Generalised and abdominal adiposity are important risk factors for chronic disease in older people: Results from a nationally representative survey

JNHA: Geriatric Science
First Online:
Received:
Accepted:

Abstract

Objectives

To look at the trends in prevalence of generalised (body mass index (BMI) ≥25 kg/m2) and abdominal obesity (waist circumference (WC) >102cm, men; >88cm, women) among older people from 1993 to 2008, prevalence of chronic disease by overweight/obesity and WC categories in England 2005 and evaluate the association of these measures with chronic diseases.

Design

Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE).

Participants

Non-institutionalised men and women aged ≥ 65years (in HSE 2005, 1512 men and 1747 women).

Measurements

Height, weight, waist circumference, blood pressure measurements were taken according to standardised HSE protocols. Information collected on socio-demographic, health behaviour and doctor diagnosed health conditions.

Results

Generalised obesity and abdominal obesity increased among men and women from 1993 to 2008. In 2005, the HSE 2005 focussed on older people. 72% of men and 68% of women aged over 65 were either overweight or obese. Prevalence of raised WC was higher in women (58%) than in men (46%). The prevalence of diabetes and arthritis was higher in people with generalised obesity in both sexes. Men were more likely to have had a joint replacement and had a higher prevalence of stroke if they were overweight only but women were more likely to have had a joint replacement only if they were obese (13%) and had a higher risk of falls with generalised obesity. The pattern was similar for the prevalence of chronic diseases by raised WC. Multivariate analysis showed that generalised and abdominal obesity was independently associated with risk of hypertension, diabetes and arthritis in both men and women. In women only, there was an association between generalised obesity and having a fall in the last year (OR: 1.5), and between abdominal obesity and having a joint replacement (OR: 1.9, p=0.01).

Conclusion

Complications of obesity such as diabetes, hypertension and arthritis, are more common in men and women aged over 65 who are overweight or obese, as well as in those with a raised WC. These conditions impact on morbidity, mortality and have cost implications for the health service and are known to improve with weight loss even in old age. Treatment strategies to address these conditions such as weight management and prevention of overweight and obesity are important even in older people. There is a need to ensure that older people are given appropriate advice about keeping physically active and eating sensibly.

