Adult obesity and the burden of disability throughout life.

OBJECTIVE To analyze the prevalence of disability throughout life and life expectancy free of disability, associated with obesity at ages 30 to 49 years. RESEARCH METHODS AND PROCEDURES We used 46 and 20 years of mortality follow-up, respectively, for 3521 Original and 3013 Offspring Framingham Heart Study participants 30 to 49 years and classified as normal weight, overweight, or obese at baseline. Disability measures were available between 36 and 46 years of follow-up for 1352 Original participants and at 20 years of follow-up for 2268 Offspring participants. We measured the odds of disability in the Original cohort after 46 years follow-up, and we estimated life expectancy with and without disability from age 50. Two disability measures were used, one representing limitations with mobility only and the second representing limitations with activities of daily living (ADL). RESULTS Obesity at ages 30 to 49 years was associated with a 2.01-fold increase in the odds of ADL limitations 46 years later. Nonsmoking adults who were obese between 30 and 49 years lived 5.70 (95% confidence interval, 4.11 to 7.35) (men) and 5.02 (95% confidence interval, 3.36 to 6.61) (women) fewer years free of ADL limitations from age 50 than their normal-weight counterparts. There was no significant difference in the total number of years lived with disability throughout life between those obese or normal weight, due to both higher disability prevalence and higher mortality in the obese population. DISCUSSION Obesity in adulthood is associated with an increased risk of disability throughout life and a reduction in the length of time spent free of disability, but no substantial change in the length of time spent with disability.

[1]  L. Branch,et al.  A prospective study of functional status among community elders. , 1984, American journal of public health.

[2]  Robert Tibshirani,et al.  An Introduction to the Bootstrap , 1994 .

[3]  A. Stunkard,et al.  Socioeconomic status and obesity: a review of the literature. , 1989, Psychological bulletin.

[4]  J. Barendregt,et al.  Methods of estimating years of life lost due to obesity. , 2003, JAMA.

[5]  D. Allison,et al.  Obesity and quality of life: mediating effects of pain and comorbidities. , 2003, Obesity research.

[6]  J. Seidell,et al.  The public health impact of obesity. , 2001, Annual review of public health.

[7]  Abdullah Al Mamun,et al.  A cardiovascular life history. A life course analysis of the original Framingham Heart Study cohort. , 2002, European heart journal.

[8]  E. Cook,et al.  Body mass index and mortality among nonsmoking older persons. The Framingham Heart Study. , 1988, JAMA.

[9]  A. Jette,et al.  Framingham Disability Study: relationship of disability to cardiovascular risk factors among persons free of diagnosed cardiovascular disease. , 1985, American journal of epidemiology.

[10]  D A Bloch,et al.  Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study. , 1993, The Journal of rheumatology.

[11]  HELEN B. HUBERT,et al.  Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26‐year Follow‐up of Participants in the Framingham Heart Study , 1983, Circulation.

[12]  Manning Feinleib,et al.  Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26‐year Follow‐up of Participants in the Framingham Heart Study , 1983, Circulation.

[13]  L. Launer,et al.  Body mass index, weight change, and risk of mobility disability in middle-aged and older women. The epidemiologic follow-up study of NHANES I. , 1994, JAMA.

[14]  B. Gompertz,et al.  On the Nature of the Function Expressive of the Law of Human Mortality , 1825 .

[15]  Stephen F Badylak,et al.  Body mass index and disability in adulthood: a 20-year panel study. , 2002, American journal of public health.

[16]  P E Leaverton,et al.  Predictors of good function: the Framingham Study. , 1987, Journal of chronic diseases.

[17]  J. Guralnik,et al.  Predictors of healthy aging: prospective evidence from the Alameda County study. , 1989, American journal of public health.

[18]  K. Anderson,et al.  Cardiovascular disease risk profiles. , 1991, American heart journal.

[19]  J. Manson,et al.  Obesity in the United States: a fresh look at its high toll. , 2003, JAMA.

[20]  Abdullah Al Mamun,et al.  Obesity in Adulthood and Its Consequences for Life Expectancy: A Life-Table Analysis , 2003, Annals of Internal Medicine.

[21]  Benjamin Gompertz,et al.  XXIV. On the nature of the function expressive of the law of human mortality, and on a new mode of determining the value of life contingencies. In a letter to Francis Baily, Esq. F. R. S. &c , 1825, Philosophical Transactions of the Royal Society of London.

[22]  Graham A. Colditz,et al.  Body weight and mortality among women , 1995 .

[23]  M. Thun,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[24]  D. Levy,et al.  Evidence for decline in disability and improved health among persons aged 55 to 70 years: the Framingham Heart Study. , 1999, American journal of public health.

[25]  H. Kesteloot,et al.  On the relationship between human all-cause mortality and age , 2002, European Journal of Epidemiology.

[26]  S. Katz,et al.  Progress in development of the index of ADL. , 1970, The Gerontologist.

[27]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2000. , 2002, JAMA.

[28]  M. Carroll,et al.  Overweight and obesity in the United States: prevalence and trends, 1960–1994 , 1998, International Journal of Obesity.

[29]  D. Sullivan,et al.  A single index of mortality and morbidity. , 1971, HSMHA health reports.

[30]  T. Dawber,et al.  Epidemiological approaches to heart disease: the Framingham Study. , 1951, American journal of public health and the nation's health.

[31]  K. Narayan,et al.  The direct health care costs of obesity in the United States. , 1999, American journal of public health.