Adapt your diet and exercise routines as you age

HERE'S how NOT to control your weight:

Sometimes it seems like that, doesn't it? Everything you put in your mouth is bad for you. It goes to your waist. Or your hips. Or someplace that used to be taut and now is - let's face it - a tad flabby.

It doesn't have to be that way. The answer starts with the familiar equation: Exercise more + eat less. Yet like many aspects of life for those in the 46-to-64 age range, it's not that simple.

As boomers age, they are encouraged to accommodate and even befriend the physical changes that come with aging. After assessing their physical condition and particular limitations, they can make changes in their diets and workout regimens. Some may even consider surgery to make their stomach smaller.

But first, consider exercise. Younger people may take up a new sport - racquetball, snowboarding, surfing. But older folks tend to dial it down.

"If you incorporate exercise into your daily activity, it's not hard to fit it in," said physical therapist Jane Oeffner. "When you get home from work, don't sit at the kitchen table to discuss how your day went. Debrief by taking a walk."

She also recommends swimming, bicycling and, especially, yoga, which can be a cardiovascular and muscle-strengthening workout. By slowly building up the time spent exercising, it can become a lifelong habit.

Just as boomers have to adapt to appropriate exercise, what they eat may be restricted by challenging medical conditions that develop with age. That's why registered dietitian Andrea Spivack recommends that boomers check with a medical professional, such as a dietitian or their primary-care physician, before making a major change in diet.

"There may be specific nutrition recommendations for disease management," she said. For example, "if someone has arthritis, cutting up vegetables could be a challenge. So consider frozen vegetables."

Anemia, hypertension, diabetes, high cholesterol and osteoporosis also present dietary restrictions and recommendations. Prescription medications may interact with certain foods, such as grapefruit or green tea.

A boomer who is lactose-intolerant needs strategies to take in sufficient calcium. And sometimes a person's teeth - or lack thereof - can affect food choices and textures. Ill-fitting dentures can limit the amount of fresh fruits and vegetables eaten and affect the amount of fiber and fluid in the diet.

Those suffering from depression may skip meals. Or a person living alone may decide it's too much of a bother to cook for one and opt instead for a bowl of cereal or a spot of tea and toast.

Eating too much can be a problem, too. "We know that empty-nesters may dine out frequently, and restaurant portions are often bigger than what they'd eat at home," said Spivack, of the Stunkard Weight Management Program at Penn Behavioral Health. "Many people underestimate their caloric intake - by a lot. [Restaurant] portions are often large and laden with fat, calories and salt.

For some boomers, vanity motivates them to lose weight. For many, however, trimming down is a medical necessity because they are, by definition, obese. Obesity is determined by body-mass index, an estimate of body fat based on height and weight. A person with a BMI between 25 and 29.9 is considered overweight; 30 and above, obese.

Obesity increases the risk of heart disease, high blood pressure, sleep apnea and type 2 diabetes, among other problems. Those who are severely obese (a BMI of 40 and above or with significant health problems caused by their weight) usually have attempted to diet and failed. These people may be candidates for an increasingly popular remedy - surgery that reduces the body's ability to take in food and absorb calories.

"Most people don't come to me without a lot of thought," said Ramsey Dallal, chief of bariatric surgery at Albert Einstein Health Network. "They've done research on the Internet. They've talked to their family and friends and their doctor.

"People come to see me with a tremendous burden of guilt and feeling of defeat. It is a very emotional issue for people. I have operated on millionaires and CEOs who feel defeated because the one thing they cannot be successful at is controlling their weight."

Since bariatric surgery was introduced more than four decades ago, doctors have made significant technical improvements that make the procedure safer and more appealing, although certainly not risk-free. Patients can develop infections, blood clots, ulcers, hernias and problems with excess skin. Long-term risks include vitamin deficiencies, osteoporosis and the rare but severe problem of low blood sugar.

Bariatric surgery is done through tiny incisions that allow for less pain, quicker recovery and lower risk of complications. Most public and private insurance covers the procedures, if performed for medical reasons.

