Seniors’ Body Weight Dissatisfaction and Longitudinal Associations With Weight Changes,Anorexia of Aging,and Obesity

Abstract

Objective: We examined longitudinal associations between weight dissatisfaction, weight changes, anorexia of aging, and obesity among 1,793 seniors followed over 4 years between 2003 and 2009. Method: Obesity prevalence (body mass index [BMI] ≥ 30) and prevalence/incidence of weight dissatisfaction, anorexia of aging (self-reported appetite loss), and weight changes ≥5% were assessed. Predictors of weight loss ≥5%, anorexia of aging, and weight dissatisfaction were examined using logistic regressions. Results: Half of seniors experienced weight dissatisfaction (50.6%, 95% confidence interval [CI] = [48.1, 53.1]). Anorexia of aging and obesity prevalence was 7.0% (95% CI = [5.7, 8.3]) and 25.1% (95% CI = [22.9, 27.3]), whereas incidence of weight gain/loss ≥5% was 6.6% (95% CI = [1.3, 11.9]) and 8.8% (95% CI = [3.3, 14.3]). Weight gain ≥5% predicts men’s subsequent weight dissatisfaction (odds ratio [OR] = 6.66, 95% CI = [2.06, 21.60]). No other association was observed. Discussion: Weight dissatisfaction is frequent but not associated with subsequent eating disorders. In men, weight gain predicted weight dissatisfaction. Seniors’ weight dissatisfaction does not necessarily equate weight changes. Due to its high prevalence, it is of public health interest to understand how seniors’ weight dissatisfaction may impact health.

Keywords

body image body weight changes obesity anorexia aging

Traditionally examined among younger ages, seniors’ body weight dissatisfaction has received little attention (Roy & Payette, 2012). This is surprising given that aging moves them farther from ideal bodies valorized in Western societies (Marshall, Lengyel, & Utioh, 2012). It is established that people typically gain 10 pounds per decade of life until their 50s (Andres, 1989). This weight gain plus a changing distribution of body fat over life span lead to body shape alterations (Visser & Harris, 2012). Because these weight changes arise in body-obsessed societies emphasizing muscular men and slim athletic women (Grogan, 2008; Roy, 2010), there are reasons to think that preoccupation with body weight stays among elders (Krauss Whitbourne & Skultety, 2004). In the scientific literature, body weight dissatisfaction has been reported as a better predictor of physical and mental health than actual body mass index (BMI) among a nationally representative sample of noninstitutionalized U.S. adults (Muennig, Jia, Lee, & Lubetkin, 2008). Dissatisfaction with weight was also found to be the second most important concern in seniors’ life after memory loss (Allaz, Bernstein, Rouget, Archinard, & Morabia, 1998; Rodin, Silberstein, & Striegel-Moore, 1985).

Relationship Between Seniors’ Weight and Health Outcomes

Opposite to younger people, being overweight after 65 years of age is no longer predictive of increased risk of death (Allison, Gallagher, Heo, Pi-Sunyer, & Heymsfield, 1997; Flicker et al., 2010). Losing weight whether or not intentionally is even predictive of negative outcomes among seniors (Tayback, Kumanyika, & Chee, 1990). Indeed, weight loss is an independent risk factor for morbidity and mortality among frail elders (Payette, Coulombe, Boutier, & Gray-Donald, 1999, 2000), seniors from assisted living facilities (Cartwright, Hickman, Perrin, & Tilden, 2006), from geriatric rehabilitation settings (Sullivan & Walls, 1994), and among seniors at home but receiving assistance (Landi et al., 2012). Despite these evidences, the perception of one’s body weight and the stigma associated with elevated BMI in Western societies is still the same no matter the age (Grogan, 2008). Seniors with excess weight and/or dissatisfied with weight may, as their younger fellow-citizens, try to lose weight for aesthetic purposes rather than for health. Seniors are, however, more vulnerable to nutritional deficiencies than younger adults or teenagers (Chandra, Imbach, Moore, Skelton, & Woolcott, 1991). Dieting to lose or maintain weight may then lead to malnutrition, eating disorders, and weight-related problems (Allaz et al., 1998).

