you haven't done it before, but usually in our 20s and 30s, we have our peak muscle and then from there, it's kind of slowly going on and we have to fight against that creep, that's just kind of how it works and as you lose this metabolically active muscle, your body's overall daily energy expenditure goes down, this directly contributes to a slower metabolism, meaning that the same amount of food that you once ate to maintain a weight can now lead to a calorie surplus, so that's a big thing and it's just these little things you don't necessarily know, right? You won't know this, you're not like, oh yeah, I lost a little bit of muscle, so I'm gonna eat less, no, it's not how it works and so just things we have to be conscious and think about because we can't actively know this is happening. So next, moving on to the final major saboteur here, this is decreasing something called non-exercise activity thermogenesis or NEET. So NEET, that's pretty neat, I almost seen that internet video, but NEET is essentially kind of stealth calorie burning, it's kind of how I think about it, it includes all the energy you burn from activities that are not sleeping, eating or formal exercise, it's kind of how I think about it, it's things like fidgeting, doing chores or walking in your car, there's some controversy in this, some people say NEET are the things that you don't consciously do, so some people say like NEET is just like your body's fidgeting or doing whatever, but you don't know you're doing that, others say and other sources of literature that I saw, they said it was anything that wasn't quote structured exercise, so that would include like extra walking where you're just like moving and trying to get calories, standing and doing other things, so it's kind of challenging to know like a true definition, but I just wanna put there for completeness, some people say NEET is not conscious, others say there is some conscious stuff, so yeah, I don't want to make it that, but either way, what we're saying is that it's critical and we often see that it is a part of metabolism, right? So we have our resting metabolic rate, we have our exercise and we have this NEET where we're just kind of like doing little extra movements and for many individuals, this NEET can account for a more significant portion of their total daily energy expenditure than their even planned workouts, so sometimes this is more than even working out and the problem is that the research shows that this NEET tends to decline as we age, so whether it's conscious or not conscious, it doesn't really matter, it tends to decrease as we age and for instance, one study noted that elderly individuals exhibited 29% less NEET than their younger counterparts, with this reduction being mainly due to decreases in simple ambulation or just walking around, so even if you're very diligent about your workouts, an unconscious reduction in those other small daily movements or shivering or fidgeting, anything like that, that can lead to significant net decrease in your overall daily calorie burn and it's important to clarify once again that you can consciously choose to exercise more. Is that gonna count as NEET? I've seen people say yes, some people say no, regardless though, the general trend that we're seeing is that as you age, you tend to move less. Conscious, unconscious, who knows? So you could, now you hear this, say, "Okay, I'm gonna consciously move more and would that count as NEET?" I don't know, but either way, it's gonna be beneficial, understanding that, hey, as I go, I might need to increase my movement and stuff like that, so yeah, that's kind of where that is from a NEET perspective, so those are the big kind of three things that are leading to this overall increase in calories that are leading to weight gain and so it is important to understand that these three factors, this metabolic slowdown, muscle loss, and reduced NEET, they don't just add up, they have a compounding effect on one another as well, so this creates a snowball-like effect or a vicious cycle, right, that can make weight management progressively more challenging over time. It kind of works like this, and you have an initial minor physiologic shift, right, so maybe a little bit of muscle loss or you're having a little bit of, you're decreasing arm or something like that. If you decrease that muscle loss though, that leads to a decrease in our resting metabolic rate, then this slightly lower resting metabolic rate, that makes it easier for you to gain fat, and then as you increase fat mass, especially visceral fat around the abdomen, it can disrupt hormones that regulate appetite and metabolism and stuff, and this hormone disruption can accelerate even more muscle loss and promote additional fat gain, creating this kind of cycle that potentially accelerates it, so it's not just like one for one, it can kind of compound and add on together and become this vicious cycle, and so it's not necessarily that easy that oh, like this happens just a little bit and so it just starts this fury, but time after time after time over a long period of time can certainly lead to a big difference. And now we're gonna move on here, we've kind of covered the mechanical and metabolic shifts, now we wanna talk about another set of factors which can be our hormones, right? And I'm gonna be the first one to say that we don't know everything about this and that it's probably not nearly as cut and dry as people on the internet wanna make you think it is. So people will say, you need to get your hormones checked, you know, if your hormones are off, that's what's causing it. Well, that's not necessarily the case, right? 