Body Mass Index and Physical Function in
Older Women
Caroline M. Apovian,* Carolin M. Frey,† G. Craig Wood,‡ Joanne Z. Rogers,§ Christopher D. Still,§
and Gordon L. Jensen¶
Abstract
APOVIAN, CAROLINE M., CAROLIN M. FREY, G.
CRAIG WOOD, JOANNE Z. ROGERS, CHRISTOPHER
D. STILL, AND GORDON L. JENSEN. Body mass
index and physical function in older women. Obes Res.
2002;10:740 –747.
Objective: We modified existing standardized measurement
tools in the Physical Performance Test and tasks from the
Frailty and Injuries: Cooperative Studies of Intervention
Technique Study to evaluate physical function in older
women. Our objectives were (1) to characterize physical
function themes based on combinations of tasks (deriving
factors or components) and (2) to quantify the correlation
between derived factors and body mass index (BMI).
Research Methods and Procedures: Nutrition risk screens
from enrollees in a Medicare-managed risk program served
as the sampling frame. To obtain adequate representation
for a range of BMI, a random sample was obtained of 90
women from the following BMI strata: BMI, 22 to ⬍27
kg/m2; BMI, 27 to ⬍30 kg/m2; and BMI, ⱖ30 kg/m2.
Subjects were asked to perform a series of 18 functional
tasks during a home visit.
Results: The mean age was similar in the three BMI groups
with an overall mean age of 71 ⫾ 4.9 years (SD). Factors
characterized by lower-body function, upper-body function,
coordination, and strength were responsible for 30%, 11%,
9%, and 9% of the variance in task scores, respectively.
BMI, controlling for age, explained 5%, 14%, 3%, and 0%
Received for review July 30, 2001.
Accepted for publication in final form April 29, 2002.
*Department of Endocrinology, Diabetes, and Nutrition, Boston University School of
Medicine, Boston, Massachusetts; †Department of Health Services and Community Re-
search, Children’s National Medical Center, Washington, DC; ‡Clinical Research Depart-
ment and §Department of Nutrition, Geisinger Medical Center, Danville, Pennsylvania; and
¶Vanderbilt Center for Human Nutrition, Nashville, Tennessee.
Address correspondence to Caroline M. Apovian, M.D., Director, Nutrition and Weight
Management Center, Associate Professor of Medicine, Boston University School of Med-
icine, Building D, Suite 614, 88 East Newton Street, Boston, MA 02118-2393.
E-mail: Caroline.Apovian@BMC.org
Copyright © 2002 NAASO
740 OBESITY RESEARCH Vol. 10 No. 8 August 2002
of the variation in these factors, respectively. Higher BMI is
associated significantly with poorer upper- and lower-body
function but is not associated significantly to strength
or coordination.
Discussion: Higher BMI seems to differentially impede
specific aspects of physical function, especially upper-body
function, and to a lesser extent, lower-body function. BMI
does not seem to be associated with levels of coordination
or strength. Better understanding of how BMI impacts phys-
ical function will aid in the design of interventions to
promote independent living in elderly, obese women.
Key words: physical function, elderly, women
Introduction
Several studies have correlated excess body weight with
the development of disability in older persons. High body
mass index (BMI), a measure of weight standardized for
height (kilograms per square meter), is positively associated
with present disability (1,2) and with risk of developing
impaired physical function among older men and women
(3,4). Other studies showed an increased risk for disability
in association with chronic disease, including cardiovascu-
lar disease, arthritis, diabetes, and pulmonary disease (2,5–
8). Recent prospective data suggest that BMI is a strong
predictor of long-term risk for mobility disability in older
women, and that this risk persists even to very old age (9).
In contrast, BMI below the 75th percentile (25.4 kg/m2 for
men and 25.2 kg/m2 for women) was associated with a high
likelihood for continued physical ability and high level of
physical function (10).
The mechanisms through which body mass may affect
disability have not been identified, although it is suspected
that part of the increased risk of disability of overweight
persons is caused by the development of chronic disease
related to obesity, particularly cardiovascular disease and
arthritis (11). However, other factors that are likely to be
contributory to disability, especially in the elderly obese,
include diminished exercise tolerance, frailty, and social or
BMI and Physical Function in Older Women, Apovian et al.
psychological disadvantages (12). Obesity may contribute
to disability by decreasing endurance, by increasing the
energy demands of ventilation, and by altering pulmonary
function (13–16). Obesity may also impede mobility and
flexibility (17). This suggests that the potential exists to
design interventions that directly target obesity-related dis-
ability in the elderly, separate from treatments for obesity-
related chronic disease.
Unfortunately, current research methodology relies on
measures of disability for the elderly (18 –24) that do not
capture the specific effect of excess body weight on phys-
ical function. The Physical Performance Test (PPT; see
Table 1) is an objective, quantifiable test assessing multiple
domains of physical function using observed performance
of tasks that simulate activities of daily living (24). It can be
