The Changing Relationship of Obesity and Disability, 19882004

1
The Changing Relationship of Obesity and
Disability, 1988-2004
Dawn Alley, PhD1, Virginia W. Chang, MD,
PhD2 1Robert Wood Johnson Foundation Health and
Society Scholars Program, 2Departments of
Medicine and Sociology, University of Pennsylvania
Abstract Recent health changes among the obese
population may have resulted in changes in the
risk of disability associated with obesity.
Using two disability indicators (functional
impairment ADL impairment) a
nationally-representative sample of adults 60,
this study finds an increase in the association
between obesity disability over the 1990s.

• Recent studies suggest that the health of obese
  population may have improved since the 1960s
• Declining mortality (Flegal et al., 2005 Flegal
  et al., 2007)
• Declining cardiovascular risk factors (Gregg et
  al., 2005)
• However, the duration of exposure to disability
  is increasing in more recent cohorts (Leveille et
  al., 2005)
• Obese population could be living longer with
  better-controlled risk factors but experiencing
  more disability.

Relative odds of functional impairment Normal
weight Period 1 relative to normal weight Period
2 0.93 (0.81-1.07) Obese Period 1 relative to
normal weight Period 1 1.78 (1.47-2.16) Obese
Period 2 relative to obese Period 1 1.43
(1.18-1.75) Obese Period 2 relative to normal
weight Period 2 2.75 (2.39-3.17)
Relative odds of ADL impairment Normal weight
Period 1 relative to normal weight Period 2
0.66 (0.50-0.88) Obese Period 1 relative to
normal weight Period 1 1.31 (0.92-1.88) Obese
Period 2 relative to obese Period 1 1.03
(0.71-1.51) Obese Period 2 relative to normal
weight Period 2 2.05 (1.45-2.88)
Disability by obesity status survey period

• Two different indicators of disability show an
  increasing association between obesity
  disability over time.
• Odds of functional impairment did not change
  among non-obese group, but increased by 43 among
  obese participants.
• Odds of ADL disability declined over 1990s for
  non-obese participants, but did not change among
  obese group.
• Increases in obesity severity may account for
  difference in ADL trend, but do not account for
  trend in functional impairment.
• Limitations Self-reported disability, lack of
  complete ADL measures
• Possible explanations Increasing life
  expectancy with obesity disability, increased
  duration of obesity
• Implications Recent improvements in the health
  of the obese population have not resulted in
  disability declines among obese older persons.
  The rising prevalence of obesity at earlier ages
  may slow disability declines among the older
  population in the future.

Functional Impairment
ADL Impairment
This study was supported by the Robert Wood
Johnson Foundation Health Society Scholars
program by grant K12-HD043459 from the National
Institute of Child Health Human Development.