It seems that aging has had a negative connotation since the beginning of time. In fact, the first anti-aging treatments are believed to have originated as early as 69 BCE.
It’s therefore no surprise that the “anti-aging” market has sustained such immense levels of success.
By definition, the term “anti-aging” describes a product or technique designed to prevent the appearance of growing older. Indeed, our fascination with preserving a youthful appearance spans far and wide and is documented through thousands of years’ worth of texts. While the proverbial “fountain of youth” may be something of lore, it is apparent by today’s abundance of age-fighting products and plethora of surgical procedures that the quest for youth has stood the test of time. Although there is no question that preserving a vibrant, youthful appearance is coveted as an ideal across virtually all societies, the question remains: Is aging really only skin deep? And, if not, is the anti-aging market missing the mark?
How do I look younger? Apparently, this is the $250 billion question. This figure represents the estimated worth of the Global Anti-Aging Market in 2016, which is projected to grow at a CAGR of 5.8%, with a forecasted value of $331.41 billion by 2021. The anti-aging market encompasses a broad range of products, treatments, services, and devices, with everything from liposuction services to remove belly fat to microdermabrasion devices for resurfacing skin. The many products and practices that fall under the umbrella of anti-aging, as well as the concerns they target, continue to remain at the forefront of middle-aged individuals’ minds.
Yet, we must ask ourselves this: If we’re spending $250 billion on anti-aging treatments worldwide, shouldn’t we be more satisfied with the results? Shouldn’t the way we look be a direct result of also feeling our best? Perhaps age management should not start on the outside, but rather, should be approached from the inside out.
First and foremost, it’s important to debunk the notion that any treatment, procedure, or product has “anti-aging” powers. Age is an inevitable fact of life; each person has been doing it since they reached maturity. In fact, in the Textbook of Age Management: Volume 1, authors Jeffrey P. Leake, MD and Todd D. Greenberg, MD confirm that aging actually begins by the age of 25. Thus, there is no such thing as anti-aging. This does not mean, however, that we must accept many of the factors that come with age: feeling always tired, struggling to maintain a healthy weight, lacking energy for exercise, fighting hormone imbalances, or living in persistent discomfort. This is precisely where age management – a more realistic and effective approach to overcoming the challenges of aging – comes in.
Many of us have used a number of anti-aging treatments. At the very least, the majority of us are aware of their potential outcomes. Yet, how well do we understand what it is we’re really trying to fight? Aging is not just a single process, though it is often summed up as just “getting older.” There are far more intricacies than two words alone can capture. What actually occurs to our bodies as we age?
In 1991, aging was defined by the book Evolutionary Biology of Aging as a “persistent decline in the age-specific fitness components of an organism due to internal physiological deterioration.” In the field of developmental biology, aging is suggested to be defined as the time-related deterioration of the physical functions necessary for survival. These characteristics of aging, along with diseases of aging (heart disease, metabolic disorders, etc.) affect all the individuals of a species.
Interestingly, of all the products, services, and devices mentioned in the Global Anti-Aging Market Research Report & Forecast, not one emphasizes improving cellular function and optimizing health to manage physiological deterioration. That’s because anti-aging services target only the visible effects of aging, without targeting their underlying causes – and therefore completely overlooking wellness as a whole.
Upon reaching physical maturity, the aging process begins in both men and women, but the process of aging typically goes on without notice throughout the twenties and thirties. More measurable changes are commonly observed by middle-age and later. For women, a significant process of aging – menopause – occurs relatively abruptly in comparison to a man’s transition from their ability to reproduce or not. In either case, by the time men and women are middle-aged, significant biomarkers of aging are commonly affected, ranging from hormone production to the ability to deliver oxygenated blood to muscle tissue. For those whose aim it is to manage these significant components of the aging process, the rewards extend far beyond the image of youthfulness alone.
In the past, health was recognized by the absence of disease. Now, however, the World Health Organization encourages us to take our approach to health further than disease prevention alone, stating that it is “a state of complete physical, mental, and social well-being.” Yet, despite the evolution of this definition throughout the last century, the model of traditional medicine is still a reactive one. In other words, most of us do not seek medical expertise until an apparent health issue has manifested. Likewise, significant medical attention is not prioritized until individual biomarkers are out of clinical ranges, by which point intervention – either invasive or noninvasive – is introduced.