completed in ⬍10 minutes using only a few simple props
and can, therefore, be readily given in the office or com-
munity setting. This test demonstrates better sensitivity in
detecting disabilities associated with chronic diseases af-
fecting physical functioning than conventional self-reported
functional scales. In general, timed physical performance
measures have been found to be strong predictors of future
functional dependence among nondisabled, free-living,
older persons (25). A preliminary study tested the validity of
the PPT as a predictor of disability specifically caused by
obesity (26). The summary PPT score was associated sig-
nificantly with measures of body fat. However, analysis of
the individual tasks in the PPT did not clearly identify which
tasks contributed most to this overall association. This sug-
gested that additional tasks might enhance the yield of infor-
mation from physical performance testing and that combi-
nations of tasks may be more informative than single tasks
in describing obesity-related decrements in performance.
The Frailty and Injuries: Cooperative Studies of Interven-
tion Techniques (FICSIT) trials were the first nationally
sponsored set of clinical trials concerning physical frailty
and risk for injuries in later life (27). The results are in-
tended to serve as a reference in designing health interven-
tions for older persons. A modification of the PPT combined
with some of the tests used in FICSIT were used to evaluate
physical function in elderly women over a wide range of BMI.
Research Methods and Procedures
Subjects for this study were gathered by random sam-
pling through a nutrition screening program of the Geisinger
Health Plan that is administered to all enrollees in a Medi-
care Managed-Risk Program (28). More than 100 Geisinger
Clinic sites throughout largely rural central and eastern
Pennsylvania implemented a one-page level II Screen de-
veloped by the Nutrition Screening Initiative (29). Clinic
staff recorded height and weight, and enrollees completed
remaining items during visits for usual care. Clinical staff
forwarded completed assessment forms to our research cen-
ter. A possible problem in ensuring equal representation of
women across the range of BMI in this study population
involved the potential for higher rates of refusal among
women with higher BMI; therefore, a stratified random
sampling scheme was used. Women were stratified into
three groups defined by tertiles of healthy to high BMI: 22
to ⬍27 kg/m2; 27 to ⬍30 kg/m2; and ⱖ30 kg/m2. Women
with BMI ⱕ22 kg/m2 were excluded because of the likeli-
hood of disability secondary to frailty and sarcopenia.
Women within each stratum, who were 65 years of age or
older, were randomly selected as potential subjects. Medical
record review excluded potential subjects who were not
community-dwelling; had a history of severe depression or
cognitive disability that could compromise meaningful con-
sent and participation; had any disease or event that might
compromise physical function independent of obesity in-
cluding rheumatoid arthritis, Paget’s disease of bone, or
other bone diseases; or had disability caused by prior
trauma. Potential subjects with diabetic neuropathy, osteo-
arthritis, sleep apnea, hypertension, hyperlipidemia, or any
other comorbidity of obesity were eligible for the study. The
study coordinator contacted eligible women by phone to
invite study participation. The Geisinger Medical Center
Institutional Research Review Board approved this study.
Study staff obtained written informed consent in person
from each subject at the home visit.
A “mini-mental status” exam (30), given to each subject
at the home visit, excluded two women who scored less than
the average for the population reference group based on age
and educational level, even though prior medical record
review did not identify cognitive deficits (one woman with
three errors and a high-school education, one woman with
four errors and an elementary-school education). Study staff
measured height and weight to verify qualifying BMI and to
correctly classify women into BMI strata. This yielded
several reclassifications between initial BMI strata. Study
staff then administered a composite set of functional per-
formance tests to study subjects.
Focusing on mobility and endurance, a composite set of
tasks was designed to combine 8 of the 9 PPT tasks (ex-
cluding a four-flight stair climb) with 10 tasks used in the
FICSIT trials (27). The added tasks included an accelerated
chair stand, hand-grip dynamometry (dominant and non-
dominant), static balance (feet together, foot halfway in
front of the other, and foot totally in front of the other),
one-legged stance (right and left), and one-legged stance
with eyes closed (right and left). All timed measures were
determined with a stopwatch. Two of the measurements—a
50-foot walk and climbing one flight of stairs—were re-
vised from the description in Reuben and Siu (24) to ac-
commodate testing in the home environment. The 50-foot
walk was modified for home use by retracing steps after
walking 25 feet. Climbing one flight of stairs (12 steps) was
accomplished using a stair stepper built specifically for this
purpose. Quartile rankings, based on the full complement of
OBESITY RESEARCH Vol. 10 No. 8 August 2002 741
BMI and Physical Function in Older Women, Apovian et al.

