Open Access Open Badges Research article

Obesity and mortality among older Thais: a four year follow up study

Patama Vapattanawong1, Wichai Aekplakorn2*, Uthaithip Rakchanyaban3, Pramote Prasartkul1 and Yawarat Porapakkham4

Author Affiliations

1 Institute for Population and Social Research, Mahidol University, Salaya, Nakhonpathom, Thailand

2 Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Rama VI Rd., Rajdevi, Bangkok 10400, Thailand

3 Department of Education, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Nakhonpathom, Thailand

4 Setting Priorities using Information on Cost-Effectiveness Project, Ministry of Public Health, Tiwanon Rd., Nonthaburi, Thailand

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BMC Public Health 2010, 10:604  doi:10.1186/1471-2458-10-604

Published: 13 October 2010



To assess the association of body mass index with mortality in a population-based setting of older people in Thailand.


Baseline data from the National Health Examination Survey III (NHES III) conducted in 2004 was linked to death records from vital registration for 2004-2007. Complete information regarding body mass index (BMI) (n = 15997) and mortality data were separately analysed by sex. The Cox Proportional Hazard Model was used to test the association between BMI and all-cause mortality controlling for demographic, socioeconomic, and health risk factors.


During a mean follow-up time of 3.8 years (60545.8 person-years), a total of 1575 older persons, (936 men and 639 women) had died. A U-shaped and reverse J-shaped of association between BMI and all-cause mortality were observed in men and women, respectively. However there was no significant increased risk in the higher BMI categories. Compared to those with BMI 18.5-22.9 kg/m2, the adjusted hazard ratios (HR) of all-cause mortality for those with BMI <18.5, 23.0-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, and ≥35.0 were 1.34 (95% CI, 1.14-1.58), 0.79 (95% CI, 0.65-0.97), 0.81 (95% CI, 0.65-1.00), 0.67 (95% CI, 0.48-0.94), 0.60 (95% CI, 0.35-1.03), and 1.87 (95% CI, 0.77-4.56), respectively, for men, and were 1.29 (95% CI,1.04-1.60), 0.70 (95% CI, 0.55-0.90), 0.79 (95% CI, 0.62-1.01), 0.57 (95% CI, 0.41-0.81), 0.58 (95% CI, 0.39-0.87), and 0.78 (95% CI, 0.38-1.59), respectively, for women.


The results of this study support the obesity paradox phenomenon in older Thai people, especially in women. Improvement in quality of mortality data and further investigation to confirm such association are needed in this population.