For Amy Campbell, a registered dietitian and diabetes educator, the DASH, Mediterranean and Mayo Clinic diets stood out as smart choices for older adults because they’re good for weight loss as well as controlling conditions such as diabetes and high blood pressure.
“The MIND diet is another consideration for older adults, as it combines the DASH and Mediterranean diets, focusing on foods that can support and improve brain health to possibly lower the risk of mental decline, including Alzheimer’s disease,” Campbell adds.
As with anyone, being overweight or having obesity can be issues for seniors, Campbell says. “People are living longer, so we’re seeing more of it in older adults. As we get older, our calorie needs go down. People don’t need to eat as much as they did when they were 20 or 30.”
Older women generally need anywhere from 1,600 to 2,200 calories per day, depending how active they are, Campbell says, while younger women need about 1,800 to 2,200 calories daily. For older men, the range is 2,000 to 2,800 calories per day, compared with 2,200 to 3,200 calories for younger men.
What about newer paths to weight loss? “Intermittent fasting, which is an approach that restricts when you eat, as well as how much you eat, can be helpful for weight loss and possibly preventing or managing diabetes,” Campbell says. However, she adds that there isn’t much evidence to support intermittent fasting being an effective strategy for weight loss in older adults.
Campbell has reservations about the ketogenic or keto diet. “One of the pitfalls with this diet – which focuses primarily on eating fat with some protein, and very little carbohydrate – for older adults is inadequate protein, which can lead to a loss of muscle mass,” she explains. “The keto diet is also a lot of work and for some, it can be monotonous. It’s best to check with your doctor before trying either of these diets to make sure they are safe and appropriate for you.”
Frail, elderly people face heightened concerns, Campbell says. A lack of protein puts people at risk for lower immune function and osteoporosis, she notes.
”Other factors can make it harder to eat healthy as you get older, including problems with chewing or swallowing, a decrease in mobility, which can make cooking and shopping challenging, changes in smell and taste and less income that can make it hard to afford food,” Campbell points out.
You don’t necessarily have to follow a specific diet, Campbell says, “just a well-rounded diet with extra protein.” That means making the most of the calories you take in, not just eating a bowl of cereal for dinner or making entire meals of toast and tea. “You don’t need animal protein in every meal,” says Campbell, who praises lentils, beans and chickpeas as great sources of inexpensive plant-based protein to round out meals.
An adult who weighs 150 pounds would need about 55 grams of daily protein (0.8 grams per kilogram) according to the U.S. Department of Agriculture’s dietary reference intake. However, some experts suggest that older adults need more protein (up to 1.2 grams of protein per kilogram) or roughly between 70 to 80 grams daily for a person that size.
Campbell says a very low-fat plan like the Ornish diet might be less appropriate for senior’s needs and harder for seniors to follow. Similarly, she says, the Biggest Loser diet would not be ideal, and the diet’s language could be hard to comprehend.
“For diets in general, it’s best to try and make it easy and fit comfortably into a person’s life,” Campbell says. “Ones that promote good health but are as easy to follow as possible.”
Simplicity, Balance and Effectiveness
Dr. Michael Davidson, director of preventive cardiology at the University of Chicago Medical Center and a U.S. News Best Diets panelist, says WW (Weight Watchers) and diets with similar structures score well because of their simplicity.
With WW, for instance, foods are assigned different points, which you add up daily to stay at your personal target, which is based on your sex, weight, height and age. “You don’t have to do a lot of thinking about balance of foods or menu plans,” Davidson says, which may be beneficial to seniors who struggle with meal planning.
Long-term compliance is an important factor in ranking diets, Davidson says: “What can be a lifelong change instead of just a short-term fix for the patient?” Therefore, he says, “it’s really more about variety and food choices, as opposed to portion sizes, that are applicable to an elderly individual. So it’s the kind of diet I prefer for those patients.”
Davidson sometimes sees iron deficiency in frail, older patients. “They don’t eat enough red meat; they don’t get enough iron in the diet,” he says. Although the paleo diet was lower-ranking among the Best Diets, he says “it could be a good diet. It’s had a little bit of a hype to it, but the principles are not far off, such as people eating more complex carbohydrates and more lean meats.” He points out that constipation can be an issue for seniors on low-carb, low-fiber diet.
Intermittent fasting – consuming no calories for about 16 of 24 hours, most commonly eating between noon and 8 p.m. – has more clinical trial evidence demonstrating improved weight loss (for adults overall), Davidson says. “In my practice, intermittent fasting has been an effective strategy to enhance the efficacy of a low-carb diet.”
While the keto diet can work for shedding weight, Davidson also has a concern. “Although the keto diet is gaining in popularity and can be a highly effective approach to weight loss, some patients may experience a marked increase in LDL cholesterol – especially with the carnivore keto plan,” he says. “If the patient wants to maintain a keto diet, I recommend checking a lipid profile and then adjust the diet to reduce the amount of saturated fats – butter especially.”