Associations Between Seniors’ Body Weight Dissatisfaction, Eating, and Weight-Related Disorders

Obesity and weight gain are potentially associated with body weight dissatisfaction. Because prevalence of seniors’ obesity is increasing (Flegal, Carroll, Kitt, & Ogden, 2012), leading to a raise of chronic conditions (e.g., diabetes, hypertension, cardiovascular diseases) and health care costs (Newman, 2009), weight disorders among older adults are of public health interest. Since 1985, among U.S. adults aged 50 to 69 years and those above 70 years, there was a 56% and a 36% increase in obesity prevalence (BMI ≥ 30; Patterson, Frank, Kristal, & White, 2004; Villareal, Apovian, Kushner, & Klein, 2005). In Canada, this increase is of smaller magnitude but still worrisome. Between 1981 and 2009, this increase was of 7.4% and 11.2% in men and women aged 60 to 69 years old, respectively (Shields et al., 2010). Furthermore, seniors’ obesity increases the risk of depression in cross-sectional studies (Kaplan, Huguet, Newsom, McFarland, & Lindsay, 2003), and among cohorts of adults aged above 50 years (Roberts, Kaplan, Shema, & Strawbridge, 2000; Wild et al., 2012).

Senior’s body weight dissatisfaction may also lead to anorexia of aging and weight loss. Anorexia of aging, a common eating disorder after 65 years of age, is different from anorexia nervosa usually observed among adolescents and young adults. Anorexia of aging is defined as a reduction and/or a loss of appetite with aging (Landi et al., 2013; Muscaritoli et al., 2010). It ranged from 23% to 62% among hospitalized seniors (Ahari & Kimigiar, 1997; Guigoz, Vellas, & Garry, 1996) and reached 85% among nursing homes (Ahmed & Haboubi, 2010). Among free-living seniors, it ranged from 5% to 25% (Donini et al., 2011; Guigoz, Lauque, & Vellas, 2002; Landi et al., 2012). Currently, there are no overt diagnostic criteria for anorexia of aging (Donini et al., 2008). One reason is that this geriatric syndrome is not only an eating disorder but also a consequence of a variety of physiological and non-physiological factors occurring during the aging process. This eating disorder is of concern because it induces weight loss which is in turn associated with morbidity and mortality (Cartwright et al., 2006; Landi et al., 2012).

The Current Study

In this study, we tried to understand the associations between seniors’ body weight dissatisfaction, and eating and weight-related disorders. It is of public health concern to examine such associations because being dissatisfied with weight may or may not translate into attempt to change weight in older adults. To build appropriate interventions tackling eating and weight-related behaviors, public health authorities need to know why some people satisfied or dissatisfied with their weight will or will not change their behavior. Toward this goal, we (a) estimate the prevalence of seniors’ body weight dissatisfaction, anorexia of aging, and obesity; (b) assess incidence of anorexia of aging and of weight changes; and (c) determine longitudinal associations between these variables. We expect that (a) seniors experience dissatisfaction with body weight, (b) seniors’ body weight dissatisfaction predicts subsequent weight loss and anorexia of aging, and (c) seniors’ weight gain predicts further body weight dissatisfaction.

Materials and Method

Study Population

Data were from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge), a 5-year observational study of 1,793 seniors (females, 52.4%) aged 67 to 84 years old in good general health at recruitment. Participants were drawn from a random sample stratified by age and sex obtained from the Quebec Medicare database for the regions of Montreal, Laval, and Sherbrooke. Free-living seniors were included if they spoke French or English, were free from disabilities in daily life activities, without cognitive impairment (Modified Mini-Mental State examination > 79; Teng & Chui, 1987), were able to walk one block or climb one floor without rest, and willing to commit to a 5-year study. Seniors who had heart failure ≥ Class II, chronic obstructive pulmonary disease requiring oxygen therapy or oral steroids, inflammatory digestive diseases, or cancer in previous 5 years were excluded. The study was approved by the ethics committees of Institut universitaire de gériatrie de Montréal and University Institute of Geriatrics of Sherbrooke. Data were collected with interviews and direct measurements, by dietitians and nurses at the research center where participants were recruited. Each participant was followed annually over 4 years between 2003 and 2009 (Gaudreau et al., 2007).