Age Management Medicine is a proactive – versus reactive – approach to optimizing health and quality of life. It is achieved by continuously measuring comprehensive biomarkers of aging.
Biomarkers of aging can measure everything from cognitive function to physical strength, as well a person’s genetic makeup. These factors provide physicians with the most comprehensive overview of an individual’s wellness as possible, thereby giving them predictive insights which can be used to develop a targeted age management plan. For instance, by collecting extensive diagnostic information and learning about a patient’s detailed lifestyle and medical history, age management physicians and clinical teams are able to develop customized nutrition, supplementation, exercise, and bioidentical hormone programs – taking a holistic approach for each individual patient.
Not only is the age management approach highly personalized according to the individual’s distinct needs, but it also surpasses traditional methods in the fact that it is preventive. The field of medicine has only just recently begun to unlock the power of preventive care. In 1995, for instance, medical experts speculated that “national attempts to change lifestyle and alter cardiovascular risk factors… will not achieve health gain.”
Fast-forward 30 years: there are now countless initiatives in place supporting the exact opposite belief. Most notably, the Office of Disease Prevention and Health Promotion is nearly a decade into its Healthy People 2020 program, which was launched in 2010. With more than 1,200 objectives across 42 topic areas, one of its critical pillars is to “attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.” With events like the Healthy Aging Summit and a specific objective of increasing the proportion of adults who are up-to-date on clinical preventive services, it’s clear that this – and many other programs – are in steadfast support of taking a risk-based, preventive approach to age management, versus a reactive one.
Indeed, experts are waking up to the immense potential of proactive healthcare. In 2014, Forbes published an article titled “The Huge, Neglected Opportunity for Proactive Medicine.” It draws attention to the fact that the U.S. healthcare system spends the majority of its resources – a whopping 80% – caring for the seriously ill. Proactive medicine, the author posits, is more challenging because it requires “really getting to know people and working with them over time to change their lives.”
Yet, focusing mainly on caring for diseases after they’ve been diagnosed versus preventing them proactively via preventive age management care only allows the vicious cycle to continue. Isn’t the preemptive quest for long-term health a better approach to take? That’s what age management doctors believe, which is why they help their patients improve across a broad range of wellness outcomes.
Age management doctors don’t simply treat the signs of aging which have already manifested (although they are experts in that area as well). Beyond addressing issues like lack of energy, hormone imbalances, struggles with weight loss programs, aging clinics also help individuals improve future health outcomes. By understanding how bodily changes influence each patient’s health, age management clinical teams can provide better personalized care, focusing on the key factors that require the most attention first. This concentrated and continual effort brings significant value to a growing field of prevention-based medicine, as each individual’s risk factors are managed within optimal ranges over decades, thereby significantly lowering the risk of disease development.
Healthy Aging – A Step-by-Step Approach
First, age management physicians perform an all-encompassing individual assessment to form a detailed overview of current wellness levels and health history. Based on their findings, they generate a treatment plan encompassing to address the following five pillars of health.
Increased Energy Levels
Low energy levels are common in older adults. By the time people reach the age of 70, roughly 30% of the muscle mass they had at the age of 20 is gone. This often results in decreased strength, increased fatigue, and overall lower energy levels.
Yet, some causes of decreased energy cannot be attributed to age alone. From anemia to chronic disorders, there could be an underlying cause for persistent tiredness. Oftentimes, however, because exhaustion is typically perceived to some degree as a normal part of aging, it is not enough in itself to prompt older adults to see their physician.
For people who are always tired, however, the fix could be as simple as adopting a new supplement regimen. This is one of the key areas in which age management doctors specialize: determining whether lifestyle changes alone are enough to address declining energy levels associated with aging, or whether a more aggressive approach is needed to target an underlying cause of the symptom.
Disordered sleep is certainly not exclusive to older adults. In fact, it is of chief importance throughout a person’s youth, because ample, quality rest supports healthy childhood and adolescent development. Yet, while sleep is also critical to wellness in older adults, its importance is often overlooked. In fact, the consequences of untreated sleep disorders can take a physical and mental toll on this age group, contributing to functional limitations and a higher risk of death from any cause.
