An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter?

Abby C King, Deborah Salvo, Jorge A Banda, David K Ahn, Thomas M Gill, Michael Miller, Anne B Newman, Roger A Fielding, Carlos Siordia, Spencer Moore, Sara Folta, Bonnie Spring, Todd Manini, Marco Pahor, LIFE Study Investigators, Marco Pahor, Jack M Guralnik, Stephen D Anton, Thomas W Buford, Christiaan Leeuwenburgh, Susan G Nayfield, Todd M Manini, Connie Caudle, Lauren Crump, Jocelyn Lee, Ching-ju Lu, Mark A Espeland, Walter T Ambrosius, William Applegate, Daniel P Beavers, Robert P Byington, Delilah Cook, Curt D Furberg, Lea N Harvin, Leora Henkin, John Hepler, Fang-Chi Hsu, Kathy Joyce, Laura Lovato, Juan Pierce, Wesley Roberson, Julia Robertson, Julia Rushing, Scott Rushing, Cynthia L Stowe, Michael P Walkup, Don Hire, W Jack Rejeski, Jeffrey A Katula, Peter H Brubaker, Shannon L Mihalko, Janine M Jennings, Evan C Hadley, Sergei Romashkan, Kushang V Patel, Denise Bonds, Mary M McDermott, Bonnie Spring, Joshua Hauser, Diana Kerwin, Kathryn Domanchuk, Rex Graff, Alvito Rego, Timothy S Church, Steven N Blair, Valerie H Myers, Ron Monce, Nathan E Britt, Melissa Nauta Harris, Ami Parks McGucken, Ruben Rodarte, Heidi K Millet, Catrine Tudor-Locke, Ben P Butitta, Sheletta G Donatto, Shannon H Cocreham, Abby C King, Cynthia M Castro, William L Haskell, Randall S Stafford, Leslie A Pruitt, Veronica Yank, Kathy Berra, Carol Bell, Rosita M Thiessen, Kate P Youngman, Selene B Virgen, Eric Maldonado, Kristina N Tarin, Heather Klaftenegger, Carolyn A Prosak, Ines Campero, Dulce M Garcia, José Soto, Linda Chio, David Hoskins, Roger A Fielding, Miriam E Nelson, Sara C Folta, Edward M Phillips, Christine K Liu, Erica C McDavitt, Kieran F Reid, Dylan R Kirn, Evan P Pasha, Won S Kim, Julie M Krol, Vince E Beard, Eleni X Tsiroyannis, Cynthia Hau, Todd M Manini, Marco Pahor, Stephen D Anton, Thomas W Buford, Michael Marsiske, Susan G Nayfield, Bhanuprasad D Sandesara, Mieniecia L Black, William L Burk, Brian M Hoover, Jeffrey D Knaggs, William C Marena, Irina Korytov, Stephanie D Curtis, Megan S Lorow, Chaitalee S Goswami, Melissa A Lewis, Michelle Kamen, Jill N Bitz, Brian K Stanton, Tamika T Hicks, Charles W Gay, Chonglun Xie, Holly L Morris, Floris F Singletary, Jackie Causer, Susan Yonce, Katie A Radcliff, Mallorey Picone Smith, Jennifer S Scott, Melissa M Rodriguez, Margo S Fitch, Mendy C Dunn, Jessica Q Schllesinger, Anne B Newman, Stephanie A Studenski, Bret H Goodpaster, Oscar Lopez, Nancy W Glynn, Neelesh K Nadkarni, Diane G Ives, Mark A Newman, George Grove, Kathy Williams, Janet T Bonk, Jennifer Rush, Piera Kost, Pamela Vincent, Allison Gerger, Jamie R Romeo, Lauren C Monheim, Stephen B Kritchevsky, Anthony P Marsh, Tina E Brinkley, Jamehl S Demons, Kaycee M Sink, Kimberly Kennedy, Rachel Shertzer-Skinner, Abbie Wrights, Rose Fries, Deborah Barr, Thomas M Gill, Robert S Axtell, Susan S Kashaf, Nathalie de Rekeneire, Joanne M McGloin, Raeleen Mautner, Sharon M Huie-White, Luann Bianco, Janice Zocher, Karen C Wu, Denise M Shepard, Barbara Fennelly, Rina Castro, Sean Halpin, Matthew Brennan, Theresa Barnett, Lynne P Iannone, Maria A Zenoni, Julie A Bugaj, Christine Bailey, Peter Charpentier, Geraldine Hawthorne-Jones, Bridget Mignosa, Lynn Lewis, Jeff Williamson, Kaycee M Sink, Hugh C Hendrie, Stephen R Rapp, Joe Verghese, Nancy Woolard, Mark Espeland, Janine Jennings, Valerie K Wilson, Carl J Pepine, Mario Ariet, Eileen Handberg, Daniel Deluca, James Hill, Anita Szady, Geoffrey L Chupp, Gail M Flynn, Thomas M Gill, John L Hankinson, Carlos A Vaz Fragoso, Erik J Groessl, Robert M Kaplan, Abby C King, Deborah Salvo, Jorge A Banda, David K Ahn, Thomas M Gill, Michael Miller, Anne B Newman, Roger A Fielding, Carlos Siordia, Spencer Moore, Sara Folta, Bonnie Spring, Todd Manini, Marco Pahor, LIFE Study Investigators, Marco Pahor, Jack M Guralnik, Stephen D Anton, Thomas W Buford, Christiaan Leeuwenburgh, Susan G Nayfield, Todd M Manini, Connie Caudle, Lauren Crump, Jocelyn Lee, Ching-ju Lu, Mark A Espeland, Walter T