DEAR DR. DONOHUE: I am 73 and overweight. I’ve been overweight most of my life. My doctor insists that I lose weight, but he’s silent about how to do so. Can you tell me with a straight face that weight loss at my age is possible? If you say it is, how do I go about it — diet, exercise, liposuction? — H.M.

ANSWER: There’s no denying the fact that weight loss at older ages is difficult, more difficult than it is at younger ages. Your eating habits are more entrenched and your lack of significant physical activity is fostered by the ills that come with age.

Another consequence of aging is loss of muscle tissue. Partly, that’s one of the effects of growing old. Partly, it’s due to becoming more of a couch potato.

Studies done the Washington University School of Medicine in St. Louis and at New Mexico University School of Medicine demonstrate that the combination of diet and exercise promotes greater weight loss and increased muscle strength than does diet alone or exercise alone.

The diet calls for a decrease in daily calorie intake of 500 to 750 calories.

The exercise program is three weekly sessions of 90 minutes each. Admittedly, that’s a long time to devote to exercise, especially for those not used to it. However, a month or two of working up to that goal make it feasible. The exercise sessions are divided into aerobics, weight lifting and balance training. Aerobics is walking or jogging on a treadmill, riding a stationary bike or stair climbing. Weight lifting is a gradual increase of lifting heavier weights and performing more repetitions until the person is able to do three sets of eight consecutive lifts (repetitions). Balance exercise is exercise such as standing on one leg.

People who combined the above exercise routine with calorie restriction not only lost more weight but gained more strength than did test subjects who dieted only or exercised only. Forget liposuction.

DEAR DR. DONOHUE: In my high-school biology class, we are studying the human body and the things that change it, like different foods and different exercises. Our teacher took little time to explain what happens when a person does too much exercise. He says muscle tissue breaks down and people can die. Will you explain what this is? — B.R.

ANSWER: Your teacher was talking about rhabdomyolysis (RAB-doe-my-OL-uh-siss), a widespread destruction of muscles with the release of myoglobin into the blood. Myoglobin is a muscle protein. Too much of it in the blood overwhelms the kidneys and shuts them down.

The pain that comes from rhabdomyolysis starts 24 to 48 hours after a grueling exercise session. The urine turns brown because of the myoglobin in it. Hot weather and dehydration add to the muscle breakdown. All of this is an emergency and frequently calls for hospitalization with intravenous fluids for treatment.

DEAR DR. DONOHUE: I want to run a marathon by next fall. I’m 56 and have not been a regular runner. My wife thinks I am crazy and have a death wish. I believe I have enough time to get in shape. What do you think? — L.H.

ANSWER: The chance of dying in a marathon is one in 100,000, not a large number but too large a number if you happen to be that one person. Sudden death during demanding exercise in those younger than 35 is usually due to cardiomyopathy, an unnatural enlargement of the heart. In older people, it’s mostly from heart artery disease that hasn’t produced any symptoms.

You need to discuss this with your doctor. The doctor might suggest a stress test. I would. And I would recommend you not enter a marathon until you had a full year of conditioning.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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