title: Obesity in Older People With and Without Conditions Associated With Weight Loss: Follow-up of 955,000 Primary Care Patients.
abstract: Moderate obesity in later life may improve survival, prompting calls to revise obesity control policies. However, this obesity paradox may be due to confounding from smoking, diseases causing weight-loss, plus varying follow-up periods. We aimed to estimate body mass index (BMI) associations with mortality, incident type 2 diabetes, and coronary heart disease in older people with and without the above confounders.
  
  
  
  Cohort analysis in Clinical Practice Research Datalink primary care, hospital and death certificate electronic medical records in England for ages 60 to more than 85 years. Models were adjusted for age, gender, alcohol use, smoking, calendar year, and socioeconomic status.
  
  
  
  Overall, BMI 30-34.9 (obesity class 1) was associated with lower overall death rates in all age groups. However, after excluding the specific confounders and follow-up less than 4 years, BMI mortality risk curves at age 65-69 were U-shaped, with raised risks at lower BMIs, a nadir between 23 and 26.9 and steeply rising risks above. In older age groups, mortality nadirs were at modestly higher BMIs (all <30) and risk slopes at higher BMIs were less marked, becoming nonsignificant at age 85 and older. Incidence of diabetes was raised for obesity-1 at all ages and for coronary heart disease to age 84.
  
  
  
  Obesity is associated with shorter survival plus higher incidence of coronary heart disease and type 2 diabetes in older populations after accounting for the studied confounders, at least to age 84. These results cast doubt on calls to revise obesity control policies based on the claimed risk paradox at older ages.
authors: Epidemiology and Public Health, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, UK.
authors: Kirsty
authors: K
authors: Bowman
authors: Epidemiology and Public Health, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, UK.
authors: João
authors: J
authors: Delgado
authors: Health Statistics Group, Institute of Health Research, University of Exeter Medical School, UK.
authors: William E
authors: WE
authors: Henley
authors: Epidemiology and Public Health, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, UK.
authors: Jane A
authors: JA
authors: Masoli
authors: Diabetes and Obesity Research Group, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK.
authors: Katarina
authors: K
authors: Kos
authors: Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, UK.
authors: Carol
authors: C
authors: Brayne
authors: School of Health and Related Research (ScHARR), University of Sheffield, UK.
authors: Praveen
authors: P
authors: Thokala
authors: Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, UK.
authors: Louise
authors: L
authors: Lafortune
authors: UConn Center on Aging, University of Connecticut Health Center, Farmington, USA.
authors: George A
authors: GA
authors: Kuchel
authors: Epidemiology and Public Health, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, UK.
authors: Alessandro
authors: A
authors: Ble
authors: Epidemiology and Public Health, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, UK. D.Melzer@exeter.ac.uk.|UConn Center on Aging, University of Connecticut Health Center, Farmington, USA.
authors: David
authors: D
authors: Melzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D011320:Primary Health Care; D012907:Smoking / Q000453:epidemiology; D015431:Weight Loss
keywords: BMI; Mortality; Overweight; Paradox