Table 1. Scoring of functional tasks

Task Recorded value Task score
Write sentence* Time (seconds) 0 if unable to do
1 if ⱖ20.5 seconds
2 if 15.5 to 20.0 seconds
3 if 10.5 to 15.0 seconds
4 if ⱕ10.0 seconds
Simulate eating* Time (seconds) 0 if unable to do
1 if ⱖ20.5 seconds
2 if 15.5 to 20.0 seconds
3 if 10.5 to 15.0 seconds
4 if ⱕ10.0 seconds
Lift book* Time (seconds) 0 if unable to do
1 if ⱖ6.5 seconds
2 if 4.5 to 6.0 seconds
3 if 2.5 to 4.0 seconds
4 if ⱕ2.0 seconds
Put on and remove a jacket* Time (seconds) 0 if unable to do
1 if ⱖ20.5 seconds
2 if 15.5 to 20.0 seconds
3 if 10.5 to 15.0 seconds
4 if ⱕ10.0 seconds
Pick up penny from floor* Time (seconds) 0 if unable to do
1 if ⱖ6.5 seconds
2 if 4.5 to 6.0 seconds
3 if 2.5 to 4.0 seconds
4 if ⱕ2.0 seconds
Circle turn* Continuous (yes/no) 0 if discontinuous and unsteady
and steady (yes/no) 2 if discontinuous and steady
2 if continuous and unsteady
4 if continuous and steady
Walk 50 feet†‡ Time (seconds) 1 if ⱖ20.5 seconds
2 if 17.5 to 20.0 seconds
3 if 15.5 to 17.0 seconds
4 if ⱕ15.0 seconds
Stair climbing†‡ Time (seconds) 0 if unable to do
1 if ⱖ38.5 seconds
2 if 29.5 to 38.0 seconds
3 if 25.5 to 29.0 seconds
4 if ⱕ25.0 seconds
Accelerated chair stand§ See right 1 if unable to do
2 if uses assistance device to push up
3 if uses arm to push up
4 if able to stand up with arms crossed
Hand-grip dynamometry—dominant hand†§ Average force of three 0 if unable to do
attempts (kg) 1 if ⱕ21.2 kg
2 if 21.2 ⬍ force ⱕ 25.2 kg
3 if 25.2 ⬍ force ⱕ 28.5 kg
4 if ⬎28.5 kg

742 OBESITY RESEARCH Vol. 10 No. 8 August 2002

BMI and Physical Function in Older Women, Apovian et al.

Table 1. continued
Task Recorded value Task score
Hand-grip dynamometry—non-dominant hand†§ Average force of three 0 if unable to do
attempts (kg) 1 if ⱕ19.3 kg
2 if 19.3 ⬍ force ⱕ 23.0 kg
3 if 23.0 ⬍ force ⱕ 26.1 kg
4 if ⬎26.1 kg
Static balance—foot halfway in front of the other§ Time up to 10 seconds Actual time
Static balance—foot totally in front of the other§ Time up to 10 seconds Actual time
One-legged stance—eyes open—right side§ Time up to 10 seconds Actual time
One-legged stance—eyes open—left side§ Time up to 10 seconds Actual time
One-legged stance—eyes closed—right side§ Time up to 10 seconds Actual time
One-legged stance—eyes closed—left side§ Time up to 10 seconds Actual time

* Unmodified task, timed tasks were rounded to the nearest half second prior to scoring.
† Score derived as quartile of non-missing recorded value for completed task with zero assigned for those tasks the subject was unable to
do.
‡ Modified Physical Performance Test task, timed tasks were rounded to the nearest half second prior to scoring.
§ Frailty and Injuries: Cooperative Studies of Intervention Techniques task.

