Aging, Body Weight, and Their Effects on Body Satisfaction and Quality of Life


Tülay Tarsuslu Şimşek 1 , Eylem Tütün Yümin 2 , Meral Sertel 3 , *

1 Dokuz Eylul University, School of Physical Therapy and Rehabilitation, Izmir, Turkey

2 Abant Izzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey

3 Kirikkale University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Kirikkale, Turkey

How to Cite: Şimşek T T, Yümin E T, Sertel M. Aging, Body Weight, and Their Effects on Body Satisfaction and Quality of Life, Iran Red Crescent Med J. Online ahead of Print ; 20(S1):e13045. doi: 10.5812/ircmj.13045.


Iranian Red Crescent Medical Journal: 20 (S1); e13045
Published Online: May 4, 2019
Article Type: Research Article
Received: January 25, 2017
Revised: May 12, 2017
Accepted: June 3, 2017




Background: Changes in body composition in advanced ages (i.e., physical, physiological, and social changes) may influence the perception of body image in the elderly population. In some studies, it is stated that negative body image is associated with the consequences of unhealthy physical and mental health status.

Objectives: The purpose of the study is to examine changes in body weight, body satisfaction, and quality of life in the elderly.

Methods: This descriptive analytical study was performed from July 2015 to April 2016 on individuals aged 45 years and above who lived in Kirikkale, Turkey. The participants were divided into four age groups of 45 - 59 years (group 1), 60 - 69 years (group 2), 70 - 79 years (group 3), and 80 years and above (group 4). Body satisfaction was evaluated using Body-Cathexis Scale (BCS), and the quality of life was evaluated using the Nottingham Health Profile (NHP).

Results: the highest body mass index (BMI) was found in the 60 - 69 years age group (29 ± 4.72 kg/cm2), whereas the lowest score was found to be in the individuals pertaining to the 80 years and above age group (26.53 ± 4.53 kg/cm2). BCS total scores were 85.95 ± 22.09 in group 1, 94.78 ± 26.68 in group 2, 103.29 ± 31.41 in group 3, and in group 4. A significant difference was found between the groups in terms of quality of life and body satisfaction (P < 0.05). There was a positive correlation between BCS and NHP in groups 1, 2, and 3 (P < 0.05). However, there was no correlation between BCS and NHP in group 4 (P > 0.05).

Conclusions: Evaluations and practices performed for body weight control in middle-aged and older adults are of importance in terms of increasing the quality of life.


Adults Aging Body-Cathexis Scale Body Composition Body Mass Index Body Weight Nottingham Health Profile Quality of Life Satisfaction

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

1. Background

Changes in body composition in advanced ages (i.e., physical, physiological, and social changes) are associated with alterations in the level of health and functional independence (1, 2). Changes caused by aging probably affect body image (3). The aging process is associated with a reduction of free fat mass, which consists of all residual tissues and substances including water, muscles, bones, connective tissues, and internal organs (4). This process is also associated with an increase in body fat; these changes in body composition may influence the perception of body image (3, 5, 6).

During the past two decades, studies regarding body image have gained importance, and there have been studies in the literature in relation to young children, young adults, and adults from different cultures. Various health problems, eating disorders, and weight-related problems cause individuals to have body satisfaction problems. Body dissatisfaction is often regarded as the displeasure one feels about certain regions of his/her body, such as his/her legs, hip, elbow, and/or external appearance (physiognomy) (6). Negative body image is linked with the consequences of unhealthy physical and mental health status (7-9).

Body weight and body satisfaction in older adults have been dealt with in a few studies in recent years, the results of which are insufficient (10). In studies conducted on older adults, the importance of investigating changes in body satisfaction along with the aging process has been highlighted. The physical and physiological changes occurring along with aging in older adults may affect their body image and satisfaction, and hence, different aspects of quality of life (6). Problems such as wrinkles that develop along with aging and weakening in mobility and physical capacity are experienced during aging, which can negatively affect body image, particularly in women. Physical changes such as weight gain, hair loss, loss of height, redistribution of body fat, and wrinkles on the skin may impact older adults’ self-confidence (11). In some studies, it was concluded that older adults were more negatively affected in terms of body image satisfaction when compared with younger individuals. However, in some other studies conducted on this topic, it was observed that individuals aged 65 years and above had higher body satisfaction levels than those aged between 40 and 50 years (12, 13).