'Cause there's enormous fluctuations of hormones from person to person, time of day, all those things, and so when someone says you need to go get a hormone panel, a lot of times that's worthless advice because we don't necessarily know what your hormones should be at. People can guess and kind of have educated numbers, but we're not necessarily entirely sure about that. And so one thing I wanna step back and say, like a lot of times we'll say, you need to fix your hormones. A lot of times we fix underlying problems that will fix the hormones themselves. And so we're kind of chasing the tail sometimes, but that's just my caveat there, but we're gonna talk about that. But as we age, there definitely are shifts in our hormones, no denying that. We have shifts in our endocrine system and create an environment that is directly influencing lots of areas in your body. So first these shifts can predispose the body to store more fat, specifically fat around the organs or visceral fat, which is worse for us. Second, these hormones can make it significantly harder to build and maintain metabolically actively muscle, which we already know is crucial for our metabolism. And finally, these hormonal changes can alter the various signals that regulate our appetite and feelings of fullness. And so in the next couple of slides, we're gonna talk about specific hormones that are driving these changes. And yeah, that's what we'll kind of go into here. So first, the aging process brings significant and multifaceted changes within the endocrine system, right? So these alterations are a primary driver of the shifts we see potentially in body composition as we age, they play a big role. The most typical changes are a decrease in muscle mass and concurrently an increase in overall fat mass. That's the general thing, right? If left to our own devices aging, like that's going to happen when we lose muscle, we're gonna gain fat, that's kind of what happens. And, but it's not just about gaining fat, like I mentioned before, it's about where that fat is stored. So aging promotes a redistribution of fat with a significant accumulation of visceral adipose tissue or VAT, which is a more harmful form of fat that is stored deep within the abdominal cavity around your internal organs. So we don't necessarily want fat around our organs. Specifically, we think of the liver, like having fatty liver, having fat that's not helpful, tends to lead to way worse outcomes. And so to give you an idea of how dramatic the shift can be, some data suggests that between our third and seventh decades of life, visceral fat can increase by over 200% in men and over 400% in women. That is a lot. It's also crucial to understand that this new fat tissue isn't just passive, right? So it's not just like, oh, fat tissue just hangs out. It's actually an active endocrine organ itself, secreting hormones and inflammatory molecules that can further disrupt your metabolic health. So that's why I said all the time, adipose tissue is not inert. It doesn't just sit there and like, okay, that's what it is. No, it is metabolically active and usually it's not helpful. So that's just something we have to think about. And for women specifically now, the transition to menopause, which typically occurs late forties, early fifties, something like that, is a pivotal event marked by a significant decline in estrogen production. And this has profound effects on body composition. This estrogen deficiency is a primary driver in the increase of central or intra-abdominal adiposity. Like I talked about that visceral adiposity, the visceral fat, and a corresponding decrease in the subcutaneous fat that is stored just beneath the skin. So we tend to think that subcutaneous fat, so fat that's right beneath the skin, that's not really as harmful. We've seen in studies that doesn't necessarily have the bad effects like that visceral adipose does. So we're saying this decrease in estrogen leads to more visceral fat and less subcutaneous fat. So it's really kind of like just redistributing fat in a worse way, which is very unfortunate. There are some animal models that show that estrogen loss can temporarily increase food intake. A more significant impact though appears to be on the other side of the balance equation or energy expenditure. So there's been some research that I saw that showed estrogen deficiency promotes obesity primarily through a reduction in overall energy expenditure, which includes decreased spontaneous physical activity and a loss of lean body mass. And additionally, estrogen normally helps to suppress the formation of fat. When estrogen levels decline, the body becomes more efficient at storing dietary fat. There's lots of you don't know about estrogen and there's a lot, I don't know necessarily about hormones. This is kind of a general overview. So this is not me diving in deep, but it seems like estrogen plays a significant role and losing estrogen as a female, as you age, tends to have negative consequences for body composition. Now let's go to the flip side. Let's talk about testosterone in men. So in men, the hormonal shift involving a slow decline in testosterone levels, some people say decreases about 25% between the ages of 25 and 75. So low