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BackgroundTooth extraction due to dental caries is associated with socioeconomic-deprivation and is a major reason for elective hospital admissions in England in childhood. Consumption of sugar-sweetened beverages is a risk factor for dental caries. We examined whether the soft drinks industry levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in incidence rates of hospital admissions for carious tooth extraction in children, 22 months post-SDIL implementation.MethodsChanges in incidence rates of monthly hospital admissions for carious tooth extractions (January 2012-February 2020) in England were estimated using interrupted time series and compared with a counterfactual scenario (no SDIL announcement or implementation). Periodical changes in admissions, auto-correlation and population structure were accounted for. Estimates were calculated overall, by index of multiple deprivation (IMD) fifths and by age group (0-4, 5-9, 10-14, 15-18 years).FindingsCompared to the counterfactual scenario, there was a relative reduction of 12·1% [95%CI 17·0%-7·2%] in hospital admissions for carious tooth extractions in all children (0-18 years). Children aged 0-4 and 5-9 years had relative reductions of 28·6% [95%CI 35·6-21·5] and 5·5% [95%CI 10·5%-0·5%], respectively; no change was observed for older children. Reductions were observed in children living in most IMD areas regardless of deprivation.InterpretationThe UK SDIL was associated with reductions in incidence rates of childhood hospital admissions for carious tooth extractions, across most areas regardless of deprivation status and especially in younger children.FundingUK National Institute of Health and Care Research, UK Medical Research CouncilResearch in ContextEvidence before this studyWe searched PubMed and Google Scholar for articles and reviews on the impact of sugar sweetened beverages and sugar sweetened beverage taxes on dental health, published from inception to October 15, 2022 using search terms (“sugar sweetened beverages” OR “soda” OR “soft drinks”) AND (“sugar tax” OR “sugar sweetened beverage tax” or “sugar levy”) AND (“tooth extractions” OR “tooth caries” OR “oral health” OR “dental caries”) AND (“childhood” OR “children”). Further relevant papers were found by checking reference lists of identified articles. Dental extractions due to caries are one of the most common reasons for children having an elective admission to hospital in many high income countries, including England. Identified studies suggest a strong relationship between consumption of sugar-sweetened beverages (SSBs) and the development of dental caries. The overall prevalence of caries in children has been declining for more than a decade. However, a strong social gradient exists with survey data showing children living in the most deprived areas have twice the number of decayed, missing (due to decay) and filled teeth as those living in the least deprived areas in England. Studies that have previously investigated the potential effect of SSB taxes on dental caries have mostly relied on public health modelling, with only a single empirical study based on observational data. Studies including young children (Added Value of this studyWe used routinely collected nationally representative hospital episodes statistics (HES), on monthly admissions of children aged 0-18 years in England, to NHS hospitals for tooth extraction due to caries between January 2012 and February 2020. Taking account of historical trends in hospital admissions for carious tooth extraction we examined changes in these admission types in relation to the UK soft drink industry levy (SDIL), a sugar sweetened beverage (SSB) tax announced in March 2016 and implemented in April 2018. Analysis was conducted overall, and by age group and Index of Multiple Deprivation (IMD) of the child’s area of residence After accounting for existing trends, we found that the SDIL was associated with an estimated overall relative reduction of 12.1% (17.0, 7.2), in hospital admissions for carious tooth extractions in children aged 0 to 18 years. Reductions were found in children living in most IMD areas regardless of deprivation and particularly in younger children aged 0-4 and 5-9 years.Implications of all available evidenceThese findings add to the currently limited evidence base that SSB taxes can improve children’s dental health. These effects were seen across the spectrum of deprivation suggesting widespread population benefits and particularly in pre-school and primary school age children who have limited agency to make their own dietary decisions.

