Self-reported disability in performing daily life activities was assessed in adults with severe obesity (BMI ≥？35？kg/m2) using the Health Assessment Questionnaire (HAQ). 262 participants were recruited into three BMI groups: Group I: 35–39.99？kg/m2; Group II: 40–44.99？kg/m2; Group III: ≥45.0？kg/m2. Progressively increasing HAQ scores were documented with higher BMI; Group I HAQ score: 0.125 (median) (range: 0–1.75); Group II HAQ score: 0.375 (0–2.5); Group III HAQ score: 0.75 (0–2.65) (Group III versus II ; Group III versus I ; Group II versus I ). HAQ score strongly correlated with BMI and age. Nearly three-fourths of the study participants reported some degree of disability (HAQ score > 0). The prevalence of this degree of disability increased with increasing BMI and age. It also correlated to type 2 diabetes, metabolic syndrome, and clinical depression, but not to gender. Our data suggest that severe obesity is associated with self-reported disability in performing common daily life activities, with increasing degree of disability as BMI increases over 35？kg/m2. Functional assessment is crucial in obesity management, and establishing the disability profiles of obese patients is integral to both meet the specific healthcare needs of individuals and develop evidence-based public health programs, interventions, and priorities. 1. Introduction Obesity is the most frequent metabolic disease worldwide and can progressively lead to a spectrum of comorbidities, including type 2 diabetes, hypertension, dyslipidaemia, cardiovascular disease, liver dysfunction, and osteoarthritis [1–3]. Preventing obesity-related co-morbidity relies on effective weight loss interventions; however, it is becoming evident that there is also a further need to focus on the daily living and well-being of obese patients. Obesity is still associated with high early mortality, but advances in the treatment of cardiovascular risk factors and acute coronary syndromes are now offering better cardioprotection options and prolong life expectancy [4]. Current data support the notion that in developed societies an increasing number of obese patients are expected to live more than previously estimated, despite failing to reduce their body weight [4, 5]. Furthermore, demographic and epidemiological projections predict growing and progressively ageing obese populations in the Western world [6–8]. These populations are expected to exhibit an escalating burden of obesity-related disease, particularly regarding complications which were previously underestimated or underexpressed due to earlier
References
[1]
W. P. James, “The epidemiology of obesity: the size of the problem,” Journal of Internal Medicine, vol. 263, no. 4, pp. 336–352, 2008.
[2]
P. Kopelman, “Health risks associated with overweight and obesity,” Obesity Reviews, vol. 8, supplement 1, pp. 13–17, 2007.
[3]
I. Kyrou and M. O. Weickert, “Clinical problems caused by obesity,” in Obesity, M. Tsch？p, Ed., MDTEXT, Dartmouth, Mass, USA, 2010, http://www.endotext.org/obesity/obesity13/obesityframe13.htm.
[4]
D. E. Alley and V. W. Chang, “The changing relationship of obesity and disability, 1988-2004,” JAMA, vol. 298, no. 17, pp. 2020–2027, 2007.
[5]
S. L. Reynolds, Y. Saito, and E. M. Crimmins, “The impact of obesity on active life expectancy in older American men and women,” Gerontologist, vol. 45, no. 4, pp. 438–444, 2005.
[6]
Centers for Disease Control and Prevention, “Public health and aging: trends in aging-United States and worldwide,” JAMA, vol. 11, pp. 1371–1373, 2003.
[7]
D. E. Arterburn, P. K. Crane, and S. D. Sullivan, “The coming epidemic of obesity in elderly Americans,” Journal of the American Geriatrics Society, vol. 52, no. 11, pp. 1907–1912, 2004.
[8]
I. Kyrou and C. Tsigos, “Obesity in the elderly diabetic patient: is weight loss beneficial?” Diabetes Care, vol. 32, pp. S403–S409, 2009.
[9]
E. W. Gregg and J. M. Guralnik, “Is disability obesity's price of longevity?” JAMA, vol. 298, no. 17, pp. 2066–2067, 2007.
[10]
D. K. Houston, J. Stevens, and J. Cai, “Abdominal fat distribution and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study,” International Journal of Obesity, vol. 29, no. 12, pp. 1457–1463, 2005.
[11]
U. E. Larsson and E. Mattsson, “Functional limitations linked to high body mass index, age and current pain in obese women,” International Journal of Obesity and Related Metabolic Disorders, vol. 25, no. 6, pp. 893–899, 2001.
[12]
R. Sturm, J. S. Ringel, and T. Andreyeva, “Increasing obesity rates and disability trends,” Health Affairs, vol. 23, no. 2, pp. 199–205, 2004.
