Obesity, Race, and Risk for Death or Functional Decline Among Medicare Beneficiaries: A Cohort Study
Publication: Annals of Internal Medicine
Volume 154, Number 10
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Abstract
Background:
The adverse effect of obesity on health outcomes may be lower in older and African American adults than in the general U.S. population.
Objective:
To examine and compare the relationship between obesity and all-cause mortality and functional decline among older U.S. adults.
Design:
Longitudinal cohort study.
Setting:
Secondary analysis of data from the 1994 to 2000 Medicare Current Beneficiary Surveys, linked to Medicare enrollment files through 22 April 2008.
Participants:
20 975 community-dwelling participants in the 1994 to 2000 Medicare Current Beneficiary Surveys who were aged 65 years or older.
Measurements:
All-cause mortality through 22 April 2008; new or worsening disability in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in 2 years.
Results:
37% of the study sample were overweight (body mass index [BMI] of 25 to <30 kg/m2), 18% were obese (BMI ≥30 kg/m2), 48% died during the 14-year follow-up, and 27% had ADL and 43% had IADL disability at baseline. Among those without severe disability at baseline, 17% developed new or worsening ADL disability and 26% developed new or worsening IADL disability within 2 years. After adjustment, adults with a BMI of 35 kg/m2 or greater were the only group above the normal BMI range who had a higher risk for mortality (hazard ratio, 1.49 [95% CI, 1.20 to 1.85] in men and 1.21 [CI, 1.06 to 1.39] in women, compared with the reference group [BMI of 22.0 to 24.9 kg/m2]; P for BMI–sex interaction = 0.003). In contrast, both overweight and obesity were associated with new or progressive ADL and IADL disability in a dose-dependent manner, particularly for white men and women. Significant interactions were detected between BMI and sex but not between BMI and race for any outcome, although risk estimates for ADL disability seemed attenuated in African American relative to white respondents.
Limitation:
This was an observational study, baseline data were self-reported, and the study had limited power to detect differences between white and African American respondents.
Conclusion:
Among older U.S. adults, obesity was not associated with mortality, except for those with at least moderately severe obesity. However, lower levels of obesity were associated with new or worsening disability within 2 years. Efforts to prevent disability in older adults should target those who are overweight or obese.
Primary Funding Source:
National Institute of Diabetes and Digestive and Kidney Diseases.
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Published In
Annals of Internal Medicine
Volume 154 • Number 10 • 17 May 2011
Pages: 645 - 655
History
Published online: 17 May 2011
Published in issue: 17 May 2011
Keywords
Copyright
© 2011 American College of Physicians.
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Obesity, Race, and Risk for Death or Functional Decline Among Medicare Beneficiaries: A Cohort Study. Ann Intern Med.2011;154:645-655. [Epub 17 May 2011]. doi:10.7326/0003-4819-154-10-201105170-00003
Obesity, Race, and Risk for Death or Functional Decline Among Medicare Beneficiaries: A Cohort Study. Ann Intern Med.2011;154:645-655. [Epub 17 May 2011]. doi:10.7326/0003-4819-154-10-201105170-00003
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Overweight -- Pros and Cons
TO THE EDITOR: Wee and colleagues (1) have found that overweight people (body mass index [BMI] 25 to <30) are more likely to have difficulty performing certain activities of daily living (for example, getting out of chairs or walking) and performing certain instrumental activities of daily living (for example, shopping or doing heavy housework). A possible explanation for the correlation of overweight and disability is hypothyroidism. Symptoms of hypothyroidism include a modest weight gain (10 to 20 pounds), fatigue, muscle aches, muscle weakness in the lower extremities, and pain and stiffness in the joints (2). Wee and colleagues also have found that overweight (but not obese) people have a lower mortality rate than people with a BMI 18.5 to 24.9. A possible explanation for this correlation involves the protective effect of fat. In the event of a fall, the additional "padding" reduces the likelihood of a hip fracture, thereby avoiding the risk of surgical complications and the risk of blood clots occurring after extended periods of traction (3).
John H. Glaser (Unaffiliated) Lexington, MA 02421
References
1. Wee CC, Huskey KW, Ngo LH, et al. Obesity, race, and risk for death or functional decline among Medicare beneficiaries. Ann Intern Med. 2011;154:645-655.
2. http://www.mayoclinic.com/health/hashimotos- disease/DS00567/DSECTION=symptoms, June 13, 2011 3. Glaser JH. Survival of the fattest. J Amer Ger Soc. 2010;58(7):1407.
Conflict of Interest:
None declared