Advertisement

Body mass index and quality of well-being in a community of older adults

  • Erik J Groessl
    Correspondence
    Address correspondence and requests for reprints to: Erik J. Groessl, UCSD Health Outcomes Assessment Program, 9500 Gilman Dr., Mail Code 0994, University of California San Diego, La Jolla CA 92093-0994, USA.
    Affiliations
    Department of Family and Preventive Medicine (Groessl, Kaplan, Barrett-Connor, Ganiats), University of California at San Diego, San Diego, California, USA

    Health Outcomes Assessment Program (Groessl, Kaplan, Ganiats), University of California at San Diego, San Diego, California, USA
    Search for articles by this author
  • Robert M Kaplan
    Affiliations
    Department of Family and Preventive Medicine (Groessl, Kaplan, Barrett-Connor, Ganiats), University of California at San Diego, San Diego, California, USA

    Health Outcomes Assessment Program (Groessl, Kaplan, Ganiats), University of California at San Diego, San Diego, California, USA
    Search for articles by this author
  • Elizabeth Barrett-Connor
    Affiliations
    Department of Family and Preventive Medicine (Groessl, Kaplan, Barrett-Connor, Ganiats), University of California at San Diego, San Diego, California, USA
    Search for articles by this author
  • Theodore G Ganiats
    Affiliations
    Department of Family and Preventive Medicine (Groessl, Kaplan, Barrett-Connor, Ganiats), University of California at San Diego, San Diego, California, USA

    Health Outcomes Assessment Program (Groessl, Kaplan, Ganiats), University of California at San Diego, San Diego, California, USA
    Search for articles by this author

      Abstract

      Background

      The impact of obesity and associated conditions on health has not been assessed in older adults using a generic, utility-based measure of health-related quality of life (HRQOL). This study evaluates the relationship between body mass index (BMI) and HRQOL scores and gives estimates of quality-adjusted life years (QALYs) lost to overweight, obesity, and associated conditions.

      Methods

      A total of 1326 adults from the Rancho Bernardo longitudinal cohort study, with a mean age of 72 years, completed the Quality of Well-Being Scale (QWB), a generic health-related quality of life measure. Height, weight, exercise, and smoking status were also assessed. Differences in QWB scores between obese adults and those with a normal BMI were used to estimate the QALYs lost due to obesity and associated conditions.

      Results

      Participants were divided into four groups based on BMI: <20 (underweight); 20 to 24.9 (normal); 25 to 29.9 (overweight); >30 kg/m2 (obese). Analysis of covariance controlling for age, gender, smoking history, and exercise showed a significant difference between group means (F(7,1310)=30.79; p <0.001). The normal BMI group had the highest QWB score (0.709), followed by the underweight (0.698), overweight (0.695), and obese (0.663) groups. The QWB score for the obese group was significantly lower than that for the normal and overweight groups. An estimated 2.93 million QALYs are lost in this country each year from obesity and associated conditions.

      Conclusions

      Obese older adults tend to have lower HRQOL than those who are overweight or of normal BMI. The lower QWB scores associated with obesity translate into millions of QALYs lost each year. Being overweight but not obese did not have a significant impact on HRQOL in this population.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Johnson C.L.
        Prevalence and trends in obesity among US adults, 1999–2000.
        JAMA. 2002; 288: 1723-1727
        • Mokdad A.H.
        • Serdula M.K.
        • Dietz W.H.
        • Bowman B.A.
        • Marks J.S.
        • Koplan J.P.
        The continuing epidemic of obesity in the United States.
        JAMA. 2000; 284: 1650-1651
        • Mokdad A.H.
        • Serdula M.K.
        • Dietz W.H.
        • Bowman B.A.
        • Marks J.S.
        • Koplan J.P.
        The spread of the obesity epidemic in the United States, 1991–1998.
        JAMA. 1999; 282: 1519-1522
        • Gutierrez-Fisac J.L.
        • Banegas J.R.
        • Artalejo F.R.
        • Regidor E.
        Increasing prevalence of overweight and obesity among Spanish adults, 1987–1997.
        Int J Obes Relat Metab Disord. 2000; 24: 1677-1682
        • Lahti-Koski M.
        • Vartainen E.
        • Mannisto S.
        • Pietinen P.
        Age, education, and occupation as determinants of trends in body mass index in Finland from 1982 to 1997.
        Int J Obes Relat Metab Disord. 2000; 24: 1669-1676
      1. World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation presented at the World Health Organization, June 1997, Geneva, Switzerland (publication WHO/NUT/NCD/98.1, 1998)