Study Samples

For this article, we used data from the first (T2), second (T3), and third (T4) follow-up of the cohort as body weight dissatisfaction was not measured at baseline (T1). Only participants with complete data were included in analyses.

Prevalence of body weight dissatisfaction, obesity, and anorexia of aging (T2) was available for 1,545, 1,503, and 1,548 participants, respectively. Those seniors did not differ from the total sample at baseline (n = 1,793) on any demographic variable. Incidence (T2-T3) of anorexia of aging and of weight changes was assessed with 1,548 and 1,456 participants, respectively, whereas 1,387 participants had complete data set for incidence of body weight dissatisfaction (T3-T4). Again, there were no differences between seniors from these samples and those from baseline (n = 1,793). The exact numbers of participants with complete data for longitudinal models are listed on the appropriate table. There were between 186 and 257 men or women with missing data, depending on the multivariate model. However, no significant differences between seniors with complete data and those with missing data with respect to outcomes, exposure, and potential confounders were observed across longitudinal models.

Measures

Body weight dissatisfaction

Body weight dissatisfaction was defined by self-reporting “no” to the question: “Currently, are you satisfied with your weight?” The reason for body weight dissatisfaction (too thin or too fat) was available. Although the use of a single item may be limited in terms of psychometric evaluation, it is worth noting that dichotomous items are commonly used in population surveys to capture dissatisfaction with ones’ weight (Green et al., 1997; Ledoux & Rivard, 2001; McLaren & Gauvin, 2002).

Eating and weight disorders

One variable was used to assess eating disorder (i.e., anorexia of aging) and three to capture weight-related disorders (i.e., obesity, weight gain ≥ 5%, weight loss ≥ 5%).

Anorexia of aging

Following the European consensual definition on anorexia of aging (Landi et al., 2013; Muscaritoli et al., 2010), an indication for this eating disorder was captured with the answer “yes, it decreased” to the question: “Did your appetite change over the previous 6 months?”

Obesity

Height and weight were measured according to standardized procedures by dietitians. Height was measured either at the research center using a stadiometer or at home with a level platform with attached measuring tape whereas weight was assessed with a beam balance with participants dressed in light indoor clothing without shoes (St-Arnaud-McKenzie, Payette, & Gray-Donald, 2010). BMI was computed—weight (kg)/height (m)²—and categorized as follows: <25, 25 ≤ BMI < 30, and ≥30.

Weight changes

Weight gain and loss ≥5% between first (T2) and second follow-up (T3) were assessed because these weight changes have been found to be associated with disability and mortality (Arnold, Newman, Cushman, Ding, & Kritchevsky, 2010; Lee et al., 2005; Locher et al., 2007; Snih, Raji, Markides, Ottenbacher, & Goodwin, 2005). They were calculated as follows: [T3 weight (kg) − T2 weight (kg) / T3 weight (kg)] × 100. Percent weight changes were dichotomized as ≥5% versus <5%.

Control variables

Seven variables were examined as potential confounders in this study (Table 1). These include age (continuous variable ranging from 67 to 84), BMI (<25, 25 ≤ 30, ≥30), education (<12 vs. ≥12 years) with a cutoff corresponding to high-school, and depressive symptoms using the 30-item Geriatric Depression Scale and classified as no depression (scores 0-9) versus mild or moderate to severe depression (score > 9; Yesavage et al., 1983). Marital status was also included (married vs. single, widowed, separated, and divorced) such as chronic conditions (19 self-reported chronic conditions, see legend of Table 1). A cutoff of two chronic conditions was used to define multimorbidity (Diederichs, Berger, & Bartels, 2011; Van den Akker, Buntinx, & Knottnerus, 1996). Finally, we included annual household income (≤$14,571 CAD vs. >$14,571 CAD) based on the 2005 low-income cutoff (after tax) provided by Statistics Canada, adjusted for people living alone in towns between 100,000 and 499,999 citizens (www.statcan.gc.ca/pub/75f0002m/2010005/tbl/tbl01-eng.htm). This cutoff corresponds to individuals living in Sherbrooke and Laval and is a more restrictive cutoff than for people living in Montreal (500,000 citizens and more).

Table 1.