Background Associations between obesity and physical inactivity are bi-directional. Both are associated with physical functioning (PF, ability to perform physical tasks of daily living) but whether obesity influences PF via inactivity is unknown. We investigated whether mid-adult obesity trajectories were associated with subsequent PF and mediated by inactivity. Methods Body mass index (BMI; kg/m²) and inactivity were recorded at: 36, 43, 53 and 60–64 years in the 1946 Medical Research Council (MRC) National Survey of Health and Development (1946-NSHD; n = 2427), and at 33, 42 and 50 years in the 1958 National Child Development Study (1958-NCDS; n = 8674). Poor PF was defined as the lowest (gender and cohort-specific) 10% on the Short-form 36 Physical Component Summary subscale at 60–64 years (1946-NSHD) and 50 years (1958-NCDS). Estimated randomized-interventional-analogue natural direct (rNDE) and indirect (rNIE) effects of obesity trajectories on PF via inactivity are expressed as risk ratios [overall total effect (rTE) is rNDE multiplied by rNIE]. Results In both cohorts, most individuals (∼68%) were never obese in adulthood, 16–30% became obese and ≤11% were always obese. In 1946-NSHD, rTE of incident obesity at 43 years (vs never) on poor PF was 2.32 (1.13, 3.51); at 53 years it was 1.53 (0.91, 2.15). rNIEs via inactivity were 1.02 (0.97, 1.07) and 1.02 (0.99, 1.04), respectively. Estimated rTE of persistent obesity from 36 years was 2.91 (1.14, 4.69), with rNIE of 1.03 (0.96, 1.10). In 1958-NCDS, patterns of association were similar, albeit weaker. Conclusions Longer duration of obesity was associated with increased risk of poor PF. Inactivity played a small mediating role. Findings reinforce the importance of preventing and delaying obesity onset to protect against poor PF.

Past studies have shown that the more unaffordable housing is to people, the worse their health, particularly mental health. However, the commonly used housing affordability indicator, the 30% measure, has limitations. There is evidence that other indicators, including the ‘30/40’ measure, might be more precise in characterizing housing unaffordability by taking into account absolute values of household incomes. In this paper, we use cross-sectional data from the UK Household Longitudinal Study, to evaluate relationships between two affordability measures (30%, 30/40) with 3 health measures: general, physical and mental health. We use logistic regression and effect modification to test whether relationships varied by age, ethnicity, housing tenure, urbanicity and sex. Out of 35,114 participants with complete data, housing was classified as unaffordable for 24.2% using the 30% measure and 10.2% for the 30/40 measure. In age-adjusted analyses, higher unaffordability was associated with worse health for all three health measures, with associations stronger for the 30/40 vs the 30% unaffordability measure. In models adjusted for age, sex and urbanicity, both ethnicity and tenure independently modified associations; with modification showing small differences by unaffordability and health measure. Further studies are needed to disentangle complex relationships between household income, housing costs, ethnicity and tenure.

Reducing population levels of frailty is an important goal and preventing its development in mid-adulthood could be pivotal. Childhood socioeconomic position (SEP) is associated with a myriad of adult health outcomes but evidence is limited on associations with frailty. Using 1958 British birth cohort data (N=8711), we aimed to: (i) establish the utility of measuring frailty in mid-life, by examining associations between a 34-item frailty index at 50y (FI50y) and mortality over an eight-year follow-up period and (ii) examine associations between early-life SEP and FI50y and investigate whether these associations were explained by adult SEP. Hazard ratios (HRs) for mortality increased with increasing levels of frailty, e.g., HRsex-adjusted was 4.07(95% CI:2.64,6.25) for highest vs. lowest fifth of FI50y. Lower early-life SEP was associated with higher FI50y: per unit decrease in early-life SEP (on a 4-point scale), FI50y increased by 12.7%(10.85%,14.6%) in a model adjusted for early-life covariates. After additional adjustment for adult occupational class and education, the association attenuated to 5.71%(3.71%,7.70%). Findings suggest that early-life SEP is associated with frailty and that adult SEP only partially explains this association. Results highlight the importance of improving socioeconomic circumstances across the life course to reduce inequalities in frailty from mid-adulthood.