study data, replaced actual times for the 50-foot walk, stair
climbing, and dominant and non-dominant hand-grip dyna-
mometry. Those subjects unable to complete the task re-
ceived scores of zero. This scheme handled uncompleted
FICSIT tasks in a manner comparable with PPT tasks. Table
1 reports the correspondence between recorded values and
scores for each of the 18 tasks. Although it is generally
preferable to use continuous valued measurements such as
those involving time where possible, it was necessary to use
ordinal assignments to allow for the inability to complete a
task (equivalently, an infinite time). The order of scores is
consistent across tasks such that lower numbers indicate
difficulty in completing tasks or poor performance, and
higher numbers indicate successful completion or excellent
performance. For some PPT tasks, this involved reversing
the order of task scores. Such reordering does not funda-
mentally change the properties of the measurement.
Medians and bootstrapped 95% confidence intervals
summarized task performance for each BMI group (Table
2). Medians permit meaningful summarizing of timed val-
ues that were right-skewed. Factor analysis (31) identified a
parsimonious set of thematically meaningful factors com-
prised by weighted combinations of tasks. The sample size
of 90 subjects was chosen because of a rule of thumb that
suggests that a minimum of five subjects per variable—18
functional tasks here— be used to support a factor analysis.
However, some data reduction before factor analysis
seemed to be prudent after initial inspection of the data. This
improves the statistical power for this analysis. The factor
analysis excludes scores for the “Static Balance-Feet To-
gether” task, which was the maximum of 10 seconds for all
subjects. Further data reduction was achieved by averaging
paired (left/right or dominant/non-dominant) measures.
This left 14 variables for input into the factor analysis. A
latent root criterion guided the retention of factors with a
latent root of at least one. Varimax rotation of retained
factors estimated factor loadings for the purpose of inter-
pretation. Multiple linear regression analysis quantified as-
sociations between BMI, while controlling for age, with
derived components characterized by specific dimensions of
physical function. Data analyses used SAS software (Sta-
tistical Analysis Systems, Cary, NC).
Results
A total of 90 women, with a BMI ⬎22 kg/m2, were
enrolled in this study, with two exclusions after the mini-
mental status exam. The 88 remaining participants were
assigned BMI categories; 32 women were in the lowest
BMI group, 27 women were in the middle BMI group, and
29 women were in the highest. There was no difference in
age between the three BMI groups (p ⫽ 0.276; 71 ⫾ 5
years).
A comparison of women who were in the sampling frame
but who did not participate in the study (n ⫽ 951) to those
enrolled (n ⫽ 88) partially addressed the representativeness
of the study sample. The study and nonstudy groups did not
differ with respect to BMI (29.1 and 29.7, respectively; p ⫽
0.297), and age (70.8 and 70.3 years; respectively, p ⫽
0.412). Additionally, the two groups did not differ with

OBESITY RESEARCH Vol. 10 No. 8 August 2002 743

BMI and Physical Function in Older Women, Apovian et al.

Table 2. Medians and bootstrap 95% confidence intervals (confidence intervals shown in parentheses) for
selected* functional tasks and standardized factor scores
BMI 22 to <27 BMI 27 to <30 BMI > 30
Tasks (kg/m2) (kg/m2) (kg/m2)
Write sentence (seconds)† 10.9 11.0 12.1
(10.0, 12.1) (10.5, 11.7) (11.3, 12.8)
Simulate eating (seconds) 9.8 10.3 11.8
(9.3, 11.2) (8.6, 11.0) (10.2, 12.6)
Lift book (seconds) 2.7 2.4 2.7
(2.5, 2.8) (2.1, 2.4) (2.4, 3.0)
Put on and remove a jacket (seconds) 6.6 6.4 7.0
(5.7, 7.2) (5.9, 6.9) (6.4, 8.5)
Pick up penny from floor (seconds) 2.2 2.3 2.3
(2.0, 2.6) (2.1, 2.3) (2.1, 2.5)
Walk 50 feet (seconds) 17.0 17.6 19.1
(15.1, 18.1) (17.0, 18.4) (17.3, 20.0)
Hand-grip dynamometry—dominant 21.7 24.7 27.3
hand (kg)‡ (19.7, 22.2) (22.3, 25.0) (22.0, 29.5)
Hand-grip dynamometry—non-dominant 21.9 22.7 25.0
hand (kg) (19.3, 23.7) (20.3, 24.2) (21.8, 26.7)
One-legged stance—eyes open—right 9.6 4.5 5.8
side (seconds) (4.8, 10.0) (1.9, 7.5) (2.2, 6.9)
One-legged stance—eyes open—left 8.1 3.8 3.7
side (seconds) (4.3, 10.0) (2.0, 6.5) (2.1, 6.1)
One-legged stance—eyes closed—right 1.5 1.9 1.6
side (seconds) (1.3, 2.2) (1.1, 2.1) (0.8, 2.0)
One-legged stance—eyes closed—left 1.7 1.8 1.2
side (seconds) (1.1, 1.9) (1.2, 2.0) (1.0, 1.8)
Stair climbing (seconds)§ 26.7 30.4 34.4
(24.5, 29.7) (25.1, 31.4) (28.5, 38.6)
Factors