Ambrosius, William Applegate, Daniel P Beavers, Robert P Byington, Delilah Cook, Curt D Furberg, Lea N Harvin, Leora Henkin, John Hepler, Fang-Chi Hsu, Kathy Joyce, Laura Lovato, Juan Pierce, Wesley Roberson, Julia Robertson, Julia Rushing, Scott Rushing, Cynthia L Stowe, Michael P Walkup, Don Hire, W Jack Rejeski, Jeffrey A Katula, Peter H Brubaker, Shannon L Mihalko, Janine M Jennings, Evan C Hadley, Sergei Romashkan, Kushang V Patel, Denise Bonds, Mary M McDermott, Bonnie Spring, Joshua Hauser, Diana Kerwin, Kathryn Domanchuk, Rex Graff, Alvito Rego, Timothy S Church, Steven N Blair, Valerie H Myers, Ron Monce, Nathan E Britt, Melissa Nauta Harris, Ami Parks McGucken, Ruben Rodarte, Heidi K Millet, Catrine Tudor-Locke, Ben P Butitta, Sheletta G Donatto, Shannon H Cocreham, Abby C King, Cynthia M Castro, William L Haskell, Randall S Stafford, Leslie A Pruitt, Veronica Yank, Kathy Berra, Carol Bell, Rosita M Thiessen, Kate P Youngman, Selene B Virgen, Eric Maldonado, Kristina N Tarin, Heather Klaftenegger, Carolyn A Prosak, Ines Campero, Dulce M Garcia, José Soto, Linda Chio, David Hoskins, Roger A Fielding, Miriam E Nelson, Sara C Folta, Edward M Phillips, Christine K Liu, Erica C McDavitt, Kieran F Reid, Dylan R Kirn, Evan P Pasha, Won S Kim, Julie M Krol, Vince E Beard, Eleni X Tsiroyannis, Cynthia Hau, Todd M Manini, Marco Pahor, Stephen D Anton, Thomas W Buford, Michael Marsiske, Susan G Nayfield, Bhanuprasad D Sandesara, Mieniecia L Black, William L Burk, Brian M Hoover, Jeffrey D Knaggs, William C Marena, Irina Korytov, Stephanie D Curtis, Megan S Lorow, Chaitalee S Goswami, Melissa A Lewis, Michelle Kamen, Jill N Bitz, Brian K Stanton, Tamika T Hicks, Charles W Gay, Chonglun Xie, Holly L Morris, Floris F Singletary, Jackie Causer, Susan Yonce, Katie A Radcliff, Mallorey Picone Smith, Jennifer S Scott, Melissa M Rodriguez, Margo S Fitch, Mendy C Dunn, Jessica Q Schllesinger, Anne B Newman, Stephanie A Studenski, Bret H Goodpaster, Oscar Lopez, Nancy W Glynn, Neelesh K Nadkarni, Diane G Ives, Mark A Newman, George Grove, Kathy Williams, Janet T Bonk, Jennifer Rush, Piera Kost, Pamela Vincent, Allison Gerger, Jamie R Romeo, Lauren C Monheim, Stephen B Kritchevsky, Anthony P Marsh, Tina E Brinkley, Jamehl S Demons, Kaycee M Sink, Kimberly Kennedy, Rachel Shertzer-Skinner, Abbie Wrights, Rose Fries, Deborah Barr, Thomas M Gill, Robert S Axtell, Susan S Kashaf, Nathalie de Rekeneire, Joanne M McGloin, Raeleen Mautner, Sharon M Huie-White, Luann Bianco, Janice Zocher, Karen C Wu, Denise M Shepard, Barbara Fennelly, Rina Castro, Sean Halpin, Matthew Brennan, Theresa Barnett, Lynne P Iannone, Maria A Zenoni, Julie A Bugaj, Christine Bailey, Peter Charpentier, Geraldine Hawthorne-Jones, Bridget Mignosa, Lynn Lewis, Jeff Williamson, Kaycee M Sink, Hugh C Hendrie, Stephen R Rapp, Joe Verghese, Nancy Woolard, Mark Espeland, Janine Jennings, Valerie K Wilson, Carl J Pepine, Mario Ariet, Eileen Handberg, Daniel Deluca, James Hill, Anita Szady, Geoffrey L Chupp, Gail M Flynn, Thomas M Gill, John L Hankinson, Carlos A Vaz Fragoso, Erik J Groessl, Robert M Kaplan

Abstract

Background: Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability.

Methods: The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence.

Results: Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4%) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4%) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis.

Conclusions: The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation.

Trial registration: Clinicaltrials.gov Identifier = NCT01072500.

Figures

Fig. 1
Fig. 1
Results of the recursive partitioning analysis for participants aged 

Fig. 2

Results of the recursive partitioning…

Fig. 2

Results of the recursive partitioning analysis for participants aged ≥ 79 years

Fig. 2
Results of the recursive partitioning analysis for participants aged ≥ 79 years
Fig. 2
Fig. 2
Results of the recursive partitioning analysis for participants aged ≥ 79 years

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