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Background: There is a lack of evidence regarding the impact of changes in waist circumference on disability among older populations in low- and middle-income countries (LMICs). This research examines the association between changes in waist circumference with disability in the older populations of Indonesia, and whether the associations are dependent on wealth or baseline abdominal obesity levels.

Methods: In 2007 the INDEPTH-WHO Study on global AGEing and adult health (SAGE) was conducted among 11,753 individuals aged 50 years and older in Purworejo District, Central Java Province, Indonesia. Of these, a total of 8,089 were followed up in 2010. On both occasions, individuals’ waist circumferences were measured and the 12-item version of the WHO Disability Assessment Schedule version 2 (WHODAS-II) was implemented to measure disability.

Results: A significant positive association was observed between waist circumference and disability at the baseline (β = 0.066; p < 0.001), and between the increase in waist circumference and the level of disability during the three-year follow-up period (β = 0.094; p < 0.001) after adjusting for baseline variables. This association was also significant among the poor, non-obese men, as well as poor and rich obese women. Among the non-obese women, a decrease in waist circumference was associated with more disabilities.

Conclusions: An increase in waist circumference is associated with increased disability among older people in Purworejo, Indonesia. Health promotion programmes aiming to prevent obesity could have positive effects in preventing and reducing disability among older adults.