Lower-body function 0.27 ⫺ 0.01 ⫺ 0.29

(⫺0.10, 0.64) (⫺0.36, 0.33) (⫺0.67, 0.10)
Upper-body function 0.33 0.06 ⫺ 0.42
(⫺0.02, 0.68) (⫺0.20, 0.32) (⫺0.87, 0.02)
Standing coordination ⫺ 0.32 0.17 0.20
(⫺0.89, 0.24) (0.08, 0.26) (0.05, 0.35)
Strength ⫺ 0.25 0.22 0.06
(⫺0.64, 0.15) (⫺0.11, 0.56) (⫺0.32, 0.44)

* Summaries for some tasks are not reported. The ordinal scores for the circle turn and accelerated chair stand are not appropriately
summarized by medians. More than one-half of subjects in each group maintained static balance (foot halfway and totally in front of other)
for the full 10 seconds such that the median is 10 for all groups. All subjects maintained static balance with feet together for the full 10
seconds so that there was no variability in the data.
† One subject (BMI ⱖ 30 kg/m2) was unable to write sentence.
‡ One subject (BMI 22 to ⬍27 kg/m2) was unable to do hand-grip dynamometry on the dominant hand.
§ Three subjects (2 with BMI 22 to ⬍27 kg/m2 and 1 with BMI ⱖ 30 kg/m2) were unable to complete the stair climbing task.

744 OBESITY RESEARCH Vol. 10 No. 8 August 2002

BMI and Physical Function in Older Women, Apovian et al.

Table 3. Rotated factor loadings for retained factors

Factor
1 2 3 4
Latent root 4.3 1.6 1.3 1.2
Percent variance explained 30% 11% 9% 9%
Lower-body function
One-legged stance—eyes open 0.79* 0.19 0.03 0.27
Static balance—foot totally in front of other 0.75 ⫺0.19 0.24 ⫺0.07
One-legged stance—eyes closed 0.51 0.17 0.00 0.39
Stair climbing 0.50 0.49 0.01 0.34
Upper-body function
Put on and remove a jacket 0.03 0.71 0.01 0.12
Pick up a penny 0.28 0.62 0.04 ⫺0.14
Write a sentence 0.19 0.61 0.18 0.13
Simulated eating ⫺0.12 0.50 0.27 0.19
Standing coordination
Static balance—foot halfway in front of the other 0.03 0.03 0.86 0.18
Accelerated chair stand 0.13 0.25 0.83 0.04
Strength
Hand-grip dynamometry 0.16 ⫺0.01 0.15 0.75
Lift a book 0.13 0.41 0.14 0.68

*Bold numbers correspond to the functional tasks that loaded highly for each factor.

respect to the self-reported responses on the Nutrition Risk relaxed criterion of 0.50 considers the importance of tasks
Level II Screen, except for a loss of 10 lbs in the last 6 for which the factor accounts for 25% of its variance, and
months (14.8% and 7.3%, respectively; p ⫽ 0.012). that is the criterion used here. The first factor was charac-
Table 2 summarizes task performance by BMI group terized as a measure of lower-body function because the
using medians and confidence intervals. There is consider- high-loaded tasks included the following: walking 50 feet,
able overlap between groups for most tasks, although per-
formance on some tasks demonstrates clear associations
with BMI. For example, median strength from hand-grip
Table 4. Summary of regressions of BMI and age on
dynamometry and median time for stair-climbing perfor-
each factor separately
mance are ordered according to BMI group, with greater
strength and longer stair-climbing times evident among BMI Age
those with higher BMI. For a number of other tasks such as
the one-legged stances, medians seem to differ for one Partial Partial
group relative to the other two. This suggests that BMI- Factor R2 p R2 p
related performance may not be graded throughout the
Lower-body
range of BMI; rather, performance may be subject to a
threshold BMI beyond which decrements are incurred. function 0.050 0.032 0.069 0.012
Table 3 summarizes the results from the factor analysis. Upper-body
The factor analysis produced four factors with latent root function 0.137 ⬍0.001 0.193 ⬍0.001
values greater than one; however, factors 3 and 4 were Standing
considered marginal. These four factors comprised 59% of coordination 0.029 0.111 0.013 0.281
the variance and were retained for further analysis. Factor Strength — 0.921 0.203 ⬍0.001
loadings of ⬃0.60 or higher are statistically significant at
the 0.05 level with a sample size of 85 (31), roughly BMI, body mass index.
corresponding to the sample size here. A somewhat more

