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Senior Citizen Health & Medicine
Overweight Senior Citizens Increase Risk of
Disability but Reduce Death Risk
Two new studies show link between being too fat and
becoming disabled
April 23, 2007 - Older Americans that are
overweight increase their risk of disability but, according to a new
report, they may also be lowering their risk of death. The recommended
body mass index is in the range of 18.5 to 25 but those with a BMI of 25
to 30 are considered overweight.
BMI is calculated as weight in kilograms divided by
height in meters squared. Click here to SeniorJournal.com's easy to read
BMI calculator.
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Health & Medicine |
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A second study (see below) reported in the today's
issue of Archives of Internal Medicine, one of the Journal of the
American Medical Association journals, found obese people more likely to
file workers’ co mpensation claims for injuries on the job. This is
further information indicating a link between being too fat and becoming
disabled.
Obesity is an increasing public health problem and
a risk factor for many chronic diseases and death, according to
background information in the articles.
In the study of senior citizens, Soham Al Snih,
M.D., Ph.D., and colleagues at the University of Texas Medical Branch,
Galveston, and colleagues studied 12,725 adults 65 years or older who
were not disabled at the beginning of the study.
At initial interviews, which occurred between 1982
and 1993, researchers gathered information about health conditions,
demographic information and psychosocial characteristics. Blood
pressure, height and weight, and physical function were also measured.
Follow-up interviews, in person or by phone, were conducted annually for
seven years.
Over the follow-up period, 3,570 participants
became disabled, 2,019 died, and 5,681 were known to be alive and
non-disabled.
The average BMI was 26.4 for non-disabled
individuals, 26.4 for disabled individuals and 25.7 for those who died.
“Subjects with BMIs of lower than 18.5
[underweight] or 30 or higher [obese] at baseline were significantly
more likely to experience disability during the follow-up period,” the
authors write.
In contrast, those who had BMIs of 25 to
34.9—considered to be overweight—had a lower risk of death during the
study compared with those whose BMIs were less than 25 or 35 or higher.
“Disability-free life expectancy is greatest among
subjects with a BMI of 25 to less than 30,” they continue.
There are several possible explanations for the
link between obesity and disability in the elderly, the authors note.
“Obesity is associated with several conditions
that, in turn, are risk factors for subsequent disability, including
osteoarthritis of the weight-bearing joints, diabetes mellitus and
cardiovascular disease,” they write.
There are also several potential reasons for the
weak link between obesity and death. For instance, BMI may not be an
accurate measure of obesity in older adults. In addition, because
obesity and death are clearly linked in younger adults, it is possible
that individuals at risk of early death because of high BMI die before
they reach age 65.
In addition, “obesity might have a protective
effect at older ages that is less important at younger ages. This
protective effect might counterbalance the known adverse consequences of
obesity on survival.” For instance, obesity might reduce the risk of hip
fractures, or allow individuals who get sick to survive with a low
calorie intake for a longer period of time.
“Assessments of the effect of obesity on the health
of older Americans should account for mortality and incidence of
disability,” the authors conclude.
Obese Workers and Disability
Increased BMI has been shown to be associated with
increased costs to employee health plans. Obese workers have up to 21
percent higher health care costs than those whose weight is in the
recommended range. “Less is known about more direct costs of obesity to
employers, such as work-related illness and injury,” the authors write.
Truls Østbye, M.D., Ph.D., and colleagues at Duke
University Medical Center, Durham, N.C., studied 11,728 health care and
university employees who completed at least one health risk assessment
questionnaire—available yearly to all employees eligible for health
benefits—between 1997 and 2004. The assessment included a measure of
height and weight.
Workers with a BMI of less than 18.5 were
categorized as underweight; between 18.5 and 24.9, recommended weight;
25 to 29.9, overweight; 30 to 34.9, obesity class I; 35 to 39.9, obesity
class II; and 40 or higher, obesity class III.
Over an average of three years of follow-up,
workers with higher BMIs tended to have more workers’ compensation
claims—those in the group with the highest BMI (40 or greater) had twice
the rate of claims as those at the recommended weight.
“Because the number of lost workdays and the costs
per claim also increase rapidly with BMI, the effects of BMI on lost
workdays and costs were even stronger,” the authors write. “The number
of lost workdays was almost 13 times higher, medical claims costs were
seven times higher and indemnity claims costs were 11 times higher among
the heaviest employees compared with those of recommended weight.”
This association between BMI and claims was
apparent for injuries or illnesses involving most parts of the body, but
was most pronounced in claims related to the back, wrist or arm, neck or
shoulder, and knee, foot or hip. The types of injuries most strongly
related to BMI were sprain or strain, contusion or bruise, and pain or
inflammation.
“Maintaining healthy weight not only is important
to workers but should also be a high priority for their employers given
the strong effect of BMI on workers’ injuries,” the authors conclude.
“Complementing general interventions to make all workplaces safer,
work-based programs targeting healthy eating and physical activity
should be developed and evaluated.”
Editorial: Further research needed to illuminate
link between obesity, disability
As evidence accumulates for an association between
obesity and frailty, a dialogue must begin regarding the consequences of
rising obesity rates for the aging population, write Luigi Ferrucci,
M.D., Ph.D., National Institute on Aging, Baltimore, and Dawn Alley,
Ph.D., University of Pennsylvania, Philadelphia, in an accompanying
editorial.
“Several important questions about the relationship
between obesity and disability remain unanswered,” Drs. Ferrucci and
Alley write.
“How does obesity result in disability independent
of disease? Are there ways to intervene in this process by making
obesity less disabling, and are there ways to intervene without weight
loss, which may be risky in older persons? Why is obesity closely
related to disability in old age but less related to mortality? Does
obesity exert a protective effect in elderly patients?”
“Given the costs, the difficulties, and the burden
associated with treating obesity, there is an overwhelming need for
research that addresses these questions,” they conclude.
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