Background The success of a government’s COVID-19 control strategy relies on public trust and broad acceptance of response measures. We investigated public perceptions of the UK government’s COVID-19 response, focusing on the relationship between trust and perceived transparency, during the first wave (April 2020) of the COVID-19 pandemic in the United Kingdom. Methods Anonymous survey data were collected (2020-04-06 to 2020-04-22) from 9,322 respondents, aged 20+ using an online questionnaire shared primarily through Facebook. We took an embedded-mixed-methods approach to data analysis. Missing data were imputed via multiple imputation. Binomial & multinomial logistic regression were used to detect associations between demographic characteristics and perceptions or opinions of the UK government’s response to COVID-19. Structural topic modelling (STM), qualitative thematic coding of sub-sets of responses were then used to perform a thematic analysis of topics that were of interest to key demographic groups. Results Most respondents (95.1%) supported government enforcement of behaviour change. While 52.1% of respondents thought the government was making good decisions, differences were apparent across demographic groups, for example respondents from Scotland had lower odds of responding positively than respondents in London. Higher educational levels saw decreasing odds of having a positive opinion of the government response and decreasing household income associated with decreasing positive opinion. Of respondents who thought the government was not making good decisions 60% believed the economy was being prioritised over people and their health. Positive views on government decision-making were associated with positive views on government transparency about the COVID-19 response. Qualitative analysis about perceptions of government transparency highlighted five key themes: (1) the justification of opacity due to the condition of crisis, (2) generalised mistrust of politics, (3) concerns about the role of scientific evidence, (4) quality of government communication and (5) questions about political decision-making processes. Conclusion Our study suggests that trust is not homogenous across communities, and that generalised mistrust, concerns about the transparent use and communication of evidence and insights into decision-making processes can affect perceptions of the government’s pandemic response. We recommend targeted community engagement, tailored to the experiences of different groups and a new focus on accountability and openness around how decisions are made in the response to the UK COVID-19 pandemic.

Background Physical functioning from mid-adulthood is important for maintaining independence and is linked to better health outcomes. Evidence is scant on long-term implications of childhood obesity and body mass index (BMI) gains over the life-course for poor physical functioning (PF) in midlife. Studies that link obesity to poor PF have typically been cross-sectional, limited to two time-points or relied on retrospectively recalled height and weight. We aimed to establish associations between PF at age 50y and i) birthweight and BMI across the life-course; ii) BMI gains at specific life-stages and iii) age of obesity onset. Methods The 1958 birth cohort includes all born in one week, in March 1958, across Britain. BMI (kg/m2) was calculated (N=4,173 (males); 4,501 (females)) using height and weight measured at school (7, 11, 16y), in participant’s homes (33, 45y) or self-reported (23, 50y). PF at 50y was assessed via postal questionnaire using the validated PF subscale of the Short-form 36 (SF-36) survey. The lowest sex-specific 10th centile were defined as poor PF. Missing data was imputed via multiple imputation. Associations were examined using logistic regression, adjusting for social class, education and health behaviours. Results Birthweight was not associated with PF. At each adult age, odds of poor PF were highest for obese (vs normal) e.g. for 23y obesity the ORadjusted for poor PF was 2.28(1.34,3.91) and 2.67(1.72,4.14) in males and females respectively. BMI gains from adolescence were related to poor PF, e.g. for females, ORadjusted per SD in BMI gain between 16–23y was 1.28(1.13,1.46); for BMI gains 45–50y it was 1.36(1.11,1.65). Mean BMI at 50y increased with earlier onset of obesity; e.g. in males, from 31.4 kg/m2 for mid-adult onset to 35.1 kg/m2 for child onset. Longer duration of obesity was associated with poor PF (p-trend Conclusion Study strengths include the large nationwide cohort followed from birth and prospective measures of BMI and PF, albeit BMI at some ages was self-reported. Obesity, BMI gains and earlier obesity onset were associated with poor PF in mid-adulthood. Findings relating to duration of obesity are important given the increasing prevalence of childhood obesity, which tends to track into adulthood. Our study highlights the importance of preventing and delaying obesity onset to mitigate the risk of poor PF in mid-adulthood.

