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Miriam Gittelson, 89, moved into the assisted-living wing of The Nottingham in Jamesville, N.Y., about two years ago, but she's convinced she'd still be in her own home if she hadn't been overweight much of her life.
At 5-foot-10, she weighed more than 200 pounds for years. She believes the extra pounds contributed to her type 2 diabetes, arthritis and impaired mobility, which have led to numerous surgeries.
"I'm sure it took a toll on my knees, hips and ankles. I have had my knees and hip replaced and some other parts operated on. I'm made up of spare parts, but I still have my head," she says.
Gittelson, who uses a wheelchair, is making the best of it, but if she could live her life over again, she says, "I would have tried to lose weight a long time ago."
She is an example of the fate that could await millions of overweight baby boomers, obesity and aging experts say, as aging and disability rates embark on a collision path. In short: Those golden years might not be so golden.
Disability has an enormous effect on the quality of life of older adults, says Barry Popkin, a nutrition professor at the University of North Carolina at Chapel Hill. His research shows that being obese increases people's chances of becoming physically disabled, staying in the hospital longer, retiring earlier, going to a nursing home sooner and staying there longer.
In one study, he found that extremely obese people -- those who are 80 or more pounds over a healthy weight -- are 2.3 times more likely than normal-weight people to stay in hospitals longer or to end up in nursing homes after an illness.
A reversal in trends
Since the early 1980s, disability has been decreasing in people 65 and older for several reasons, including better treatments for heart disease and strokes, more knee and hip replacement surgeries, improved education and environments better adapted to help people with limitations function in everyday life, says Richard Suzman of the National Institute on Aging. This has been one of the most positive trends in aging, he says. But the nation's obesity problem could reverse or slow the trend, because people who have been obese for years are more likely to enter their older years less healthy, he says.
Extra pounds usually cause several medical problems, not just one, says Sharon Brangman, a geriatrician in Syracuse, N.Y., and a board member of the American Geriatrics Society.
"People who are 30 or 40 pounds overweight are more likely to have high blood pressure, type 2 diabetes and lots of joint pain and problems. Osteoarthritis of the knees is probably the biggest problem I deal with," she says. Knees and hips may wear out sooner and require replacement.
"Another factor is decreased muscle mass and quality, which results in less strength," says Samuel Klein, director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis. In his research, he has found that obese adults had less muscle strength than other older adults.
All older people lose some muscle strength because their muscle fibers shrink in diameter, says Jennifer Sacheck, an exercise scientist who studies muscle physiology at the Friedman School of Nutrition at Tufts University in Boston. That is caused by metabolic and neurological factors that change with age. But for obese people, the situation is worse because the extra pounds wreak havoc on hormones such as insulin that affect muscle quality as you age, she says. "With strength training, you can offset some of that decrease in size but not all of it."
Doing it for the children
Deborah McFadden, 49, of Clarksville, Md., decided a few months ago that she needed to lose weight and get in shape. She didn't want to end up dependent on her children or -- even worse -- not be around to watch them grow up.
She has two adopted daughters: Tatyana, 17, who is among the world's top wheelchair racers, and Hannah, 10, who is also a runner and swimmer. Hannah has a prosthetic leg. "My children were orphans once. I can't let my weight affect my health so that I orphan them again."
McFadden, who started out at 215 pounds, has lost 18 pounds since the beginning of March by following the Jenny Craig program and exercising for at least 30 minutes a day. "I don't want to be in a nursing home with someone waiting on me. I'd rather be fit and healthy and playing with my grandchildren," McFadden says.
Gittelson believes middle-aged people need to take action while they are younger and more active. This winter, a cardiologist challenged her to lose 35 pounds in six months. She went on a strict diet and has lost 11 pounds in three months. Her advice to middle-aged people: "Take it off now while you can, because when you are old and wheelchair-bound and unable to exercise adequately, it is very difficult to lose weight.
"Keep fit and keep active so that when you get older, you won't have to go through this."
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