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Forget Body Mass, Think Muscle Mass for Longevity

Quality Weight Loss


A 70-year-old lady visitor to our website was up against a catch-22. After improving her appearance tremendously by losing 43 pounds, she learned about a new study saying that older people who are overweight live longer. She  went from pleased to concerned in a flash.

Her weight reduction program was sensible eating, resistance training, brief intervals, and walking. “I’m in better shape than when I was young,” she wrote—and included a photo to prove it. At five one and 121 pounds, she looked trim and fit. Calipers put her body fat at 19.6%. She had every reason to be optimistic--and little, if any, cause for worry. I’ll tell you—and her—why.

The study she read about was published in the April 2014 issue of The American Journal of Clinical Nutrition. Researchers led by Deakin University professor of nutrition and aging Caryl A Nowson analyzed studies published between 1990 and 2013 to determine the relationship between Body Mass Index (BMI) and risk of death in people 65 and over. Surprisingly, being overweight (BMI over 25) was found not to be associated with an increased risk of mortality; an increased risk was found for those at the lower end of the recommended BMI range (20-25). Adults over 65 with an average BMI of 27.5 were found to live longest. “Our results showed that those…with a BMI of between 23 and 33 lived longer [than those above or below that range],” Professor Nowson reported. For example, death risk increased 19 percent when BMI was between 20 and 21, and by 21 percent when BMI was from 35 to 36.

You can see why our friend was concerned. Could it be that she was better off weighing 164?

An online BMI calculator revealed that she falls within the study’s BMI long-life range (23-33) at both weights; her BMI was 23 at 121, and 31 at 164. Her present BMI falls onto the middle of “normal” category for her height (18.5-24.9), while she would be considered slightly obese at 164.

Another thing she had going for her is that she reduced in a manner calculated to build and maintain muscle.

BMI is not the whole story. Professor Nowson hastened to add that advice on ideal body weight should take into account more than BMI. “Factors such as chronic disease and the ability to move around need to be considered,” Nowson explained.

Another study, by Australian researchers, publish in the February 2014 online journal PLoS, questioned the accuracy of the earlier research on the basis that it didn’t sufficiently take in account major health factors such as smoking and illness, which can leave people thinner but not healthier. Lead author Dr. Grace Joshy (Australian National Centre for Epidemiology and Population Health) and her colleagues found that overweight and obese people have a higher risk of premature death. “It is a pretty simple truth, especially given the clear evidence that the risk of cardiovascular disease and cancer…are higher for those who are overweight or obese,” Dr. Joshy said. After accounting for smoking and illness, they found that a BMI of 22.5-24.9 was the most favorable for longevity. Our friend is squarely in the sweet spot.

This should help to clear up confusion and uncertainty about the health and longevity impact of being overweight. But the best and most helpful news is yet to come, especially for those willing to help themselves.

A third study moved the matter of weight and longevity in older adults a giant step forward.

Dr. Nowson observed that “the ability to move around” is a key factor in longevity. The driving force behind motion is, of course, muscle. UCLA researchers tested the connection between muscle mass and longevity, demonstrating convincingly that relative muscle mass is very likely the key predictor of longevity. In other words, the more relative muscle mass you have, the less likely you are to die. (The detail are reported in the March 15, 2014 issue of The American Journal of Medicine.)

Co-authors Preethi Srikanthan, MD, MS, and Arun S Karlamangla, MD, PhD, associate professors at the Geffen School of Medicine at UCLA, focused on 3659 men and women between 55 and 65 or older when surveyed between 1988 and 1994. They determined how many had died from natural causes based on a follow-up survey in 2004.

Importantly, they also determined the amount of muscle relative to height—similar to a body mass index—based on bioelectrical impedance, which involves passing an electrical current through the body. Muscle allows the current to pass more easily than fat, because muscle is largely water. (See our FAQ(6) for a discussion of the Tanita bioelectrical impedance scale: http://www.cbass.com/FAQ6.htm )

They found all-cause mortality to be significantly lower for those in the top one quarter of the muscle mass index compared to than those in the bottom quarter. “In other words, the greater your muscle mass, the lower your risk of death,” Dr. Karlamangla, told Science Daily. “Thus, rather than worry about weight or body mass index, we should be trying to maximize and maintain muscle mass.”