[13]
K. F. Ferraro, Y. P. Su, R. J. Gretebeck, D. R. Black, and S. F. Badylak, “Body mass index and disability in adulthood: a 20-year panel study,” American Journal of Public Health, vol. 92, no. 5, pp. 834–840, 2002.
[14]
K. R. Fontaine and I. Barofsky, “Obesity and health-related quality of life,” Obesity Reviews, vol. 2, no. 3, pp. 173–182, 2001.
[15]
I. Kyrou, G. P. Chrousos, and C. Tsigos, “Stress, visceral obesity, and metabolic complications,” Annals of the New York Academy of Sciences, vol. 1083, pp. 77–110, 2006.
[16]
A. Hammond and R. Levine, “The economic impact of obesity in the United States Diabetes, Metabolic Syndrome and Obesity,” Targets and Therapy, vol. 3, pp. 285–295, 2010.
[17]
J. G. Trogdon, E. A. Finkelstein, T. Hylands, P. S. Dellea, and S. J. Kamal-Bahl, “Indirect costs of obesity: a review of the current literature,” Obesity Reviews, vol. 9, no. 5, pp. 489–500, 2008.
[18]
S. Allender and M. Rayner, “The burden of overweight and obesity-related ill health in the UK,” Obesity Reviews, vol. 8, no. 5, pp. 467–473, 2007.
[19]
World Health Organization, World Health Report 2002, WHO, Geneva, Switzerland, 2003.
[20]
R. V. Burkhauser and J. Cawley, Obesity, Disability and Movement Onto the Disability Insurance Rolls, Michigan Retirement Research Center, University of Michigan, Ann Arbor, Mich, USA, 2004.
[21]
J. F. Fries, P. Spitz, G. Kraines, and H. Holman, “Measurement of patient outcome in arthritis,” Arthritis and Rheumatism, vol. 23, no. 2, pp. 137–145, 1980.
[22]
D. R. Ramey, J. P. Raynauld, and J. F. Fries, “The Health Assessment Questionnaire 1992: status and review,” Arthritis Care and Research, vol. 5, no. 3, pp. 119–129, 1992.
[23]
B. Bruce and J. F. Fries, “The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation,” Journal of Rheumatology, vol. 30, no. 1, pp. 167–178, 2003.
[24]
S. Lillegraven and T. K. Kvien, “Measuring disability and quality of life in established rheumatoid arthritis,” Best Practice and Research: Clinical Rheumatology, vol. 21, no. 5, pp. 827–840, 2007.
[25]
K. G. Alberti, P. Zimmet, J. Shaw, and IDF Epidemiology Task Force Consensus Group, “The metabolic syndrome-a new worldwide definition,” Lancet, vol. 366, no. 9491, pp. 1059–1062, 2005.
[26]
E. Krishnan, T. Sokka, A. H？kkinen, H. Hubert, and P. Hannonen, “Normative values for the Health Assessment Questionnaire disability index: benchmarking disability in the general population,” Arthritis and Rheumatism, vol. 50, no. 3, pp. 953–960, 2004.
[27]
S. Walter, A. Kunst, J. MacKenbach, A. Hofman, and H. Tiemeier, “Mortality and disability: the effect of overweight and obesity,” International Journal of Obesity, vol. 33, no. 12, pp. 1410–1418, 2009.
[28]
A. H. Mokdad, E. S. Ford, B. A. Bowman et al., “Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001,” JAMA, vol. 289, no. 1, pp. 76–79, 2003.
[29]
A. Peeters, L. Bonneux, W. J. Nusselder, C. de Laet, and J. J. Barendregt, “Adult obesity and the burden of disability throughout life,” Obesity Research, vol. 12, no. 7, pp. 1145–1151, 2004.
[30]
S. Al Snih, K. J. Ottenbacher, K. S. Markides, Y. F. Kuo, K. Eschbach, and J. S. Goodwin, “The effect of obesity on disability vs mortality in older Americans,” Archives of Internal Medicine, vol. 167, no. 8, pp. 774–780, 2007.
[31]
C. A. Okoro, J. M. Hootman, T. W. Strine, L. S. Balluz, and A. H. Mokdad, “Disability, arthritis, and body weight among adults 45 years and older,” Obesity Research, vol. 12, no. 5, pp. 854–861, 2004.
[32]
M. Reuser, L. G. Bonneux, and F. J. Willekens, “Smoking kills, obesity disables: a multistate approach of the US health and retirement survey,” Obesity, vol. 17, no. 4, pp. 783–789, 2009.