Background Child maltreatment (neglect and abuse) is not uncommon and has established associations with adverse socioeconomic and health outcomes; however there is sparse evidence on its relationship with premature mortality in adulthood. While different types of maltreatment co-occur, previous studies have examined types of maltreatment separately or as a combined score and there is little understanding of possible differential effects. Using a general population birth cohort, we aimed to establish whether different types of maltreatment were associated with risk of all-cause mortality in mid-adulthood. Methods Using data from the 1958 British cohort (N=9311), we examined associations between child neglect (prospectively recorded at 7y and 11y) and physical, psychological, witnessing and sexual abuse (retrospectively recorded at 44/45y) with risk of all-cause mortality between 2002/3 (when participants were 44/45y) and December 2016. Death was ascertained through receipt of certificates from the NHS Central Register (n=296) and from information from relatives or close friends (n=16). Associations were examined for each type of maltreatment separately and also combined as a score, to assess cumulative burden, using Cox proportional hazard models with and without adjustment for gender, early-life covariates (e.g. childhood socioeconomic position) and for other maltreatment types to allow for co-occurrence. Results Approximately 22% of participants reported at least one type of maltreatment in childhood and 3.4% had died between 2002/3 and 2016. Individuals identified with neglect (10.4% of the population), physical (6%) or sexual abuse (1.6%) were at increased risk for all-cause mortality during the follow-up period, independent of other types of maltreatments and childhood socioeconomic position: adjusted Hazard Ratios (HRs) were 1.43(95% CI:1.04,1.95), 1.76(1.11,2.80) and 3.07(1.77, 5.33) respectively. Childhood psychological and witnessing abuse were not associated with mortality after allowing for other factors. In general, risk of all-cause mortality increased with number of types of maltreatment, with HRs of 1.61(1.21,2.14) and 3.43(2.28,5.17) for a single and 3+ types of maltreatments respectively, compared to those with none. Conclusion Adult survivors of child neglect, physical and sexual abuse are at increased risk of premature mortality in mid-adulthood. Findings suggest that periodic health assessments for survivors of specific types of child maltreatment over the life-course may help eradicate differences in premature mortality. Child abuse was reported retrospectively in adulthood, although child neglect and potential confounding factors were ascertained prospectively.

Background Evidence is scant on long-term implications of childhood obesity and body mass index (BMI) gains over the life-course for poor physical functioning (PF). The objective was to establish whether (i) birthweight and BMI across the life-course, (ii) BMI gains at specific life-stages and (iii) age of obesity onset were associated with PF at 50 y. Methods In the 1958 British birth cohort (n = 8674), BMI (kg/m2) was calculated using height and weight [measured (7, 11, 16, 33 and 45 y); self-reported (23 and 50 y)]. PF was assessed at 50 y using the validated PF subscale of the Short-form 36 survey; the bottom (gender-specific) 10% was classified as poor PF. Missing data were imputed via multiple imputation. Associations were examined using logistic regression, adjusting for health and social factors. Results Birthweight was not associated with PF. At each adult age, odds of poor PF were highest for obese (vs normal), e.g. for 23 y obesity the odds ratio (OR)adjusted for poor PF was 2.28 (1.34, 3.91) and 2.67 (1.72, 4.14) in males and females respectively. BMI gains were associated with poor PF, e.g. for females, ORadjusted per standard deviation (SD) in BMI gain 16–23 y was 1.28 (1.13, 1.46); for BMI gains 45–50 y it was 1.36 (1.11, 1.65). Longer duration of obesity was associated with poor PF, e.g. in males, ORadjusted was 2.32 (1.26, 4.29) for childhood obesity onset and 1.50 (1.16, 1.96) for mid-adulthood onset (vs never obese, P-trend Conclusion Obesity, BMI gains, and earlier obesity onset were associated with poor PF in mid-adulthood, reinforcing the importance of preventing and delaying obesity onset.

Objective: To identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI).Methods: Data from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780).Results: Increasing age (HR: 1.08 (CI: 1.08-1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54-2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09-1.30)), obesity (HR: 1.33 (CI: 1.18-1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13-1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18-1.41)), pain (HR: 1.39 (CI: 1.34-1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76-2.78) and lower body strength (HR: 1.07 (CI: 1.06-1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors.Conclusion: The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.

BACKGROUND: Volunteering has been linked to reduced mortality in older adults, but the mechanisms explaining this effect remain unclear. This study investigated whether volunteering is associated with increased survival in participants of the English Longitudinal Study of Ageing and whether differences in survival are modified by functional disabilities. METHODS: A multivariate Cox Proportional Hazards model was used to estimate the association of volunteering with survival over a period of 10.9 years in 10 324 participants, while controlling for selected confounders. To investigate effect modification by disability, the analyses were repeated in participants with and without self-reported functional disabilities. RESULTS: Volunteering was associated with a reduced probability of death from all causes in univariate analyses (HR=0.65, CI 0.58 to 0.73, p

The aim of this study was to determine whether frailty in older adults is associated with the risk of subsequent dementia. A total of 8,722 older adults from the English Longitudinal Study of Ageing were followed-up every two years until they reported a diagnosis of dementia, died, or were right censored. Frailty was defined using a frailty index comprised of 47 health deficits. To test if cognitive function influences the relationship between frailty and incident dementia, the analyses were repeated according to lower or upper three quartiles of baseline cognitive function. Competing risks regression and Cox proportional hazard models were used to evaluate whether the degree of baseline frailty was associated with incident dementia. Compared with non-frail participants, pre-frail (HR: 1.51 95%CI [1.12–2.02]) and frail participants (HR: 1.73 95%CI [1.22–2.43]) had a higher risk of developing dementia, after adjustment for covariates. The association between frailty and incident dementia was significant for adults in the upper three quartiles of global cognitive function (HR: 3.48 95%CI [1.98–6.12]), but not for adults who were in the lowest quartile of cognitive function (HR: 1.13 95%CI [0.74–1.71]). Frailty should be monitored alongside cognitive functioning when assessing risk factors for dementia in older adults.