testosterone levels though are directly linked to unfavorable changes in body composition, including decreased muscle mass and strength and an increase in central body fat. Once again, just like estrogen, not the changes we wanna see. And this is because testosterone plays a critical anabolic role by stimulating muscle protein synthesis. This is why people take anabolic steroids and they take testosterone 'cause it helps you build muscle. However, there is significant debate in the field about this. So some evidence suggests that in many men, it's not necessarily aging that decreases your testosterone, but kind of accumulating coexisting conditions, specifically obesity. And these are the main drivers of testosterone decline. So some people say, as you get older, testosterone going down, like guaranteed. Others say, no, it's because of these other changes we talked about as you accumulate adiposity and fat, that leads to lowering testosterone. So that's kind of how it goes. But does suggest that for many men, addressing obesity through comprehensive lifestyle changes may be the best strategy for supporting healthy testosterone. I 100% agree with that. If someone comes to me and we're not doing any of the big rocks saying, hey, I'm not exercising, not sleeping, my diet is garbage. I'm not gonna just gonna start with testosterone. I'm gonna say, hey, let's try to work on all these things. And we might lose weight and our body composition improves and our testosterone improves as well. So that's kind of where I always start thinking about lifestyle changes first. But that is just interesting to note that if we have a decrease in testosterone, whether it's from just a primary decrease or from some other cause, that may lead to unfavorable body composition changes. And so kind of hopping on that, another significant hormonal shift we see that affects both men and women is the decline in growth hormone, which is normally secreted from the pituitary gland. And this kind of is called somatopause. So this decline is quite dramatic. Growth hormone secretion can diminish by much as 50% every seven to 10 years after a person goes through mid puberty. So if you're watching this, you're probably not in puberty. And so surprise, surprise, our growth hormone's probably going down male or female. It definitely happens. And this reduction in growth hormone is directly correlated with an increased percentage of total body fat, visceral fat, along with decreased muscle mass and physical fitness potentially. And I'm the first person to say, it's not like once again, oh, you're screwed. Like that's it, you can't have it. No, you can have really high performing people, be really fit, have lots of muscle. This is just the general trends that we see. And growth hormone has a natural lipolytic action, meaning it helps promote breakdown of fat. Therefore reduced levels of growth hormone with aging may actually contribute to both decreased energy expenditure and increased fat storage. And it's worth noting though, that the role of growth hormone is complex, right? And growth hormone therapy is not necessarily something you see. We see testosterone therapy, we see estrogen therapy. We don't see people, a lot of people on growth hormone. We typically think that more from an anabolic steroid perspective. And so it's not necessarily one you'll see out there prescribed very commonly. There's concerns about safety, efficacy, the right dose, all that stuff. But once again, I'm just painting this picture of what happens to your hormonal milieu as you age. And moving on here, we're gonna talk about next, we need to discuss the primary stress hormone cortisol, right? So people talk about cortisol all the time, talk about cortisol, they talk about adrenal fatigue, all these things. Well, kind of, that's a whole other topic. We can talk all about that. But aging is definitely associated with alterations in cortisol secretion. So usually as increases in late day. So you normally have cortisol increasing as you go late in the day and evening concentrations, you have an alteration in those things as you age. Chronic stress may also lead to elevations in cortisol as well. And this elevation in cortisol may lead to negative effects on weight and body composition as well. The question is, are there actually clinically significant changes in cortisol that you can measure with like saliva tests that people will claim? That's a whole another debate and topic. And once again, probably different podcast, but we do know that cortisol can impact your weight. Absolutely. Can increase your appetite potentially, may lead to more cravings for higher calorie comfort foods. And it can also lead to muscle breakdown or catabolism, which directly counteracts our effect to maintain metabolically active lean muscle tissue. And so cortisol definitely can play a role. How much of an increase actually happens? That's up for debate. Can you detect it clinically in a lab? That's also up for debate, but this hormone undoubtedly plays some role. In what would be a discussion on weight gain without talking about insulin, right? This is a big one. So with increasing age, whole body insulin sensitivity is often demonstrably reduced. So definitely decrease as we know that as you age, you are less insulin sensitive. And the state, once you get to the point where you can't really handle it as well, and you can't handle sugar, you get become insulin resistant. And that can be even