Older people ‘should be told to maintain a buffer weight’

The NHS should tell slim elderly patients to maintain a higher “buffer weight” to prevent frailty and illness in old age, a former health secretary has said.

Dame Patricia Hewitt, 76, who was health secretary in Tony Blair’s government, said she had realised the dangers of being too thin after she nearly died while on a “holiday of a lifetime” with her family in Australia.

She became severely ill with dehydration after going on a bushwalk in the “ferocious sun”. She said she had been “on death’s door” and had had to spend six weeks recovering in hospital, during which time her weight fell “absolutely catastrophically”.

The medical team who looked after her explained the concept of “geriatric BMI [body mass index]” — that the optimum weight for people over 65 is higher than for the younger population — and told her that she should aim to put on several kilograms.

Research has shown that there is a “longevity paradox” in that overweight older adults outlive those who are underweight or are at the lower end of the healthy range, as measured by BMI. This is because thinner adults tend to have less muscle mass, which can limit independence and lead to falls and frailty.

In a letter to The Times, Hewitt urged the National Institute for Health and Care Excellence to overhaul NHS weight guidelines so that doctors do not focus only on tackling obesity but also do more to help underweight older adults. She said that thin older adults should be encouraged to “lose their waist rather than worrying about their weight”.

Hewitt said: “Being overweight or being obese is dangerous. It is a matter of life or death or disability. But so is being underweight or having inadequate nutrition. What is a healthy weight for you as you grow older, particularly if you’re a woman, is almost certainly higher than you think it is.”

She said that as people aged they needed “physiological reserves” of muscle and fat. “As you get older, of course, you’re more likely to get ill, have a fall, or go into hospital, which causes you to lose weight,” she said. “Then when you come out of hospital and get better your weight recovers, but it doesn’t recover to what it used to be. It’s a little bit lower.

Older people should carry more weight as a “buffer zone”, Hewitt said

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“You have to have a buffer zone [of weight] as you age, and without it you are at real risk of frailty and multiple comorbidities and premature death, when all of those things could be and might have been avoided.”

Hewitt added that she had counted herself “jolly lucky” in the past that she seemed to be “genetically predisposed to not putting on weight easily”. She said she had weighed 7st 11lbs (50kg), which dropped below 7st when she was sick in hospital, and that she had been advised to get up to 9st 5lbs (60kg).

Hewitt was health secretary from 2005 to 2007 in the Labour government. She has worked in health policy since then, most recently as chair of NHS Norfolk and Waveney Integrated Care Board, a post she retired from this year.

Hewitt was born in Australia and was on a five-week holiday visiting family when she became ill after walking in Kangaroo Island, south Australia, with her son. Days before she was due to fly back to England she became severely dehydrated after going out without enough water, and was hospitalised for six weeks, an experience she said had been “terrifying” for her family.

Hewitt said that the incident had been a “wake up call”, adding that she was now nearly fully recovered and “happier and healthier than ever”.

She has written to the chair of Nice, urging the the watchdog to incorporate the needs of older people into new draft guidelines on the management of obesity. Doctors should be trained in the concept of “geriatric BMI”, she said, and be encouraged to ensure that elderly patients were not underweight or malnourished.

BMI has been used as the standard method of diagnosing obesity for decades. A BMI over 30 is considered obese, over 25 is overweight and between 18.5 and 25 is normal. However, geriatricians have suggested that, in over-65s, a BMI between 23 and 30 is optimal for longevity and health.