Baseline Characteristics of Study Participants.

	Overall (n = 1,793)	Men (n = 850)	Women (n = 943)
Variable	% (95% CI)	% (95% CI)	% (95% CI)
M age (T2)	75.4 [73.4, 77.4]	75.3 [72.4, 78.4]	75.5 [72.8, 78.2]
BMI (T2)
<25	26.6 [22.2, 31.0]	22.1 [17.5, 26.7]	30.7* [26.7, 34.7]
25 ≤ BMI < 30	48.1 [44.4, 51.8]	53.0* [48.9, 57.1]	43.6 [39.2, 48.0]
≥30	25.3 [20.8, 29.8]	24.9 [18.4, 31.4]	25.7 [19.5, 31.9]
Education (T1)
≥12 years	35.3 [31.6, 39.0]	37.7 [32.4, 43.0]	33.1 [27.9, 38.3]
Income (T2)
≤$14 571 CAD	15.9 [11.3, 20.5]	10.0 [3.3, 16.7]	22.0* [17.8, 26.2]
Marital status (T2)
Married	58.6 [55.4, 61.8]	75.9* [72.4, 79.4]	42.6 [37.4, 47.8]
Depression (T2)
Mild or moderate to severe	12.4 [7.7, 17.1]	9.5 [2.7, 16.3]	15.0 [8.6, 21.4]
Chronic conditions (T2)^a
2 and more	83.5 [81.5, 85.5]	79.6 [76.3, 82.9]	87.0* [84.5, 89.5]

Note. All potential confounders were assessed at first follow-up (T2) with the exception of education (T1). CI = confidence interval; BMI = body mass index.

Chronic conditions included cancer, arthritis, edema, asthma, emphysema, high blood pressure, heart trouble, circulation trouble, diabetes, ulcers of the digestive system, other digestive trouble, liver/gall bladder disease, urinary problem, osteoporosis, anemia, thrombosis/cerebral hemorrhage, Parkinson’s disease, thyroid/gland problems, and skin disorders.

Significant different proportions according to sex (p < .05).

Statistical Analyses

Prevalences of body weight dissatisfaction, obesity, and anorexia of aging were computed overall and as a function of sex at first follow-up (T2). Overall and sex-specific 1-year cumulative incidences of body weight dissatisfaction (T3-T4), anorexia of aging, and weight changes (T2-T3) were computed. 95% confidence intervals (CIs) around prevalences and incidences were finally generated to examine whether there are any significant sex differences.

Following these descriptive analyses, we tested the hypothesis that seniors’ body weight dissatisfaction predicts subsequent weight loss ≥5% and anorexia of aging following three steps of modeling. First, and prior to regression modeling, we examined which potential confounder was significantly associated with outcomes—anorexia of aging (T3) and weight loss ≥5% (T3)—using chi-square tests. Second, separate bivariate logistic regressions (one for each outcome) were run to model incidence of anorexia of aging (T3) and of weight loss ≥5% (T3) from body weight dissatisfaction (T2). In the final step, separate multivariate logistic regression models, including significant confounders, were examined to detect if previous bivariate associations were attenuated due to their inclusion. We then tested the hypothesis that seniors’ weight gain ≥5% predicts further body weight dissatisfaction with the same three-step procedure. To test this hypothesis, logistic regressions were conducted to model the incidence of body weight dissatisfaction (T4) from weight gain ≥5% (T3). Incidence of body weight dissatisfaction was estimated at third (T4) follow-up of the study to establish the chronological sequence between weight gain and onset of body weight dissatisfaction. Because weight status is likely to modify the associations under investigation, BMI was included as a potential confounder in all multivariate models. All regression models and chi-square tests were run separately for men and women. Statistical analyses were carried out using the survey family procedures (surveyfreq, surveymeans, surveylogistic; Chen & Gorell, 2008) in SAS software (version 9.2) to account for the sampling design of the NuAge cohort.

Results

Participant Characteristics

In our cohort, men were more likely than women to be married and overweight. Inversely, women were more likely to have a BMI in normal weight category or less, to live under the low-income threshold, and to have at least two chronic conditions (Table 1).

