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Dear Mark: Too Late for Health? Never.

For today’s Dear Mark [1], I’m answering just a single reader question, but it’s a big one. Janice and her husband have endured their family’s light-hearted ribbing about their “caveman lifestyle” for years. Now that the paterfamilias of the clan is severely obese, almost 80 years old, and recovering from a relatively mild stroke, the family has turned to Janice’s expertise for help changing his ways. How can she convince her father that it’s never too late to get healthy? That changing your diet, exercise, and lifestyle can improve even the most unhealthy person’s trajectory and enjoyment of life? She’s confident that if she can just get through to her dad, the rest of the family—who also needs an intervention—will inevitably follow suit.

Let’s give it a shot:

I am looking for information/inspiration to share with my 77 year old father who thinks it’s too late to try and be healthy. I’m not expecting a miracle weight loss story here, however I will not forgive myself if I don’t at least try. Here is our (my 2 sisters our spouses and his 3 grand-daughters) challenge in point form about my (our) father:

– 5’9″ frame approximately 380lbs (I may be low here)
– all blood work comes back (suprisingly normal) but I do not have the details.
– had a stroke 2 weeks ago that luckily left him with nothing but short term memory issues.
– very defensive about his weight, therefore difficult to converse with.

My husband and I have been followers of yours for 4 years and have been “teased” by our family members for our “caveman” lifestyle up until now – now they believe that we should try and share our knowledge to help dad. Even though we have tried to lead by example (all of them overweight and very inactive) none of them have really given us the time of day to share our knowledge because we are “lucky to have that metabolism” and being “fitness freaks” will “do that to ya”. My husband and I are okay with that. At least they are paying attention now.

I would like an article that will give him information that will support losing weight and being active at any age will make a difference. I have read 2 success stories in the past that I had actually forwarded to him (previous to this stroke). One of a woman, perhaps in her 80’s and another of a man I believe in his 60’s. Neither one sparked any conversation with him.

I honestly believe that if I can help my dad live healthier then it may inspire my whole family to jump on “the band wagon”. Something that would make both me and my husband the happiest people in the world.

Any and all article suggestions would be greatly appreciated.

Thank you for your time and consideration.

Kindest Regards,

Janice

Hats off to you, Janice. You’re undertaking the most noble pursuit of all in my opinion. You’re directly contradicting the most pernicious conventional wisdom around—that old folks are going to wither away and die, and they they should simply accept this “fact,” preferably while dozing in front of bad TV at 2 o’clock in the afternoon. We know, and you know, that life doesn’t end after 80. It’s never too late. And this isn’t just inspirational fluff I’m talking. A vast body of research confirms that seniors can and do benefit from healthy lifestyle modifications.

The good news is that your father is likely “obese but metabolically normal [2].” Obesity usually comes with sky-high inflammation, poor metabolic health, bad lipid numbers, and all other kinds of dysfunction. If your dad is 380 pounds but has normal blood work, he probably has a lower baseline level of inflammation than most other obese people and should respond well to lifestyle modifications. What should he do and what evidence exists that it will help?

He’s got to start lifting heavy things. Older folks need strength training more than younger folks, simply to maintain their quality of life and freedom of movement [3]. It’s the most important type of exercise for this population because lean mass is the single best predictor of mortality risk [4] in seniors. Not BMI, not some specific nutrient or superfood in your diet, not whether or not you meditate every day or practice gratitude or visit the doctor regularly. Lean muscle mass [5] keeps you young and hard to kill.

Okay, but surely it’s too late for a guy in his late 70s to build strength or muscle?

Nope. Multiple studies show that seniors (of both sexes [6]) can build muscle with resistance training [7]. Resistance training can also help seniors lose fat while, most importantly, preserving or even adding muscle. This is key. Your dad wants to lose fat, not “weight.” Resistance training even helps older adults target “hard to reach” visceral fat [8], the kind that sticks between organs and wreaks metabolic havoc.

Strength training [9] even makes dieting more effective. For instance, seniors who lift weights enjoy better skeletal muscle insulin sensitivity [10]. Higher muscle insulin sensitivity is linked to improved lifespan and better carbohydrate metabolism (since the carbs you eat have a place to go—the muscles).

