Taking a Out of Weight Loss

As described by Brillat-Savanin, for so many older persons it is the loss of the desire to eat that leads to a loss of enjoyment of life, weight loss and eventually death. The “ano r ex i a c a c h ex i a ” syndrome is characterized by poor appetite and a progressive depletion of caloric stores, body fat and muscle. Older persons often develop this “wasting syndrome” which is associated with an extremely poor quality of life. The GAIN registry demonstrated that in a thousand persons Nutrition remains an extremely understudied area of medicine and one in which physicians often have a paucity of knowledge and practical advice. Much of what passes for modern knowledge was already entrenched in the literature of medicine at the start of the modern era. Thus Aretaeus the Cappadocian described the anorexia of aging thus, “...for in old men, even without any disease, owing to their being near the close of life, the appetite is nearly gone” and correctly attributes its pathogenesis living in nursing homes around the United States, from Washington State to Florida, over 30% of those who continued to lose weight died, whereas over 90% of those who reversed their weight loss survived (Figure 1). Numerous studies have shown that weight loss in older persons leads to increased morbidity and mortality. Older persons with protein-energy malnutrition are more likely to have pressure ul-