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To examine the association between weight history in young and middle adulthood and weight status in late adulthood with physical performance in late adulthood using data from the Health, Aging and Body Composition study.

Participants were eligible if they reported no difficulty in walking one-fourth of a mile, climbing up 10 steps or performing basic activities of daily living (ADLs) were free of life-threatening illness, planned to remain in the geographic area for at least three years and were not enrolled in lifestyle trials.

• Participants who were missing recalled weight at age 25 or 50 or recalled height at 25 and participants who were underweight (body mass index (BMI) <18.5kg/m²) at study baseline were excluded 
• Participants who were missing the Health ABC short physical performance battery (SPPB) and other pertinent covariates were also excluded 
• Participants were also excluded if they were excluded from the 400-meter walk or did not complete the 400-meter walk 
• Exclusion criteria for the four-mile walk included: Potentially acute electrocardiography abnormalities, elevated blood pressure (≥200/110mm Hg), resting heart rate <40 or >120 beats per minute, reported a recent cardiac event or procedure or reported new or recent worsening cardiac symptoms.

Recruitment

Participants were recruited from a random sample of white and all black Medicare residents in the Pittsburgh, Pennsylvania and Memphis, Tennessee metropolitan areas.

Design

Prospective cohort study 

Blinding used

Not used 

Intervention

Not applicable 

Statistical Analysis

• Multiple linear regression models were used to examine the associations between BMI status at age 25, 50 and study baseline (ages 70-79) and physical performance measures and least-squares means reported
• Two-way interactions between gender and BMI status at ages 25, 50 and study baseline were tested and interactions were found at the significance level α=0.10 
• Interactions between race and BMI status at ages 25, 50 and study baseline within gender group were also tested but were not significant. In analyses stratified by gender and race, results for blacks and whites were similar within gender groups, so all analyses are reported in men and women separately with race groups combined. 
• Models were adjusted for age, race, field center, education, smoking status and physical activity at baseline. Additional models were also adjusted for prevalent health conditions at study baseline. 
• The association between a history of overweight and/or obesity across all three time points vs. maintenance of normal weight and physical performance was also examined.

Timing of Measurements

April 1997 to June 1998 

Dependent Variables

Physical performance measured through short physical function battery and 400-meter walk time

Independent Variables

• Usual body weight at 25
• Usual body weight at 50
• Weight at baseline
• Recalled height at age 25
• Height at baseline.

Control Variables

• Age
• Race
• Education
• Smoking status
• Physical activity
• Prevalent chronic conditions including: Diabetes, stroke, coronary heart disease, congestive heart failure, chronic obstructive pulmonary disease, knee pain, depression, cognitive impairment.

 

• Initial N: 2,803
• Attrition (final N): 2,138
• Age:  70-79
  • Men were 73.7±2.9 years
  • Women 73.4±2.8 years 
• Ethnicity:
  • Men were 35.4% black
  • Women were 43.9% black
• Other relevant demographics: 

	Men	Women
Education
Less than High school	26.3	21.2
High school graduate	25.2	40.2
More than High school	48.4	38.6
Smoking status
Never	29.7	57.3
Current	10.3	8.8
Former	60	33.9

• Anthropometrics:

	Men	Women
Physical Activity
<500kcal per week	41.7	60.2
500-<1,500kcal per week	28.4	27
≥1500 kcal per week	29.8	12.7
Prevalent chronic conditions
Diabetes	15.9	12.9
Stroke	6.7	7.8
Coronary heart disease	22.2	11.6
Congestive heart failure	1.8	.9
Chronic obstructive pulmonary disease	11.8	11.4
Knee pain	14.1	18.3
Depression	3.8	5.5
Cognitive Impairment	8.2	5.5

• Location: 
  • Pittsburgh, Pennsylvania
  • Memphis, Tennessee.

