Association between self-reported body mass index and active life expectancy in a large community-dwelling sample of older U.S. adults

BACKGROUND: Obesity may have a protective effect (greater survival) in older adults, a finding known as the “obesity paradox.” This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults. METHODS: Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants’ baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs). RESULTS: Small differences in life expectancy were noted among persons in normal weight (BMI 18.5–24.9 kg/m(2)), overweight (BMI 25–29.9 kg/m(2)), and obesity ranges (BMI 30 kg/m(2) and higher). However, persons with obesity had a significantly lower ALE. ALE at age 65 was 11.1 (11.0–11.2) years for persons with obesity, 1.2 (1.1–1.3) years less than that for the normal weight and overweight persons (12.3 years for both, 12.2–12.4). Persons with class III obesity had a significantly lower life expectancy and ALE than normal weight persons. Although persons with class I or II obesity had a similar life expectancy as normal weight persons, they have a shorter ALE. CONCLUSIONS: Although older adults with obesity have a similar life expectancy as normal weight persons, they have a significantly shorter ALE. Given the complex relationship of BMI and ALE, a “one size fits all” approach to weight management is not advisable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-03021-7.