Abstract
Background:While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies.Methods:Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5–24.9 kg m−2) to obesity class II (⩾35 kg m−2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category.Results:The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts.Conclusions:Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.
Highlights
Obesity is a major global public health challenge of our times
Obesity was most common among English men (24%) and women (29%) in English Longitudinal Study of Ageing (ELSA), followed by Finnish and Swedish men and women being around 15% in Finnish Public Sector study (FPS) and Swedish Longitudinal Occupational Survey of Health (SLOSH)
There were some differences in the prevalence of sub-optimal self-rated health across study cohorts ranging among men from 19% (GAZEL) to 37% (FPS) and among women from 20% (SLOSH) to 34% (FPS)
Summary
Obesity is a major global public health challenge of our times. The prevalence of overweight and obesity has increased significantly over the past three decades and concerns about the health risks associated with obesity have become nearly universal.[1]. Among older people, obesity carries an increased risk of lower extremity osteoarthritis,[7] and reduced functional capacity and quality of life.[8,9,10,11] The adverse effects of obesity raise the question about corresponding losses in life spent in good health. RESULTS: The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. CONCLUSIONS: Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations
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