Obesity Over the Life Course: A Study of How Obesity Produces Health Disadvantage and Excess Mortality in the United States

This dissertation explores the influence of obesity on U.S. population morbidity and mortality. Across three essays, I examine the relation of obesity to work disability, activity impairment, and mortality. Chapter 1 looks at how obesity in early adulthood affects work disability at young and middle ages. Using data from the National Longitudinal Study of Youth 1979, I employ logistic regression to assess whether an early onset of obesity affects the likelihood of developing a work disabling condition and use event history analysis to predict the time at which that work disability occurs. Results indicate that early obesity increases the likelihood that a person will develop a work disability and uniformly increases the relative hazard of the disability occurring. The association of obesity and work disability remains robust to the inclusion of covariates and modeling the process that selects a person to become obese. Chapter 2 shifts to looking at how mid-life obesity may alter the effect of occupational exposures on later life limitations in activities of daily living. Using data from the Health and Retirement Study and latent growth curve models, I find that the effects of past occupational exposures differ by whether or not a respondent is obese around retirement. For non-obese respondents, physically demanding occupations are associated with a lower risk of developing health impairments, but no such association is found for obese persons. Instead, although not statistically significant, physically demanding occupations are associated with a greater rate of accumulation in health limitations for obese persons. Chapter 3 moves to examine why it is that older obese adults appear more likely to get sick but less likely to die. Using data from the Health and Retirement Survey and a multi-state modelling framework, I find that the obesity-mortality paradox may be explained by obese adults having a higher risk of becoming ill, losing weight, and subsequently dying having a history of obesity. Together, these three chapters suggest important influences of obesity on the health and well-being of adults throughout the life course and highlight the importance of studying the obesity-health relationship in a longitudinal framework.

Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-09-02 First page - n/a

0573:Public health