The relationship between weight and body satisfaction in different age groups has been examined in many studies (especially in adolescents), but there are limited studies on elderly individuals. At the same time, it was observed that multiple age group comparisons have not been included in a single study, and previous studies have included only one or two age group comparisons.

2. Objectives

In this study, we sought to evaluate body satisfaction in different age groups and examine the effects of body weight and aging on body satisfaction and the quality of life. In this study, it was also aimed to analyze the differences in body weight, body satisfaction, and the quality of life among middle-aged and older adults.

3. Methods

3.1. Design and Study Population

This descriptive analytical study was performed among individuals aged 45 years and above who lived in Kirikkale (living in the home environment), Turkey. The participants were selected by the simple random sampling method from July 2015 to April 2016. The participants comprised 418 adults [204 (48.8%) males and 214 (51.2%) females] with a mean age of 60.84 ± 11.59 years (age range: 45 - 94 years).

The inclusion criteria consisted of age 45 years and above, lack of institutionalization, and the ability to understand and answer the questions asked and to give statements in an accurate way. Individuals who were institutionalized, had a medical history of mental or intellectual disorders, were aphasic, had severe dementia, or refused to participate in the study were excluded. All the participants provided informed consent for participation in the study. This study was evaluated and approved by Kirikkale University Clinic Research Ethics Committee (No. 14/05/01.06.2015).

The sample size was determined 400 people using power analysis performed in Epi Info™ 7 ( program with the power of 80% and a margin of error of 0.05 at 95% confidence level.

The individuals included in the study were divided into four age groups (as those aged 45 - 59, 60 - 69, 70 - 79, and 80 years and above) so as to be able to better analyze the changes observed along with the aging process. The results obtained were interpreted according to age distributions.

3.2. Instruments

The participants were assisted by a researcher to complete the evaluation form and the questionnaire. For illiterate individuals and those who had difficulty in reading, the questions were asked orally, and the answers given by the individual were recorded by the researcher.

The recommendations of the World Health Organization (14) were used to determine the degree of obesity, that is, underweight [body mass index (BMI) < 18.5 kg/m2], normal-weight (BMI = 18.50 - 24.99 kg/m2), overweight (BMI = 25.00 - 29.99 kg/m2), and obese (BMI > 30 kg/m2).

Weight was measured to the nearest 0.1 kg using a weighing scale with the participant dressed in indoor clothing without shoes. Height was measured to the nearest 0.1 cm using a wall-mounted stadiometer. BMI was calculated as weight (kg)/height (m)2.

Nottingham Health Profile (NHP) was used to evaluate health-related quality of life. The tool is a valid and reliable scale containing six different subcategories that test physical activity (PA), energy level (EL), pain (P), social isolation (SI), sleep (S), and emotional reactions (ER). Scores in each section can range from 0 to 100 with lower scores indicating lower levels of distress. In this study, the Turkish version of NHP developed by Kucukdeveci et al. was employed (15).

The Body Cathexis Scale (BCS) is a self-report questionnaire measuring the level of body satisfaction. The scale was translated into Turkish by Hovardaoğlu (16). Body satisfaction is evaluated based on a five-point Likert scale from the most negative attitude towards a body part or function to the most positive attitude toward a body part or function. The minimum possible total score is 40, and the maximum possible total score is 200. The cut-off score of this scale is 135. Obtaining a score of less than 135 demonstrates a decrease in an individual’s satisfaction about his/her body parts or functions, whereas a score of 135 or more denotes an increase in the mentioned variable.

