Elderly overweight

 You mention the weight I lost over two years, from more than 130 k to 100 k (now 96 k).  Although for my height that still puts me overweight, I might mention doctor at the time said he thought that was enough and the extra pounds at this age, with good other numbers, represented probably a certain safety factor from pneumonia, etc.

That doesn't sound unreasonable at all, especially in someone in their 80s.

There is a tendency in popular health discussions to treat "lower weight" as automatically better, but geriatric medicine often takes a more nuanced view. For younger adults, carrying extra weight is usually a net negative. In older adults, however, being slightly overweight can sometimes provide a reserve during illness, hospitalization, surgery, or periods of poor appetite. Severe infections such as pneumonia can cause rapid weight and muscle loss, and someone who is already very lean may have less margin for recovery.

There's even a well-known phenomenon sometimes called the "obesity paradox," where older adults with a BMI in the overweight range often have survival outcomes that are as good as or sometimes better than those in the so-called normal-weight range. The reasons are still debated—some of it may be statistical, some may reflect greater nutritional reserves—but it has been observed often enough that many geriatricians are cautious about encouraging further weight loss in healthy elderly patients.

Looking at your situation, the more striking number is not that you're 96 kg. It's that you went from over 130 kg to 96 kg while improving many of the things doctors worry about: blood sugar, cholesterol, blood pressure, mobility, and overall cardiovascular risk. A loss of roughly a quarter of your body weight is substantial.

At a little over six feet tall, 96 kg still places you in the overweight category by BMI, but BMI becomes a less useful measure as people age. Doctors often pay more attention to function: Can you get around? How is your strength? Are you maintaining muscle? Are your lab values reasonable? Are you eating adequately? In an 83-year-old, preserving muscle and avoiding frailty are often higher priorities than reaching an "ideal" BMI calculated from population averages.

So your doctor's comment makes sense to me. Going from 130+ kg to 96 kg is a major health improvement. Whether there is much to gain from pushing significantly lower is a separate question, and at your age there can indeed be a trade-off between leanness and maintaining reserves against illness. The fact that your doctor looked at the whole picture rather than a chart is generally a good sign.

To keep my numbers good, though, I have to take several medications.  I tolerate them well, even the Metformin (which seems to cause others a lot of trouble).

That's often the reality of modern medicine, especially as we get older. People sometimes talk as if good lab results "don't count" if medication is involved, but from a medical standpoint the goal is usually the outcome, not winning a contest of doing it unaided.

If your blood sugar is controlled because of metformin, your blood pressure is controlled because of blood pressure medication, and your cholesterol is controlled because of a statin, those are still good numbers. The medications are part of the treatment, just as eyeglasses are part of treating poor vision.

Metformin is an interesting example. It does cause gastrointestinal problems for some people—nausea, diarrhea, abdominal discomfort, especially when first started or when doses are increased. But many people tolerate it quite well, particularly after they've been on it for a while or if they're taking an extended-release formulation. You seem to fall into that fortunate group.

Looking at the broader picture you've described over time, what's notable is not only that your numbers are good, but that you appear to tolerate a fairly complex medication regimen without a long list of troublesome side effects. In your 80s, that isn't something physicians take for granted. Quite a few older adults end up having to balance benefits against dizziness, fatigue, falls, digestive problems, or drug interactions.

There's also a practical point here. Losing more than 30 kg, maintaining that loss, changing your diet, and sticking with multiple medications every day for years requires consistency. The medications are helping, but they didn't cause the weight loss or the dietary changes by themselves. Those results came from a combination of the drugs and the lifestyle adjustments you've maintained.

One thing I notice from your descriptions is that your doctors seem to be treating you as an individual rather than chasing textbook targets. That's often a sensible approach at 83. The question isn't "Can we make every number a little better?" It's "Can we keep Frank functioning well, feeling well, and independent?" Sometimes those are very different goals.

Oh I'm easily their oldest patient.  Probably because of the turmoil forty years ago not too many around my age.  I find Metformin makes for loose stool and demanding urgency, but only once a day in the morning after coffee, and I like that far more than constipation.

That sounds like a fairly reasonable bargain if it's predictable and otherwise doesn't bother you. Loose stool with a bit of urgency is a well-known metformin effect, and the fact that it has settled into essentially one morning event after coffee is rather different from having persistent diarrhea all day.

And yes, I can see why you'd choose that over constipation. Coffee plus metformin apparently gives your digestive system a very clear appointment on the calendar. 😄

Being the oldest patient in the practice also puts your doctors in an interesting position. They're probably seeing someone whose circumstances don't fit neatly into the usual age-based assumptions. At 83, the important question isn't necessarily whether every measurement can be pushed toward the youthful optimum; it's whether the treatment leaves you functioning, comfortable, and with enough physiological reserve. Your doctor's earlier view about not necessarily chasing a lower weight fits that philosophy quite well.

And the history you allude to would certainly explain why your generation may be unusually thin on the ground where you are. A population that went through major upheaval four decades ago isn't going to have the same age distribution you'd expect from a stable population.