Prevalence of Body Weight Dissatisfaction, Anorexia of Aging, and Obesity

Overall prevalence of body weight dissatisfaction at first follow-up (T2) was 50.6% and higher in women whereas prevalence of obesity was 25.1% and similar in both sexes (Figure 1). Among seniors dissatisfied with body weight, 90.7% perceived themselves as being too fat, and only 9.3% perceived themselves as being too thin. Anorexia of aging was observed in less than 10% of study participants (Figure 1). Prevalence of body weight dissatisfaction and anorexia of aging was higher among women as compared with men.

Figure 1.

Prevalence of body weight dissatisfaction, obesity, and anorexia of aging among seniors from the Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada) at first follow-up (T2).

Incidence of Body Weight Dissatisfaction, Anorexia of Aging, and Weight Changes

One-year incidence of body weight dissatisfaction, anorexia of aging, and weight changes are reported in Table 2. Incidences were all below 12% and not significantly different as a function of sex.

Table 2.

One-Year Incidence of Anorexia of Aging, Weight Gain and Loss ≥5%, and Body Weight Dissatisfaction Among Seniors From the NuAge Study.

	Overall	Men	Women
	% (95% CI)	% (95% CI)	% (95% CI)
Anorexia of aging (T3)	8.8 [4.1, 13.5]	5.6 [0.6, 10.6]	10.8 [4.3, 17.3]
Weight gain ≥ 5% (T3)	6.6 [1.3, 11.9]	5.5 [0.1, 10.9]	7.3 [0.1, 14.5]
Weight loss ≥ 5% (T3)	8.8 [3.3, 14.3]	8.4 [0.1, 16.7]	9.1 [1.8, 16.4]
Body weight dissatisfaction (T4)	11.8 [6.8, 16.8]	11.8 [4.1, 19.5]	11.7 [5.2, 18.2]

Note. Large 95% CIs around incidences are likely due to small number of new cases of anorexia of aging or weight gain/loss ≥5% between T2 and T3, and of body weight dissatisfaction between T3 and T4 among men and women of the NuAge study. CI = confidence interval.

Potential Confounders Associated With Outcomes

Men with higher education (75.9% vs. 61%; p = .03) and with depressive symptoms (17.0% vs. 9.0%; p = .04) were more likely to develop anorexia of aging (T3). Among women, higher education (42.0% vs. 31.8%; p = .04) and obesity (33.3% vs. 25.2%; p = .02) increased this likelihood. No potential confounder was associated with incidence of weight loss (T3) among both sexes. Incidence of body weight dissatisfaction (T4) was found to be more elevated among higher educated seniors (men, 49.3% vs. 36.6%; p = .04 and women, 37.2% vs. 32.2%; p = .04) and non-obese women (85.2% vs. 73.5%; p = .02).

Association Between Body Weight Dissatisfaction and Weight Loss ≥5% or Incidence of Anorexia of Aging

No significant associations were found between body weight dissatisfaction (T2) and weight loss ≥5% (T3) or incidence of anorexia of aging (T3) in both sexes (Table 3) neither in bivariate nor in multivariate models. Post hoc restrictive logistic regression models conducted with seniors feeling too fat and probably wanting to lose weight (i.e., which exclude seniors feeling too thin and wanting to gain weight) did not change the results. Higher education (≥12 years vs. less) was found to be associated with increased likelihood of incidence of anorexia of aging among women (Table 3).

Table 3.

Longitudinal Associations Between Seniors’ Body Weight Dissatisfaction, Weight Changes, and Anorexia of Aging Among Seniors From the NuAge Study Using Multivariate Logistic Regression Modeling.