Inability to fall and stay asleep is fairly common: 38% of Americans report feeling poorly rested four or more days each week, and just over half (54%) are able to clock in the recommended seven to eight hours of sleep every night. Yet, just because an issue is common does not mean it should be ignored. Sometimes, individuals fall under the false assumption that common is synonymous with normal, and therefore neglect to seek medical help.
Both lack of sleep and poor sleep quality put an individual at risk for a broad range of short- and long-term health issues. On a short-term basis, sleep is needed for immune system functionality, metabolic function, and safety while completing daily tasks. Over the long-term, untreated sleep disorders are associated with increased risks of high blood pressure, heart disease, obesity, diabetes, and Alzheimer’s.
Specifically, there is a proven interplay between sleep and inflammation – particularly in the cardiovascular system. The Textbook of Age Management Medicine: Volume 1, describes this relationship as follows: “Sleep duration is inversely associated with plaque formation and coronary artery calcification among middle-aged adults, and is inversely associated with carotid intima media thickness.” Indeed, several pro-inflammatory markers are inversely associated with sleep duration, which confirms the fact that sleep deprivation is linked to morbidity and mortality, as well as increased cardiovascular disease.
There are many barriers to a good night’s sleep, with sleep-disordered breathing (SDB) being a main cause in older adults. The Textbook of Age Management Medicine: Volume 1 explains that obstructive sleep apnea (OSA) in particular is an epidemic affecting up to 24% of the population, though the actual volume of cases could be even higher as many patients are undiagnosed. OSA is a condition that largely affects obese individuals, but it can also afflict others. It is characterized by insufficient airflow, for which both noninvasive treatments such as weight loss, as well as surgery, may be recommended.
No matter the speculated cause, a physician must assess each individual’s sleep-related issues to determine the best means of treatment. By addressing the sleep disorders themselves, instead of the byproducts they create, age management physicians can help patients improve both long- and short-term health.
Mental Acuity – Enhanced Cognitive Function
The mind is something that changes with age. Yet, neural and cognitive functions are complex, and age-related changes in brain structure and function are not uniform across the population. Promoting cognitive function in middle-aged and older individuals is therefore an endeavor that requires an individualistic approach.
In Brain Aging: Models, Methods, and Mechanisms, author Elizabeth L. Glisky writes that “the basic cognitive functions most affected by age are attention and memory.” Yet, age alone is not the only factor which plays a role in the performance of these cognitive functions. As the Textbook of Age Management Medicine: Volume 1 explains, exercise, alcohol consumption, sleep, diet, and even caffeine intake can all contribute to brain health.
Determining the many ways in which these factors affect the mind as we age requires an extensive look into an individual’s current measures of health, medical history, and lifestyle. Through approaches such as nutraceuticals (natural compounds reported to enhance natural functions), and prescriptive lifestyle adjustments, physicians can advise a tailored preventive treatment plan to help patients minimize the impact of age-related cognitive decline.
Weight Loss – Effective Weight Management
There is a general perception that few individuals ever succeed with long-term weight loss. Because metabolic rate declines by 2% or more per decade after the age of 25, it is also a widely held belief that weight loss becomes more challenging with age. Yet, factors like age, and even exercise, are less important than the volume and types of food we eat. In fact, the Textbook of Age Management Medicine: Volume 1 explains that the belief that obesity is caused by a contemporary sedentary lifestyle and lack of exercise is a myth. Rather, obesity is a result of eating too much.
The text also reveals a silver lining: obesity is the most preventable disease in the U.S. The question remains, then: What is the best way to lose weight? If the volume and types of food being consumed are contributing to obesity, which is directly linked to morbidity in the form of heart disease, cancer, diabetes, and high blood pressure, why do so many people continue to struggle with an eating plan that supports weight management? The CDC confirms that more than a third of all U.S. adults are obese, with the highest concentration of obese individuals falling within the middle age range (40.2%).
