Reduced social isolation, loneliness helps people with obesity live longer

Addressing social isolation and loneliness in people with obesity can counter their increased risk of death, according to a study.

In a cohort of 398,972 adults (mean age 55.85 years, 55.26 percent women, 91.16 percent White) from the UK Biobank, the risk of all-cause death was 15–26-percent lower among participants with obesity and low social isolation index (0-1) than among their counterparts with social isolation index of ≥2 (0: hazard ratio [HR], 0.74, 95 percent confidence interval [CI], 0.69–0.80; 1: HR, 0.85, 95 percent CI, 0.79–0.91; p<0.001 for trend). [JAMA Netw Open 2024;7:e2352824]

Likewise, for loneliness, an index of 0 or 1 attenuated the risk of all-cause death as compared with an index of ≥2 (0: HR, 0.86, 95 percent CI, 0.79–0.94; 1: HR, 0.97, 95 percent CI, 0.89–1.06).

When the comparison was made between participants with obesity and those without, the risk of all-cause mortality decreased by 36 percent and 9 percent as the index of social isolation and loneliness, respectively, went from highest to lowest. Similar results were obtained for cardiovascular disease (CVD) mortality.

Relative importance analysis showed that social isolation posed a greater threat to the lifespan of participants with obesity than did loneliness. Interestingly, social isolation also outranked other known risk factors such as depression, anxiety, and lifestyle-related risk factors (ie, alcohol, physical activity, and diet).

Of the participants, 93,357 (23.40 percent) had obesity and 305,615 (76.60 percent) had not. Social isolation and loneliness had significantly greater prevalence among people with obesity than among those without (p<0.001). Over a median follow-up of 12.73 years, a total of 22,872 incident cases of death were recorded, including 11,442 cancer-related deaths, 4,372 CVD-related deaths, and 7,058 other deaths.

The index of social isolation and loneliness used in the study was created using questionnaires that included items such as the number of people living together in the household, the frequency of visiting friends/family or being visited by them, the frequency of attending clubs/classes/group activities, the frequency of feeling lonely, and the frequency of being able to confide in someone.

Greater role for social isolation

Social isolation is not synonymous with loneliness, the investigators noted. Social isolation is the scarcity of contact with others and related health resources, whereas loneliness conveys a sense of detachment potentially linked to emotional states like depression. [Lancet Public Health 2017;2:e260-e266]

“Social isolation and loneliness are distinct factors that correlate differently with health outcomes and mortality… Individuals can experience loneliness even when married or living with others,” they said. [Res Aging 2017;39:635-656]

The findings of the study suggest that interventions targeting social isolation could yield greater benefits in reducing mortality risk among people with obesity, according to the investigators. As to how, they explained that social interaction and support may reduce stress, promote healthy behaviours, and provide emotional support. [Psychiatry 2007;4:35-40]

“A lack of social support may exacerbate the health-risk behaviours of people with obesity including smoking, inactivity, and unhealthy diets and might also neglect health-protective behaviours, such as adherence to medical recommendations,” the investigators said. [Health Psychol 2011;30:377-385]

“Moreover, those who live alone or lack social contacts may be at a heightened risk of death if they develop acute symptoms because they might not have a strong network of confidantes to urge them to seek medical attention,” they added. [https://www.cdc.gov/aging/publications/features/lonely-older-adults.html]