Original ResearchIndependent associations between weight status and disability in adults: Results from the health survey for England
Introduction
The recent White Paper for England and Wales entitled ‘Choosing Health’1 specified tackling obesity as a public health priority. The prevalence of both obesity2 and disability3 are increasing, and although links between obesity and some conditions are well-established, other types of disability have been neglected in obesity research. The Health Survey for England (HSE) included a special focus on disability in 2001, and this has remained a largely untapped source of information about potential links between disability and weight status. However, it showed that one in 20 people has a severe disability and 22% are obese. The increasing prevalence of these conditions means that they are both salient public health issues and any link should be a priority for research.
It is well-known that obesity is associated with an increased risk of type 2 diabetes, cardiovascular disease,4, 5 some cancers6 and osteoarthritis.7 There is also mounting evidence for links between obesity and other musculoskeletal disorders,7 and some respiratory conditions8 including asthma.9 Population studies investigating relationships between obesity and mental illness, however, have produced inconsistent results.10, 11, 12, 13
There is now a growing body of research indicating links between obesity and functionally defined disability. In one study, participants with a disability (physical, mental, emotional or relating to communication) were more likely to be obese than participants without a disability.14 Obesity has been found to be cross-sectionally associated with greater back pain,15 and to longitudinally predict locomotor disability13, 16, 17 and work disability.18, 19 Another study found that having a sight or hearing disability independently raises participants' odds of obesity.13
More research is needed in this field and all previous studies have limitations, such as not controlling for confounding variables,14 and relying on self-reported rather than measured height and weight data.13 In three studies, a broad range of disabilities were grouped. In one of these studies, the disability group included people with physical, mental, emotional and communication disabilities,14 and the other studies included participants with any type of disability causing them to claim work disability pensions.18, 19 While locomotor disabilities have been analysed as discrete categories,13, 16, 17 only one study has investigated links between weight status and sight and hearing disabilities.13
The present study investigated the association between weight status and disability status in the general population. The risk of specific disabilities was analysed by weight status, whilst controlling for a number of variables that may confound the relationship.
Section snippets
Methods
The data were from the HSE; a cross-sectional survey of the population living in private households in England, the results of which are published annually. The year 2001 was selected because of its focus on disability. Other topics, such as height and weight, smoking and alcohol consumption, are assessed every year. Details of HSE methodology were found online.20, 21
Results
General descriptive statistics can be found in Table 1.Of the participants, 3.9% were underweight, 32.7% were in the ideal weight range, and 63.4% were overweight, obese or morbidly obese. The prevalence of each disabling condition in the whole sample and in each weight status group is shown in Table 2.The prevalence of the conditions in the overall sample ranged from 0.5% for osteoarthritis and allied disorders to 19.0% for musculoskeletal illnesses. In general, the prevalence of the disabling
Discussion
The present results are consistent with the well-documented findings on the association between obesity and osteoarthritis.7 The results also add to the growing body of evidence showing that obesity is associated with other musculoskeletal disorders,7 locomotive disability16, 17 and asthma.9 The present study also found an independent association between obesity and hearing disability, consistent with one previous study,13 and personal care disability.
There are several pathways by which obesity
Acknowledgements
Data were created by the Office of National Statistics. Crown copyright material was reproduced with the permission of the Controller of Her Majesty's Stationery Office and kindly provided by the National Centre for Social Research and University College London, Department of Epidemiology and Public Health; Health Survey for England, 2001 (computer file); Colchester, Essex: UK Data Archive (distributor) (February 2003, SN: 4628); none of whom bear responsibility for the further analysis or
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