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Body Mass, Physical Activity and Future Care NeedsOlena Nizalova, Julien Forder, and Katerina GousiaILPN, LSE, LondonSeptember 1, 2014
2 
•Obesity in the UK is on the rise: quarter of the population obese by 2013 
•P(Obese) highest at 45-64, P(Overweight|Obese) highest at 65-74 
Figure 1: Prevalence of Obesity Among Adults 16+ 
Source: Health Survey for England 1993-2012 (3-year average)
3 
Obesity –health bomb 
•Obesity contributes to the development of long-term conditions: 
–mental health problems 
–liver disease 
–type 2 diabetes 
–cardiovascular disease 
–muscular skeletal disease 
•The resulting NHS costs attributable to overweight and obesity are projected to reach £10 billion by 2050, with wider costs to society estimated to reach £50 billion per year (Foresight 2007)
4 
Obesity –care bomb? 
•Long-term health conditions 
•Severe obesity may lead to severe physical difficulties inhibiting ADLs: 
–Housing adaptations 
–Specialist care for house bound people 
–Provision of appropriate transport and facilities 
•SES-obesity gradient, ethnic differences in obesity –increasing inequality in health and social care
5 
Research Question 
•What is the impact of obesity on the use of various modes of care in the future, in addition to its impact through long-term health conditions? 
•Does physical activity play a role in the future care use?
BMI and long term care: literature 
•Few studies take BMI explicitly into account as a determinant of care needs 
•All evidence comes from US studies only 
•Mixed evidence 
–Both obese and under-weight adults are at greater relative risk of nursing home admissions (Zizzaet al. 2002) 
–Midlife obesity predicted nursing home admission in later life compared with normal BMI (Elkins et al. 2006) 
–No evidence on effect of BMI on informal care (Resniket al. 2005) 
•Cox proportional hazard models, logit
7 
Data 
•English Longitudinal Study of Ageing 2002- 2011 
•65+ sample: overall (N=8100) and those not using care initially (N=5721), men vs. women 
•BMI from Nurse data (wave 0, wave 2, wave 4) 
•Care status data (wave 3, wave 5)
8 
Methodology 
•Multinomial Logit for various care needs controlling for non-response and death: 
–Comparison of the impact on 2-year transitions to the longer run impact of variables of interest at the baseline 
–Exploring the importance of obesity in determining future care use after controlling for available related health conditions and limitations (ADLs, iADLs, HBP, diabetes, cancer, lung disease, heart disease, stroke, psychic problems, arthritis) 
–Exploration of the role of the physical activity 
•Outcomes: future care needs (informal care, privately purchased care, social care, nursing/care home) 
•Controls: demographic and socio-economic characteristics
9 
Nonparametric evidence – 1 
0 
.2 .4 .6 .8 
0 20 40 60 80 
Any Care Care Home 
Informal Care Social Care 
Private Care 
Receving care (by type) and BMI last wave 
Figure 1 : BMI and Care Needs in 2 years.
10 
Nonparametric evidence –2 
Figure2:BMIatBaselineandCareNeedsEver. 
0.2.4.6 020406080Any CareCare HomeInformal CareSocial CarePrivate CareEver receving care (by type) and BMI
11 
Whole 
sample 
No of observations 
8100 
In care home 
0.01 
Any mode of care 
0.27 
Informal care 
0.24 
Formal care 
0.03 
Privately paid care 
0.04 
Sample Description –1
12 
Whole 
sample 
Underweight 
0.01 
Overweight 
0.43 
Obese 
0.28 
Female 
0.55 
No EducQualif 
0.42 
Non-white 
0.02 
Sample Description –2
13 
Whole 
sample 
R Age 
74.10 
Married 
0.54 
Number of Children 
2.22 
Living Alone 
0.26 
R Working 
0.04 
Home owned 
0.75 
Sample Description –3
14 
0.00 
0.05 
0.10 
0.15 
0.20 
0.25 
0.30 
0.35 
0.40 
0.45 
0.50 
No care 
IC 
IC+PC 
FC 
Non-R 
D 
Underweight 
Overweight 
Obese 
Figure3:WeightStatusbyCareUse.
15 
Figure4:FunctionalLimitationsCountbyCareUse. 