before you get diabetes, right? So I think of insulin resistance as a spectrum. So first year when you're a kid, you can just gobble up anything and your body can handle it, no problem. And then on the way in, we have type two diabetes where you're insulin resistant to the point where you pretty much are really struggling to get glucose in your cells. And then insulin resistance, you can still be insulin resistant before you get to diabetes. So that's really important to know. And usually insulin resistance is driven by several factors we've already discussed, including increased in central body fat, progressive decline in skeletal muscle mass, all those things. And insulin resistance has direct and negative impacts on your body composition, weight reduction, all those things. It definitely impairs your glucose uptake, we know that. And that's not helpful. And for lots of different things, we don't have sugar floating on the blood and more than we need it. That's for sure, we need sugar, but not too much. And yeah, what happens though, is if we can't take it in our cells, it can shunt to the liver where it can be converted to fat. And so insulin resistance directly promotes lipogenesis or the creation of fat. And this topic of insulin resistance is a complex enough topic for a literally like entire season of podcast episodes. There's people who talk about these for hours and hours, but the key takeaway for our purposes is that, yeah, the entire state contributes to positive energy balance. So all of these hormones, we have insulin, we have cortisol, we have growth hormone, testosterone, estrogen, all those things, you know, that in terms of other changes that we've had leads to this increased positive energy balance, making weight gain significantly more likely. So just this is stacking the deck against you a little bit. Once again, not to the point where you're screwed by any means, but we have to work maybe a little bit harder. And so now I just wanna talk about real quick, we understand there's why this is happening, right? From a metabolic and hormonal perspective, why weight gain happens as age, we get that. But now why does it matter? And gaining excess weight in life, especially in the form of abdominal or visceral fat goes beyond cosmetic concerns, right? A lot of people, it's very valid too, if there's like, hey, I don't like how my body looks, that is very reasonable to have concerns about cosmetic conditions, but there's other things as well. Increased adiposity elevates the risk for a wide spectrum of chronic diseases that can impact your overall health and quality of life. And yeah, I just want to talk in general about what this can do for you, 'cause we have lots of podcasts material all about this. But yeah, I wanna talk about how we can focus on health span as well as not necessarily lifespan. So the goal isn't to live longer, but how do we have a longer but healthier life at the same time? And as we age, our body composition undergoes significant shifts, right? Even in the number on the bathroom scale, if it stays the same, if you're always at the same weight, your body composition can change. And the most prominent of these changes are a decrease in muscle mass and increase in fat, like we talked about. But because dense muscle tissue is often replaced by less dense fat tissue, your BMI can be a misleader when we're talking about your health risks. And so that's why once again, I've talked about B time and time again, that BMI is not the best thing in the world to use, but it can be a misnomer if you're staying the exact same, it can not necessarily show the whole underlying picture of what's going on. So what can lead here? If you kind of, you're tracking your percentage of weight change over time and consider it a better indicator of what you're losing. So if your body composition is good and let's say you're losing primarily fat mass and you're checking your waist measurements, things like that, and that's like a better indicator necessarily than just BMI. But yeah, that's what we wanna talk about. But as you age, you lose this muscle and you gain fat, and this is a particularly dangerous condition if it goes too extreme, we can lead to something called sarcopenic obesity, which represents kind of a double trouble for your health. It is where you have low muscle mass and strength. So like true clinical sarcopenia coexisting with excessive fat mass or adiposity, and that's awful. And usually this is often characterized by a vicious cycle where muscle loss and fat accumulation reinforce each other, leads to chronic inflammation, insulin resistance, all these bad things. And yeah, and people with sarcopenic obesity have a substantially higher risk of adverse heart and all outcomes really, any adverse health income outcome, really, I'm sorry, comes to that there. So compared to people who have just sarcopenia or obesity, they both have increased risk, but if you combine them and you have sarcopenic obesity, you have an even higher risk unsurprisingly. And as I mentioned, there's lots of issues with excess weight gain. So I've detailed podcasts all about these things, talked about these ad nauseum. You know, we talk about the risk of cardiovascular disease, type two diabetes, musculoskeletal disorders, certain cancers, diminished quality of life, all those things happen. But I just wanted to mention them here, at least for completeness. And crucial point on these goals is when we talk