Conditions Attributable to Obesity in Older Adults in the U.S.: A Cross-Sectional Study

Obesity is prevalent among older adults and can lead to obesity-related conditions, but aging can also drive the development of the same conditions. Estimating the population attributable fraction for obesity-related conditions due to obesity may clarify the potential benefit of obesity prevention and treatment in this population.

This was a cross-sectional study of the National Health and Nutrition Examination Survey (years 2017-2023), analyzed in 2025. Adults aged ≥65 years with a BMI ≥18.5 kg/m² were included. Using complex survey methods, prevalences and adjusted RRs of obesity-related conditions among individuals with and without obesity (BMI ≥30 kg/m²) were estimated. These estimates were used to calculate population attributable fractions, representing the proportion of each obesity-related condition attributable to obesity.

The cohort included 4,029 individuals representing 50,755,846 older adults (mean age of 73 (SE=0.2) years, 55.3% female, 40.2% with obesity). Population attributable fractions due to obesity were statistically significant for congestive heart failure (33.3% [95% CI=24.7, 39.7]), diabetes (25.3% [95% CI=20.4, 29.5]), asthma (19.4% [95% CI=6.0, 29.0]), metabolic dysfunction-associated steatotic liver disease (17.9% [95% CI=14.3, 21.2]), obesity-associated cancer (12.3% [95% CI=1.9, 20.3]), urinary incontinence (10.6% [95% CI=7.6, 13.3]), arthritis (10.9% [95% CI=7.5, 14.0]), coronary artery disease (10.3% [95% CI=3.3, 16.0]), chronic kidney disease (9.2% [95% CI=2.2, 15.1]), hypertension (9.3% [95% CI=7.3, 11.1]), probable obstructive sleep apnea (8.7% [95% CI=5.2, 11.9]), and dyslipidemia (5.8% [95% CI=3.2, 8.2]) but not stroke.

In older adults, multiple obesity-related conditions were substantially attributable to obesity, although the development of obesity-related conditions was still possible outside of obesity. Future work is needed to determine the extent to which modern obesity treatments can reduce the burden of these obesity-related conditions in older adults.