	Anorexia of aging (T3)	Weight loss ≥ 5% (T3)	Body weight dissatisfaction (T4)
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Men	n = 667	n = 632	n = 627
Body weight dissatisfaction (T2)	1.04 [0.46, 2.32]	1.30 [0.44, 3.85]
Weight gain ≥ 5% (T3)			6.66 [2.06, 21.60]***
25 ≤ BMI < 30 (T2)	1.41 [0.41, 4.87]	2.37 [0.55, 10.18]	2.73 [0.90, 8.24]
BMI ≥ 30 (T2)	2.51 [0.58, 10.96]	0.31 [0.04, 2.51]	3.32 [0.90, 12.23]
Depressive symptoms (T2)	1.45 [0.38, 5.53]
Higher education (T2)	0.74 [0.23, 2.37]		1.38 [0.61, 3.10]
Women	n = 735	n = 689	n = 683
Body weight dissatisfaction (T2)	0.84 [0.29, 2.45]	0.65 [0.28, 1.48]
Weight gain ≥ 5% (T3)			2.36 [0.71, 7.89]
Age (T2)	1.08 [0.98, 1.18]
25 ≤ BMI < 30 (T2)	2.53 [0.77, 8.27]	1.26 [0.53, 2.96]	0.84 [0.38, 1.88]
BMI ≥ 30 (T2)	1.89 [0.43, 8.41]	1.12 [0.36, 3.48]	0.77 [0.26, 2.24]
Higher education (T2)	3.02 [1.58, 3.78]***		0.99 [0.46, 2.12]

Note. OR = odds ratio; CI = confidence interval; BMI = body mass index.

***

p < .001.

Association Between Weight Gain ≥5% and Incidence of Body Weight Dissatisfaction

In men, bivariate analysis showed an association between weight gain ≥5% (T3) and subsequent body weight dissatisfaction (T4; odds ratio [OR] = 7.23, 95% CI = [2.31, 22.63]). Adjusting for education and BMI slightly attenuated the strength of this association (Table 3). No association was observed between weight gain ≥5% and body weight dissatisfaction among women.

Discussion

To our knowledge, this study is the first to estimate seniors’ dissatisfaction with weight and to examine prospective associations between this variable, weight changes, eating, and weight-related disorders. Our findings show that prevalence of body weight dissatisfaction among Quebec free-living seniors is high. Overall, one senior out of two was dissatisfied with his body weight. This proportion is similar to the prevalence of body dissatisfaction observed among younger adults, teenagers, and children in Western countries (Paquette & Raines, 2004; Ricciardelli, McCabe, Holt, & Finemore, 2003; Tiggemann, 2005). Furthermore, as observed in younger samples (Grogan, 2008; Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006), the prevalence of body weight dissatisfaction was higher in women (58.8%) as compared with men (37.7%). Our results then support findings suggesting that dissatisfaction with ones’ weight appears to be stable across life span (Tiggemann, 2004; Wilcox, 1997), and that body appearance (Krauss Whitbourne & Skultety, 2004) and body weight (Allaz et al., 1998) are still of concern with increasing age. Some people may be tempted to argue that body weight dissatisfaction may be beneficial, especially in front of the elevated proportions of excess weight in Western societies. However, and in contrast to younger ages, being overweight (25-30 k/m²) after 65 years old is linked to better health outcomes and increased longevity (Allison et al., 1997; Flicker et al., 2010; Locher et al., 2007; Pischon et al., 2008). This highlights a potential mismatch between seniors’ body weight evaluation and actual public health recommendations. If being overweight increased the likelihood of better health outcomes, seniors’ weight-related interventions should only target obesity rather than excess weight.

The overall prevalence of obesity in this study was 25.1% (men, 23.0%; women, 26.5%). This was slightly higher than the Canadian surveillance data reporting an obesity prevalence of 20.7% among seniors (men, 21.2%; women, 20.2%; Public Health Agency of Canada/Canadian Institute for Health Information, 2011; Statistics Canada, 2012). A post hoc chi-square analysis also revealed that non-obese women were more likely to be dissatisfied with their weight as compared with their obese counterpart (prevalence at T2, 59.6% vs. 40.6%; p = .001). We think this suggests that dissatisfaction with ones’ weight is not solely attributable to BMI but to other features of the body image experience as well. In our cohort, the prevalence of anorexia of aging was relatively low (men, 3.2%; women, 9.4%) but still in the lower bound of the 5% to 25% range previously reported among free-living seniors (Donini et al., 2011; Guigoz et al., 2002; Landi et al., 2012). Higher prevalence estimates of anorexia of aging were also previously reported among women as compared with men (Donini, Savina, & Cannella, 2010; Donini et al., 2008).