The Textbook of Age Management Medicine: Volume 1 sheds some light on this issue:
We tend to maintain the same weight over time. We do so by eating similar weight and/or volumes of food each week. However, because of processed foods, which are abnormally dense in energy, that similar weight and volume of food results in a constant insult to the body (inflammation and insulin surges).
While scientists are continuing to refine their understanding of how the human body interacts with our environment, we are still a long way from manufacturing the nutritional value of natural food. Thus, consuming whole foods (versus processed foods) is the best way to achieve sustainable weight loss. Yet, this is complicated by the fact that a calorie is not just a calorie. Following a well-rounded diet geared toward weight management requires a precise balance of macronutrient intake, including being mindful of carbohydrate and protein levels in foods consumed. We must eat what we need, not what we want, which requires commitment to an active process that is achieved most effectively when overseen by nutritional experts.
Weight Loss – Quick Solutions?
Weight loss is one area in which age management and age-fighting approaches may vary most drastically. The age-fighting industry tends to prioritize “quick fixes” and those which yield the most noticeable cosmetic results. Liposuction services, abdominoplasty, and anti-cellulite treatment devices are marketed as effective means of improving appearances for overweight individuals. Even bariatric surgery is sometimes positioned as a quick fix to obesity, allowing severely overweight individuals to shed pounds by surgically enforcing restrictive eating habits.
What’s important to remember is this: there is no way to achieve sustainable weight loss without maintaining a healthy diet. Even solutions which may reduce fat quickly will not have lasting results without long-term commitment to eat well on the patient’s part. More importantly, these quick fixes do not carry the same far-reaching health benefits of a nutritional eating plan to achieve an improved clinical state.
What About Exercise?
If nutrition is the single most important factor in maintaining a healthy weight, is it even worthwhile to pursue regular physical activity? The answer is a resounding yes. As the Textbook of Age Management Medicine: Volume 1 confirms, “Exercise is perhaps the least used but most effective and most thoroughly studied therapy we have against chronic disease and ailments of age.” It protects against decline in the physical, sexual, and emotional domains, and is especially powerful in reducing inflammation.
Yet, this still leaves many adults wondering: What types of exercise are best? How much exercise should I be getting each week? Or, for that matter, each day? Is high-intensity interval training (HIIT) more beneficial than moderate-intensity exercise? These answers will vary significantly based on each individual’s specific goals; strength, endurance, and flexibility levels; current health measures; and even their genetic markers. This is just yet another example of an instance in which a physician-led, comprehensive approach to age management is ideal.
A declining libido isn’t something that occurs overnight. Loss of sexual desire is impacted by physical and mental health factors, along with age. While it is something that is seldom discussed openly, declining sex drive can take its toll on an individual’s overall wellbeing, as well as the quality of a relationship.
Research shows that loss of libido impacts women more than men, with 34% of females and 15% of males reporting a noticeable decline in their sex drive. The challenge in addressing low sexual interest lies in the fact that the condition can stem from a host of contributing factors. Fatigue, poor mental health, and even relationship factors can affect sex drive for both men and women.
Additionally, the body experiences immense hormonal changes with age. The Textbook of Age Management Medicine: Volume 2 explains that in men, for instance, dwindling testosterone can have a negative impact on the physical, sexual, and emotional domains of wellness. Women, too, can face health risks when they become hormone deficient.
Like weight management, exercise, and sleep, addressing variances in sex drive necessitates a patient-centric approach. It requires physicians to perform a comprehensive analysis into overall physical and mental health to determine the best course of action.
By this point, it’s clear that the undeniable, far-reaching impact of age management clearly overpowers the isolated results anti-aging solutions aim to achieve. The anti-aging industry addresses common pain points shared among many middle-aged and older adults, offering services such as hair restoration, eyelid procedures, and weight loss surgeries, as well as anti-wrinkle products and laser devices. All of these costly treatment options only address issues that are skin-deep, and therefore fail to make any impact on the true underlying agents that actually contribute to these symptoms of aging.
Age management, on the other hand, takes a more powerful and all-encompassing approach to wellness and aging. By addressing all of the internal and external factors that can compromise wellness as we age, physicians specializing in age management effectively tackle health challenges from the inside out. Increased energy levels, weight management, better sleep, improved cognitive function, and stabilized libido are the end result, with a more vibrant, lean, and youthful appearance simply being an added benefit.