 

Key Findings

Mean Physical Performance Measures

• SPPB scores in men who were overweight or obese at age 25 were significantly lower and 400-meter walk times in men who were obese at age 25 were significantly slower compared to those who were normal weight (P<0.05)
• In women, those who were overweight at age 25 had significantly lower SPPB scores, while those who were obese had significantly slower 400-meter walk times compared to those who were normal weight (P<0.05)
• Men and women who were obese at age 50 or at study baseline had significantly lower SPPB scores and slower 400-meter walk times compared to those who were normal weight or overweight (P<0.05)
• The SPPB scores were also significantly lower among women who were overweight at age 50 or at study baseline compared to those who were normal weight (P<0.05)
• 400-meter walk times in men and women who were overweight at age 50 and in women who were overweight at study baseline were also significantly slower compared to those who were normal weight (P<0.05). 

Associations with Baseline and Other Time Points

• The associations between weight status at study baseline and physical performance measures were similar when recalled height at age 25 was used in place of measured height at study baseline
• Adjusting for prevalent health conditions at baseline attenuated the associations between weight status at ages 25, 50 and study baseline and physical performance slightly, but in general, the associations remained significant
• Further adjustment for BMI at study baseline attenuated the associations between weight status at age 25 and 50 and physical performance; however, with the exception of weight status at age 25 in women, the trends remained similar.
• The percent of men and women excluded from or unable to complete the 400-meter walk increased with increasing weight status at all three time-points. 

Adjusted Mean Physical Performance Measures By History of Overweight and Obesity

• Men and women who were normal weight at all three time-points had significantly better SPPB scores and 400-meter walk times than those who had a history of overweight or obesity (P<0.05)
• Women who were overweight or obese at age 50 or earlier had significantly worse SPPB scores and 400-meter walk times than those who were overweight or obese at study baseline, but not a age 50 or 25
• SPPB scores in men and women and 400-meter walk times in women were also significantly worse in those who were normal weight at study baseline, but had a history of overweight or obesity at age 50 compared to those who were normal weight al all three time-points
• Adjusting for prevalent health conditions at baseline attenuated the associations between a history of overweight or obesity and physical performance slightly, but in general, the associations remained significant
• Similar associations between physical performance and a history of obesity were also observed; however, substantially fewer participants (<10%) had a history of obesity in midlife or earlier.

 

Obesity in young, middle and late adulthood was associated with worse physical performance in late adulthood compared to normal weight in both men and women. Overweight at the three time-points was also generally associated with worse physical performance in late adulthood in women. Having a history of overweight and/or obesity in midlife or earlier was associated with worse physical performance in both men and women compared to those who were normal weight and overweight and/or obese in late adulthood but who did not have a history of overweight and/or obesity in midlife or earlier.

Obesity may lead to joint wear and tear, reduced exercise capacity and a higher rate of chronic disease such as cardiovascular disease, diabetes and arthritis thus resulting in physical disability. The onset of obesity in young and middle adulthood may result in lower physical activity contributing to decreased muscle strength and cardiovascular fitness and greater declines in physical performance. This is because of a longer duration of excess body weight and earlier onset of chronic disease. Health ABC participants who had a history of being overweight or obese in midlife or earlier had worse physical performance than those who were normal weight throughout or who became overweight or obese in late adulthood.

It is difficult to untangle the independent effects of reported weight status in young and middle adulthood vs. weight status in late adulthood as they are often correlated. Sarcopenia, the age-associated loss of muscle mass may also occur in the presence of obesity and thus contribute to worse physical performance among older adults. 

Government:	Intramural Research Program of the NIH, National Institute on Aging
University/Hospital:	Wake Forest University Claude D. Pepper Older Americans Indepdence Center

The authors note the following limitations:

• The use of recalled weight and height from the distant past
• The participants were recruited to be well functioning and free of lower-extremity functional limitations at baseline. It is possible that the associations between weight status and physical performance may have been stronger had participants of all functional ability been included.
• A substantial number of participants were excluded from or were unable to complete the 400-meter walk, possibly resulting in selection bias. However, the proportion of those who were excluded or were unable to compete the 400-meter walk was progressively higher among those who were overweight and obese compared to normal weight at each age studied.
• The observational nature of our study did not allow for the evaluation of a causal association between weight status and weight history and physical performance. It is biologically plausible that a history excess weight may result in poor physical performance. Although the analyses were adjusted for smoking, physical activity and prevalent health history may serve as a proxy measure for other relevant participant characteristics that may lead to both overweight and obesity and poor physical performance.