3.3. Statistical Analysis

Normal distribution of the data was examined using Kolmogorov-Smirnov/Shapiro-Wilk’s test. Anthropometric and socio-demographic characteristics, body satisfaction, depression level, and health-related quality of life status of the participants are presented as numbers, percentages, means, and standard deviations. One-way analysis of variance (ANOVA) was used to compare BMI, BCS, and NHP values. When an overall significance was observed, pairwise post-hoc and Tukey’s tests were performed. Levene’s test was run to assess the homogeneity of the variances. The correlations among BMI, weight, height, body image, health-related quality of life, and depression were analyzed using Pearson’s correlation coefficient.

4. Results

We found a significant difference among the groups in terms of age, height, and BMI (P < 0.01). The highest BMI value was found in the group aged 60 - 69, whereas the lowest BMI value was found in those aged 80 years and above. Also, there was a significant difference in terms of the educational level, marital status, presence of a chronic disease, and the use of an ancillary equipment among the groups (P < 0.05; Table 1).

Table 1. Socio-Demographic Data of the Subjectsa
Group 1, N = 154Group 2, N = 160Group 3, N = 79Group 4, N = 25Fb, χ2cP Valued
Age, y47.82 ± 4.5364.03 ± 2.9172.98 ± 2.4582.2 ± 3.621324.60< 0.01
Range45 - 5960 - 6970 - 79≥ 80
Height, cm1.66 ± 0.0821.63 ± 0.081.62 ± 0.111.67 ± 0.0810.28< 0.01
Weight, kg77.85 ± 12.6177.49 ± 11.3473.83 ± 13.2174.72 ±
BMI, kg/cm227.47 ± 4.8529 ± 4.7228.03 ± 5.7626.53 ± 4.533.400.01
Female80 (51.9)73 (45.6)35 (44.3)16 (64)
Male74 (48.1)87 (54.4)44 (55.7)9 (36)
Educational level88.78< 0.01
Primary school51 (33.1)68 (42.5)37 (46.8)15 (60)
Secondary school26 (16.9)28 (17.5)12 (15.2)3 (12)
High school36 (23.4)26 (16.3)5 (6.3)1 (4)
Collage32 (20.8)12 (7.5)--
Master’s degree5 (3.2)1 (0.6)--
Illiterate4 (2.5)25 (15.7)25 (31.6)6 (24)
Civil status54.69< 0.01
Married140 (90.9)130 (81.3)55 (69.6)15 (60)
Single9 (5.8)2 (1.3)--
Widowed/divorced5 (3.2)28 (17.5)24 (30.4)10 (40)
Living area14.490.10
Village12 (7.8)15 (9.4)12 (15.2)7 (28)
Town1 (0.6)4 (2.5)2 (2.5)1 (4)
County40 (26)38 (23.8)16 (20.3)3 (12)
City101 (65.6)103 (64.4)49 (62)14 (56)
Chronic disease64.86< 0.01
Hypertension17 (11)46 (28.8)25 (31.6)8 (32)
Diabetes mellitus10 (6.5)22 (13.8)11 (13.9)3 (12)
Rheumatic diseases5 (3.2)18 (11.3)11 (13.9)2 (8)
Chronic obstructive pulmonary disease2 (1.3)3 (1.9)-1 (4)
Orthopedic diseases42 (27.3)10 (6.3)4 (5.1)1 (4)
Coronary artery disease-5 (3.1)-1 (4)
Heart failure-5 (3.1)3 (3.8)3 (12)
None78 (50.6)53 (33.1)25 (31.6)6 (24)
Use of assistive devices65.930< 0.01
Yes1 (0.6)13 (8.1)25 (31.6)9 (36)
No153 (99.4)147 (91.9)54 (68.4)16 (64)

Abbreviation: BMI, body mass index.

aValues are expressed as mean ± SD or No. (%).


cχ2 = chi-square test.

dP < 0.05.

