What Does Self-rated Health Mean? Changes and Variations in the Association of Obesity with Objective and Subjective Components Of Self-rated Health

Abstract

There are concerns about the meaning of self-rated health (SRH) and the factors individuals consider. To illustrate how SRH is contextualized, we examine how the obesity-SRH association varies across age, periods, and cohorts. We decompose SRH into subjective and objective components and use a mechanism-based age-period-cohort model approach with four decades (1970s to 2000s) and five birth cohorts of National Health and Nutrition Examination Survey data (N = 26,184). Obese adults rate their health more negatively than non-obese when using overall SRH with little variation by age, period, or cohort. However, when we decomposed SRH into objective and subjective components, the obesity gap widened with increasing age in objective SRH but narrowed in subjective SRH. Additionally, the gap narrowed for more recently born cohorts for objective SRH but widened for subjective SRH. The results provide indirect evidence that the relationship between obesity and SRH is socially patterned according to exposure to information about obesity and the availability of resources to manage it.

Keywords: NHANES; adults; cohorts; obesity; periods; self-rated health.

Figure 1

Mechanism-based APC Path Model

Figure 2

Drugs on the U.S. market for obesity-related conditions and annual number of New York Times articles on obesity, by year

Figure 3

Predicted Self-rated Health Among non-obese Persons (BMI<30); based on models shown in Table 6; higher values indicate better health

Figure 4

Predicted Gap in Self-rated Health from non-obese Persons (BMI<30); grey line = obese I (BMI 30-34); black line = obese II (BMI=35+); higher values indicate better health; based on models shown in Table 6