The 1-year incidences of anorexia of aging, and of weight changes, were lower in this study as compared with other reporting weight fluctuation among free-living seniors (Newman et al., 2001; Payette et al., 2000). This may reflect the good general health at recruitment of seniors from this cohort. However, anorexia of aging and weight fluctuation are clinically relevant and should always be addressed in older adults given the associated mortality and morbidity outcomes (Arnold et al., 2010; Lee et al., 2005; Locher et al., 2007; Snih et al., 2005). A 5% weight change was indeed found to double the risk of disability in a U.S. nationally representative cohort of free-living seniors aged 60 to 74 years old over a follow-up varying between 8 and 16 years (Launer, Harris, Rumpel, & Madans, 1994).

Our results showed no evidence of prospective associations between seniors’ body weight dissatisfaction and weight loss ≥5% and/or anorexia of aging. It is possible that these associations are specific to children, adolescents, and young adults (Attie & Brooks-Gunn, 1989; Graber, Brooks-Gunn, Paikoff, & Warren, 1994; Killen et al., 1996; Killen et al., 1994; Striegel-Moore, Silberstein, Frensch, & Rodin, 1989), and that experiencing body weight dissatisfaction during aging does not translate into similar outcomes as observed among younger ages. Although dissatisfaction with weight was shown to have an impact on weight-related behaviors and/or intentions among younger ages, it could influence other areas of the body image experience among seniors. This absence of association may finally reflect the need for a longer follow-up. Although we observed that better educated women were more likely to develop anorexia of aging, we are unaware of researches examining mechanisms explaining this association. Maybe higher educated women are more likely to interiorize healthy eating public health interventions by reducing their food intake. Further research will be needed to explore which characteristics of more educated people may be responsible of appetite loss.

Our results on the associations between weight gain ≥5% and incidence of body weight dissatisfaction are similar to those reported among younger ages (Presnell, Bearman, & Stice, 2004; Rierdan, Koff, & Stubbs, 1989; Stice & Shaw, 2002; Stice & Whittenton, 2002). They, however, differ from this literature on two specific points. First, they were only significant for men. It may be that women with weight gain were already dissatisfied with weight or that weight gain among them does not translate into body weight dissatisfaction as seen in younger women. It may also be that other aspects of body image than body weight are affected by weight gain in older women. Post hoc analyses revealed that this latter hypothesis may be more appropriated because women with weight gain (T2-T3) are equally divided between body weight dissatisfaction (48.9%) and satisfaction (51.1%). Moreover, our association may be imprecise as reflected by the wide CI (Table 3). Studies with larger sample size of seniors gaining weight will be needed to provide a more precise estimation of the association between weight gain and further body weight dissatisfaction.

Study Limitations

Our research has limitations. The self-reported nature of anorexia of aging can lead to biases. Social desirability may indeed encourage seniors to report no change in their appetite even though they experienced a decrease. The use of one single dichotomous item to capture dissatisfaction with ones’ body weight may also have an impact on the validity of our results. Furthermore, because participants in the NuAge study were all free-living seniors in good general health at recruitment, results cannot be generalized to institutionalized and/or frail and less healthy older adults.

Conclusion

Our findings demonstrate that more than half of Quebec free-living seniors in good general health have reported body weight dissatisfaction whereas one quarter is obese. They highlight that weight gain predicts subsequent body weight dissatisfaction among older men only. They also support that dissatisfaction with weight does not predict incidence of weight loss or anorexia of aging in older adults. We think these results help unravel prospective associations between closely related variables. Indeed, being dissatisfied with ones’ weight does not necessarily mean that this person will try (or even succeed) to change weight. Consequently, it is of public health interest to examine whether body weight dissatisfaction traduces in intention or action regarding body weight modification. This information is relevant for public health authorities in elaboration of appropriate interventions tackling eating behaviors and weight-related problems. Further studies with longer follow-up are finally needed to support these findings and to identify potential mediators or moderators in these associations.

Footnotes

Authors’ Note

The first author of this article holds a postdoctoral fellowship from the Fonds de recherche du Québec – Santé (FRQ-S, # 22691).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The NuAge study was funded by the Canadian Institutes of Health Research (MOP 62842, MOP 84318), the Quebec Network for Research on Aging, and by the Fonds de Recherche du Québec-Santé.

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