The work was supported by the National Institute on Aging in the United States (grants 2RO1AG7644-01A1 and 2RO1AG017644) and a consortium of UK government departments coordinated by the Office for National Statistics. Background: Frail older adults are heavy users of health and social care. In order to reduce the costs associated with frailty in older age groups, safe and cost-effective strategies are required that will reduce the incidence and severity of frailty. Objective: We investigated whether self-reported intensity of physical activity (sedentary, mild, moderate or vigorous) performed at least once a week can significantly reduce trajectories of frailty in older adults who are classified as non-frail at baseline (Rockwood’s Frailty Index [FI] ≤ 0.25). Methods: Multi-level growth curve modelling was used to assess trajectories of frailty in 8649 non-frail adults aged 50 and over and according to baseline self-reported intensity of physical activity. Frailty was measured in five-year age cohorts based on age at baseline (50–54; 55–59; 60–64; 65–69; 70–74; 75–79; 80+) on up to 6 occasions, providing an average of 10 years of follow-up. All models were adjusted for baseline sex, education, wealth, cohabitation, smoking, and alcohol consumption. Results: Compared with the sedentary reference group, mild physical activity was insufficient to significantly slow the progression of frailty, moderate physical activity reduced the progression of frailty in some age groups (particularly ages 65 and above) and vigorous activity significantly reduced the trajectory of frailty progression in all older adults. Conclusion: Healthy non-frail older adults require higher intensities of physical activity for continued improvement in frailty trajectories. Publisher PDF

Improved understanding of predictors of frailty is key to delaying its onset. Yet, few studies have examined whether early-life socioeconomic position (SEP) predicts frailty in midlife. In the 1958 British Birth Cohort (n=7601), we examined (i) associations between early-life SEP and frailty at 50y and (ii) whether associations were due to continuities in disadvantage into mid-adulthood. Frailty was measured using an index composed of 37 health-deficits. Associations between early-life SEP and frailty were examined using linear regression. Lower early-life SEP was associated with higher frailty, e.g. compared to professional/managerial class, the frailty index was higher by 3.09% (95% CI:-0.65%, 6.84%) for skilled non-manual, 10.8% (8.20%, 13.4%) for skilled manual and 14.2% (11.1%, 17.2%) for partly skilled/unskilled. After adjustment for adult disadvantage, the trend remained, albeit weaker. Findings suggest that interventions in mid-adulthood targeted to those exposed to early-life disadvantage could reduce the risk of developing frailty when entering later life.

Associations between obesity and physical inactivity are bi-directional. Both are associated with physical functioning (PF) but whether obesity influences PF via inactivity is unknown. We investigated whether mid-adult obesity trajectories were associated with subsequent PF and mediated by inactivity in the 1946 National Survey of Health and Development (1946-NSHD; N=2,427) and the 1958 National Child Development Study (1958-NCDS; N=8,674). Estimated randomised-interventional-analogue natural direct (rNDE), indirect (rNIE) and total (rTE=rNDExrNIE) effects of obesity trajectories on PF via inactivity are expressed as risk ratios. In 1946-NSHD, rTE of incident obesity at 43y (vs never) on poor PF=2.32(1.13,3.51); at 53y=1.53(0.91,2.15). rNIEs via inactivity were 1.02(0.97,1.07) and 1.02(0.99,1.04) respectively. Estimated rTE of persistent obesity from 36y=2.91(1.14,4.69), with rNIE of 1.03(0.96,1.10). Longer obesity duration was associated with increased risk of poor PF. Inactivity played a small mediating role. Findings reinforce the importance of preventing and delaying obesity onset to protect against poor PF.

