title: Loss of Weight in Obese Older Adults: A Biomarker of Impending Expansion of Multimorbidity?
abstract: OBJECTIVE
  To determine whether weight loss in older adults may be a marker of impending burden of multimorbidity regardless of initial weight, testing the hypotheses that obesity but not overweight in elderly adults is associated with greater number of diseases than normal weight and that obese older adults who lose weight over time have the greatest burden of multimorbidity.
  
  
  METHODS
  Longitudinal cohort study (Invecchiare in Chianti Study).
  
  
  METHODS
  Community.
  
  
  METHODS
  Individuals aged 60 and older at baseline followed for an average of 4 years (N = 1,025).
  
  
  METHODS
  Multimorbidity was measured as number of diagnosed diseases. Baseline body mass index (BMI) was categorized as normal weight (<25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Loss of weight was defined as decrease over time in BMI of at least 0.15 kg/m(2) per year. Age, sex, and education were covariates.
  
  
  RESULTS
  Baseline obesity was cross-sectionally associated with high multimorbidity and greater longitudinal increase of multimorbidity than normal weight (P = .005) and overweight (P < .001). Moreover, obese participants who lost weight over follow-up had a significantly greater increase in multimorbidity than other participants, including obese participants who maintained or gained weight over time (P = .005). In nonobese participants, changes in weight had no effect on changes in multimorbidity over time. Sensitivity analyses confirmed that one specific disease did not drive the association and that competing mortality did not bias the association.
  
  
  CONCLUSIONS
  Loss of weight in obese older persons is a strong biomarker of impending expansion of multimorbidity. Older obese individuals who lose weight should receive thoughtful medical attention.
authors: Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.|Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors: Elisa
authors: E
authors: Fabbri
authors: Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
authors: Toshiko
authors: T
authors: Tanaka
authors: Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
authors: Yang
authors: Y
authors: An
authors: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors: Marco
authors: M
authors: Zoli
authors: Department of Geriatric Medicine, Azienda Sanitaria di Firenze, Florence, Italy.
authors: Stefania
authors: S
authors: Bandinelli
authors: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors: Jack M
authors: JM
authors: Guralnik
authors: Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
authors: Eleanor M
authors: EM
authors: Simonsick
authors: Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: Cynthia M
authors: CM
authors: Boyd
authors: Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
authors: Stephanie A
authors: SA
authors: Studenski
authors: Geriatric Epidemiology Section, Laboratory of Epidemiology, Demography, and Biometry, National Institutes of Health, Bethesda, Maryland.
authors: Tamara B
authors: TB
authors: Harris
authors: Intramural Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland.
authors: Luigi
authors: L
authors: Ferrucci
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015431:Weight Loss
keywords: BMI; multimorbidity; obesity; older adults; weight loss