Abstract
Background
Carrying excess weight is associated with various chronic conditions especially in older adults, and can have a negative influence on the quality of life of this population.
Objective
The objective of this study was to estimate the independent (i.e. adjusted for demographic, socioeconomic and health status differences) impact of Body Mass Index (BMI) on health-related quality of life.
Design
A mail survey was sent to 60,000 older adults living in 10 states. Methods: The survey assessed quality of life using the average physical component scores (PCS) and mental component scores (MCS) obtained from the Veterans Rand 12-item (VR-12) health status tool embedded in the survey. Ordinary least squares (OLS) regression techniques were used to estimate the independent impact of each BMI category on quality of life, compared to the impact of other chronic conditions.
Results
A total of 22,827 (38%) eligible sample members responded to the survey. Of those, 2.2% were underweight, 38.5% had a normal BMI, 37.0% were overweight, 18.5% were obese and 1.9% were morbidly obese. Following OLS regression techniques, respondents’ PCS values were statistically significantly lower for the underweight, overweight, obese and morbidly obese BMI categories, compared to the normal BMI group. Compared with all other chronic conditions, being morbidly obese (−6.0 points) had the largest negative impact on the PCS. Underweight was the only BMI category with a statistically significantly lower MCS value.
Conclusions
The greatest negative impacts of the various BMI categories on quality of life were on physical rather than mental aspects, especially for those in the underweight, obese and morbidly obese categories, more so than many other chronic conditions.
Similar content being viewed by others
References
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–241.
CDC. Centers for Disease Control and Prevention 2009. Health Data Interactive Data Sources. 2009 [cited 2011 August 29, 2011]; Available from: http://www.cdc.gov/nchs/data_access/hdi/hdi_data_sources.htm.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298(17):2028–2037.
Lang IA, Llewellyn DJ, Alexander K, Melzer D. Obesity, physical function, and mortality in older adults. J Am Geriatr Soc. 2008;56(8):1474–1478.
Hubert HB, Bloch DA, Fries JF. Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study. J Rheumatol. 1993;20(3):480–488.
Houston DK, Ding J, Nicklas BJ, Harris TB, Lee JS, Nevitt MC, et al. Overweight and obesity over the adult life course and incident mobility limitation in older adults: the health, aging and body composition study. Am J Epidemiol. 2009;169(8):927–936.
Holvoet P, Kritchevsky SB, Tracy RP, Mertens A, Rubin SM, Butler J, et al. The metabolic syndrome, circulating oxidized LDL, and risk of myocardial infarction in well-functioning elderly people in the health, aging, and body composition cohort. Diabetes. 2004;53(4):1068–1073.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293(15):1861–1867.
Scott KM, McGee MA, Wells JE, Oakley Browne MA. Obesity and mental disorders in the adult general population. J Psychosom Res. 2008;64(1):97–105.
Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523–1529.
Anandacoomarasamy A, Caterson ID, Leibman S, Smith GS, Sambrook PN, Fransen M, et al. Influence of BMI on health-related quality of life: comparison between an obese adult cohort and age-matched population norms. Obesity (Silver Spring). 2009;17(11):2114–2118.
Coons SJ, Rao S, Keininger DL, Hays RD. A comparative review of generic quality-of-life instruments. Pharmacoeconomics. 2000;17(1):13–35.
Groessl EJ, Kaplan RM, Barrett-Connor E, Ganiats TG. Body mass index and quality of well-being in a community of older adults. Am J Prev Med. 2004;26(2):126–129.
Hawthorne G, Richardson J, Osborne R. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res. 1999;8(3):209–224.
Osborne RH, Hawthorne G, Lew EA, Gray LC. Quality of life assessment in the community-dwelling elderly: validation of the Assessment of Quality of Life (AQoL) Instrument and comparison with the SF-36. J Clin Epidemiol. 2003;56(2):138–147.
Yan LL, Daviglus ML, Liu K, Pirzada A, Garside DB, Schiffer L, et al. BMI and healthrelated quality of life in adults 65 years and older. Obes Res. 2004;12(1):69–76.
Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–111.
Kolotkin RL, Head S, Hamilton M, Tse CK. Assessing Impact of Weight on Quality of Life. Obes Res. 1995;3(1):49–56.
Le Pen C, Levy E, Loos F, Banzet MN, Basdevant A. “Specific” scale compared with “generic” scale: a double measurement of the quality of life in a French community sample of obese subjects. J Epidemiol Community Health. 1998;52(7):445–450.
Mannucci E, Ricca V, Barciulli E, Di Bernardo M, Travaglini R, Cabras PL, et al. Quality of life and overweight: the obesity related well-being (Orwell 97) questionnaire. Addict Behav. 1999;24(3):345–357.
Zabelina DL, Erickson AL, Kolotkin RL, Crosby RD. The effect of age on weight-related quality of life in overweight and obese individuals. Obesity (Silver Spring). 2009;17(7):1410–1413.
Himes CL, Reynolds SL. Effect of obesity on falls, injury, and disability. J Am Geriatr Soc. 2012;60(1):124–129.
Jensen GL, Hsiao PY. Obesity in older adults: relationship to functional limitation. Curr Opin Clin Nutr Metab Care. 2010;13(1):46–51.
Hopman WM, Berger C, Joseph L, Barr SI, Gao Y, Prior JC, et al. The association between body mass index and health-related quality of life: data from CaMos, a stratified population study. Qual Life Res. 2007;16(10):1595–1603.
Huang IC, Frangakis C, Wu AW. The relationship of excess body weight and healthrelated quality of life: evidence from a population study in Taiwan. Int J Obes (Lond). 2006;30(8):1250–1259.
