09/05/2014 04:37 pm ET Updated Nov 05, 2014

Dare to Be 100: Danger Ahead -- Fat and Frail

When we think of a person as being frail we generally presume that he or she is skinny. A recent article published in the British Geriatrics Society Journal is entitled, "You Don't Need to Be Thin to Be Frail." It was written by Katie Sheehan of the Irish Longitudinal Study of Aging. She reported on a study in which obese middle age people had a higher incidence of frailty as they age. This recapitulates an article published a few years ago by Hubbard et al entitled, "Frailty, Body Mass Index, and Abdominal Obesity in Older People." (1) The articles suggest that there is an increasing epidemic of frail fat people. Since frailty is known to increase the risk of dependency and mortality this is to be viewed with alarm.

The proposed sequence suggests that obesity represents a threat to physical activity because of the higher work load imposed by lugging around the extra pounds. The less we move the greater is the tendency to put on more weight, and so the sequence is continued. Less movement means weaker muscles leading to what is termed sarcopenic obesity. Body composition is compromised as muscle is replaced by fat. Diabetes lurks. Falls are too common.

The global epidemic of obesity places in context the important finding of Steve Blair that fitness compensates for the higher health risks of fatness. This suggests that fitness is the antidote to frailty. It further suggests that when a person ages the risks of disability and prolonged dependency rise. With all the health risks associated with them. Despite being 40 pounds overweight for the entirety of her post-me life, my mother lived 95 healthy years. But, she was fat and fit. She walked prodigiously, she climbed stairs, and carried her groceries the whole way.

A recent study conducted by a Stanford colleague of mine Yuri Ladabaum in the American Journal of Medicine suggests that we are becoming progressively more physically inactive. (2) Using statistics from the famous NHANES study he compared the years 1990 and 2010. In 1990 7.3 percent of younger men reported only minimal physical activity, 9.1 percent of middle aged men, and 16.3 percent of older men. By 2010 the figures for young men were 28.6 percent, 43.1 percent for middle aged men, and 54.9 percent of older men. Looking at female physical activity patterns for the same years reveals an even greater sloth. Old women are fat and inactive ant thereby frail. Unlike Mother, only 23.3 percent remain physically active. Muscles seem to be becoming vestigial. Can we afford to be old, fat, and frail?

Someone wise observed that how old you are is not nearly as important as how you are old. And don't ever forget that the devil can't hit a moving target.


1) Hubbard,EE et al Frailty, Body Mass Index, and Abdominal Adiposity in Older People . J. Geront and Biol Sciences April 2003.

2) Ladabaum , al Trends in Obesity,Physical Activity, and Caloric Intake. Amer. J. Medicine,2014, 127: 720-727.