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Mortality and disability: the effect of overweight and obesity

International Journal of Obesity volume 33, pages 1410–1418 (2009)Cite this article

Abstract

Context:

Prevalence of obesity is increasing globally. The effect of obesity on mortality and morbidity and its implication on the future prevalence of disability in the older population has not been conclusively analyzed.

Objective:

To determine the influence of overweight and obesity on mortality and disability by quantifying the effect in terms of disability-free life expectancy and years lost to disability (YLD) in the older people.

Design, Setting and Participants:

For 5980 participants from the Rotterdam Study cohort, regression techniques were used to estimate the association of body mass index (BMI) and waist circumference (WC) separately with mortality, incident disability and recovery from disability. Disability was assessed using the Stanford Health Assessment Questionnaire Disability Index, an activity of daily living scale. Multistate life table methodology was used to calculate life expectancies.

Main Outcome Measures:

In total, 15-year mortality risk, 6-year disability incidence, total life expectancy, healthy life expectancy and years of disabled life expectancy.

Results:

We observed 2388 deaths. Our analysis revealed no association between body mass index, or WC and mortality in the healthy population. Body mass index and WC were related to disability (‘overweight’ 25 ⩽BMI <30, odd ratio (OR)=1.33, 95% confidence interval (CI) (1.10; 1.61), ‘obesity I’ 30⩽ BMI <35, OR=2.03, 95% CI (1.55; 2.65)) and negatively to recovery from disability. We observed an increase of years lost to disability with increasing weight for men (‘normal weight’—4.69 years, ‘overweight’—5.87 years and ‘obesity I’—7.06 years) and for women (‘normal weight’—10.95 years, ‘overweight’—12.82 years, ‘obesity I’—15.17 years and ‘obesity II/III’—13.13 years).

Conclusion:

Results do not support the hypothesis that an increased body weight reduces total life expectancy in the older people. Although increased body weight was associated with a higher risk of becoming and remaining disabled. These results remained using WC.

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Acknowledgements

The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam, the Netherlands Organisation of Scientific Research (NWO), the Netherlands Organisation for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports and the European Commission (DG XII). Stefan Walter is funded by NETSPAR and the NETSPAR theme ‘Living Longer in Good Health’. The sponsors had no role in the design or conduct of the study; in the collection, management, analysis or interpretation of the data; or in the preparation, review or approval of the paper.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands

    S Walter, A Hofman & H Tiemeier

  2. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

    S Walter, A Kunst & J Mackenbach

  3. Department of Child- and Adolescent Psychiatry, Erasmus MC, Rotterdam, The Netherlands

    H Tiemeier

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  1. S Walter
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Correspondence to H Tiemeier.

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Author Contributions

Stefan Walter had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Walter, Kunst, Tiemeier. Acquisition of the data: The Rotterdam Study Investigators. Analysis and interpretation of the data: Walter, Kunst, Mackenbach, Hofman, Tiemeier. Critical revision of the paper for important intellectual content: Walter, Kunst, Mackenbach, Hofman, Tiemeier. Statistical analysis: Walter. Obtained funding: Mackenbach, Hofman. Study supervision: Kunst, Tiemeier. Additional contributions: Wilma Nusselder, PhD (Department of Public Health, Erasmus MC), Caspar Looman (Department of Public Health, Erasmus MC), and Istvan Majer (Department of Public Health, Erasmus MC) provided technical assistance in the statistical analysis.

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Walter, S., Kunst, A., Mackenbach, J. et al. Mortality and disability: the effect of overweight and obesity. Int J Obes 33, 1410–1418 (2009). https://doi.org/10.1038/ijo.2009.176

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