Old, obesity and lifespan vs. health span

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Hi All,

It seems that the actual message of the below pdf-available paper that is given

for

its citation, tables 1 and 2 and Discussion seems to be that there was no upside

and

the downside is obese oldsters will live with more disability than non-obese

oldsters.

Reynolds SL, Saito Y, Crimmins EM.

The impact of obesity on active life expectancy in older american men and women.

Gerontologist. 2005 Aug;45(4):438-44.

PMID: 16051906

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16051906 & query_hl=26

.... Table 1. Number of Health Transitions for Adults Aged 70 and Older, by

Obesity

Status: AHEAD 1993–1998.

............................................

Sample State in 1993 and 1998 All (N = 7,381) Obese (n = 973) Not Obese (n =

6,408)

............................................

Remained active in 1998 3,637 (49.3) 404 (41.5) 3,233 (50.5)

Became disabled in 1998 978 (13.3) 162 (16.7) 816 (12.7)

Became active in 1998 322 (4.4) 66 (6.8) 256 (4.0)

Remained disabled in 1998 550 (7.5) 141 (14.5) 409 (6.4)

Died by 1998 1,894 (25.5) 200 (20.5) 1,694 (26.4)

Total 7,381 (100.0) 973 (100.0) 6,408 (100.0)

............................................

Note: Percentages appear in parentheses.

.... Table 2. Total, Active, and Disabled Life Expectancy, in Years and Percent

Remaining Life for Obese and Not Obese Adults Aged 70, 80, and 90 Years: AHEAD

1993–1998.

...............................................

Gender Total 95% CI Active 95% CI Disabled 95% CI Disabled (%)

..............................................

Male

Not obese

70 12.3 11.9–12.8 9.8 9.4–10.2 2.5 2.3–2.8 20.7

80 6.7 6.4–7.1 4.5 4.2–4.7 2.3 2.1–2.5 33.7

90 3.9 3.6–4.1 2.1 2.0–2.3 1.7 1.6–1.9 45.1

Obese

70 12.4 11.4–13.3 8.4 7.7–9.1 4.0 3.4–4.5 32.0

80 6.8 6.1–7.5 3.3 3.0–3.7 3.5 3.0–4.0 51.1

90 4.3 3.8–4.8 1.8 1.6–2.0 2.4 2.0–2.9 57.1

Female

Not obese

70 15.3 14.8–15.7 10.5 10.1–10.8 4.8 4.5–5.1 31.4

80 8.9 8.6–9.3 4.8 4.5–5.0 4.2 3.9–4.4 46.6

90 5.1 4.8–5.5 2.0 1.8–2.1 3.2 2.9–3.5 62.0

Obese

70 15.5 14.4–16.6 8.1 7.4–8.8 7.4 6.5–8.3 47.7

80 9.6 8.7–10.5 3.7 3.3–4.1 5.9 5.1–6.7 61.5

90 5.8 5.1–6.6 1.5 1.3–1.7 4.3 3.6–5.0 74.2

.... Discussion

In summary, we found that obesity had little effect on life expectancy for

either

older men or women, once people had reached age 70. These results are consistent

with the literature on age, obesity, and mortality, which generally indicate a

lessening of the link between obesity and mortality with increasing age (Ferraro

et

al., 2003; Thorpe & Ferraro, 2004). Active life expectancy, however, is

significantly shorter and disabled life expectancy significantly longer for

obese

persons at older ages. Our results are also consistent with the literature

indicating that obesity has a deleterious effect on older adults' ability to

function (Peeters et al., 2004; Visscher et al., 2004).

Our approach to estimating the effect of obesity allows us to conclude that at

age

70, when compared to a nonobese woman, the average obese woman can expect to

live

2.4 years less being able to perform all ADLs without difficulty and 2.6 years

longer with ADL problems. The average obese man lives 1.4 fewer active years

than a

nonobese man at age 70 and 1.5 more disabled years.

Having difficulty with ADL tasks is often associated with the need for personal

care

so the excess years of disability can be difficult for both the individuals and

their families. In order to better understand the population impact of obesity,

we

estimated the excess disabled years in the 1995 population associated with being

obese by weighting the average number of years lived in disability among the

obese

and the nonobese by their representation in the population. If we assume that

the

obese lived the same number of years in disability as the nonobese, the total

number

of years lived with ADL disability in the 70+ population would be reduced by 8%

among older women and 5.4% among older men. Obesity has increased at all ages in

recent decades and is projected to increase in the future (Arterburn, Crane, &

Sullivan, 2004). This, along with projected increases in the number of older

persons, means that there will be significant increases in disability, absent

interventions to retard or halt the increase in adult obesity in the United

States.

