Obesity, Physical Function, and Mortality in Older Adults

Epidemiology and Public Health Group, Peninsula Medical School, Exeter, United Kingdom.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 07/2008; 56(8):1474-8. DOI: 10.1111/j.1532-5415.2008.01813.x
Source: PubMed


To estimate the effects of excess body weight on objective and subjective physical function and mortality risks in noninstitutionalized older adults.
Population-based cohort study.
The English Longitudinal Study of Ageing (ELSA).
Three thousand seven hundred ninety-three participants in the ELSA aged 65 and older followed up for 5 years.
Analyses compared the risks of impaired physical function and mortality for subjects who were at the recommended weight (body mass index (BMI)=20.0-24.9) with those who were overweight (BMI=25.0-29.9), obese (BMI=30.0-34.9) or severely obese (BMI>or=35.0). Outcome measures were difficulties with activities of daily living (ADLs), score on the Short Physical Performance Battery, and mortality.
Participants in higher BMI categories had greater risk of impaired physical function at follow-up but little or no greater risk of mortality. For example, compared with men of recommended weight, obese men (BMI=30.0-34.9) had relative risk ratios of difficulties with ADLs of 1.99 (95% confidence interval (CI)=1.42-2.78), of measured functional impairment of 1.51 (95% CI=1.05-2.16), and of mortality of 0.99 (95% CI=0.60-1.61). Findings were robust when excluding those who lost weight, smoked, or had poor self-rated health.
Excess body weight in people aged 65 and older is associated with greater risk of impaired physical function but not with greater mortality risk. Societies with growing numbers of overweight and obese older people are likely to face increasing burdens of disability-associated health and social care costs.

12 Reads
  • Source
    • "Accordingly, as compared to non-diabetic older adults, diabetic older adults reportedly experience a 9-year reduction in disability-free life expectancy (Andrade, 2010). Similarly, the relationship between obesity and physical function has been widely examined (Vincent et al., 2010; Coakley et al., 1998; Lang et al., 2008; Rejeski et al., 2010; Alley et al., 2008), and data show that high body weight and high BMI are associated with increased risk for functional impairment and disability. Functional impairments and disabilities in older adults can lead to a loss of independence (Mor et al., 1994), increased use of support services (Branch and Jette, 1982), hospitalization (Branch and Jette, 1981; Ostir et al., 2001), and mortality (Manton, 1988; Reuben and Siu, 1990). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity and diabetes are known risk factors for the development of physical disability among older adults. With the number of seniors with these conditions rising worldwide, the prevention and treatment of physical disability in these persons has become a major public health challenge. Sarcopenia, the progressive loss of muscle mass and strength, has been identified as a common pathway associated with the initial onset and progression of physical disability among older adults. A growing body of evidence suggests that metabolic dysregulation associated with obesity and diabetes accelerates the progression of sarcopenia, and subsequently functional decline in older adults. The focus of this brief review is on the contributions of obesity and diabetes in accelerating sarcopenia and functional decline among older adults. We also briefly discuss the underexplored interaction between obesity and diabetes that may further accelerate sarcopenia and place obese older adults with diabetes at particularly high risk of disability. Finally, we review findings from studies that have specifically tested the efficacy of lifestyle-based interventions in maintaining the functional status of older persons with obesity and/or diabetes.
    Experimental gerontology 07/2013; 48(9). DOI:10.1016/j.exger.2013.06.007 · 3.49 Impact Factor
  • Source
    • "A total possible score of 12 was created using the sum of four possible points for tests of chair stands, gait speed, and standing balance. Functional limitation was defined as an SPPB score of less than 9 (21, 22). Subjects were first asked to balance in a standing position with their feet side by side, semi-tandem, and fully tandem for 10 sec each. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Age-related body composition changes such as sarcopenia and obesity affect functional decline in the elderly. We investigated the relationship between body composition parameters and functional limitation in older Korean adults. We enrolled 242 men and 231 women aged ≥ 65 yr from the Korean elderly cohort. We used appendicular skeletal muscle mass (ASM) divided by height(2) (ASM/Ht(2)) and ASM divided by weight (ASM/Wt). The isokinetic strength of knee extensor muscles were measured using an isokinetic device. Functional limitations were assessed using the Short Physical Performance Battery (SPPB) score less than nine. Men within the bottom tertile of ASM/Ht(2) confer an increased risk for functional limitation compared with those within the top tertile (OR, 6.24; 95% CI, 1.78-22.0). However, in women, subjects within the lowest ASM/Wt tertile had a higher risk compared with those within the highest tertile instead of ASM/Ht(2) (OR, 7.60; 95% CI, 2.25-25.7). Leg muscle strength remained the strong measure even after controlling for muscle mass only in women. Only large waist circumference was positively associated with functional limitation only in women. We might consider a different muscle index to assess functional limitation according to the gender.
    Journal of Korean medical science 07/2013; 28(7):1041-7. DOI:10.3346/jkms.2013.28.7.1041 · 1.27 Impact Factor
  • Source
    • "Obesity has been associated with higher prevalence of disability in cross-sectional and longitudinal studies [4, 11–13]. This positive association has been found among middle-and older-aged adults [13] [14] [15], and it appears that this association has not changed over time [16] [17]. Additionally, the association between body mass index (BMI) and disability is strongest among those who are underweight ( "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to examine the association between body mass index and weight changes on disability transitions and mortality among Brazilian older adults. Longitudinal data from the Health, Well-Being, and Aging in Latin America and the Caribbean Study conducted in São Paulo, Brazil (2000 and 2006), were used to examine the impact of obesity on disability and mortality and of weight changes on health transitions related to disability. Logistic and multinomial regression models were used in the analyses. Individuals who were obese were more likely than those of normal weight to have limitations on activities of daily living (ADL), instrumental activity of daily living (IADL), and Nagi's limitations. Obesity was associated with higher incidence of ADL and IADL limitations and with lower recovery from Nagi's limitations. Compared to those who maintained their weight, those who gained weight experienced higher incidence of ADL and Nagi's limitations, even after controlling for initial body mass index. Higher mortality among overweight individuals was only found when the reference category was "remaining free of Nagi limitations." The findings of the study underline the importance of maintaining normal weight for preventing disability at older ages.
    Journal of aging research 04/2013; 2013(1):905094. DOI:10.1155/2013/905094
Show more