0.00 
0.20 
0.40 
0.60 
0.80 
1.00 
1.20 
1.40 
1.60 
1.80 
No care 
IC 
IC+PC 
FC 
Non-R 
D 
ADL Count 
IADL Count
16 
Results –1 
MLOGIT: RRR 
W/o controls 
Underweight 
1.55 
(0.42) 
Overweight 
0.92 
(0.07) 
Obese 
1.79** 
(0.14)
17 
Results –2 
MLOGIT: RRR 
W/o controls 
+(i)ADLs 
Underweight 
1.55 
1.19 
(0.42) 
(0.39) 
Overweight 
0.92 
1.05 
(0.07) 
(0.08) 
Obese 
1.79** 
1.68** 
(0.14) 
(0.15)
18 
Results –3 
Extended Care Status 
MLOGIT: RRR 
IC 
IC+PC 
FC 
Underweight 
1.25 
1.11 
1.02 
(0.44) 
(0.75) 
(0.69) 
Overweight 
1.02 
1.39+ 
1.02 
(0.09) 
(0.26) 
(0.19) 
Obese 
1.68** 
1.87** 
1.42+ 
(0.16) 
(0.37) 
(0.29)
19 
Results –4 
With no care at baseline 
MLOGIT: RRR 
IC 
IC+PC 
FC 
Underweight 
1.67 
1.23 
1.34 
(0.71) 
(1.40) 
(1.48) 
Overweight 
0.89 
1.86* 
0.95 
(0.11) 
(0.54) 
(0.35) 
Obese 
1.68** 
2.24* 
1.37 
(0.22) 
(0.72) 
(0.56)
20 
Results –5 
+ Health conds 
MLOGIT: RRR 
IC 
IC+PC 
FC 
Underweight 
1.30 
1.16 
1.04 
(0.46) 
(0.81) 
(0.70) 
Overweight 
0.99 
1.29 
1.00 
(0.09) 
(0.24) 
(0.19) 
Obese 
1.53** 
1.55* 
1.30 
(0.15) 
(0.32) 
(0.28)
21 
Results –6 
+ Health conds+ PA + HBeh 
MLOGIT: RRR 
IC 
IC+PC 
FC 
Underweight 
1.24 
1.32 
0.80 
(0.49) 
(0.97) 
(0.62) 
Overweight 
0.97 
1.41+ 
0.97 
(0.09) 
(0.29) 
(0.21) 
Obese 
1.54** 
1.64* 
1.08 
(0.16) 
(0.37) 
(0.26) 
Physicalactivity 
0.63** 
0.56** 
0.34** 
(0.07) 
(0.11) 
(0.07)
22 
Results –7 
+ Health conds+ PA + Pre-diabetes 
MLOGIT: RRR,Any care 
(1) 
(2) 
(3) 
Obese 
1.52** 
1.89** 
1.91** 
(0.15) 
(0.43) 
(0.43) 
Physicalactivity 
0.58** 
0.33** 
0.33** 
(0.06) 
(0.11) 
(0.11) 
Prediabetes 
0.84 
(0.34) 
N obs 
5142 
2492 
2492
23 
Results –8 
+ Health conds+ PA + Abdominal Obesity 
MLOGIT: RRR, Any care 
(1) 
(2) 
(3) 
(4) 
Obese 
1.52** 
1.48** 
1.32* 
(0.15) 
(0.20) 
(0.18) 
Physicalactivity 
0.58** 
0.62** 
0.62** 
0.61** 
(0.06) 
(0.10) 
(0.10) 
(0.10) 
Abdominal 
1.44** 
1.48** 
obesity 
(0.17) 
(0.17) 
N obs 
5142 
5035 
5035 
5035
24 
Results –9 
Obesity effect by gender 
0.1.2.3.4.5Probability uwnwowobewgrfemale=0female=1Informal Care Only
25 
Results –10 
PA effect by gender 
.1.15.2.25Probability 01Physical Exercise female=0female=1Informal Care Only
26 
Thank you

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Body Mass, Physical Activity and Future Care Needs in the UK

  • 1. Body Mass, Physical Activity and Future Care NeedsOlena Nizalova, Julien Forder, and Katerina GousiaILPN, LSE, LondonSeptember 1, 2014
  • 2. 2 •Obesity in the UK is on the rise: quarter of the population obese by 2013 •P(Obese) highest at 45-64, P(Overweight|Obese) highest at 65-74 Figure 1: Prevalence of Obesity Among Adults 16+ Source: Health Survey for England 1993-2012 (3-year average)
  • 3. 3 Obesity –health bomb •Obesity contributes to the development of long-term conditions: –mental health problems –liver disease –type 2 diabetes –cardiovascular disease –muscular skeletal disease •The resulting NHS costs attributable to overweight and obesity are projected to reach £10 billion by 2050, with wider costs to society estimated to reach £50 billion per year (Foresight 2007)
  • 4. 4 Obesity –care bomb? •Long-term health conditions •Severe obesity may lead to severe physical difficulties inhibiting ADLs: –Housing adaptations –Specialist care for house bound people –Provision of appropriate transport and facilities •SES-obesity gradient, ethnic differences in obesity –increasing inequality in health and social care
  • 5. 5 Research Question •What is the impact of obesity on the use of various modes of care in the future, in addition to its impact through long-term health conditions? •Does physical activity play a role in the future care use?