[33]
ü. Ta？, A. P. Verhagen, S. M. Bierma-Zeinstra et al., “Incidence and risk factors of disability in the elderly: the Rotterdam Study,” Preventive Medicine, vol. 44, no. 3, pp. 272–278, 2007.
[34]
J. M. Jordan, G. Luta, J. B. Renner et al., “Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of sociodemographic factors, obesity, and knee pain,” Arthritis Care and Research, vol. 9, no. 4, pp. 273–278, 1996.
[35]
L. Sinigaglia, A. Nervetti, Q. Mela et al., “A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis,” Journal of Rheumatology, vol. 27, no. 11, pp. 2582–2589, 2000.
[36]
M. B. Yunus, S. Arslan, and J. C. Aldag, “Relationship between body mass index and fibromyalgia features,” Scandinavian Journal of Rheumatology, vol. 31, no. 1, pp. 27–31, 2002.
[37]
R. J. Johnson and F. D. Wolinsky, “The structure of health status among older adults: disease, disability, functional limitation, and perceived health,” Journal of Health and Social Behavior, vol. 34, no. 2, pp. 105–121, 1993.
[38]
A. Anandacoomarasamy, I. Caterson, P. Sambrook, M. Fransen, and L. March, “The impact of obesity on the musculoskeletal system,” International Journal of Obesity, vol. 32, no. 2, pp. 211–222, 2008.
[39]
H. B. Hubert, D. A. Bloch, and J. F. Fries, “Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study,” Journal of Rheumatology, vol. 20, no. 3, pp. 480–488, 1993.
[40]
B. Bruce and J. F. Fries, “The Stanford Health Assessment Questionnaire: dimensions and practical applications,” Health and Quality of Life Outcomes, vol. 1, article 20, 2003.
[41]
F. Wolfe, K. Michaud, and V. Strand, “Expanding the definition of clinical differences: from minimally clinically important differences to really important differences. Analyses in 8931 patients with rheumatoid arthritis,” Journal of Rheumatology, vol. 32, no. 4, pp. 583–589, 2005.
[42]
R. T. Ackermann, S. L. Edelstein, K. M. Venkat Narayan et al., “Changes in health state utilities with changes in body mass in the diabetes prevention program,” Obesity, vol. 17, no. 12, pp. 2176–2181, 2009.
[43]
D. Oman, D. Reed, and A. Ferrara, “Do elderly women have more physical disability than men do?” American Journal of Epidemiology, vol. 150, no. 8, pp. 834–842, 1999.
[44]
J. M. Friedmann, T. Elasy, and G. L. Jensen, “The relationship between body mass index and self-reported functional limitation among older adults: a gender difference,” Journal of the American Geriatrics Society, vol. 49, no. 4, pp. 398–403, 2001.
[45]
S. Larrieu, K. Pérès, L. Letenneur et al., “Relationship between body mass index and different domains of disability in older persons: the 3C study,” International Journal of Obesity and Related Metabolic Disorders, vol. 28, no. 12, pp. 1555–1560, 2004.
[46]
R. A. DeFronzo, “Pathogenesis of type 2 diabetes mellitus,” Medical Clinics of North America, vol. 88, no. 4, pp. 787–835, 2004.
[47]
E. Atlantis and M. Baker, “Obesity effects on depression: systematic review of epidemiological studies,” International Journal of Obesity, vol. 32, no. 6, pp. 881–891, 2008.
[48]
A. J. Stunkard, M. S. Faith, and K. C. Allison, “Depression and obesity,” Biological Psychiatry, vol. 54, no. 3, pp. 330–337, 2003.
[49]
M. S. Faith, P. E. Matz, and M. A. Jorge, “Obesity—depression associations in the population,” Journal of Psychosomatic Research, vol. 53, no. 4, pp. 935–942, 2002.
[50]
J. Ma and L. Xiao, “Obesity and depression in US women: results from the 2005-2006 national health and nutritional examination survey,” Obesity, vol. 18, no. 2, pp. 347–353, 2010.
[51]
G. Gariepy, J. Wang, A. D. Lesage, and N. Schmitz, “The longitudinal association from obesity to depression: results from the 12-year national population health survey,” Obesity, vol. 18, no. 5, pp. 1033–1038, 2010.
[52]
A. M. Sharma and R. F. Kushner, “A proposed clinical staging system for obesity,” International Journal of Obesity, vol. 33, no. 3, pp. 289–295, 2009.
