The complexity of reaching and maintaining a healthy body weight - the experience from adults with a mobility disability

Physical activity positively impacts disability outcomes during transition from midlife to early older age irrespective of body mass index

We examined the effects of physical activity (PA) and body mass index (BMI) longitudinal patterns (trajectories) on subjective measures of mobility, function, and disability in adults and assessed whether effects of PA trajectories on function varied due to BMI. Group-based trajectory analyses were used to determine patterns of change in PA and BMI using data from the Health and Retirement Study 1931-1941 birth cohort (n = 10,507). Physical function was assessed by Mobility Limitations (0-5 scale) and Large Muscle Function (0-4 scale) Indexes, as well as with score for activities of daily living (ADLs) and instrumental activities of daily living (IADLs), with higher scores being worse. Our analyses estimated four distinct PA trajectories: decreasing, (2) fluctuating, (3) stable high, and (4) emergent (previously low/sedentary with increased PA over the study period). Worse mobility limitations, large muscle function, ADLs, and IADLs were associated with Decreasing and Fluctuating PA groups. Better outcomes were associated with Emergent and Stable High PA groups. The five BMI trajectories were stable normal/overweight, modest decreasing, fluctuating, steep decreasing, and increasing. No significant interaction existed between PA and BMI trajectories for Mobility Limitations (P= 0.577), Large Muscle Function (P= 0.511), ADLs (P= 0.600), and IADLs (P= 0.152). These findings may empower clinicians to promote messages to midlifers that meaningful changes in PA can improve function in older age.

Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S

INTRODUCTION

Obesity has been associated with disability; yet, the proportion who meet clinical criteria for obesity treatment among adults with disabilities remains poorly defined. Characterization of obesity and treatment eligibility by disability type may prioritize high-need groups. This study assessed the prevalence of obesity and eligibility for antiobesity pharmacotherapy and/or bariatric surgery in adults with disability.

METHODS

This cross-sectional weighted analysis of the 2019 National Health Interview Survey, including self-reported health and sociodemographic information, was conducted in 2021. Burden of obesity defined by BMI and odds of meeting consensus criteria for antiobesity pharmacotherapy and/or surgery were calculated by functional disability type: vision, hearing, cognition, communication, mobility, and self-care.

RESULTS

From 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for U.S. adults overall (p<0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p<0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4). Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy.

CONCLUSIONS

Individuals with disabilities have higher odds of obesity and eligibility for antiobesity treatments. Comorbidities should be considered, accommodations should be provided, and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.

Differences in Body Mass Index Trajectories and Their Classification, Sociodemographic Characteristics, and Health Behaviors between People with and without Disabilities Using Korea Health Panel Survey Data

A high body mass index (BMI) is an important factor that negatively affects the health of people with disabilities. In particular, since the high BMI has a cumulative effect on the occurrence of complications such as cardiovascular disease, it is required to investigate the data through longitudinal studies rather than cross-sectional studies. Therefore, we conducted a longitudinal follow-up study to examine the differences in the BMI trajectories of people in South Korea with disabilities, as well as the sociodemographic characteristics and health behaviors that classify individual trajectories into clusters. Participants aged 40 to 79 years who responded to the Korea Health Panel Survey (KHPS) from 2009 to 2018, 283 people with physical disabilities or brain lesion disorders, and 849 people without disabilities, were extracted. We found that the differences in the initial BMI between clusters were larger in 60-79-year-old people with disabilities (men 22.5 kg/m², 26.9 kg/m²; women 23.8 kg/m², 28.1 kg/m²) than in those without disabilities (men 22.1 kg/m², 23.3 kg/m²; women 24.8 kg/m², 25.6 kg/m²). Also, logistic regression analysis showed that, among the people with disabilities, women (OR = 1.94), those who lived alone (OR = 2.36), and those who were economically inactive (OR = 1.78) were more likely to be classified into the higher BMI category than those who were not. To effectively manage the BMI, it would be better to focus on women with disabilities, people with disabilities living alone, and people who are economically inactive.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability

Aim

Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability.

Design

Empirical research ‐ qualitative.

Method

Classic grounded theory with face‐to‐face interviews, 2017–2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients.

Results

To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses’ facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person‐centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work.

Conclusions

Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi‐professional cooperation. The implication is testing the emerged theory at primary health care centres.

Impact

Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.