  • 6. BMI and long term care: literature •Few studies take BMI explicitly into account as a determinant of care needs •All evidence comes from US studies only •Mixed evidence –Both obese and under-weight adults are at greater relative risk of nursing home admissions (Zizzaet al. 2002) –Midlife obesity predicted nursing home admission in later life compared with normal BMI (Elkins et al. 2006) –No evidence on effect of BMI on informal care (Resniket al. 2005) •Cox proportional hazard models, logit
  • 7. 7 Data •English Longitudinal Study of Ageing 2002- 2011 •65+ sample: overall (N=8100) and those not using care initially (N=5721), men vs. women •BMI from Nurse data (wave 0, wave 2, wave 4) •Care status data (wave 3, wave 5)
  • 8. 8 Methodology •Multinomial Logit for various care needs controlling for non-response and death: –Comparison of the impact on 2-year transitions to the longer run impact of variables of interest at the baseline –Exploring the importance of obesity in determining future care use after controlling for available related health conditions and limitations (ADLs, iADLs, HBP, diabetes, cancer, lung disease, heart disease, stroke, psychic problems, arthritis) –Exploration of the role of the physical activity •Outcomes: future care needs (informal care, privately purchased care, social care, nursing/care home) •Controls: demographic and socio-economic characteristics
  • 9. 9 Nonparametric evidence – 1 0 .2 .4 .6 .8 0 20 40 60 80 Any Care Care Home Informal Care Social Care Private Care Receving care (by type) and BMI last wave Figure 1 : BMI and Care Needs in 2 years.
  • 10. 10 Nonparametric evidence –2 Figure2:BMIatBaselineandCareNeedsEver. 0.2.4.6 020406080Any CareCare HomeInformal CareSocial CarePrivate CareEver receving care (by type) and BMI
  • 11. 11 Whole sample No of observations 8100 In care home 0.01 Any mode of care 0.27 Informal care 0.24 Formal care 0.03 Privately paid care 0.04 Sample Description –1
  • 12. 12 Whole sample Underweight 0.01 Overweight 0.43 Obese 0.28 Female 0.55 No EducQualif 0.42 Non-white 0.02 Sample Description –2
  • 13. 13 Whole sample R Age 74.10 Married 0.54 Number of Children 2.22 Living Alone 0.26 R Working 0.04 Home owned 0.75 Sample Description –3
  • 14. 14 0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45 0.50 No care IC IC+PC FC Non-R D Underweight Overweight Obese Figure3:WeightStatusbyCareUse.
  • 15. 15 Figure4:FunctionalLimitationsCountbyCareUse. 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 No care IC IC+PC FC Non-R D ADL Count IADL Count
  • 16. 16 Results –1 MLOGIT: RRR W/o controls Underweight 1.55 (0.42) Overweight 0.92 (0.07) Obese 1.79** (0.14)
  • 17. 17 Results –2 MLOGIT: RRR W/o controls +(i)ADLs Underweight 1.55 1.19 (0.42) (0.39) Overweight 0.92 1.05 (0.07) (0.08) Obese 1.79** 1.68** (0.14) (0.15)
  • 18. 18 Results –3 Extended Care Status MLOGIT: RRR IC IC+PC FC Underweight 1.25 1.11 1.02 (0.44) (0.75) (0.69) Overweight 1.02 1.39+ 1.02 (0.09) (0.26) (0.19) Obese 1.68** 1.87** 1.42+ (0.16) (0.37) (0.29)
  • 19. 19 Results –4 With no care at baseline MLOGIT: RRR IC IC+PC FC Underweight 1.67 1.23 1.34 (0.71) (1.40) (1.48) Overweight 0.89 1.86* 0.95 (0.11) (0.54) (0.35) Obese 1.68** 2.24* 1.37 (0.22) (0.72) (0.56)
  • 20. 20 Results –5 + Health conds MLOGIT: RRR IC IC+PC FC Underweight 1.30 1.16 1.04 (0.46) (0.81) (0.70) Overweight 0.99 1.29 1.00 (0.09) (0.24) (0.19) Obese 1.53** 1.55* 1.30 (0.15) (0.32) (0.28)
  • 21. 21 Results –6 + Health conds+ PA + HBeh MLOGIT: RRR IC IC+PC FC Underweight 1.24 1.32 0.80 (0.49) (0.97) (0.62) Overweight 0.97 1.41+ 0.97 (0.09) (0.29) (0.21) Obese 1.54** 1.64* 1.08 (0.16) (0.37) (0.26) Physicalactivity 0.63** 0.56** 0.34** (0.07) (0.11) (0.07)
  • 22. 22 Results –7 + Health conds+ PA + Pre-diabetes MLOGIT: RRR,Any care (1) (2) (3) Obese 1.52** 1.89** 1.91** (0.15) (0.43) (0.43) Physicalactivity 0.58** 0.33** 0.33** (0.06) (0.11) (0.11) Prediabetes 0.84 (0.34) N obs 5142 2492 2492
  • 23. 23 Results –8 + Health conds+ PA + Abdominal Obesity MLOGIT: RRR, Any care (1) (2) (3) (4) Obese 1.52** 1.48** 1.32* (0.15) (0.20) (0.18) Physicalactivity 0.58** 0.62** 0.62** 0.61** (0.06) (0.10) (0.10) (0.10) Abdominal 1.44** 1.48** obesity (0.17) (0.17) N obs 5142 5035 5035 5035
  • 24. 24 Results –9 Obesity effect by gender 0.1.2.3.4.5Probability uwnwowobewgrfemale=0female=1Informal Care Only
  • 25. 25 Results –10 PA effect by gender .1.15.2.25Probability 01Physical Exercise female=0female=1Informal Care Only