Abstract
BackgroundStudies have consistently found that obesity is associated with poor self-rated health, but how body mass index (BMI) developed in the lead up to poor self-rated health is unknown.MethodsWe nested a longitudinal case-control study in the English Longitudinal Study of Ageing (1998–2015) to investigate BMI trajectories in the years preceding a first self-report of poor health. Participants rated their health at each data collection; every other collection included a BMI assessment by a nurse. Case status was defined as a first report of poor health during follow-up. Three age- and sex-matched controls were identified per case using density sampling. BMI trajectories were fitted to time backwards prior to first report of poor health using mixed-effects models. Age and sex were potential modifiers. We conducted subgroup analyses of those not reporting certain chronic diseases or smoking.ResultsWe identified 732 cases and 2195 controls. Age, but not sex, modified the association between BMI and self-rated health. Participants reporting poor health at age 60 had a 1.5 kg/m2 (95%CI: 0.8 to 2.1) higher BMI at the time of reporting than controls, and their BMI had previously increased markedly (1.3 kg/m2 95%CI: 0.9 to 1.8 over ten years). After age 75, cases no longer had higher BMI than controls, and their BMI had decreased sharply prior to reporting poor health (e.g. -2.0 kg/m2 95%CI: -2.6 to -1.5 per decade on average for those reporting poor health at age 90). Age was also an effect modifier among those without diabetes, however BMI trajectories were more similar among the middle-aged. The subgroup analysis of those without cardiovascular disease, cancer and chronic lung disease showed similar results to the main findings.ConclusionDevelopment of BMI was associated with poor self-rated health; however, the nature of the association depended markedly on age.
Highlights
Self-rated health is a robust and independent predictor of health outcomes and mortality [1,2]
Studies have consistently found that obesity is associated with poor self-rated health, but how body mass index (BMI) developed in the lead up to poor self-rated health is unknown
Little is known about the development of BMI prior to poor self-rated health, nor how this may differ by age and sex
Summary
Self-rated health is a robust and independent predictor of health outcomes and mortality [1,2]. It is a construct that encapsulates physical, mental and social dimensions of health The weighting of these dimensions within each individual is generally unknown [3], studies indicate that self-assessment of physical functioning is a substantial contributor to selfrated overall health [4,5]. Among the elderly, changes in BMI generally reflect loss of muscle mass, and sarcopenia has been associated with greater mortality [10] Chronic conditions, such as chronic obstructive pulmonary disease (COPD), are among the main potential causes of unintended weight loss among elderly [11]. Studies have consistently found that obesity is associated with poor self-rated health, but how body mass index (BMI) developed in the lead up to poor self-rated health is unknown
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