Now, strength training can intimidate the uninitiated [11]. He might pick up a copy of Body By Science [12], a system revolving around the safest, most effective, most “bang for your buck” exercises. Its author, Dr. Doug McGuff, contributed a guest post about safe strength training [13] some years back. Read that and you’ll have a good foundation for your father’s training. Whatever you do, consider finding a trainer who specializes in older adults, at least until your dad gets his sea legs.

Walking [14] is also crucial. For one, the ability to walk briskly presages a longer, better-lived life for seniors. One study [15] of nearly 40,000 recreational walkers found that walking intensity predicted mortality risk. Those who walked the fastest tended to die the least. Of course, this wasn’t an interventional trial where walkers were coached to walk faster; this merely observed the relationship between natural walking speed and mortality risk. That said, coaching seniors with mild cognitive impairment to walk regularly [16] has been shown to improve working memory [17]. And taking a short walk in the morning and after meals can reduce postprandial blood glucose [18] and 24-hour glucose control in sedentary seniors.

He’ll need to change his diet. The basic Primal approach [19]—eating more plants and animals, dropping grains [20], excess carbs, sweets, sugar, soda, and other junk food—is absolutely crucial. Not only will eating more fat and protein and fewer carbs help him drop body fat, a low-sugar [21] diet may protect him against age-related cognitive decline [22].

He’ll need to emphasize protein. Older folks need more protein than younger people because they’re less efficient at processing and metabolizing it. Seniors lose thigh muscle mass and exhibit lower urinary nitrogen excretion [23] when given the standard 0.8 g protein/kg bodyweight, so eat well above that. Several recent studies [24] indicate that a baseline intake of 1.0-1.3 g protein/kg bodyweight or 0.5-0.6 g protein/lb bodyweight is more suitable for the healthy and frail elderly to ensure nitrogen balance. But that’s just balance, and balance isn’t enough for your dad, especially since he’ll be embarking on his new resistance training regimen (right?). Evidence suggests that increasing protein above normal levels can both improve physical performance [25] without necessarily increasing muscle mass [26] and increase muscle mass when paired with extended resistance training [27] in the elderly. Making sure to obtain enough protein may spontaneously reduce intake of more problematic foods, since protein is such a filling macronutrient.

Include some whey protein, too. Studies show that whey protein [28] is the most effective protein supplement for countering sarcopenia [29], or muscle-wasting, especially compared to soy [30]. A buddy of mine can attest to this; last year, after his grandmother hadn’t eaten for a few days, was suffering from diarrhea, mental confusion, and basically appeared to be on her deathbed, he made her a whey protein milk shake with egg yolks, heavy cream, and some high-quality ice cream every day. She drank them, kept them down, and recovered. Who can turn down a milk [31] shake, after all? The shakes helped her hold on for another four months until Thanksgiving, when the rest of the family was due to make it out for a visit. She got to say her goodbyes in a reasonably alert state.

He should start eating fish or taking fish oil supplements [32]. Fish oil supplementation increases muscle protein synthesis [33] (required for gaining strength and muscle) in older adults.

So even if your dad just wants to stay where he is without regressing, he needs to start lifting weights, eating more protein (plus some whey), increasing low-level physical activity, and cutting back on carbs, sugar, and bad fats.

But we’re humans. We love stories. We tell ourselves stories about the lives we lead and respond most strongly to the stories others tell. Look what you can do at 87 [34]. Look what thousands have done [35]. Look at Papa Grok [36].

Now, coming from his admittedly severely obese state, he’s not going to be a fitness model and he probably won’t end up with a six pack. That’s fine. That stuff doesn’t matter in the end.

So, Janice’s dad: it’s undeniable. I’ve got both moving anecdotes from people like you and the strongest science on my side, all confirming in no uncertain terms that we can improve our health, vitality, and ability to appreciate life at any age, from any starting point. It’s not too late.

You know when it is too late? When you’re getting your lower leg amputated because your diabetes [37] prevented a shin wound from healing and you were already bedridden from a C. dif infection picked up during your last in-patient procedure. When you flatline in the ambulance after a massive coronary. When you give up, throw in the towel, and convince yourself you’re a lost cause. Don’t get to that point.

It’s times like these that written text fails and I wish words could enable the raw transmission of infectious emotion. Hopefully you can provide that. I’m confident you, as a loving daughter, can. Let us know how it all goes.

Thanks for reading, everyone. If you or anyone you know has any positive stories that might convince Janice’s dad to start making better choices, light up the comment section! People need to hear!