Key words

Older people obesity chronic diseases population survey 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Haslam D, Sattar N, Lean M. ABC of obesity. Obesity—time to wake up. BMJ 2006; 333: 640–642.PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organisation. Obesity and overweight. WHO, 2006. [On-line] available at www.who.int/dietphysicalactivity/publications/facts/obesity/en/ (accessed 21/5/10).
  3. 3.
    Kopelman PG. Obesity as a medical problem. Nature 2000; 404:635–643.PubMedGoogle Scholar
  4. 4.
    Corrada MM, Kawas CH, Mozaffar F, Paganini-Hill A. Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol 2006;15;163:938–949.CrossRefGoogle Scholar
  5. 5.
    Jonsson S, Hedblad B, Engstrom G et al Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22,025 men from an urban Swedish population. Int J Obes Relat Metab Disord 2002; 8:1046–1053.CrossRefGoogle Scholar
  6. 6.
    Stein CJ, Colditz GA. The Epidemic of Obesity. J Clin Endocrinol 2004; 89:2522–2525.CrossRefGoogle Scholar
  7. 7.
    Corrada MM, Kawas CH, Mozaffar F, Paganini-Hill A. Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol 2006;15;163:938–949.CrossRefGoogle Scholar
  8. 8.
    Janssen I, Katzmarzyk PT, Ross R. Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 2005; 53:2112–2118.PubMedCrossRefGoogle Scholar
  9. 9.
    Heieat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to older persons. Arch Intern Med 2001;161:1194–1203.CrossRefGoogle Scholar
  10. 10.
    Flegal KM. Excess deaths associated with obesity: cause and effect. Int J Obes 2006;301171–301172.Google Scholar
  11. 11.
    Cundiff DK. BMI: a poor surrogate for diet and exercise in assessing risk of death. Int J Obes 2006; 30:1173–1175.CrossRefGoogle Scholar
  12. 12.
    Evans WJ, Campbell WW. Sarcopenia and age-related changes in body composition and functional capacity. J Nutr 1993; 123:465–468.PubMedGoogle Scholar
  13. 13.
    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; 13:1849–1863.PubMedCrossRefGoogle Scholar
  14. 14.
    Sjostrom L. Obesity and its relationship to other diseases (Chapter 11.4) pp 235–239. in Shetty PS, McPherson K (eds). Diet, nutrition and chronic disease: lessons from contrasting worlds 1996. London School of Hygiene and Tropical Medicine Sixth Annual Public Health Forum. Wiley, London, 1997.Google Scholar
  15. 15.
    de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-tohip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007; 28(7): 850–856.PubMedCrossRefGoogle Scholar
  16. 16.
    Zaninotto P, Pierce M, Breeze E, Oliveira CD, Kumari M. BMI and Waist Circumference as Predictors of Well-being in Older Adults: Findings From the English Longitudinal Study of Ageing. Obesity 2010. [Epub ahead of print]Google Scholar
  17. 17.
    International Obesity Task Force. [On-line] www.iotf.org (accessed 21/7/10).
  18. 18.
    The Information Centre. The Health Survey for England 2008: Trend tables. [Online] http://www.ic.nhs.uk/webfiles/publications/HSE/HSE08trends/Health_Survey_for_england_trend_tables_2008.pdf. Accessed 21/05/10.
  19. 19.
    Craig R, Mindell J. The Health Survey for England 2005: The Health of Older Adults. The Health Survey for England series. The Information Centre, London, UK. 2007.Google Scholar
  20. 20.
    Craig R, Mindell J. The Health Survey for England 2005. Volume 3: Methodology and Documentation. The Information Centre, London, UK. 2007.Google Scholar
  21. 21.
    National Institutes of Health. Third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md: National Institutes of Health. NIH Publication, 2001. 01-3670.Google Scholar
  22. 22.
    Organisation for Economic Co-operation and Development (OECD). Working Paper on Obesity Epidemic [On-line] http://www.olis.oecd.org/olis/2009doc.nsf/LinkTo/NT00000EFE/$FILE/JT03261624. (accessed 21/05/2010).
  23. 23.
    O’Rahilly S, Farooqi IS. Human obesity: a heritable neurobehavioral disorder that is highly sensitive to environmental conditions. Diabetes 2008;57(11):2905–2910.PubMedCrossRefGoogle Scholar
  24. 24.
    Zaninotto P, Wardle H, Stamatakis E, et al. Forecasting obesity to 2010. Department of Health, London, 2006. [On-line] www.dh.gov.uk/assetRoot/04/13/86/29/04138629.pdf (accessed 21/05/2010).Google Scholar
  25. 25.
    The World Health Organisation. [On-line] http://www.who.int/ageing/en/index.html. (accessed 21/05/2010).
  26. 26.
    Wanless D. Securing good health for the whole population. HM Treasury, London, 2004. [On-line] www.hmtreasury.gov.uk/consultations_and_legislation/wanless/consult_wanless04_final.cfm (accessed 21/05/2010).Google Scholar