Background Child neglect and abuse are not uncommon. Both are associated with deleterious outcomes in adulthood, but there is sparse evidence on the association between such trauma and premature adult mortality. We aimed to establish whether different types of child maltreatments were associated with all-cause mortality in mid-adulthood and examined potential intermediaries of this association. Methods Using the 1958 British birth cohort (n=9310), we examined associations between child neglect (prospectively recorded at years 7 and 11 of age) and abuse (physical, psychological, witnessing and sexual; self-reported at years 44–45 of age) with all-cause mortality, using Cox proportional hazard models adjusted for early-life covariates and other maltreatment types. We tested interactions between each maltreatment type and sex; there was little evidence of effect modification (pinteraction>0·001), hence models also adjust for sex. Mortality follow-up was between 2002–03 and December 2016 (participants aged 44–45 to 58 years). Death was ascertained from the National Health Service Central Register (n=296) or from survey updates (n=16). Potential intermediaries included: adult social factors, health behaviours, adiposity, mental health, cardiometabolic markers, and growth (height) at years 7 to 45 of age. Missing data were imputed via multiple imputation. Findings Child maltreatment prevalence varied from 1·6% (n=149; sexual abuse) to 11% (n=1000; physiological abuse); 77% (n=6536) reported no maltreatment. Neglect and abuse (physical and sexual) were associated with increased risk of premature death, independent of covariates and other maltreatment types; adjusted hazard ratios (HRs) were 1·47 (95% CI 1·05–2·05) for neglect, 1·73 (1·10–2 ·71) for physical abuse, and 2·60 (1·49–4·52) for sexual abuse. Associations for neglect and physical abuse disappeared after adjustment for adult health behaviours, and, for neglect only, social factors; other intermediaries had little effect on these associations. Sexual abuse associations were largely unexplained by examined intermediaries. Risk of all-cause mortality increased with the number of maltreatments (versus none): adjusted HRs were 1·44 (1·07–1·93) for one maltreatment and 2·04 (1·45–2·87) for at least two maltreatments. Interpretation Child neglect and physical and sexual abuse are associated with increased risk of premature mortality in mid-adulthood. Our findings highlight the importance of preventing specific child maltreatments and of supporting survivors to potentially mitigate differences in premature mortality. Child abuse was reported retrospectively and estimated associations for sexual abuse might be imprecise due to low prevalence. However, child neglect, potential confounders, and mediators were ascertained prospectively. Funding US National Institute on Aging, the UK Economic and Social Research Council, the UK Biotechnology and Biological Sciences Research Council, and the UK National Institute for Health Research Biomedical Research Centre.

Background Physical functioning (PF) from mid-adulthood is important for maintaining independence and is linked to better health outcomes. Studies have linked obesity to poor PF; however, they have typically been cross-sectional, limited to two timepoints, or relied on retrospectively recalled height and weight. We aimed to establish associations between physical functioning at age 50 years and birthweight and body-mass index (BMI) across the life-course; BMI gains at specific life stages; and duration of obesity. Methods The 1958 birth cohort includes all individuals born in 1 week, in March, 1958, across Britain. BMI was calculated (4173 males, 4501 females) using height and weight measured at school (ages 7, 11, 16 years) or in participants' homes (33, 45) or were self-reported (23, 50). Primary outcome (required to be included in this study) was PF at 50 years, assessed via postal questionnaire with the validated PF subscale of the Short Form 36 Health Survey; the lowest sex-specific tenth percentile were defined as having poor PF. Missing data were imputed via multiple imputation. Associations were examined with logistic regression, and adjusted for social class, education, and health behaviours. Ethics approval and informed consent was obtained from participants at various ages. For the 50 year survey, ethics approval was provided by the London Multi-centre Research Ethics Committee (ref 08/H0718/29). Findings Birthweight was not associated with PF. BMI at all ages from 11 years was associated with poor PF (eg, in males, adjusted odds ratio [OR] for poor PF per SD increase in BMI was 1·13 (95% CI 1·02–1.25, p=0·018) at 11 years and 1·34 (1·22–1·47, p Interpretation Study strengths include the large nationally representative cohort followed from birth and prospective measures of BMI and PF, though PF was self-reported. BMI and BMI gains from adolescence were associated with mid-adult PF. A particularly novel finding relates to duration of obesity, with earlier obesity onset associated with increased risk of poor PF, highlighting the importance of maintaining a healthy BMI from early life to mitigate the risk of poor PF in mid-adulthood. Funding Department of Health Policy Research Programme through the Public Health Research Consortium.