A significant difference was observed in the quality of life and body satisfaction among the groups (P < 0.05; Table 2). In the comparative analyses performed, all the sub-parameters of NHP and total NHP showed differences among the groups (P < 0.05; Table 2). The group that was different in energy level, pain, emotional reaction, and sleep parameters was group 1 (aged 45 - 59). Younger individuals were observed to score higher in the parameters of quality of life (P < 0.05). However, total BCS value was found to be lower in the group aged between 45 - 59 years (P < 0.05; Table 2). Body satisfaction was determined to have increased along with the aging process.

Table 2. The Comparison of Health-Related Quality of Life and Body Satisfaction Between the Groups
Quality of Life (NHP)Group 1, N = 154Group 2, N = 160Group 3, N = 79Group 4, N = 25FP Value
Age, y45 - 5960 - 6970 - 79≥ 80
Energy level15.94 ± 15.6340.65 ± 33.9648.76 ± 33.7155.80 ± 33.8729.79< 0.01
Pain11.49 ± 17.2940.07 ± 30.4647.83 ± 32.7144.68 ± 32.0345.23< 0.01
Emotional reaction13.72 ± 18.9325.04 ± 24.8728.61 ± 25.2635.26 ± 26.7112.46< 0.01
Social isolation9.80 ± 18.6816.21 ± 25.1420.23 ± 24.3732.68 ± 35.588.51< 0.01
Sleep11.44 ± 18.3831.23 ± 30.0237.06 ± 30.2542.14 ± 32.6825.11< 0.01
Physical mobility12.12 ± 16.9329.63 ± 20.7041.78 ± 24.5846.67 ± 32.7646.28< 0.01
Total74.24 ± 88.18180.02 ± 117.93225.04 ± 123.58257.39 ± 150.0647.15< 0.01
BCS85.95 ± 22.0994.78 ± 26.68103.29 ± 31.41107.28 ± 35.849.93< 0.01

Abbreviation: BCS, body cathexis scale.

In the correlational analysis performed, a positive relationship was found between body satisfaction and energy level, pain, emotional reaction, physical activity, and total NHP values of group 1 (P < 0.05). In addition, in the individuals in group 1, a negative correlation was noted between BMI and weight and pain; yet, a positive correlation was observed between BMI and height (P < 0.05; Table 3). On the other hand, a positive correlation was found between body satisfaction and age, energy level, pain, emotional reaction, physical activity, and total NHP in the individuals in group 2 (P < 0.05). In group 3, however, a negative correlation was found between body satisfaction and height; yet, a positive correlation was seen between body satisfaction and energy level, pain, emotional reaction, physical activity, and total NHP in this group (P < 0.05).

Table 3. Correlation Analysis in Group 1 and Group 2
Group 1Group 2
P value0.210.830.470.680.330.230.440.770.010.470.02
P value< 0.010.0500.020.010.950.470.59<
P value< 0.01< 0.01< 0.010.310.700.040.580.670.740.740.18
P value0.20< 0.01<
P value0.070.350.140.31< 0.01< 0.01< 0.010.01< 0.01< 0.01< 0.01
P value<< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01
P value< 0.010.520.070.32< 0.01< 0.01< 0.01< 0.010.01< 0.010.03
P value< 0.010.550.460.30< 0.01< 0.01< 0.01< 0.010.02< 0.010.05
P value< 0.010.300.590.35< 0.01< 0.01< 0.01< 0.010.03< 0.010.09
P value< 0.010.370.070.06< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01
P value< 0.010.430.060.27< 0.010< 0.01< 0.01< 0.0< 0.01< 0.01
P value0.770.010.210.640.

Abbreviations: BCS, body cathexis scale; BMI, body mass index; EL, energy level; ER, emotional reaction; NHP, Nottingham health profile; NHPtot: Nottingham health profile total score; P, pain; PA, physical activity; S, sleep; SI, social isolation.

aP < 0.05.

bP < 0.01; Pearson’s correlation analyses.