  27. 27.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010 Jan 20;303(3):235–241.PubMedCrossRefGoogle Scholar
  28. 28.
    Faria AN, Ribeiro Filho FF, Gouveia Ferreira SR, Zanella MT. Impact of visceral fat on blood pressure and insulin sensitivity in hypertensive obese women. Obes Res 2002; 10: 1203–1206.PubMedCrossRefGoogle Scholar
  29. 29.
    Harris MM, Stevens J, Thomas N, Schreiner P, Folsom AR. Associations of fat distribution and obesity with hypertension in a bi-ethnic population: the ARIC study. Atherosclerosis Risk in Communities Study. Obes Res 2000;8(7): 516–524.PubMedCrossRefGoogle Scholar
  30. 30.
    Gregg EW, Cheng YJ, Cadwell BL et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005;293:1868–1874.PubMedCrossRefGoogle Scholar
  31. 31.
    Yalcin BM, Sahin EM, Yalcin E. Which anthropometric measurement is most closely related to elevated BP? Fam Pract 2005;22:541–547PubMedCrossRefGoogle Scholar
  32. 32.
    Leveille SG, Wee CC, Iezzoni LI. Trends in obesity and arthritis among baby boomers and their predecessors, 1971–2002. Am J Public Health 2005 95:1607–1613.PubMedCrossRefGoogle Scholar
  33. 33.
    Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Canesi B. Osteoarthritis: an overview of the disease and its treatment strategies. Semin Arthritis Rheum 2005; 35(1 Suppl 1):1–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Turley M, Tobias M, Paul S. Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults. Aust N Z Public Health 2006; 30:231–237.CrossRefGoogle Scholar
  35. 35.
    Rogers RG, Hummer RA, Krueger PM. The effect of obesity on overall, circulatory disease- and diabetes-specific mortality. J Biosoc Sci 2003;35(1):107–129.PubMedCrossRefGoogle Scholar
  36. 36.
    Walker SP, Rimm EB, Ascheno A, Kawachi I, Stampfer MJ, Willett WC. Body size and fat distribution as predictors of stroke among US men. Am J Epid 1996; 144: 1143–1150.Google Scholar
  37. 37.
    Molarius A, Seidell JC. Selection of anthropometric indicators for classification of abdominal fatness — a critical review. Int J Obes 1998; 22:719–727.CrossRefGoogle Scholar
  38. 38.
    Singh MAF. Exercise comes of age. Rationale and recommendations for a geriatric exercise prescription. J Gerontol 2002; 57A:M262–M282.Google Scholar
  39. 39.
    Waaler HT. Hazard of obesity—the Norwegian experience. Acta Med Scand Suppl 1988;723:17–21.PubMedGoogle Scholar
  40. 40.
    Lehmann AB, Bassey EJ. Longitudinal weight changes over four years and associated factors in 629 men and women aged over 65. Eur J Clin Nutr 1996; 50:6–11.PubMedGoogle Scholar
  41. 41.
    Elia M. Organ and tissue contribution to metabolic rate. In: Kinney JM, Tucker HN, eds. Energy Metabolism: Tissue Determinants and Cellular Corollaries. Raven Press, New York, 1992.Google Scholar
  42. 42.
    Gensini GF, Comeglio M, Colella A. Classical risk factors and emerging elements in the risk profile for coronary artery disease. Eur Heart J 1998; 19Suppl A: A53–A61.PubMedGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    Whelton PK, Appel LJ, Espeland MA et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA 1998; 279: 839–846.PubMedCrossRefGoogle Scholar
  45. 45.
    Pi-Sunyer FX. Short-term medical benefits and adverse effects of weight loss. Ann Int Med 1993; 119: 722–726.PubMedGoogle Scholar
  46. 46.
    Huang Z, Reddy A. Weight change, ideal weight and hypertension. Current Opinions in Neph Hypert 1999; 8(3): 343–346.CrossRefGoogle Scholar
  47. 47.
    Broom J. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. The Research Findings Register, 2004. [On-line] http://www.ReFeR.nhs.uk/ViewRecord.asp?ID=1274. (accessed 25/05/10)
  48. 48.
    Messier SP, Loeser RF, Miller GD et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 2004; 50: 1501–1510.PubMedCrossRefGoogle Scholar
  49. 49.
    Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, Fantin F, Bissoli L, Bosello O. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 2005; 29:1011–1029.CrossRefGoogle Scholar
  50. 50.
    Witham MD, Avenell A. Interventions to achieve long-term weight loss in obese older people: a systematic review and meta-analysis. Age Ageing 2010;39(2):176–184. Epub 2010. Review.PubMedCrossRefGoogle Scholar
  51. 51.
    Price GM, Uauy R, Breeze E, Bulpitt CJ, Fletcher AE. Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 2006;84:449–460.PubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  1. 1.Department of Epidemiology and Public Health, University College London Medical SchoolUniversity College LondonLondonUK

Personalised recommendations