The two main types of surgery - gastric bypass and adjustable gastric band - create a sense of fullness and decrease food's access to a portion of the stomach. Gastric bypass, the most commonly performed bariatric operation in America, is reversible only by another surgery. The gastric band, which was approved by the Food and Drug Administration in 2001, is inserted through a single incision in a patient's belly button. In this outpatient procedure, a surgeon places an adjustable, plastic ring over the stomach to create a small pouch, which later can be fine-tuned for tightness in the doctor's office.

Bariatric surgery is more than a physical procedure. After surgery, patients are expected to participate in long-term follow-up care that includes seeing registered dietitians, exercise trainers and a psychologist. The medical payoff of the weight loss can be a significant decrease in joint pain, blood pressure and, for those with type 2 diabetes, blood-sugar levels.

The follow-up is critical, because surgery doesn't end the weight-loss battle. Patients on average lose 62 percent of their excess weight after bypass surgery, and 48 percent with banding. But most patients regain some of that weight.

Many patients who would be helped by the surgery don't consider it because they think it's too risky, said Dallal. If the procedure is performed at a site designated a Bariatric Surgery Center of Excellence by the American Society of Metabolic and Bariatric Surgery (www.surgicalreview.org/locate.aspx#srch), he said, the risk is no greater than having a hip replaced.

Bariatric surgery was suggested to Terry Callahan. Medically, he was an appropriate candidate, since he was severely obese with a BMI of 43 and he suffered from sleep apnea. But last year, at age 48, Callahan chose another way.

"Fit by 50, that was my plan," he recalled. "I knew I could lose the weight by diet and exercise since I had done it before."

So he dieted down to 160 by age 19. Then he rebounded to 230 pounds. Then back down to 165. Over the next eight years, he bounced up to 240 pounds. He lost 30. Then he regained those pounds. And many more.

He developed sleep apnea, which is a reduction or pause in breathing while asleep, and turned to the Sleep Center at Penn for treatment. Eventually, he was referred to the Stunkard program. In April, he began what he expects to be a one-way weight-loss journey.

"I started at 287 pounds, and now I am at 185," he said recently in a conversation over coffee. (Black, no sugar.) "My target is 160."

The outpatient program includes the purchase of calorie-controlled prepared meals and shakes. Initially, he was limited to 1,100 calories daily plus a multivitamin. "It does get boring," he conceded. "There are 14 entrées and, for the first 13 weeks, you have no decision. You cannot eat anything else. I was looking forward to adding fruits and vegetables for variety."

Callahan also meets in a support group, which is three-quarters female, to exchange strategies for keeping off the weight. He works in network and computer support at a Center City office and has learned to walk around the cookies and doughnuts offered on a colleague's desk. When he travels for work, he packs his Stunkard meals and gets a hotel room with a microwave.

"I don't have food cravings anymore," he said. "I went to a graduation party and ate what everyone else ate. Except I had no bread and no dessert. And I still go to a bar to play Quizzo, but I drink seltzer instead of beer."

To avoid regaining weight, he has learned that he should exercise an hour a day. So he walks his two beagles in Pennypack Park. And he has begun long-distance bicycle riding with a goal of doing an Easton-to-Bristol ride next year.

Callahan's new physique puts him at odds with most adult Americans. More than two-thirds are overweight or obese. In Pennsylvania, 28 percent of adults (including 38 percent of African-Americans and 33 percent of Latinos) are obese. As a subset, one-third of Pennsylvania's boomers ages 55 to 64 are obese.

It's no surprise to learn that American adults walk much less than their counterparts in other nations, according to research published last month by the American College of Sports Medicine. While adults in western Australia, Switzerland and Japan averaged 9,695, 9,650 and 7,168 daily steps, respectively, this study found that the average U.S. adult walked just 5,117 steps per day.

That's why Oeffner, a physical therapist with Good Shepherd Penn Partners, recommends wearing a pedometer to determine how much you are walking. "Even a modest amount of walking will help you maintain healthy body weight," she said.

She is also a big proponent of yoga for boomer women and men.

"As people get older, they see a decrease in bone density and they may lose their sense of balance," Oeffner said. "Yoga is wonderful for balance. With the yoga poses, it also is a weight-bearing activity. You can get more flexible, and this will help prevent falling."