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Epidemiology and Population Health

Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults



While older adults with pre-obesity and Class I obesity have similar or lower mortality risk versus those with normal weight, a heavier body mass index (BMI) may not translate into more healthy life years. Utilizing longitudinal data on 3452 older (≥60 years) Singaporeans, we assessed the association between BMI and years of remaining life overall with and without limitation in physical function and in activities of daily living (ADLs).


Difficulty in any of nine tasks involving upper or lower extremities was considered as limitation in physical function, and health-related difficulty in any basic ADL or instrumental ADL as limitation in ADLs. We utilized multistate life tables, including BMI as a time-varying covariate.


At age 60, life expectancy (LE) was similar for those with normal weight, pre-obesity and obesity. However, those with obesity, versus normal weight, had 6.3 [95% confidence interval: 3.4–9.2] more years with limitation in physical function and 4.9 [3.4–6.5] less years without limitation in physical function. Those with pre-obesity, versus normal weight, also had 3.7 [1.9–5.3] more years with limitation in physical function. The same pattern across BMI categories was observed for years of life with and without limitation in ADLs. In stratified analyses, similar associations of BMI with years of life with and without limitation in physical function and in ADLs were observed across gender, ethnicity, and educational status.


The increasing global prevalence of obesity may result in an increase in years of life with limitation in physical function and in ADLs at older ages. Older adults, their families and healthcare systems should be cognizant of this issue.

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  1. 1.

    Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

    Article  Google Scholar 

  2. 2.

    United Nations. Ageing. 2016. Accessed 02 May 2018.

  3. 3.

    Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71–82.

    CAS  Article  Google Scholar 

  4. 4.

    DeCaria JE, Sharp C, Petrella RJ. Scoping review report: obesity in older adults. Int J Obes. 2012;36:1141–50.

    CAS  Article  Google Scholar 

  5. 5.

    Diehr P, O’Meara ES, Fitzpatrick A, Newman AB, Kuller L, Burke G. Weight, mortality, years of healthy life, and active life expectancy in older adults. J Am Geriatr Soc. 2008;56:76–83.

    Article  Google Scholar 

  6. 6.

    Reynolds SL, McIlvane JM. The impact of obesity and arthritis on active life expectancy in older Americans. Obesity. 2012;17:363–9.

    Article  Google Scholar 

  7. 7.

    Reynolds SL, Saito Y, Crimmins EM. The impact of obesity on active life expectancy in older American men and women. Gerontologist. 2005;45:438–44.

    Article  Google Scholar 

  8. 8.

    Saito Y, Robine J-M, Crimmins EM. The methods and materials of health expectancy. Stat J IAOS. 2014;30:209–23.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Walter S, Kunst A, Mackenbach J, Hofman A, Tiemeier H. Mortality and disability: the effect of overweight and obesity. Int J Obes. 2009;33:1410.

    CAS  Article  Google Scholar 

  10. 10.

    Stenholm S, Head J, Aalto V, Kivimäki M, Kawachi I, Zins M, et al. Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Obes. 2017;41:769–75.

    CAS  Article  Google Scholar 

  11. 11.

    Stenholm S, Head J, Kivimäki M, Kawachi I, Aalto V, Zins M, et al. Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Epidemiol. 2016;45:1260–70.

    PubMed  Google Scholar 

  12. 12.

    Leigh L, Byles JE, Jagger C. BMI and healthy life expectancy in old and very old women. Br J Nutr. 2016;116:692–9.

    CAS  Article  Google Scholar 

  13. 13.

    Zajacova A, Huzurbazar S, Greenwood M, Nguyen H, Long-term BMI. trajectories and health in older adults. J Aging Health. 2015;27:1443–61.

    Article  Google Scholar 

  14. 14.

    Dong X, Chang E-S, Simon MA. Physical function assessment in a community-dwelling population of U.S. Chinese older adults. J Gerontol A Biol Sci Med Sci. 2014;69(Suppl 2):S31–S38.

    Article  Google Scholar 

  15. 15.

    Østbye T, Krause KM, Norton MC, Tschanz J, Sanders L, Hayden K, et al. Ten dimensions of health and their relationships with overall self-reported health and survival in a predominately religiously active elderly population: the cache county memory study. J Am Geriatr Soc. 2006;54:199–209.

    Article  Google Scholar 

  16. 16.

    Yong V, Saito Y, Chan A. Changes in the prevalence of mobility limitations and mobile life expectancy of older adults in Singapore, 1995-2005. J Aging Health. 2010;22:120–40.

    Article  Google Scholar 

  17. 17.

    Brown CJ, Flood KL. Mobility limitation in the older patient: a clinical review. JAMA. 2013;310:1168–77.

    CAS  Article  Google Scholar 

  18. 18.

    Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, et al. Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: The Concord Health and Ageing in Men Project. Age Ageing. 2017;46:413–20.

    Article  Google Scholar 

  19. 19.

    Vellas B, Hausner L, Cantet I, Gardette V, Reynish E, Gillette S, et al. Obesity impairs ADL and IADL in Alzheimer’s disease subjects. Alzheimers Dement. 2012;8(4, Supplement):P324.

    Article  Google Scholar 

  20. 20.

    Chan A, Malhotra R, Matchar DB, Ma S, Saito Y. Gender, educational and ethnic differences in active life expectancy among older Singaporeans. Geriatr Gerontol Int. 2016;16:466–73.

    Article  Google Scholar 

  21. 21.

    Malhotra R, Chan A, Ajay S, Ma S, Saito Y. Variation in the gender gap in inactive and active life expectancy by the definition of inactivity among older adults. J Aging Health. 2016;28:1279–98.

    Article  Google Scholar 

  22. 22.

    Malhotra R, Malhotra C, Chan A, Østbye T. Life-course socioeconomic status and obesity among older Singaporean Chinese men and women. J Gerontol B Psychol Sci Soc Sci. 2013;68:117–27.

    Article  Google Scholar 

  23. 23.

    StataCorp. Stata Multiple-Imputation Reference Manual Release 13. College Station, TX: StataCorp LP; 2013.

    Google Scholar 

  24. 24.

    World Health Organization. BMI classification. 2018. Accessed 20 Mar 2018.

  25. 25.

    Nagi SZ. An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc. 1976;54:439–67.

    CAS  Article  Google Scholar 

  26. 26.

    Lièvre A, Brouard N, Heathcote C. The estimation of health expectancies from cross-longitudinal surveys. Math Popul Stud. 2003;10:211–48.

    Article  Google Scholar 

  27. 27.

    Crimmins EM, Hayward MD, Hagedorn A, Saito Y, Brouard N. Change in disability-free life expectancy for Americans 70 years old and older. Demography. 2009;46:627–46.

    Article  Google Scholar 

  28. 28.

    Pongiglione B, Stavola BLD, Ploubidis GB. A systematic literature review of studies analyzing inequalities in health expectancy among the older population. PLoS ONE. 2015;10:e0130747.

    Article  Google Scholar 

  29. 29.

    Gilsing AM, Weijenberg MP, Hughes LA, Ambergen T, Dagnelie PC, Goldbohm RA, et al. Longitudinal changes in BMI in older adults are associated with meat consumption differentially, by type of meat consumed. J Nutr. 2012;142:340–9.

    CAS  Article  Google Scholar 

  30. 30.

    Heiland EG, Welmer AK, Wang R, Santoni G, Angleman S, Fratiglioni L, et al. Association of mobility limitations with incident disability among older adults: a population-based study. Age Ageing. 2016;45:812–9.

    Article  Google Scholar 

  31. 31.

    Ministry of Health, Singapore. Nursing Home capacity and demand | ministry of health. 2018. Accessed 20 Jul 2018.

  32. 32.

    Singapore Department of Statistics. Population and population structure - latest data. 2018. Accessed 20 Jul 2018.

  33. 33.

    Alexander NB, Guire KE, Thelen DG, Ashton-Miller JA, Schultz AB, Grunawalt JC, et al. Self-reported walking ability predicts functional mobility performance in frail older adults. J Am Geriatr Soc. 2000;48:1408–13.

    CAS  Article  Google Scholar 

  34. 34.

    Young Y, Boyd CM, Guralnik JM, Bandeen-Roche K, Fried LP. Does self-reported function correspond to objective measures of functional impairment? J Am Med Dir Assoc. 2010;11:645–53.

    Article  Google Scholar 

  35. 35.

    Samper-Ternent R, Al Snih S. Obesity in older adults: epidemiology and implications for disability and disease. Rev Clin Gerontol. 2012;22:10–34.

    Article  Google Scholar 

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Waves 1, 2 and 3 of the Panel on Health and Ageing of Singaporean Elderly (PHASE) were funded or supported by the following sources: Ministry of Social and Family Development, Singapore; Singapore Ministry of Health’s National Medical Research Council under its Singapore Translational Research Investigator Award “Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore” (NMRC-STAR-0005-2009), and its Clinician Scientist – Individual Research Grant - New Investigator Grant “Singapore Assessment for Frailty in Elderly-Building upon the Panel on Health and Aging of Singaporean Elderly” (NMRC-CNIG-1124-2014); and Duke-NUS Geriatric Research Fund.

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Correspondence to Rahul Malhotra.

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Tareque, M.I., Saito, Y., Chan, A. et al. Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults. Int J Obes 43, 2244–2253 (2019).

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