Table 4. Correlation Analysis in Group 3 and Group 4
Group 4Group 3
P value0.230.850.200.880.490.460.450.790.760.90.44
P value0.460.010.010.02<
P value0.950.02<
P value0.510.7500.010.030.450.
P value0.750.090.160.64< 0.01< 0.010.08< 0.01< 0.01< 0.01< 0.01
P value0.380.240.390.98< 0.01< 0.010.09< 0.01< 0.01< 0.010.07
P value0.620.960.860.80< 0.010.03< 0.01< 0.01< 0.01< 0.010.02
P value0.270.470.470.780.020.01< 0.010.08< 0.01< 0.010.08
P value0.440.< 0.010.83
P value0.580.280.190.64<< 0.01< 0.01
P value0.960.140.120.49< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01< 0.01
P value0.640.

Abbreviations: BCS, body cathexis scale; BMI, body mass index; EL, energy level; ER, emotional reaction; NHP, Nottingham health profile; NHPtot: Nottingham health profile total score; P, pain; PA, physical activity; S, sleep; SI, social isolation.

aP < 0.01; Pearson’s correlation analyses.

bP < 0.05.

In group 3, a negative correlation was found between total NHP and BMI, height, weight, energy level, pain, social isolation, sleep, and physical activity (P < 0.05; Table 4). In the individuals in group 4, on the other hand, the correlation between body satisfaction and energy level and physical activity was in a positive direction, whereas the correlation between BMI and weight was in a negative direction (P < 0.05).

5. Discussion

The results of our study suggested that with advancing age, body weight declined and that body satisfaction in older adults was higher than that of younger adults; yet, there was also a decrease in the values pertaining to the quality of life in this population.

In our study, a significant difference was observed in height and BMI among the groups. Although the difference was not significant, the lowest weight was observed in those aged 80 years and above. These results are in agreement with those of other studies (1, 17). In previous studies, it was reported that weight loss in older adults is caused by various reasons such as hormonal changes, deficiency in protein consumption, changes in protein metabolism, and decrease in the muscular mass due to muscular atrophy, which may lead to morbidity and physical inability (18, 19). In addition, educational level, age, marital status, health condition, employment status, place of residence, and gender were stated to affect BMI. In former studies, it was also noted that low educational level and being married were associated with high BMI values in male subjects (20-23). It was also shown that place of residence, employment status, and chronic diseases were highly associated with obesity in women and men (21).

Padez reported that adult males living in villages were at a lower risk of getting overweight than those living in cities (22). In contrast, Tchicaya and Lorentz showed in their study that the risk of getting overweight in adults living outside urban areas was even higher than others (24). Our findings reflected a difference in educational status, chronic diseases, and marital status among the groups. BMI in divorced older adults was higher, while their educational level was lower than others.

BMI in older adults with chronic diseases was significantly lower than younger individuals. In previous studies, the relationship between socio-economic factors and BMI was examined in a single age group. In our study, however, the relationship between different age groups and BMI was examined, and it was determined that BMI was lower in older adults and there was a correlation between BMI and age only in those aged 45 - 59 years.

In the conducted studies, it was observed that body image and body satisfaction in individuals of advanced age, particularly in women, were higher than those of younger ones (13), which was explained by the fact that those in their advanced ages had adapted themselves to the changes in their bodies and accepted those body changes. In our study, we found a significant difference in terms of body satisfaction and the quality of life among the age groups.

Even though body satisfaction in none of the groups proved to be rather high (the cut-off value for BCS: 135 points), it was observed that with advancing, body satisfaction also increased in comparison to younger individuals. Although BMI was determined to be higher in the 60 - 69 and 70 - 79 ages groups, body satisfaction of younger individuals (age group: 40 - 59 years) was determined to be higher. These results suggest that body satisfaction seen along with the aging process does not stem from only BMI and body weight. The period between 40 and 50 years is when menopause and hormonal and weight changes, along with changes in physical appearance (wrinkles and gray hair), occur in women.

Adaptation of individuals to constitutional bodily changes is in proportion to their body dissatisfaction. Not only do these changes occur in women but also in men. In our study, although there was no difference among the groups in terms of gender distribution, the number of female subjects in the age groups 40-59 years and 80 years and above was higher.

