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Senior Citizen Health & Medicine
Seniors Improving Heart Health but the Obese are
Sliding into Functional Disability
Exercise, lifestyle changes may help but we need a
successful public health strategy to prevent obesity, says editorial
 Nov. 6, 2007 – Obese senior citizens appear to be
winning the war against heart disease, with all the help they can muster
from cholesterol fighting statins and newer high blood pressure
medicine, but the picture is not all rosy. The number of obese older
people is growing and they increasingly suffer more problems with
functional abilities associated with normal daily life.
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Health & Medicine |
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Recent studies have suggested that the obese
population may have grown healthier since the 1960s, with the prevalence
of high cholesterol and high blood pressure declining among obese
individuals. There has remained, however, a question of whether
improvements in cardiovascular risk factors have been accompanied by
improvements in other health outcomes, according to a study in the
November 7 issue of the Journal of the American Medical Association.
Dawn Alley, Ph.D., and Virginia W. Chang, M.D.,
Ph.D., of the University of Pennsylvania, Philadelphia, conducted a
study to determine whether the association between obesity and
disability has changed among individuals age 60 years and older.
A previous analysis of trends in obesity and
disability showed a constant effect of obesity on disability over time,
with disability increasing in both obese and nonobese populations.
“Disability in this age group is of particular
importance, given the current context of population aging and an
increasing prevalence of obesity among older-aged individuals.
Furthermore, obesity-associated disability is associated with
significant burden in terms of both quality of life and health care
costs in this age group,” the authors write.
The researchers analyzed data from the nationally
representative National Health and Nutrition Examination Surveys (NHANES
III [1988-1994] and NHANES 1999-2004). The population set for this study
included 9,928 adults age 60 years and older with measured body mass
index (BMI).
The participants were surveyed regarding difficulty
or inability to perform tasks in two disability domains:
● functional limitations (walking one-fourth mile, walking up 10
steps, stooping, lifting 10 pounds, walking between rooms, and standing
from an armless chair) and
● activities of daily living (ADL) limitations (getting in and out of
bed, eating, and dressing).
The researchers found that the prevalence of
obesity (a BMI of 30 or greater) increased by 8.2 percentage points over
time from 23.5 percent of the population age 60 years and older in
1988-1994 (time 1) to 31.7 percent in 1999-2004 (time 2).
During both time ranges, obese individuals were
more likely than normal-weight individuals to have a functional
impairment. During time 2, obese individuals were also more likely to
have an ADL impairment.
Examining trends over time showed that the
prevalence of functional impairment did not change significantly among
normal-weight individuals, but increased among obese individuals by 5.4
percent, from 36.8 percent to 42.2 percent.
The odds of being functionally impaired did not
change for nonobese individuals from time 1 to time 2, but increased 43
percent among obese individuals.
There was an increasing association between obesity
and disability over time.
● At time 1, obese individuals had a 78 percent
increased odds of functional impairment relative to those with normal
weight.
● At time 2, the odds of functional limitation
for obese individuals were 2.75 times greater than for those with normal
weight.
In terms of ADL limitations, the risk of ADL
impairment in obese older individuals was not significantly different
from normal weight during time 1.
Between 1988-1994 and 1999-2004, the odds of ADL
impairment decreased by 34 percent within the nonobese population, but
did not change in the obese population.
At time 2, the odds of ADL impairment for obese
individuals was about twice as great than for those with normal weight.
“Obese participants in NHANES 1999-2004 were more
likely to report functional impairments than obese participants in
NHANES III (1988-1994), which suggests an increasing risk of disability
in the obese population.
“Furthermore, reductions in ADL disability observed
among nonobese older individuals did not occur among obese individuals.
“Taken together, these findings suggest that recent
improvements in cardiovascular health have not been accompanied by a
reduction in disability burden among obese individuals; instead, the
risk of some types of disability is actually increasing,” the authors
conclude.
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 Obesity,
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Editorial: Is Disability Obesity’s Price of
Longevity?
“Disability represents in part the collective
effects of multiple obesity-related conditions, which bodes poorly for
any simple clinical or public health solutions to modify the
obesity-associated disability trends. This challenge is compounded by
the lack of commonly practiced interventions directly aimed at reducing
disability in at-risk populations,” writes Edward W. Gregg, Ph.D., of
the Centers for Disease Control and Prevention, Atlanta, and Jack M.
Guralnik, M.D., Ph.D., of the National Institutes of Health, Bethesda,
Md., in an editorial in JAMA regarding obesity and disability.
“Structured exercise and weight loss programs may
be among the most promising unifying interventions because they appear
to help prevent type 2 diabetes, reduce arthritis symptoms, and improve
physical functioning—i.e., they can reduce each of the outcomes of
obesity that have persisted over time.
“Thus, these findings make a compelling case to
overcome the barriers of integrating effective lifestyle and exercise
programs into health systems and communities. In the end, however,
reducing the effect of obesity on morbidity by simply altering its
course or accommodating its presence may never have an impact equal to a
successful public health strategy to prevent obesity.”
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