Modeling obesity histories in cohort analyses of health and mortality

Epidemiology. 2013 Jan;24(1):158-66. doi: 10.1097/EDE.0b013e3182770217.

Abstract

There is great interest in understanding the role of weight dynamics over the life cycle in predicting the incidence of disease and death. Beginning with a Medline search, we identify, classify, and evaluate the major approaches that have been used to study these dynamics. We identify four types of models: additive models, duration-of-obesity models, additive-weight-change models, and interactive models. We develop a framework that integrates the major approaches and shows that they are often nested in one another, a property that facilitates statistical comparisons. Our criteria for evaluating models are two-fold: the model's interpretability and its ability to account for observed variation in health outcomes. We apply two sets of nested models to data on adults age 50-74 years at baseline in two national probability samples drawn from National Health and Nutrition Examination Survey. One set of models treats obesity as a dichotomous variable and the other treats it as a continuous variable. In three of four applications, a fully interactive model does not add significant explanatory power to the simple additive model. In all four applications, little explanatory power is lost by simplifying the additive model to a duration model in which the coefficients of weight at different ages are set equal to one another. Other versions of a duration-of-obesity model also perform well, underscoring the importance of obesity at early adult ages for mortality at older ages.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Age Factors
  • Aged
  • Body Mass Index
  • Follow-Up Studies
  • Health Status
  • Humans
  • Middle Aged
  • Models, Biological*
  • Models, Statistical*
  • Nutrition Surveys
  • Obesity / complications
  • Obesity / mortality*
  • Retrospective Studies
  • Time Factors
  • United States / epidemiology