Retrospective observational analysis of limitations in activities of daily living in a large cohort of patients with clinical obesity.
Paolo Capodaglio, Raffaella Cancello, Davide Soranna and 4 others
Full dependence in daily tasks among obese adults in rehabilitation was associated with older age, higher weight, and lower muscle strength; continence and toileting were the most affected activities (n=3,229).
Key findings
1Of 3,229 patients, 6.0% were fully dependent in daily tasks, 9.0% had moderate limitation, 19.5% were partially independent, and 65.5% were fully independent. The most frequently affected activities were urine/fecal continence (24.7%) and toileting (15.5%).
2A logistic model identified five factors associated with full dependence: higher age (OR 1.08), higher weight (OR 1.02), and larger waist circumference (OR 1.02) increased the probability, while greater muscle mass (OR 0.97) and higher handgrip strength (OR 0.93) lowered it.
3From the most disabled group to the independent group, there was a significant decreasing trend in age, BMI, waist circumference, and fat mass, and a significant increasing trend in fat-free mass, handgrip strength, and muscle mass. Osteoarthritis prevalence fell from 52% to 33% across the same groups (P < 0.0001).
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Cross-sectional design: all data were collected at admission, so the study shows associations, not causation, and cannot show whether rehabilitation improved or worsened function. Single centre in Italy; generalisability to other settings, countries, or obesity subpopulations is uncertain. ADLs were self-reported via the modified Katz Index; no performance-based functional tests were used to confirm the limitations. All patients had at least one comorbidity, so the findings do not apply to isolated obesity without other conditions. The feeding item was removed from the Katz Index to improve sensitivity, which means swallowing-related difficulties are not captured. Retrospective data collection means the quality and completeness of records depend on what was documented at admission.
Declared interests
No conflicts of interest declared. Funded by the Italian Ministry of Health (Ricerca Corrente).
The easy way to misread this
Do not read the association between muscle mass, handgrip strength, and ADL independence as evidence that strengthening exercises will reduce disability in obesity. This is a cross-sectional snapshot taken at admission; no patient was followed over time, no intervention was tested, and the direction of causation cannot be determined. The study describes who is disabled when they arrive, not what rehabilitation does for them.
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