about the benefits of weight stability, this is primarily for individuals already at a relatively healthy body composition, right? Sometimes we'll say the goal of aging is to maintain weight neutrality, not have it creep up over time, kind of keep a same baseline level of weight. But it's only for people if you have a healthy body composition. If you have lots of obesity or struggle with obesity, then we're not gonna say, "Hey, like that's fine, just stay at that weight." No, we still wanna get you down to a healthy body composition. So that's the biggest thing. Gradual, intentional weight loss can be helpful in that situation. But otherwise, if you're in a otherwise normal spot, what we wanna think about is, "Hey, do we wanna increase weight?" Probably not necessarily necessarily leaning, adding lean, body tissue, or do you wanna lose weight? Definitely not if it's a lot of muscle, maybe if it's excess fat. So that's just something to think about. You'll hear in the aging advice, like, you know, keep a neutral weight. The big thing is that we wanna avoid just avoid large unintentional weight changes. That's kind of what we're looking at there. But as I mentioned before, cardiovascular disease, type 2 diabetes, all those things are linked there. Even musculoskeletal disorders, right? So weight gain is strongly linked to osteoarthritis, especially of the knee. And critically also, significantly increases the risk of falls, which are a leading cause of injury and loss of independence in older adults. And so lots of reasons why we wanted to do that. But beyond even these specific diseases, perhaps the most profound impact of later life weight gain is in a person's day-to-day function, overall quality of life. But time and time again, it shows in the data that people will have a decreased quality of life when they have increased adiposity. And so we're trying to tackle that as well. And I do wanna talk specifically a little bit about that. So this does bring us to a crucial concept that emerges from the research, which can be called the disability over death dilemma. Now, this is kind of where it gets a little nuanced as well. So there may have been data you've seen suggesting that people with a higher BMI, it's sometimes linked with better survival in older age. And research definitely acknowledges this, noting that the direct link between obesity and life expectancy may lessen in the oldest age groups. So this is likely though, because unintentional weight loss and a very low BMI can be signs of frailty and underlying illnesses. So what I'm saying here is there's some data showing that people with higher BMIs tend to quote, live longer. A lot of times what this is saying, they're comparing it's lower BMI and these people with lower BMI have this sarcopenia, right? They have no real muscle mass. They have other conditions that are leading to kind of a small BMI. So it's not necessarily the same. So I do wanna say this should not be misinterpreted as the reason to aim for obesity, right? Say, oh, like if I have a higher BMI and would live longer, that's definitely not the case. The data consistently shows that while life expectancy may not change necessarily within a slightly elevated BMI, the number of years lived with this stability increases dramatically. So the goal is to have a healthy, stable body composition to yeah, with adequate reserves, but not a high BMI and you'd excess fat. So the way I think about it is people who have more reserve are people who have muscle tissue, who are fit, have a good VO2 max, all those things. If you have a good reserve, that's probably protecting you much, much more than just a number on the scale or your BMI level. We just happen to see that people who have a higher BMI tend to have a little bit higher chance of survival. But once again, that's more for me, I think if you're very low, that is probably a sign of underlying conditions, whereas you're high, it's just kind of have a little more reserves. But once again, long-term, those people with excess adiposity tend to have decreased quality of life outcomes. And to put a number on the disability risk, one study that I looked at of older women found that those with class one obesity, which is a BMI between 30 and 35, essentially had 3.2 times the odds of a mobility disorder by the age of 85, whereas class two obesity, which is BMI of 35 to 39, they essentially, those odds jumped up to 6.6 times higher. And so for most active individuals, the primary concern of weight gain should be therefore shift from whether it will shorten your life to whether it will diminish the quality of life that you have, your independence, all those things you wanna do. So that's another thing. I think a lot of times people are like, okay, cool, heart disease, Jordan, you're talking about that again. No, like quality of life really matters as well. So I wanted to mention that. And so now we've been through the understanding of the challenges, right? It's time to kind of pivot two solutions. Despite the inherent age-related predispositions we've discussed, significant weight gain is not an inevitable thing. You're probably listening to this and be like, oh, cool, Jordan, something to look forward to, or like, hey, I'm in that age range, I'm screwed. No, that's not the case at all. The extent of these changes and their impact on your health are highly modifiable, right? So knowledge of these mechanisms allow us to develop targeted and