Article    Table of Contents                    Full Text of this article Free    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Gregg, E. W.    Williamson, D. F.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Intentional Weight Loss and Death in Overweight and Obese U.S. Adults 35 Years of Age and Older

Edward W. Gregg, PhD; Robert B. Gerzoff, MS; Theodore J. Thompson, MS; and David F. Williamson, PhD

4 March 2003 | Volume 138 Issue 5 | Pages 383-389

Background: Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates.

Objective: To examine the relationships among intention to lose weight, weight loss, and all-cause mortality.

Design: Prospective cohort study using a probability sample of the U.S. population.

Setting: Interviewer-administered survey.

Participants: 6391 overweight and obese persons (body mass index 25 kg/m²) who were at least 35 years of age.

Measurements: Intention to lose weight and weight change during the past year were assessed by self-report in 1989. Vital status was followed for 9 years. Hazard rate ratios (HRRs) were adjusted for age, sex, ethnicity, education, smoking, health status, health care utilization, and initial body mass index.

Results: Compared with persons not trying to lose weight and reporting no weight change, those reporting intentional weight loss had a 24% lower mortality rate (HRR, 0.76 [95% CI, 0.60 to 0.97]) and those with unintentional weight loss had a 31% higher mortality rate (HRR, 1.31 [CI, 1.01 to 1.70]). However, mortality rates were lower in persons who reported trying to lose weight than those in not trying to lose weight, independent of actual weight change. Compared with persons not trying to lose weight and reporting no weight change, persons trying to lose weight had the following HRRs: no weight change, 0.80 (CI, 0.65 to 0.99); gained weight, 0.94 (CI, 0.65 to 1.37); and lost weight, 0.76 (CI, 0.60 to 0.97).

Conclusions: Attempted weight loss is associated with lower all-cause mortality, independent of weight change. Self-reported intentional weight loss is associated with lower mortality rates, and weight loss is associated with higher mortality rates only if it is unintentional.

Editors' Notes Context Although being overweight is associated with many adverse health outcomes, observational studies of weight loss show associations between weight loss and increased mortality. This may be because these studies did not distinguish between intentional and unintentional weight loss. Contribution In a national survey of 6391 U.S. adults, people who were trying to lose weight had decreased mortality whether they lost weight or not. Lowest mortality was associated with modest intentional weight loss. People who lost weight unintentionally had increased mortality. Implications Weight loss has adverse associations with mortality only if it is unintentional. Trying to lose weight may have benefit even if people do not actually lose weight. –The Editors

 

Author and Article Information

From the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.

Grant Support: By the U.S. Centers for Disease Control and Prevention.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Edward W. Gregg, PhD, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-10, Atlanta, GA 30341; e-mail, edg7{at}cdc.gov.

Current Author Addresses: Drs. Gregg and Williamson, Mr. Gerzoff, and Mr. Thompson: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-10, Atlanta, GA 30341.

Author Contributions: Conception and design: E.W. Gregg, D.F. Williamson.

Analysis and interpretation of the data: E.W. Gregg, R.B. Gerzoff, T.J. Thompson.

Drafting of the article: E.W. Gregg.

Critical revision of the article for important intellectual content: E.W. Gregg, R.B. Gerzoff, T.J. Thompson, D.F. Williamson.

Final approval of the article: E.W. Gregg, R.B. Gerzoff, T.J. Thompson, D.F. Williamson.

Statistical expertise: R.B. Gerzoff, T.J. Thompson, D.F. Williamson.

Administrative, technical, or logistic support: E.W. Gregg, R.B. Gerzoff, T.J. Thompson

Collection and assembly of data: E.W. Gregg, R.B. Gerzoff.

Related articles in Annals:

Summaries for Patients
The Relationship between Intentional Weight Loss and Mortality

Annals 2003 138: I-56. [Full Text]  

This article has been cited by other articles:

				J. L. Locher, D. L. Roth, C. S. Ritchie, K. Cox, P. Sawyer, E. V. Bodner, and R. M. Allman Body Mass Index, Weight Loss, and Mortality in Community-Dwelling Older Adults J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2007; 62(12): 1389 - 1392. [Abstract] [Full Text] [PDF]

				P. Poirier, T. D. Giles, G. A. Bray, Y. Hong, J. S. Stern, F. X. Pi-Sunyer, and R. H. Eckel Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler. Thromb. Vasc. Biol., May 1, 2006; 26(5): 968 - 976. [Abstract] [Full Text] [PDF]

