PORTLAND, OR — Individuals who were overweight or obese when they were young and continued to gain weight had significantly worse physical capabilities 4 decades later compared with their peers whose weight remined normal, independent of other risk factors for cardiovascular disease, in a new study[1].

Specifically, among participants in the Chicago Healthy Aging study who were assessed when they were, on average, 33 years old and then 71 years old, those who were overweight or obese (body mass index [BMI] >25 kg/m2) to start with and then gained 20 or more pounds were much more likely to walk slowly, have a poor Short Physical Performance Battery (SPPB) score, and have low grip strength when they were elderly than individuals who maintained a normal BMI.

Dr Thanh Huyen T Vu (Northwestern University, Chicago, IL) presented these findings in a poster at the EPI|LIFESTYLE 2017 Scientific Sessions.

"The main message is that obesity and overweight at a younger age and substantial weight gain is significantly associated with low physical performance in old age," she told heartwire from Medscape.

Being too lean has been associated with frailty in older age, but this study in this unique cohort shows that older individuals who have always been overweight or obese are less agile and have less grip strength in old age than their peers who are the same age but have maintained a normal weight, she noted.

How Piling on the Pounds Affects Physical Fitness in Old Age

Obesity is associated with medical complications, a lower quality of life, and a magnified age-related decline in physical abilities, but the impact of consistent excess weight throughout adulthood on physical abilities in old age is not clear.

To examine this, Vu and colleagues analyzed findings from participants the Chicago Healthy Aging study, a subset of the Chicago Heart Association Detection Project, which enrolled 39,565 participants from Chicago workplaces who were 18 to 74 during 1967–1973.

The researchers had complete data from 1325 men and women who were examined at baseline and again from 2007 to 2010.

The three measures of physical performance at follow-up were: hand-grip strength, 4-m walking speed, and the SPPB score—a composite score of 4-m walking speed, time to rise from a seated position, and standing balance, for a total score of 0 (worst) to 12 (best).

The participants were classed into six groups depending on their baseline BMI and change in weight after 39 years:

  • BMI >25 kg/m2; >10-pound weight loss (n=50).

  • BMI <25 kg/m2; 10-pound weight loss up to a 20-pound weight gain (n=319; reference group; minimal weight change).

  • BMI <25 kg/m2; >20-pound weight gain (n=312).

  • BMI >25 kg/m2; >10-pound weight loss (n=130).

  • BMI >25 kg/m2; 10-pound weight loss up to a 20-pound weight gain (n=300).

  • BMI >25 kg/m2; >20-pound weight gain (n=214).

About a quarter of the sample (29%) were women and 9% were black.

At follow-up, 10.3% of the participants had a low SPPB score (≤8); 8.4% had slow walking speed (<0.8 m/s on a 4-m course); and 23.8% had low sex-specific handgrip strength (<18 kg for women and <30 kg for men).

Compared with participants with a normal initial BMI and minimal weight change at the follow-up examination, those who were initially overweight and had gained the most weight (>20 pounds) were significantly more likely to have a low SPPB score, a slow walking speed, or low sex-specific handgrip strength (odds ratios 4.55, 4.58, and 1.86, respectively, after adjustment for sex, race, initial cardiovascular disease risk factors, and current age, education, ankle-brachial index, systolic blood pressure, total cholesterol, smoking status, diabetes, cholesterol, and blood-pressure medication use).

Similarly, compared with the reference group, those who were initially overweight or obese and lost less than 10 pounds or gained up to 20 pounds were significantly more likely to have a low SPPB score or a low sex-specific handgrip strength (ORs 2.11 and 1.59, respectively)

Individuals who were the thinnest to start with and lost more than 20 pounds had a significant threefold increased risk of having a worse SPPB score, but this was a very small group (50 participants) and would need to be confirmed in a larger study, Vu noted.

Laura Graham (University of Alabama at Birmingham School of Public Health), not connected with the study, wondered to heartwire whether some of the thin patients who had lost weight might have had cancer.

Dr Vu speculated that the patients who had cancer would be less likely to return for the follow-up visit.

"There is always a survival bias," she acknowledged. Some of the participants who came for the return visit were in their 80s and possibly lived in another state, so they were likely to be healthier than the participants who did not come for the follow-up visit.

The study was supported by the National Institutes of Health and the National Heart, Lung, and Blood Institute. The authors have no relevant financial relationships.

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