This would mean a significant change in current trends toward improving

disability,

as well as a major impact on our health care systems (Arterburn et al.).

To date, few studies of interventions to reduce obesity in older adults have

been

conducted. Major questions related to interventions in obesity include the

ability

of older adults to lose weight intentionally, the best means of accomplishing

intentional weight loss, and what factors influence the success or failure of

potential weight loss interventions.

Several studies have found older adults able to lose either weight or body fat,

but

these studies vary widely in the length of clinical trials, from 3 to 6 weeks

(Hays,

DiSabatino, Gorman, , & Stillabower, 2003; Sartorio, Lafortuna, Agosti,

Proietti, & Maffiuletti, 2004) to 9 months to a year (Binder et al., 2002; Zhu

et

al., 2003). Although there is little evidence to suggest that older adults

cannot

lose weight intentionally, lack of success in maintaining weight loss in adults

who

are overweight implies that prevention of obesity may be more effective in the

long

term (Lee et al., 2001).

In terms of effective means of accomplishing reductions in obesity, there is

conflicting evidence on whether diet (or proper nutrition) or physical activity

is

best. For example, Hays and colleagues (2002) found that eating behaviors were

strongly related to prevention of adult-onset obesity. In addition, Zhu and

colleagues (2003) studied caloric restriction weight loss, exercise programs,

and

weight-reducing medications and concluded that weight loss through dieting was

the

most beneficial. In another study, Hays and colleagues (2003) found evidence of

weight loss with a high saturated fat and no-starch diet successfully reduced

obesity without harmful effects on lipids; however, this study was conducted

over

just 6 weeks. Other studies place a higher emphasis on physical activity as a

means

to reducing obesity and its effects (Bijnen, Feskens, Caspersen, Mosterd, &

Kromhout, 1998; Binder et al., 2002).

Finally, in order to maximize the effectiveness of potential interventions on

reducing obesity in older adults, more research should focus on factors that

impact

both obesity and the ability to respond to treatment for obesity. Physical

activity

levels for example, have been found to vary by gender and ethnicity (Bijnen et

al.,

1998), attitudes and psychosocial attributes, such as body-image (DiPietro,

2001;

King, , Haskell, & DeBusk, 1988), self-motivation, and earlier-age

activity

levels (King, 2001). There is a great deal more research needed to determine the

most effective ways to reduce obesity in older adults; however, the implications

of

this article suggest that the impact of obesity on disability in older adults

makes

research of potential interventions worthwhile for those even at the oldest

ages.

This study has some limitations, including the reliance on self-reported obesity

at

one point in time. First, there is evidence that there are gender differences in

the

accuracy of self-reports of weight, particularly by women, who are likely to

underreport their weight (Bendixen et al., 2004). Consequently, it is possible

that

our results represent an underestimation of the impact of obesity on older

women.

Second, we did not know the history of weight change among the sample so we did

not

incorporate this in our analysis; in addition, there was very little change in

weight over the 5 year period, so analysis of weight change during the period

was

not examined. Another limitation is the small number of obese persons,

particularly

at the oldest ages; it is possible that analysis of the oldest ages was hampered

by

lack of statistical power.

Public health policy for older adults should be concerned with the prospect of

growing numbers of longer-lived disabled obese adults (Arterburn et al., 2004),

particularly since obese respondents in AHEAD also had high levels of

hypertension,

diabetes, and arthritis (data not shown), conditions also associated with

disability

in old age. In addition to further study on the impact of obesity on

functioning,

disability, disease, and death, future research should also focus on effective

means

of reducing obesity. While this study presents further evidence that obesity has

decidedly negative effects on the quality of life for adults aged 70 years and

older, other research indicates that reduction of obesity in older adults is

complicated, but quite possible (Binder et al., 2002; Hays et al., 2003;

Sartorio et

al., 2004; Zhu et al., 2003). This study also suggests that such interventions

could

have a major impact on disability rates in older adults, particularly those who

are

at high risk for disability and obesity.

Al Pater, PhD; email: old542000@...

____________________________________________________

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