The Irish Longitudinal Study on Ageing (TILDA) highlights the consequences of high rates of obesity for health and health service demand in the over 50s in Ireland
DUBLIN, 22-7-2014 — /EuropaWire/ — A new report released today by the Irish Longitudinal Study on Ageing (TILDA), a national study of over 8,000 people aged 50 and over in Ireland, led by Trinity College Dublin, shows nearly four out of five adults over the age of 50 are overweight or obese. A similar proportion has an ‘increased’ or ‘substantially increased’ waist circumference*. This means that just one fifth of the over 50s have a normal BMI or waist circumference. The report also highlights the increased health risks and health services burden in older adults due to high rates of obesity.
The prevalence of obesity in men over 50 in Ireland is comparable with US men over 50 (while English rates are much lower). The prevalence of obesity in women over 50 in Ireland is lower than among comparable women in the US, and broadly similar to the prevalence among older English women.
A higher proportion of men and women with central obesity (i.e., a ‘substantially increased’ waist circumference) report a doctor’s diagnosis of at least one cardiovascular disease (e.g. angina, heart attack, heart failure, stroke), compared to those with a normal waist circumference. In addition, central obesity is associated with a higher prevalence of risk factors for cardiovascular disease. High blood pressure is diagnosed in twice as many older adults with central obesity compared to those with a normal waist circumference, while diabetes is over four times more common in the centrally obese group.
As well as the increased risk of cardiovascular disease and risk factors, obesity is associated with a greater prevalence of arthritis, asthma, chronic pain and decreased physical function, particularly in women. The prevalence of arthritis among obese women is 44%, compared with 25% of women with a normal weight.
The report also highlights the serious burden that these levels of obesity and overweight are placing on Ireland’s health services. Obese older adults visit their GP more frequently, take more medications, and a higher proportion report polypharmacy (i.e., concurrent use of five or more medications) than normal weight individuals. A 2012 study carried out for Safefood estimated that overweight and obesity cost the economy of the Republic of Ireland €1.3billion through increased health services utilisation, work absenteeism and premature mortality.
- Based on body mass index (BMI) measurements, 36% of Irish over 50s are obese and a further 43% are overweight.
- Based on waist circumference measurements, 52% of Irish over 50s are ‘centrally obese’, i.e., with a ‘substantially increased’ waist circumference, while a further 25% have an ‘increased’ waist circumference.
- Using BMI as an indicator of obesity, a higher proportion of men (38%) are obese than women (33%); however, using waist circumference as an indicator of obesity, a higher proportion of women (56%) have a ‘substantially increased’ waist circumference than men (48%).
- There is a much stronger relationship between obesity and socioeconomic status for Irish women than for Irish men; for example, 39% of women in the lowest quintile of wealth are obese, in comparison to 24% of women in the highest wealth quintile.
- There are strong relationships between obesity, particularly central obesity, and cardiovascular diseases such as angina, heart failure and heart attack; 21% of centrally obese men report at least one cardiovascular disease compared to 14% of men with a normal waist circumference. Corresponding rates for women are 17% compared to 11%.
- Cardiovascular disease risk factors are more prevalent in those with central obesity. For example, 48% of those with central obesity report a doctor’s diagnosis of high blood pressure compared with 22% of those with a normal waist circumference. 11% of those with central obesity report a doctor’s diagnosis of diabetes in comparison with just 2.5% of those with a normal waist circumference.
- Chronic conditions such as arthritis are more common among obese individuals; for example, the prevalence of arthritis among obese women is 44%, compared with 25% of women with a normal weight.
- There is a clear relationship between obesity and objective measures of physical functioning in both men and women; for example, obese women walk over 10cm per second slower than normal weight women.
- The relationship between obesity and physical activity is stronger in women than men. 47% of obese women report ‘low’ levels of physical activity, indicating that they do not meet the recommended levels of physical activity, compared to 30% of normal weight women.
- Obese individuals visit their GP more frequently, take more medications, and a higher proportion report polypharmacy (i.e., concurrent use of five or more medications) than non-obese individuals.
Speaking about the findings, Dr Siobhan Leahy, TILDA Research Fellow and lead author of the report said: “TILDA is the first study to look specifically at obesity in the over 50s in Ireland. Our findings show not only worryingly high levels of obesity but also the impact of these levels on health and everyday activity among the over 50s in Ireland. The proportion of over 50s in Ireland who are overweight or obese is significantly higher than that of the general adult population in Ireland. While this age group is already more likely to be affected by age-related illness, frailty and cardiovascular disease, these conditions are exacerbated by the presence of obesity and significantly higher levels of disease and disability are evident in obese individuals. Our study highlights the combined impact of the obesity crisis and a rapidly ageing population on health and health service demand.”
Dr Anne Nolan, TILDA Research Director and co-author of the report said: “At a time when the Irish health service is faced with the challenge of delivering services with fewer resources, the finding that obesity is associated with a significantly higher use of health services is a cause for concern. A greater focus on health promotion and prevention is required to not only improve population health and well-being, but also to ensure the future sustainability of our health system.”
The report is available from the TILDA website here.
For more information about TILDA please visit their website here.
Definition of obesity
Obesity is a chronic disease defined by the World Health Organisation (WHO) as a condition of abnormal or excessive fat accumulation, to the extent that health may be impaired.
*Measurement of obesity
Obesity is most commonly defined according to body mass index (BMI). A BMI greater than 30kg/m2 indicates obesity. The use of BMI has been questioned in older adults as it does not reflect the age-associated changes in body composition such as loss of muscle mass or an increase in fat mass deposited in the abdominal area.
Waist circumference is therefore considered to be a more useful measure of excess fat in this population. A ‘normal’ waist measurement is less than 80cm (32 inches) in women and less than 94cm (35inches) in men. A waist measurement greater than 88cm (35inches) in women and 102cm (40inches) in men indicates central obesity. An increased waist circumference is more strongly associated with cardiovascular problems than an increased BMI.
Both measurements were used in this study and reported on separately and in relation to each other. The proportions of people who were recorded in this study as overweight or obese were similar regardless of whether BMI or waist circumference measurements were used.
The Irish Longitudinal Study on Ageing (TILDA) was launched in November 2006 to study a representative cohort of over 8,000 people aged 50 and over and resident in Ireland, charting their health, social and economic circumstances over a 10-year period. It the most comprehensive study of ageing ever carried out in Ireland and is modelled closely on long-running ‘sister’ studies worldwide, such as the US Health and Retirement Survey and the English Longitudinal Study on Ageing. The study is being carried out by Trinity College Dublin in collaboration with an interdisciplinary panel of scientific researchers, with expertise in various fields of ageing from the Economic and Social Research Institute (ESRI), National University of Ireland Galway (NUIG), Royal College of Surgeons in Ireland (RCSI), University College Cork (UCC) and Waterford Institute of Technology (WIT). A group of international scientists advises the TILDA investigators. Funding has been provided by the Department of Health, Irish Life and the Atlantic Philanthropies.
Future planned TILDA studies on obesity
TILDA Wave 3, currently underway, includes a comprehensive health assessment where participants’ height and weight are being re-measured. This will allow the first longitudinal analysis of changes in BMI and waist circumference at a population level and help to identify predictors and consequences of weight change in older Irish adults. Future waves of TILDA will also identify transitions into and out of obesity over time and help to establish the independent effects of ageing, co-morbidities and health behaviours on such change.