Informing and supporting middle-aged individuals about the changes occurring in the body will allow them to be at peace with their bodies and to boost their self-confidence levels. In such a case, the individual will not suffer from stress due to the changes occurring in his/her body and will experience less emotional problems (e.g., depression and anxiety) caused by physical changes.

Sonati et al. conducted a study to evaluate the relationship between the quality of life, body image, and body composition. They assigned the individuals to three groups as those aged 60 - 64 (n = 21), 65 - 69 (n = 29), and 70 years and above (n = 31). They found no significant difference among these three groups in terms of the general quality of life, health, and body image. However, a positive correlation was observed between the acceptance of physical appearance, lower free-fat mass, body image, and health in those aged above 70 years. Free-fat mass was found to be more common in those aged 65 - 69 years. In the same way, a positive correlation was found between body image, health and free-fat mass (1).

In a systematic review conducted by Roy and Payette, it was understood that the western elderly were disgruntled with their own bodies and had misperceived their body image. This consensus about elderly body image is similar to the body image of younger populations. In the same study, the specific health-related problems in seniors were found to be associated with negative body image (7).

In a study conducted by Kim et al. it was reported that BMI and race/ethnicity had a major effect on self-rated mental health (SRMH), in addition to which they pointed out the fact that understanding the relationship between BMI and mental health would be helpful in the treatment of individuals with unhealthy weight (25). In the study, it was observed that decreased energy level, physical activity, and quality of life were experienced along with the aging process and that emotional problems were experienced more along with social isolation. Body satisfaction in those aged 40 - 59, 60 - 69, and 70 - 79 years was associated with all the parameters of NHP, except for sleep. On the other hand, body satisfaction in those aged 80 years and above was associated with body weight, BMI, energy level, and physical activity level.

A positive body image is also an important parameter that affects the participation of the individual in physical activities (26). In a study conducted by An and Shi on middle-aged and older adults, it was observed that there was a correlation between body weight and functional independence and that mobility limitations were more common in overweight older adults, which negatively affected daily life activity-independence and impaired the quality of life (27).

In our study, the lowest BMI was seen in the individuals of the advanced age group (80 years and above). However, when compared to other conducted studies, BMI values and overweight rate were high.

Excessive weight gain and obesity, when coupled with the changes in bodily systems along with aging (e.g., muscular dystrophy and balancing problems), may adversely affect the energy level and activity participation of an individual, which is also a significant finding suggesting that body dissatisfaction in older adults is much more influenced by the parameters that affect activity participation. While body satisfaction in younger individuals was affected by the parameters such as the emotional reaction and the social isolation, body satisfaction in the advanced ages was more affected by the parameters involving physical performance and participation in activities. Since obesity increases energy consumption, it may undermine social participation of older adults. For this reason, body weight should be considerably dwelled on in geriatric rehabilitation. Excessive weight gain and obesity in advanced ages affect the quality of life to a considerable degree due to activity limitations rather than dissatisfaction with external appearance. Individuals can be more influenced by the effects of weight on their health.

The strength of this study is that individuals in different age groups were included in the study and the results were presented comparatively in terms of age groups. The fact that there is a limited number of studies conducted on this subject is the other strong aspect of our study in terms of content. Our study provides a different perspective on the effects of old age and the physical and physiological changes occurring in the body during the aging process. In this regard, our study has provided important results that can be used as a reference in the literature. In the literature, the number of comparative studies examining the effects of body weight, body satisfaction, and quality of life in different age groups is very limited; thus, our work can make significant contributions to the literature. The limitation of our study was that a small number of elderly individuals were included in the study. Accordingly, we recommend conducting further studies with larger sample sizes.


Weight problems experienced in older adults are quite common. Along with advancing age, weight problems can lead to activity limitation and impair the quality of life to a considerable extent. Proper weight management during aging and early assessment of physical problems in overweight and obese middle-aged and older adults are warranted to prevent functional limitation and to enhance health-related quality of life. Further comparative studies on this issue are required.



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