        • Must A.
        • Spadano J.
        • Coakley E.H.
        • Field A.E.
        • Colditz G.
        • Dietz W.H.
        The disease burden associated with overweight and obesity.
        JAMA. 1999; 282: 1523-1529
      2. Belanger AJ, Cupples LA, D'Agostino RB. The Framingham Study: the epidemiological investigation of cardiovascular disease, section 36. Means at each examination and inter-examination consistency of specified characteristics. Framingham Heart Study: 30-year Follow-up, Bethesda MD: National Heart, Lung, and Blood Institute, 1988

        • Berkham L.F.
        • Breslow L.
        Health and ways of living.
        Oxford University Press, New York1983
        • Epstein F.H.
        • Napier J.A.
        • Block W.D.
        • et al.
        The Tecumseh study.
        Arch Environ Health. 1970; 21: 402-407
        • Lew E.A.
        • Garfinkel L.
        Variations in mortality by weight in 750,000 men and women.
        J Chronic Dis. 1979; 32: 563-576
        • Manson J.E.
        • Willett W.C.
        • Stamfer M.J.
        • et al.
        Body weight and mortality among women.
        N Engl J Med. 1995; 333: 677-685
      3. Cox CS, Mussolino ME, Rothwell ST, et al. Plan and operation of the NHANES I Epidemiological Followup Study, 1992. Vital Health Stat 1 1997;35

        • Barrett-Connor E.L.
        Obesity, atherosclerosis, and coronary heart disease.
        Ann Intern Med. 1985; 103: 1010-1019
        • Allison D.B.
        • Fontaine K.R.
        • Manson J.E.
        • Stevens J.
        • VanItallie T.B.
        Annual deaths attributable to obesity in the United States.
        JAMA. 1999; 282: 1530-1538
        • Kaplan R.M.
        • Bush J.W.
        Health-related quality of life measurement for evaluation research and policy analysis.
        Health Psychol. 1982; 1: 61-80
        • Kaplan R.M.
        • Anderson J.P.
        The quality of well-being scale: rationale for a single quality of life index.
        in: Walker S.R. Rosser R. Quality of life: assessment and application. MTP Press, London1988: 51-77
      4. Kaplan RM, Anderson JP. The general health policy model: an integrated approach. In: Spilker B, ed. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven, 1996:309–22

        • National Heart, Lung, and Blood Institute Obesity Task Force
        Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report.
        Obes Res. 1998; 6: 51-209
        • Fryback D.G.
        • Dasbach E.J.
        • Klein R.
        • et al.
        The Beaver Dam Health Outcomes Study.
        Med Decis Making. 1993; 13: 89-102
        • Strauss R.S.
        Childhood obesity and self-esteem.
        Pediatrics. 2000; 105: e15
      5. U.S. Census Bureau. Population and household economic topics, 2001. Available at: www.census.gov/ftp/pub/population/www. Accessed January 1, 2003

        • Le Pen C.
        • Levy E.
        • Loos F.
        • Banzet M.N.
        • Basdevant A.
        “Specific” scale compared with “generic” scale.
        J Epidemiol Community Health. 1998; 52: 445-450
        • Stevens J.
        • Cai J.
        • Pamuk E.R.
        • Williamson D.F.
        • Thun M.J.
        • Wood J.L.
        The effect of age on the association between body mass index and mortality.
        N Engl J Med. 1998; 338: 1-7
        • Finkelstein M.M.
        Body mass index and quality of life in a survey of primary care patients.
        J Fam Pract. 2000; 49: 734-737
        • Michels K.B.
        • Greenland S.
        • Rosner B.A.
        Does body mass index adequately capture the relation of body composition and body size to health outcomes?.
        Am J Epidemiol. 1998; 147: 167-172
      6. Hollingshead A. Two-factor index of social position. New Haven CT: Department of Sociology, Yale University, 1965