effective strategies to fight this off. So this section here, we're gonna focus and turn that knowledge into action. So first things first, from a dietary perspective, right? So to streamline our discussion, here are the most important dietary strategies for active individuals maintaining age-related body composition changes. So there's not a lot of changes here. From a general healthy pattern, like nothing's gonna be straight from here. It's not like you managed to become 40, 50, 60, 70, and it's like, oh, this drastically changes, but this is just some considerations we have as we age that might be a little more important than when you were a little younger. And the first and most important thing is to prioritize protein, I feel like, in our diet. So as you age, we have that chance of increasing our, I'm sorry, decreasing our muscle mass, so increasing the rate at which we lose it. So to fight that off, resistance training is super important. We'll talk about that, but also having enough protein. So recommendations from different varying bodies, say anywhere from 1.2 to 1.6 grams of protein per kilogram of body weight is often recommended. You'll see numbers go higher than that even if you're truly trying to maximize hypertrophy. I've seen people go up to 2.3 grams per kilogram. Regardless, the thing I'm trying to say is prioritize protein, that should be helpful. And on top of that, we should be focusing on nutrient density. So as overall caloric needs decrease with age, meaning you have lower resting metabolic rate, all that stuff, it becomes really important to choose foods that are packed with lots of vitamins and minerals, like fruits and vegetables and whole grains if you eat them, to ensure you're meeting your nutritional needs, right? So if you have unfortunately less empty calories to afford. So as you are aging, you just can't eat empty things anymore. You wanna make the biggest bang for your buck, which are these nutrient dense foods. And third on top of that, we want you once again to embrace healthy dietary patterns. I've talked about all the time, the biggest thing is a dietary pattern. So rather than focusing on a single nutrient, adapting an overall healthy pattern, some examples may be Mediterranean diets or dash diets or what have you, but the big thing is they are full of non-processed and whole foods, right? Lean proteins that provide you with enough protein and yeah, overall it's consistently shown time and time again be helpful with weight management. And the last thing that I'll mention is hydration. So the sense of thirst can diminish as you age, making dehydration more common. So sometimes the body can misinterpret thirst signals as hunger and so ensuring adequate fluid intake is important. We see this a lot in our elderly where they don't drink much, they get dehydrated and they visit me in the hospital and they have lots of issues that have fall or their electrolytes are off or something like that. And so I'm not saying that once again, as you turn forward, you're like, oh no, I don't have this. But as we age, that may be something to think about that. We wanna make a more conscious effort of hydration. I usually don't say you have to go nuts on hydration. I'm not usually that person to say like, oh, this is super, super important all the time. I usually say, just listen to your cues, but as you age, you may have to be a little more proactive about that. And so next talking about resistance training exercise, what should we do? So for older adults, the most effective exercise program is a comprehensive one and it kind of combines a bunch of different things. So the first thing that's non-negotiable is resistance training and this should be considered kind of the cornerstone of everything. It's the most direct and effective intervention to combat sarcopenia, build the metabolically active tissue and support your resting metabolism. So the general recommendations is to train all major muscle groups at least for twice per week on non-consecutive days. So once again, these are just the physical activity guidelines. I talk about them all the time, but we should be resistance training at least twice a week. And on top of that, we should be doing aerobic exercise though, right? It's vital for, you know, we do get, we burn calories from there, but improves your cardiovascular health, your fitness. And we know that that's just very, very helpful for many things. And the guidelines, like we talked about again, 150 minutes of moderate intensity per week or 75 minutes of vigorous. And third, I think it's important to discuss flexibility and balance in this age group specifically. Now, normally I don't emphasize these heavily. You know, I say resistance training, aerobic, those are the big, big things. And if you only have time for those, do those, like do not do flexibility and balance over those. I think this is a bigger bang for buck. You'll get some balance and flexibility doing full range resistance training things. So I'm not saying that, but for older adults, balancing exercises might actually become more important, specifically more preventing falls and which are kind of a leading cause of injury and morbidity that we talked about. And flexibility may kind of help as well. It may help maintain those ranges of motion you need for everyday activities. Like I said, a lot of these things you will get from resistance training, you will get stronger. And I think strong being strong