Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health

Stella T Lartey; Lei Si; Petr Otahal; Barbara de Graaff; Godfred O Boateng; Richard Berko Biritwum; Nadia Minicuci; Paul Kowal; Costan G Magnussen; Andrew J Palmer

doi:10.1016/j.socscimed.2020.112821

Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health

Soc Sci Med. 2020 Jan 28:247:112821. doi: 10.1016/j.socscimed.2020.112821. Online ahead of print.

Authors

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: stella.lartey@utas.edu.au.
² Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health, University of New South Wales, Kensington, NSW, 2042, Australia.
³ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁵ Department of Community Health, University of Ghana, Accra, Ghana.
⁶ National Research Council, Neuroscience Institute, Padova, Italy.
⁷ World Health Organization (WHO), Geneva, Switzerland; University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia.
⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: Andrew.palmer@utas.edu.au.

PMID: 32018114
DOI: 10.1016/j.socscimed.2020.112821

Abstract

Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and <25.0 kg/m²), overweight (BMI ≥25.0 and <30.0 kg/m²), and obesity (BMI ≥30.0 kg/m²), among older adults aged ≥50 years in Ghana. Data were used from a nationally representative, multistage sample of 1496 (44.3% females) older adults in both Waves 1 (2007/8) and 2 (2014/15) of the Ghana WHO SAGE. A multistage Markov model was used to estimate annual transition probabilities. We further examined the impact of specific socio-economic factors on the transition probabilities. At baseline, 22.8% were overweight and 11.1% were obese. The annual transition probability was 4.0% (95% CI: 3.4%, 4.8%) from normal weight to overweight, 11.1% (95% CI: 9.5%, 13.0%) from overweight to normal weight and 4.9% (95% CI: 3.8%, 6.2%) from overweight to obesity. For obese individuals, the probability of remaining obese, transitioning to overweight and completely reverting to normal weight was 90.2% (95% CI: 87.7%, 92.3%), 9.2% (95% CI: 7.2%, 11.6%) and 0.6% (95% CI: 0.4%, 0.8%) respectively. Being female, aged 50-65 years, urban residence, having high education and high wealth were associated with increased probability of transitioning into the overweight or obese categories. Our findings highlight the difficulty in transitioning away from obesity, especially among females. The estimated transition probabilities will be essential in health economic simulation models to determine sustainable weight management interventions.

Keywords: Multistage markov model; Obesity; Sub-Saharan Africa; Transition probabilities; WHO SAGE.

Grants and funding

001/WHO_/World Health Organization/International