Re: Longeivty & Health (& Obesity)

March 10, 2006

>

> New report out from the Census Bureau..

I read the story about this report in this morning's NY Times. The

report is undoubtedly going to be played in the media as predicting

that the impact of aging baby boomers on the health care system is

going to be less than previously thought, i.e., good news, pass the

french fries!

But when you read past the first part, you discover that all it

actually says is that the impact may be delayed because today's

seniors become disabled later in life than previous generations. This

is no doubt due to the fact that our health care system, while very

poor at preventing illness, is excellent at keeping sick people alive

and active longer, albeit at great cost. And the report apparently

does warn of the impact of diabetes and other health problems that

will result from obesity.

That's not the way it will be spun in the headlines, though. Also, we

should keep in mind that this comes out of the government's Census

Bureau and was compiled from statistics to show, no doubt, exactly

what the government wants us to believe: there is nothing to worry

about, eat hearty, live for today and keep on spending!

March 10, 2006

>

> New report out from the Census Bureau..

I read the story about this report in this morning's NY Times. The

report is undoubtedly going to be played in the media as predicting

that the impact of aging baby boomers on the health care system is

going to be less than previously thought, i.e., good news, pass the

french fries!

But when you read past the first part, you discover that all it

actually says is that the impact may be delayed because today's

seniors become disabled later in life than previous generations. This

is no doubt due to the fact that our health care system, while very

poor at preventing illness, is excellent at keeping sick people alive

and active longer, albeit at great cost. And the report apparently

does warn of the impact of diabetes and other health problems that

will result from obesity.

That's not the way it will be spun in the headlines, though. Also, we

should keep in mind that this comes out of the government's Census

Bureau and was compiled from statistics to show, no doubt, exactly

what the government wants us to believe: there is nothing to worry

about, eat hearty, live for today and keep on spending!

March 10, 2006

The following was from a discussion I had on another list on the topic of

obesity and longevity.....

Jeff

>>Here is the data on obesity in the elderly in the U.S. There are very

sigificant numbers of overweight and obese people who do live into their 70's

and 80's. They may have avoided contact with you, but they are out there....

and not doing very well at all.

The information you posted is based on telephone surveys and self reported data.

Form the actual report...

http://www.publichealthreports.org/userfiles/119_3/119356.pdf

" We analyzed data from the BRFSS for all 50 states and the District of Columbia.

The BRFSS is a cross-sectional telephone survey conducted by state health

departments with assistance from the Centers for Disease Control and Prevention

(CDC). Questions on the BRFSS questionnaire are used primarily to monitor

personal behaviors that increase risk of death. The BRFSS uses a multistage

cluster design based on random-digit dialing to select a representative sample

from each state?s adult noninstitutionalized civilian residents aged 18 years or

older. State data are pooled to produce nationally representative estimates.

The report actually concluded...

" Although older Americans appear to be living more healthfully now, their higher

rates of obesity, high blood pressure, and diabetes are not good signs; perhaps

these rates can be tied to the higher rates we found for days of poor physical

and mental health.7

So, I next looked up the actual questionairres they used which you can find here

to see how they asked the questions...

http://www.cdc.gov/brfss/questionnaires/pdf-ques/2000brfss.pdf

To determine BMI, the phone survey asked ...

10.13. How much do you weigh? (163-165)

Weight

pounds

Don't know/Not sure

Refused

10.14. About how tall are you without shoes? (166-168)

Round down fractions

Height /ft/inches

Don't know/Not sure

Refused

Now, I wouldnt call this a precise scientific measure.

So, I next went to reference 7 which was referenced for the above comment about

the higher rates of obesity not being a good sign ..

7. Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP. Self-reported body mass

index and healthrelated quality of life: findings from the Behavioral Risk

Factor Surveillance System. Obes Res 2001;9:21-31.

we all can read the full text here

http://www.obesityresearch.org/cgi/content/full/9/1/21

Instead of highlighting one or two sentences, I though the information was so

valuable to the topic, I am copying the final discussion. All mentioned

references can be found at the above link.

Discussion: In the largest study yet to examine the relationship between

self-reported BMI and health-related quality of life, our results are consistent

with findings from previous studies that have shown that overweight and obese

persons have a worse health-related quality of life (2) (6) (7) (8) (9) (10)

(11) (12) (13) . Our results extend previous findings by showing that the direct

associations between excess weight and worse health-related quality of life

include all adult age groups, both sexes, and whites, African Americans, and

Hispanics. Because we combined representative samples from each of the 50

states, the results of our investigation are generalizable to the U.S.

population (31) .

In the Swedish Obese Subjects Intervention study, 1743 obese participants had

diminished mental well-being and psychosocial functioning compared with 89

healthy reference participants (6) . Overweight and obesity were positively

associated with physical impairment (defined as an inability to run a short

distance, enter a bus without problems, or take a short walk), reduced mobility,

back pain, and severe pain in hands and legs in a representative sample of

12,988 men and 13,414 women from Sweden (7) .