is the most important thing for preventing falls. So once again, if you had to choose one, do that, but it's kind of a combination of those things and really putting them all together, you should have a well thought out resistance training program. And that's just kind of what it always comes out to, right? Like you shouldn't just do a bro split where you're benching every day. I literally had a resident of mine the other day. It was awesome. He told me that in high school, they benched every day and whatever they could fit in, they just did more of that afterwards. And I was like, oh my gosh, that's the worst thing I've ever heard, but we want to have a balance, right? So that's general, you know, strength and conditioning. We have shav aerobic. We should have resistance here. We can mix in flexibility in a potential balance as well, but just having a good overall plan. And now even with this action plan here, you might find that losing weight or preventing gain kind of feels harder than it used to be, or just can't do it. Right. It's just this, yeah, that you might be discouraged and I didn't mean for that to happen. I just want to be aware. Right. So if we know a problem is coming or we know an issue, then we can tackle it. So yeah, it's, but I do also want to give some validation that there is some credence to this where people say, man, I just feel like I can't do it anymore. There is some physiologic changes that are happening. And it's important to understand that these hurdles though, are, are here and are overcomeable, right? So you can get over them and can happen. So we're going to talk about a couple of hurdles here that may happen as you age and to think about. So first things first, a common feeling that shedding excess weight becomes progressively more and more difficult with each passing decade is accurate. Potentially it's rooted in this physiologic response as well. How much does it happen is different for each person. So some people may not have an issue until they're later in life. Other people may happen earlier and that's okay. But what happens is your body responds differently to this. So there's a response called metabolic adaptation or adaptive thermogenesis. So to step back and understand this, we first have to know what's normal. So when you lose weight, your metabolism is expected to slow down slightly, right? Simply because a smaller body requires fewer calories to maintain itself. So, right? So as you lose weight, you will decrease your resting metabolic rate because there's less of you in a smaller person requires less. However, metabolic adaptation is an additional metabolic slowdown that occurs on top of that normal, predictable drop. It's your body overreacting to the calorie deficit and becoming extra efficient to conserve energy, almost like a survival mechanism against famine. Obviously you're not going through famine, you're doing, trying to lose weight, but that can happen. And one study looked at and that was involving older women demonstrated this perfectly. So they lost a very little weight. So their metabolism should have only dropped by a very small predictable amount. Instead of their resting metabolic rate decreased by a much larger than expected 94 calories per day after 32 weeks. So it kind of showed this extra slowdown of adaptation. This adaptive responses by weight loss, plateaus are a common thing and why maintaining lost weight can be very challenging as well. Your body's actively working against your efforts and slowing down your metabolism more than should. Once again, I'm not just trying to scare you, but I'm saying these are plateaus and hurdles that we could have as we age as to why it's becoming more challenging. And then hurdle number two, I do want to talk about here is potentially medications. A lot of older adults are managing other chronic health conditions and they take medications and these prescription medications may have implications when it comes to weight gain. And some of the most common classes include certain diabetes medications like insulin and sulfonylureas, older beta blocker medications like a tenolol, specific antidepressants, and of course, oral cortical steroids like prednisone. Those are not ideal. And the issue also, this can be amplified by a concept we have called polypharmacy. We talk about medicine. It's the cumulative effect of several drugs that cause modest weight gain or other side effects. So polypharmacy can mean you can have, you know, falls or delirium or issues. Essentially it's just multiple medications interacting together, leading to something worse. And so if you are on a medication and you're like, man, could this be contributing weight gain? You know, there's a couple of things I want you to do. First is not just, don't just stop medication. Please don't just stop medication. Cause you heard some dude on the internet tell you, talk about this. So I'm just something to do with the internet to you. I'm not your doctor. Do not stop that. It can lead to lots of issues and I don't want you to do that. Instead, bring it up with your doctor, right? Talk to them. In many cases, there may be alternative medications you can have or a lower dose or something like that. But either way, regardless of any medications effect, continuing to focus on your diet and exercise throughout this whole process is going to be paramount and super important. And so finally finishing up here, I want to wrap it up. Let's summarize