OBESITY RESEARCH Vol. 10 No. 8 August 2002 745

BMI and Physical Function in Older Women, Apovian et al.
static balance—foot totally in front of the other, one-legged
stance (eyes open), one-legged stance (eyes closed), and
stair climbing. The second factor may be interpreted as a
measure of upper-body function because the high-loaded
tasks included the following: writing a sentence, simulating
eating, putting on and removing a jacket, and picking up a
penny from floor. The third factor may be interpreted as a
measure of coordination in standing because the high-
loaded tasks included only the accelerated chair stand and
the static balance task with one foot halfway in front of the
other. The fourth factor may be interpreted as a measure of
strength because the high-loaded tasks included only a
lifting task and hand-grip dynamometry. Table 2 illustrates
the extent to which factor scores vary with BMI, with mean
factor scores and their 95% confidence intervals reported.
Regression analysis evaluated the ability of BMI, while
controlling for age, to predict physical function based on the
derived components (Table 4). BMI, controlling for age,
explained modest variation in factor scores for lower-body
function (5%; p ⫽ 0.032) and upper-body function (14%;
p ⬍ 0.001), but not standing coordination or strength.
Discussion
The study population is generally representative of the
health system membership from which the sample was
drawn. An isolated finding that self-reported recent weight
loss was more prevalent among nonparticipants is the
only evidence of potential nonrepresentativeness. Because
this was the only difference found by comparing a num-
ber of responses on the Nutrition Screen, this finding
is likely spurious.
It has been previously determined that nutritional status,
indicated by BMI, is related to the functional capabilities of
the elderly, and that the relationship fits roughly the same
U-shaped curve that has described the relationship between
mortality and BMI (3). However, just as the causes of
higher mortality in persons with low and high BMI differ, so
likely do the causes of impaired functionality in persons
with low and high BMI. Tests of physical function should
ideally be able to distinguish these two types of disability.
This study found associations between excess body
weight (BMI) on functional performance in older women.
The results suggest that higher BMI seems to impede spe-
cific aspects of physical function. It was previously thought
that weight-related disability would primarily affect lower-
body function (9). Our results indicate that while controlling
for age, upper-body function and, to a lesser extent, lower-
body function were related to BMI. No evidence was pro-
vided to support a link between BMI and strength or BMI
and coordination.
In older, obese women, use of the upper body (for tasks
such as eating, writing, and dressing) and use of the lower
body (for tasks such as standing, walking, and climbing)
become more difficult. By focusing on upper-body and lower-
746 OBESITY RESEARCH Vol. 10 No. 8 August 2002
body functions, the design of interventions to promote
independent living in elderly, obese women may improve.
Prior studies on disability have focused on that subset of
the elderly considered “frail,” those with low BMI and
sarcopenia (32). We propose that obese older women are
also frail in that they also exhibit specific impairments in
functionality (33). A strong association between weight and
physical function in women has been documented in longi-
tudinal data using quality-of-life questionnaires to measure
aspects of functionality (34). This study used a set of direct
measures of physical function to test the effect of weight on
specific tasks that could be related to activities of daily
living. We hope our findings will ultimately improve the
design of future physical performance testing to detect
disability of obese older persons. Additional effort is needed
to determine whether findings presented here can be gener-
alized to other rural, and perhaps also to urban, populations.
Similarly, efforts to replicate these findings as well as to
establish the face validity of the derived factors would be an
important next step. Finally, consideration of the potential
confounding or modifying effects of habitual activity levels
on physical function would substantially improve the design
of meaningful future interventions aimed at improving func-
tion in elderly obese women.
Acknowledgments
This work was supported by a grant from Geisinger
Medical Center, which supported the principal investigator:
The Geisinger Clinic Clinician-Investigator Career Devel-
opment Award.
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