If a patient’s blood level of “bad” LDL cholesterol is elevated, he advises replacing saturated fats with healthier fats such as omega-3 fats or monounsaturated fats like avocado and olive oils.
Heart Health and Diabetes
“Of the ranked diets, both DASH and the Mediterranean diet can help people with both diabetes prevention and management,” Campbell says. They work because they encourage a variety of foods and make people aware of the carbs they consume, she adds. Both diets are mentioned in the latest nutrition guidelines from the American Diabetes Association.
Davidson says people with high cholesterol do better with low-saturated fat diets that call for low-fat dairy sources, lean meats and fish. It’s important for seniors with high cholesterol to avoid sweet baked goods with trans fats, he says: “We now recognize that trans fats are especially bad among all the fats we can consume.”
“We’re all creatures of habit,” Campbell says. So, she says, “imagine you’re 75 years old and have to change your habits and incorporate foods that you may not be used to eating, such as tempeh or farro. Although most diets offer plenty of online and printed resources, they can be overwhelming. “It’s hard sometimes to pick up a book and say, ‘what should I be eating.'” For older adults, it can help to work with dietitians.
Davidson says the WW point system works well, because it makes eating balanced meals easy. Others that provide prepared meals throughout the day, such as Jenny Craig and Nutrisystem, “keep caloric content low but steady throughout the day,” he says. “And those work for the elderly quite well.”
Cost can be an issue. Jenny Craig foods cost an average about $21 per day, or $24 per day including snacks and personal coaching. With WW, nonfood expenses can reach nearly $50 per month at the highest level of coaching, plus the cost of foods.
“You can try and mimic the Weight Watchers diet and find prepared meals that work for patients when expense is an issue for the elderly,” Davidson says. His office provides a seven-day meal plan with menus and counseling for patients.
Fruits and Veggies
U.S. News also ranks Best Plant-Based Diets, with the Mediterranean and flexitarian diets in the top spots. Seniors often fall short when it comes to fruits and vegetables, Campbell says.
It’s possible to eat healthy produce on a limited budget. “Frozen fruits and vegetables can be cheaper and sometimes even healthier than fresh, depending where they’re shipped from,” Campbell says. Canned produce can be OK, she says, if there’s no added salt.
Sense of thirst can decline with age, so drinking enough water is important for preventing dehydration. Fluids such as soda or fruit juice add a lot of calories, Campbell notes, and it’s not good for people with diabetes to drink juice all day. Instead, she suggests flavored water or water with a slice of lemon.
She has good news for coffee and tea lovers: Caffeine is not as dehydrating as once thought. “Plus, coffee and tea have potential health benefits, including a lower risk of some cancers, heart disease, stroke and Type 2 diabetes,” she adds. “But, check with your doctor as to how much caffeine is safe for you to consume.”
Davidson says with the Atkins diet, especially in the first phase, patients on diabetes medications can experience low blood sugar and diuresis (they may urinate more). While he generally supports very carb-restrictive diets, he says moderate programs are better for many seniors.
Older adults trying to lose weight may have at least one advantage. “Many clients I work with who are 70 and older just report not being as hungry,” says Elisabetta Politi, a certified diabetes educator, dietitian clinician and health and wellness coach with the Duke Lifestyle and Weight Management Center. “In a way that helps, because it’s so hard to help someone lose weight when they’re always complaining they’re ravenously hungry – which is more of an issue with the younger population.”
Politi takes clients’ age into account when tailoring weight-loss approaches, in light of their increased vulnerability. “You really want to advise them to lose weight cautiously because you don’t want to compromise their immune system at the time of a pandemic,” she says. “Also you want to preserve their energy. Very restrictive diets might really impact energy, which we know is a predictor of long-term success – to stay active and exercise.” That can be a challenge for the aging population, she notes, as issues with mobility and knee or back pain are common.
Motivation and Effort
Older adults want effective eating plans.
“I try to find something sustainable, which takes into account their lifestyle and preferences, but that will yield results,” Politi says. “Because I know how frustrating it is wanting to lose weight and making some changes – but the scale doesn’t move. That’s something I see frequently among my older patients because they don’t burn as many calories as the younger ones.”
Balanced diets that motivate people with results – yet won’t have any negative impact on their energy, health or immune systems – are good options, Politi says. She’s a fan of the MIND diet, the hybrid form of the Mediterranean diet and DASH. An added MIND plus: “It’s really geared at preventing neural degenerative changes and preserving alertness and mental acuity.”
As for the Mediterranean diet, Politi says, “it’s a good example of something that is not as extreme as keto.” She praises the Mediterranean plan’s emphasis on healthy fats and whole foods. “It has protein, so we will not lose lean tissue, which is definitely another concern with when we think of older adults,” she says. “We want to preserve their muscles.”
An individualized approach is also important, Politi says. That includes honoring personal preferences and looking realistically at the food preparation and cooking effort involved with any particular diet. For some clients, she says, meal delivery kits can be a useful shortcut.
Motivation is a key factor in losing weight. Politi always asks clients what has been successful in the past because success is motivating and increases confidence when embarking on a new eating plan.