That, of course, is what our 70-year-old lady correspondent was doing as she reduced her body weight from 164 pounds to 121 pounds. Rather than worry, she should be patting herself on the back for a job well done.

“We conclude that measurement of muscle mass relative to body height should be added to the toolbox of clinicians caring for older adults,” Professors Srikanthan and Karlamangla wrote. Importantly, they emphasized the need to look beyond weight and BMI in assessing the health risk of older adults.

And there’s more.

Quality Weight Loss

An exciting new model for healthy aging was proposed in the March 2014 Translational Behavioral Medicine  by psychologist Richard Winett, PhD, exercise physiologist Stuart Phillips, PhD, and colleagues. Bemoaning the prevalence of low-muscle-to-fat ratio in middle-aged and older adults, they take issue with the traditional focus on calorie reduction and low-intensity activities such as walking. Instead, they stress increasing or maintaining muscle mass while reducing body fat. They term this “quality weight loss.”

The new treatment paradigm includes “additional protein, higher-intensity aerobic training, effort-based resistance training, and structured physical activity.” Sounds like our 70-year-old lady may be ahead of the curve. Let’s look at some of the key details.

The nutritional focus is away from calorie counting and toward an optimal dietary pattern. The aim is to replace “energy-dense, nutrient-poor food choices with nutrient-rich healthful food choices.” Put another way, satisfying foods that fill you up—for example, fruits, vegetables, and whole grains—and provide for your nutritional needs without providing more calories than you need. Importantly, protein intake is spread throughout the day, rather than the all-too-common concentration in the evening meal. In addition to being more satisfying, this provides useable protein for muscle building and repair throughout the day.

Simple resistance training is a core component of the new approach. “Compelling evidence shows that relatively simple, brief, lower volume resistance training protocols performed two to three times a week and focusing on exercise movements that affect multiple muscle groups can provide adequate stimulus to promote strength and hypertrophy and increase resting energy expenditure for 72 hours post training,” Winett et al wrote. Read that again; it packs a lot of details into one sentence. Moreover, resistance training (separate and apart from cardiovascular training) is “inversely associated with many disease risk factors and premature death.” In other words, aerobic training no longer has a monopoly in health and longevity. Resistance training, like aerobic training, promotes health and longevity.

We now know that light weights build and maintain muscle as well as heavy weights—so long as lifting is continued to the point of fatigue. The focus is now on effort, not load.

“In practice, middle-aged to older adults can, in this manner, more safely perform resistance training two to three times a week with whole body routines taking about 35-45 minutes.” Importantly, the considerable benefits of resistance training are now within reach of just about everyone. With few exceptions, resistance training should be included in every weight loss program.

Aerobic training is also made more appealing. Higher intensity interval training (short bursts interspersed with rest periods) is suggested for just about everyone. This is in sharp contrast to the low-to-moderate intensity, long duration, steady state protocols traditionally recommended. Additionally, single set graded exercise protocols—brief warm-up followed by an up-to 4-minute work segment at about 75% of maximum and a brief cool down--have proven effective for increasing aerobic fitness. Like effort-based resistance training, these new approaches make the benefits of aerobic training available to just about everyone—replacing the “arduous, traditional long duration, lower to moderate [intensity] endurance training.”

“Such brief training would allow an entire session that also includes resistance training to only require about 45 minutes,” Winett and colleagues enthusiastically report.

That brings us to “structured physical activity.” Studies have shown that only 5% of adults meet physical activity guidelines. “Lower step counts are associated with higher BMI and more hours of sitting which has recently been shown to be associated with morbidity and premature mortality,” Winett et al wrote. Increased physical activity is an important component of programs to prevent obesity and related disorders, such as diabetes. They recommend a simple pedometer step-count program as an effective way to increase physical activity.

I can tell you from personal experience that a pedometer provides a powerful incentive to keep moving. After years of urging, Carol persuaded me to try a pedometer. To my surprise, I really like it. Precise goal setting adds challenge to physical activity. My daily physical-activity level has never been more consistent—and interesting. It’s a red-letter (and rare) day when I beat Carol.

*  *  *

I hope and trust that our 70-year-old lady friend is now back to feeling good about her marvelous transformation—and that others have benefited as well.

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