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Epidemiology and Population Health

Body mass index, waist circumference, waist-to-hip ratio, and body fat in relation to health care use in the Canadian Longitudinal Study on Aging

International Journal of Obesity volume 45, pages 666–676 (2021)Cite this article

Subjects

Abstract

Background/objectives

Obesity is associated with increased health care use (HCU), but it is unclear whether this is consistent across all measures of adiposity. The objectives were to compare obesity defined by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and percent body fat (%BF), and to estimate their associations with HCU.

Subjects/methods

Baseline data from 30,092 participants aged 45–85 years from the Canadian Longitudinal Study on Aging were included. Measures of adiposity were recorded by trained staff and obesity was defined as BMI ≥ 30.0 kg/m2 for all participants and WC ≥ 88 cm and ≥102 cm, WHR ≥ 0.85 and ≥0.90, and %BF > 35% and >25% (measured using dual energy x-ray absorptiometry) for females and males, respectively. Self-reported HCU in the past 12 months was collected for any contact with a general practitioner, specialist, emergency department, and hospitalization. Pearson correlation coefficients (r) compared each measure to %BF-defined obesity, the reference standard. Relative risks (RR) and risk differences (RD) adjusted for age, sex, education, income, urban/rural, marital status, smoking status, and alcohol use were calculated, and results were age- and sex-stratified.

Results

Obesity prevalence varied by measure: BMI (29%), WC (42%), WHR (62%), and %BF (73%). BMI and WC were highly correlated with %BF (r ≥ 0.70), while WHR demonstrated a weaker relationship with %BF, with differences by sex (r = 0.29 and r = 0.46 in females and males, respectively). There were significantly increased RR and RD for all measures and health care services, for example, WC-defined obesity was associated with an increased risk of hospitalization (RR: 1.40, 95% CI: 1.28–1.54 and RD per 100: 2.6, 95% CI:1.9–3.3). Age-stratified results revealed that older adult groups with obesity demonstrated weak or no associations with HCU.

Conclusions

All measures of adiposity were positively associated with increased HCU although obesity may not be a strong predictor of HCU in older adults.

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Acknowledgements

The CLSA is led by Drs Parminder Raina, Christina Wolfson, and Susan Kirkland. Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference LSA 94473 and the Canada Foundation for Innovation. This research has been conducted using the CLSA’s dataset Baseline Tracking version 3.4 and Baseline Comprehensive Version 4.0, under Application Number 19CA004.

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Authors and Affiliations

  1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

    Alessandra T. Andreacchi, Lauren E. Griffith, G. Emmanuel Guindon, Alexandra Mayhew, Carol Bassim & Laura N. Anderson

  2. Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada

    G. Emmanuel Guindon & Laura N. Anderson

  3. Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada

    Marie Pigeyre

  4. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Marie Pigeyre

  5. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada

    Saverio Stranges

  6. Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg

    Saverio Stranges

  7. Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada

    Saverio Stranges

  8. Division of Child Health Evaluative Sciences (CHES), Sick Kids Research Institute, Toronto, Ontario, Canada

    Laura N. Anderson

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Correspondence to Laura N. Anderson.

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Conflict of interest

The authors declare that they have no conflict of interest. The opinions expressed in this manuscript are the author’s own and do not reflect the views of the Canadian Longitudinal Study on Aging.

Ethics approval

All participants provided written informed consent upon enrollment into the CLSA. Further, secondary data analysis for this specific project was approved by the Hamilton Integrated Research Ethics Board, Hamilton, Ontario (HiREB# 2019-7221-C).

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Andreacchi, A.T., Griffith, L.E., Guindon, G.E. et al. Body mass index, waist circumference, waist-to-hip ratio, and body fat in relation to health care use in the Canadian Longitudinal Study on Aging. Int J Obes 45, 666–676 (2021). https://doi.org/10.1038/s41366-020-00731-z

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