Age management solutions are not exactly simple, however. Because each individual has a complex set of genetic, environmental, and lifestyle factors to consider, the approach must be tailored precisely to a person’s unique needs. From exercise recommendations to nutrition plans, hormone replacement therapy to a regimen of nutraceuticals, there are many ways age management physicians can derive tailored treatment plans targeting specific wellness outcomes. While pinpointing a person’s exact needs and establishing an individualized age management plan may require a small investment of time up front, the lasting benefits are well worth the effort.
The growing field of age management differs from anti-aging in many ways, but the most obvious is in the name. The aging process cannot be stopped, but one can effectively manage the progression of age-related decline. Through tactics such as frequent blood analysis, food and nutrient testing, exercise analysis, body composition assessments, and other types of biometric data collection, age management physicians can not only track how food, exercise, and sleep influence a patient’s health, but also how properly managing hormone levels can reduce risk factors associated with serious conditions like heart disease and metabolic syndrome.
Ultimately, the consumers of anti-aging solutions want to live vibrant, healthy lives until their final day, but are most attracted to the perception of health. The outcome of age management and anti-aging solutions may not seem very different but, for the latter, the course of action is almost always short-sighted. As the field of age management continues to develop, a growing number of consumers are beginning to educate themselves and are subsequently taking the more effective and comprehensive approach to address aging. Now, you can consider yourself among the well-informed individuals who know that wellness and youthful energy lies far deeper than the skin’s surface, and that the biomarkers of aging hold the true power to measuring and promoting long-term wellness.
This guide was produced with contributions from the following key resources:
The Cenegenics Education and Research Foundation
The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy
The Textbook of Age Management Medicine Volume 2: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy
Jeffrey Park Leake, M.D., CPT
Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Education Foundation.
Todd David Greenberg, M.D., CSCS
Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.
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 Morrill, Hannah. “Charting: A Brief History of Anti-Aging.” Harper’s BAZAAR. 2016.
 Global Anti-Aging Market Research Report and Forecast to 2017-2022; OrbisResearch.com.
 Rose, Michael R. Evolutionary Biology of Aging. Oxford University Press, 1994.
 World Health Organization, 2018. Retrieved from URL: http://www.who.int/suggestions/faq/en/
 American Federation for Aging Research, 2018. Retrieved from URL: https://www.afar.org/infoaging/biology-of-aging/biomarkers-of-aging/
 Biomarkers of Aging. American Federation for Aging Research, 2016.
 Gillies et al. “Balancing proactive and reactive care.” Occasional paper series, Royal College of General Practitioners, 1995.
 “Healthy People 2020.” National Centers for Health Statistics, Centers for Disease Control and Prevention, 2015. Retrieved from URL: https://www.cdc.gov/nchs/healthy_people/hp2020.htm
 “Older Adults.” Healthy People 2020. Retrieved from URL: https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults/objectives
 Hixon, Todd. “The Huge, Neglected Opportunity for Proactive Medicine.” Forbes. 19 Aug. 2014.
 Dennis, Helen. “Successful Aging: Causes of energy loss in older adults.” Los Angeles Daily News. 29 June 2015.
 Paudel et al. “Rest/Activity Rhythms and Mortality Rates in Older Men: MrOS Sleep Study.” Chronobiology International. 06 Apr. 2010.
 Sleep and tiredness survey. YouGov. 02 June 2015. https://today.yougov.com/topics/lifestyle/articles-reports/2015/06/02/sleep-and-dreams
 Glisky, Elizabeth L. Brain Aging: Models, Methods, and Mechanisms. CRC Press. 2007.
 Boston, Gabriella. “Basal metabolic rate changes as you age.” Washington Post. 05 March 2013.
 Stanford Health Care. Retrieved from URL: https://stanfordhealthcare.org/medical-conditions/healthy-living/obesity.html
 “Adult Obesity Facts.” CDC. 29 Aug. 2017. https://www.cdc.gov/obesity/data/adult.html
 Graham et al. “What factors are associated with reporting lacking interest in sex and how do these vary by gender?” BMJ Open. 2017.