Abstract
Background/Objectives:Some obese adults have a normal metabolic profile and are considered ‘healthy’, but whether they experience faster ageing than healthy normal-weight adults is unknown. We compared decline in physical function, worsening of bodily pain and likelihood of future mobility limitation and disability between these groups.Subjects/Methods:This was a population-based observational study using repeated measures over 2 decades (Whitehall II cohort data). Normal-weight (body mass index (BMI) 18.5–24.9 kg m−2), overweight (25.0–29.9 kg m−2) and obese (⩾30.0 kg m−2) adults were considered metabolically healthy if they had 0 or 1 of 5 risk factors (hypertension, low high-density lipoprotein cholesterol, high triacylglycerol, high blood glucose and insulin resistance) in 1991/1994. Decline in physical function and worsening of bodily pain based on change in Short Form Health Survey items using eight repeated measures over 18.8 years (1991/1994–2012/2013) were compared between metabolic-BMI groups using linear mixed models. Odds of mobility limitation based on objective walking speed (slowest tertile) and of disability based on limitations in ⩾1 of 6 basic activities of daily living, each using three repeated measures over 8.3 years (2002/2004–2012/2013), were compared using logistic mixed models.Results:In multivariable-adjusted mixed models on up to 6635 adults (initial mean age 50 years; 70% male), healthy normal-weight adults experienced a decline in physical function of −3.68 (95% CI=−4.19, −3.16) score units per decade; healthy obese adults showed an additional −3.48 (−4.88, −2.08) units decline. Healthy normal-weight adults experienced a −0.49 (−1.11, 0.12) score unit worsening of bodily pain per decade; healthy obese adults had an additional −2.23 (−3.78, −0.69) units worsening. Healthy obesity versus healthy normal-weight conferred 3.39 (2.29, 5.02) times higher odds of mobility limitation and 3.75 (1.94, 7.24) times higher odds of disability.Conclusions:Our results suggest that obesity, even if metabolically healthy, accelerates age-related declines in functional ability and poses a threat to independence in older age.
Highlights
Obesity is a considered a serious threat to public health.[1]
Sample attenuation patterns were similar for outcomes of mobility limitation and disability, with the exception of a larger reduction (1306 participants) from the 6641 with body mass index (BMI)-metabolic data due to missing data on either outcome; data collection for these began later than for physical function and bodily pain
Compared with participants who had metabolic-BMI data and had data on mobility (n = 5507), those who had metabolic-BMI data but had missing data on mobility (n = 1134) were older (51.1 vs 49.2 years, Po 0.001), more likely to be female (34.7 vs 28.2%, P o0.001), more likely to be of a non-white ethnicity (13.3 vs 8.5%, P o 0.001) and more likely to be of the lowest occupational position (27.1 vs 13.3%, P o 0.001)
Summary
Obesity is a considered a serious threat to public health.[1]. Health risks of obesity are largely mediated through disruptions to metabolism, which emerge in response to excess fat[2] and which may subsequently lead to type 2 diabetes, cardiovascular diseases and premature mortality.[3,4,5] As many as one-in-three obese adults at any given time, present without metabolic dysfunction in the form of metabolic risk factor clustering and are considered ‘healthy’.6,7 This healthy subset was initially assumed to be protected from the adverse health consequences typical of obesity, but have since demonstrated strong tendencies to become insulin resistant,[8] to progress to unhealthy obesity[9] and to develop type 2 diabetes,[10] and cardiovascular disease[11,12,13] all at greater rates than normal-weight adults who are healthy.To our knowledge, excess risk for outcomes related to ageing among healthy obese adults has not been examined, such evidence would form an important basis from which to advise on weight loss. Obesity is a considered a serious threat to public health.[1] Health risks of obesity are largely mediated through disruptions to metabolism, which emerge in response to excess fat[2] and which may subsequently lead to type 2 diabetes, cardiovascular diseases and premature mortality.[3,4,5] As many as one-in-three obese adults at any given time, present without metabolic dysfunction in the form of metabolic risk factor clustering and are considered ‘healthy’.6,7 This healthy subset was initially assumed to be protected from the adverse health consequences typical of obesity, but have since demonstrated strong tendencies to become insulin resistant,[8] to progress to unhealthy obesity[9] and to develop type 2 diabetes,[10] and cardiovascular disease[11,12,13] all at greater rates than normal-weight adults who are healthy. Using repeated measures over 2 decades in a well-characterised
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