Annual transition probabilities of overweight and obesity in older adults: Evidence from World Health Organization Study on global AGEing and adult health
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Date
2020-01-28
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Publisher
Social Science & Medicine
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
Description
Research Article
Keywords
Multistage markov model, Obesity, Transition probabilities, Sub-Saharan Africa, WHO SAGE