Environmental Factor, November 2009, National Institute of Environmental Health Sciences
Presentation Addresses Obesity as a Disability
By Eddy Ball
The NIEHS Disability Advocacy Committee (DAC) began its observance of National Disability Employment Awareness Month on September 30 with a presentation on "Obesity, Mortality and Quality of Care: Implications for Disability."
The lecture, hosted by DAC Chair Alicia Moore, featured physician and sociologist Virginia Chang, M.D., Ph.D. Chang offered encouraging news about trends in mortality and treatment trends among obese people. However, she also cautioned that the impact of obesity on quality of life and medical costs could increase as more obese people live longer with functional and activities-of-daily-living (ADL) disabilities.
With research interests in obesity and weight-related behaviors, social epidemiology and health disparities, Chang(http://www.med.upenn.edu/crrwh/faculty/Chang/Chang.html) is an assistant professor of medicine and sociology in the Division of General Internal Medicine at the University of Pennsylvania (Penn) School of Medicine. She is also a member of the Asian American Studies Program at Penn as well as an attending physician at the Philadelphia Veteran Affairs (VA) Medical Center.
Chang opened her talk with a review of the conventional wisdom about obesity and health that her research findings have led her to question. Although the medical community has long considered obesity a major cause of "avoidable mortality" - and compared it to smoking as a risk factor for premature death - "There is another strain of literature out there," she said, "showing that the obese population may actually have gotten healthier, especially when we consider cardiovascular [CV] aspects."
Analyzing data from several cohorts spanning populations born from 1931 to the 1960s, Chang compared changes in mortality among different age groups of obese and normal-weight people over time, as well as trends in treatment for obese people reflected in VA and Medicare claims data. According to Chang, the evidence suggests that the added risk of death from obesity has fallen to the 3- to 5-percent range and is currently only "a modest contributor to mortality." She said it also appears that "physicians are actually being more attentive to obese patients and treating them more aggressively" than in the past, and for some conditions, obese patients are more likely to get preventive care.
For the final portion of her talk, Chang turned to trends in the relationship of obesity and disabilities. She compared the odds of having functional and ADL impairments among obese and normal-weight people aged 60 and over during two time periods, the 1980s and the late 1990s to 2004. Chang found that while obese people in the 1980s had 78 percent increased odds for functional disabilities and only insignificantly increased odds for ADL disabilities, in the 1990s, obese people in the age group showed nearly three times the odds of being functionally impaired and twice the likelihood of having ADL disabilities - at a time when normal-weight people experienced no increase in ADL impairment and a slight decrease in functional disability.
"The same amount of weight now confers a greater risk of disability than it did in the past," Chang concluded, especially for people falling into obesity BMI classes I and II, and "people are getting obese at younger ages." She ended her talk with a quote from a recent editorial - "Disability may be one of obesity's most important and persistent effects."