Using the SF-36 questionnaire, other investigators have found that health and

health-related quality of life worsened as BMI or waist circumference increased

(8) (9) (11) (12) (13) . Data from the Monitoring Cardiovascular Health (MORGEN)

study in the Netherlands showed that physical functioning and bodily pain were

significantly associated with increased BMI among 1885 men and 2156 women (11) .

In a reanalysis of these data, these associations were similar using BMI

categories adopted by the National Institutes of Health and the World Health

Organization (13) . Among 56,510 participants of the Nurses? Health Study, four

scales of a modified version of the SF-36 questionnaire (i.e., physical

functioning, vitality, bodily pain, and role functioning) were significantly and

inversely related to self-reported BMI (8) . In the Whitehall II study, poor

physical functioning increased monotonically as BMI increased in 2412 women,

whereas poor physical functioning was increased only in 5449 men whose BMI was

>=<C:\DOCUME~1\JEFFRE~1\LOCALS~1\Temp\ge.gif> 27 kg/m2 (12) .

In our study, the number of poor physical health days during the previous 30

days (physical functioning) appeared more strongly related to self-reported BMI

than the number of days of poor mental health during the previous 30 days

(mental functioning). Although the MORGEN researchers found no association

between BMI and the mental health components of the SF-36 (9) , we did find a

significant association between BMI and the risk of having

>=<C:\DOCUME~1\JEFFRE~1\LOCALS~1\Temp\ge.gif> 14 unhealthy mental days during

the previous 30 days.

That many obese persons experience a diminished health-related quality of life

is not surprising. Obese persons are more likely than persons who are not obese

to suffer from low self-esteem and depression and to experience poor peer

relationships (2) (10) . Prejudice and discrimination directed at obese persons

are ubiquitous in U.S. society (32) . Many conditions for which obesity

increases risk, such as type 2 diabetes and cardiovascular disease, also

decrease health-related quality of life (33) (34) . Furthermore, in at least two

prospective studies, overweight persons had an increased risk of disability (35)

(36) .

The increase in unhealthy days among lean respondents is more difficult to

explain. Health-related quality of life among very lean persons has not been

studied extensively (7) . The increased mean number of unhealthy days in such

respondents agrees with numerous studies showing increased all-cause mortality

at lower BMIs (5) . Consistent with previous findings (37) , we found low

self-reported BMI to be significantly associated with female gender, a risk

factor for anorexia nervosa (38) , and linked to greater weight loss goals when

dieting (39) . Lean respondents are likely to be very heterogeneous and include

healthy persons who either diet or exercise a lot, persons with eating

disorders, and clinically or subclinically sick persons. Such respondents are

also more likely to smoke than others. The shape of the relationship between

self-reported BMI and the number of unhealthy days (physical or mental) among

persons who had never smoked resembled that for the entire analytic sample (data

not shown). Unfortunately, the BRFSS does not include information needed to

distinguish subgroups (except for current smokers) within lean respondents.

Similar to many previous studies, our study was cross-sectional. Such a design

provides a snapshot of the burden of adverse effects experienced by obese or

very lean persons but does not allow conclusions about cause and effect. Thus,

although obesity may reduce quality of life, poor quality of life may be due to

other factors that led to weight gain. Because weight and height were

self-reported in our study, misclassification may have affected our results.

Obese persons are more likely to underreport their weights and over-report their

heights than are persons who are not obese (thus decreasing calculated BMI), and

men are more likely to over-report their heights than are women (4) .

Reliability studies of the BRFSS questionnaires in various settings have

reported {kappa}<C:\DOCUME~1\JEFFRE~1\LOCALS~1\Temp\kgr.gif> coefficients of

0.77 to 0.96 for BMI and categories of overweight or obese (41) (42) (43) and

correlation coefficients of 0.84 to 0.94 for height, weight, and BMI (44) .

Validity studies of the BRFSS have shown sensitivities of 0.74 to 0.77 and a

specificity of 0.99 for obesity (45) (46) . Correlation coefficients for

self-reported height and BMI were 0.94 and 0.96, respectively (45) . The

prevalence of obesity from a BRFSS survey was

~<C:\DOCUME~1\JEFFRE~1\LOCALS~1\Temp\sim.gif> 45% less than that from the

Five-City Project Survey (47) . If little or no misclassification of the

reference category occurred, the likely result of misclassification would be

relatively accurate ORs for the lowest and highest BMI classes but increased ORs

for the intermediate classes. Telephone coverage bias is not likely to have

affected these results, because a high proportion of U.S. residents own

telephones. The mean BMI for participants with a telephone in the Third National

Health and Nutrition Examination Survey resembled that of those without a

telephone (48) . However, for subgroups of the U.S. population with low

telephone coverage, the associations between BMI and quality of life

measurements may differ from those described in this article.

In conclusion, this is the largest study to have examined health-related quality

of life measures related to self-reported BMI. Our results agree with previous

studies and show that health-related quality of life diminishes as BMI increases

or decreases from the normal range. With the increasing prevalence of obesity

becoming recognized as a public health crisis (49) , our results may be useful

in better monitoring the full impact of this health condition and its economic

consequences. Health-related quality of life measures from population-based

studies such as the BRFSS may provide insights into health perceptions that may

affect the efforts of individuals to maintain or change their weight.

Regards

Jeff

March 10, 2006