the most important actionable takeaways from our discussion today. So first I do want to acknowledge there is a potential shift going on. So due to underlying physiologic changes that we've discussed, the diet and exercise routine that's worked for you in your younger years may not be enough to prevent weight gain anymore. Adaptation is necessary, right? That's the big thing. People are like, oh, I used to, you know, run a mile three times a week, can do some pushups and sit ups. And now I'm gaining weight. What you did previously may not work anymore as we age. Something we have to think about. As we age, I then want you to prioritize protein and muscle. So make resistance training a non-negotiable part of your routine, taking back muscle loss and support your metabolic rate. Pair this with a protein rich diet and we're doing all you can to help support your body's muscle health. That's important. Third, and once again, comprehensive exercise. We definitely want that resistance training, but also aerobic exercise, potentially balance exercises for falling as well. And then fourth, I want you to focus on body composition, not just weight. So I don't just want you to focus on the scale. Your goal should be to build and maintain muscle or reducing harmful visceral fat, which is a much better indicator of health than the number on the scale. And finally, I want you to be proactive advocate for your own health. So this means regularly looking at your medications you're on, talk with your healthcare provider about that, you know, making sure you have goals and outcomes you want, having an overall good plan. And that's kind of what I think about. And so my takeaways from this whole thing is that this is something that increases your risk of gaining weight as you get older. It's not a guarantee, as I mentioned before, but it certainly does lead to an increased risk. Like most things, just because you have an increased risk of X, Y, or Z, doesn't mean you have to let that happen. So the biggest things like I always preach I'm boring. Like my nothing I tell you is like groundbreaking, right? Exercise, stress management, eat well, sleep well, all the big things, maintain your risk factors. Those are the big things for aging, but specifically in this population for trying to keep our weight at a healthy body composition, we really, really want to prioritize our exercise and being conscious of that. Hey, you may have to shift how you eat a little bit because your body doesn't need as much anymore. So maybe you could get away with that, you know, treat every night or that alcohol every so often or something like that. You may differ as you go, as you increase in age. Now, if you're saying Jordan, you're taking away all my, my fun, I'm not going to do that ever. Well then that's fine. I just want you to be aware of things. You're an autonomous adult. You can do what you want. I'm never going to tell you what you have to do, but just think about as we age, that may be going on. And you may ask Jordan, what age is this? I can't give you an answer. I would say based off of what I've seen, it's certainly not this like, oh, I turned 30, 40, 50. It's automatically there. As I mentioned, it's kind of over lifetime of things. I think a lot of times, if you were to have an honest look compare high school self, which everyone's like, I was this at high school, high school is so different, but anyways, compare your high school self to what you are now, how much more activity did you have as a high schooler? Were you walking to classes? Were you involved in multiple sports? Did you do all those things? And then compare that to your 50 year old self, where you are sitting in your car to work, sitting at work, coming back, maybe working out for a little bit of time. It's just one of those things. I think if we had to think about it, it's less of, you know, my hormones being way off. Like that's, that's the culprit of it. And you know, and that's why I don't want to use it as a scapegoat. It's possible. And there are physiologic mechanisms for why that may happen. So I'm certainly not saying it can't be hormone related, but I think if you really to think about it, it's probably the fact that we're moving less and the way we eat is probably not as, as whole in terms of the, the, the nutrition we had there. Maybe that's not true. I think if you lock in those two things, the majority of these issues will probably go away without worrying about, you know, getting expensive, you know, hormone labs or taking crazy treatments or supplements or what, anything like that. And so that's just my two cents to take them for what they're worth, but that's kind of it. But in conclusion, the tendency to gain weight with age is a complex issue driven by lots of physiologic changes, social changes, psychological changes, all that stuff. And so biggest takeaway is I just want you to know that I just want you prepared, right? Have an understanding of what may be happening and just, yeah, be ready for it. And that's kind of where I, where I wanted to leave this. But if you did find this helpful, it'd mean the world to me if either like this video or subscribe on YouTube or your podcast platform of choice. And if you did find helpful, sharing with a friend would be like the greatest compliment for me, I really appreciate it, but thanks for stopping by. Now get off your phone, get outside, have a great rest of your day and we'll see you next time.