Lynch CP, McTigue KM, Bost JE, Tinker LF, Vitolins M, Adams-Campbell L, et al. Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds. J Womens Health (Larchmt). 2010;19(8):1449–1458.
Medpac. Medpac Report. 2011 [June 14, 2011]; June:[Available from: http://www.medpac.gov/documents/Jun11_EntireReport.pdf.
Wee HL, Wu Y, Thumboo J, Lee J, Tai ES. Association of body mass index with Short-Form 36 physical and mental component summary scores in a multiethnic Asian population. Int J Obes (Lond). 2010;34(6):1034–1043.
Selim AJ, Rogers W, Fleishman JA, Qian SX, Fincke BG, Rothendler JA, et al. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res. 2009;18(1):43–52.
Resnick B, Nahm ES. Reliability and validity testing of the revised 12-item Short-Form Health Survey in older adults. J Nurs Meas. 2001;9(2):151–161.
Ware J, Jr., Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233.
Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health and quality of life outcomes. 2008;6:11.
NHLBI. National Heart, Lung, and Blood Institute (NHLBI) Obesity Task Force. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obes Res. 1998;6((Suppl 2)):51–209.
Rogers WH, Qian S, Kazis L. Imputing the Physical and Mental Summary Scores (PCS and MCS) for the MOS SF-36 and the Veterans SF-36 Health Survey in the presence of Missing Data. 2004 [December 4, 2012]; Available from: http://hosonline.org/surveys/hos/download/HOS_Veterans_36_Imputation.pdf.
Kosinski MK, Bayliss MS, Bjorner JB, Ware JE. Improving estimates of SF-36® health survey scores for respondents in missing data. Medical Outcomes Trust Monitor. 2000;5:8–10.
Ware JE, Kosinski, M., Turner-Bowker, D.M., and Gandek, B. SF-12v2™: How to Score Version 2 of the SF-12® Health Survey. Lincoln, RI: Quality Metric Incorporated. 2002.
Neumann PJ, Araki SS, Gutterman EM. The use of proxy respondents in studies of older adults: lessons, challenges, and opportunities. J Am Geriatr Soc. 2000;48(12):1646–1654.
Hawkins K, Bottone FG, Jr., Ozminkowski RJ, Musich S, Bai M, Migliori RJ, et al. The prevalence of hearing impairment and its burden on the quality of life among adults with Medicare Supplement Insurance. Qual Life Res. 2011.
World_Medical_Association. World Medical Association Declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects. Cardiovascular research. 1997;35(1):2–3.
ICMJE. International Committee of Medical Journal Editors (ICMJE): Uniform Requirements for Manuscripts Submitted to Biomedical Journals: writing and editing for biomedical publication. Haematologica. 2004;89(3):264.
Kvamme JM, Wilsgaard T, Florholmen J, Jacobsen BK. Body mass index and disease burden in elderly men and women: the Tromsø Study. European journal of epidemiology. 2010;25(3):183–193.
CMS. Medicare HOS 2009 Medicare Advantage Baseline Report. June 2010. 2010 [March 24, 2011]; Available from: http://www.hosonline.org/surveys/hos/download/HOS_SampleBaseline_C12.pdf.
Hassan MK, Joshi AV, Madhavan SS, Amonkar MM. Obesity and health-related quality of life: a cross-sectional analysis of the US population. Int J Obes Relat Metab Disord. 2003;27(10):1227–1232.
Gorber SC, Tremblay M, Moher D, Gorber B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8(4):307–326.
Okoro CA, Hootman JM, Strine TW, Balluz LS, Mokdad AH. Disability, arthritis, and body weight among adults 45 years and older. Obes Res. 2004;12(5):854–861.
Renzaho A, Wooden M, Houng B. Associations between body mass index and health-related quality of life among Australian adults. Qual Life Res. 2010;19(4):515–520.
Garcia-Poma A, Segami MI, Mora CS, Ugarte MF, Terrazas HN, Rhor EA, et al. Obesity is independently associated with impaired quality of life in patients with rheumatoid arthritis. Clin Rheumatol. 2007;26(11):1831–1835.
Garner RE, Feeny DH, Thompson A, Bernier J, McFarland BH, Huguet N, et al. Bodyweight, gender, and quality of life: a population-based longitudinal study. Qual Life Res. 2011.
Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res. 2005;13(11):1849–1863.
Kolotkin RL, Crosby RD, Williams GR, Hartley GG, Nicol S. The relationship between health-related quality of life and weight loss. Obes Res. 2001;9(9):564–571.
Kolotkin RL, Norquist JM, Crosby RD, Suryawanshi S, Teixeira PJ, Heymsfield SB, et al. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health and quality of life outcomes. 2009;7:53.
O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg. 2010;20(9):1199–1205.
Villareal DT, Banks M, Sinacore DR, Siener C, Klein S. Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med. 2006;166(8):860–866.
Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, et al. Weight loss, exercise, or both and physical function in obese older adults. The New England journal of medicine. 2011;364(13):1218–1229.
USPSTF. Screening for Obesity in Adults, Topic Page. November 2011. U.S. Preventive Services Task Force. 2011 [cited 2012 5/22/2012]; Available from: http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm.
Final Coverage Decision Memorandum for Intensive Behavioral Therapy for Obesity [database on the Internet]. 2011. Available from: http://www.cms.gov/medicare-coveragedatabase/details/nca-decision-memo.aspx?NCAId=253&ver=1&b c=AAAAAAAAIAAA&.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bottone, F.G., Hawkins, K., Musich, S. et al. The relationship between body mass index and quality of life in community-living older adults living in the United States. J Nutr Health Aging 17, 495–501 (2013). https://doi.org/10.1007/s12603-013-0022-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-013-0022-y