				P. Poirier, T. D. Giles, G. A. Bray, Y. Hong, J. S. Stern, F. X. Pi-Sunyer, and R. H. Eckel Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, February 14, 2006; 113(6): 898 - 918. [Abstract] [Full Text] [PDF]

				T. Hillier, A Fagot-Campagna, E Eschwege, S Vol, M Cailleau, B Balkau, and and the D.E.S.I.R. Study group Weight change and changes in the metabolic syndrome as the French population moves towards overweight: The D.E.S.I.R. Cohort Int. J. Epidemiol., February 1, 2006; 35(1): 190 - 196. [Abstract] [Full Text] [PDF]

				J. T. Gronniger A Semiparametric Analysis of the Relationship of Body Mass Index to Mortality Am J Public Health, January 1, 2006; 96(1): 173 - 178. [Abstract] [Full Text] [PDF]

				J. S. Lee, S. B Kritchevsky, T. B Harris, F. Tylavsky, S. M Rubin, and A. B Newman Short-term weight changes in community-dwelling older adults: the Health, Aging, and Body Composition Weight Change Substudy Am. J. Clinical Nutrition, September 1, 2005; 82(3): 644 - 650. [Abstract] [Full Text] [PDF]

				J. S. Lee, S. B. Kritchevsky, F. Tylavsky, T. Harris, E. M. Simonsick, S. M. Rubin, A. B. Newman, and for the Health ABC Study Weight Change, Weight Change Intention, and the Incidence of Mobility Limitation in Well-Functioning Community-Dwelling Older Adults J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2005; 60(8): 1007 - 1012. [Abstract] [Full Text] [PDF]

				S. G. Wannamethee, A. G. Shaper, and L. Lennon Reasons for Intentional Weight Loss, Unintentional Weight Loss, and Mortality in Older Men Arch Intern Med, May 9, 2005; 165(9): 1035 - 1040. [Abstract] [Full Text] [PDF]

				M. A. Schattner, H. J. Willis, A. Raykher, P. Brown, O. Quesada, B. Scott, and M. Shike Long-Term Enteral Nutrition Facilitates Optimization of Body Weight JPEN J Parenter Enteral Nutr, May 1, 2005; 29(3): 198 - 203. [Abstract] [Full Text] [PDF]

				S. Eilat-Adar, M. Eldar, and U. Goldbourt Association of Intentional Changes in Body Weight with Coronary Heart Disease Event Rates in Overweight Subjects Who Have an Additional Coronary Risk Factor Am. J. Epidemiol., February 15, 2005; 161(4): 352 - 358. [Abstract] [Full Text] [PDF]

				C. G. Solomon and R. G. Dluhy Bariatric Surgery -- Quick Fix or Long-Term Solution? N. Engl. J. Med., December 23, 2004; 351(26): 2751 - 2753. [Full Text] [PDF]

				J. S. Lee, S. B Kritchevsky, F. A Tylavsky, T. Harris, J. Everhart, E. M Simonsick, S. M Rubin, and A. B Newman Weight-loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change Am. J. Clinical Nutrition, August 1, 2004; 80(2): 466 - 474. [Abstract] [Full Text] [PDF]

				J.-M. Gaullier, J. Halse, K. Hoye, K. Kristiansen, H. Fagertun, H. Vik, and O. Gudmundsen Conjugated linoleic acid supplementation for 1 y reduces body fat mass in healthy overweight humans Am. J. Clinical Nutrition, June 1, 2004; 79(6): 1118 - 1125. [Abstract] [Full Text] [PDF]

				E. W. Gregg, R. B. Gerzoff, T. J. Thompson, and D. F. Williamson Trying to Lose Weight, Losing Weight, and 9-Year Mortality in Overweight U.S. Adults With Diabetes Diabetes Care, March 1, 2004; 27(3): 657 - 662. [Abstract] [Full Text] [PDF]

				Other articles noted Evid. Based Med., January 1, 2004; 9(1): 31 - 32. [Full Text] [PDF]

				C. Lorenzo, M. Okoloise, K. Williams, M. P. Stern, and S. M. Haffner The Metabolic Syndrome as Predictor of Type 2 Diabetes: The San Antonio Heart Study Diabetes Care, November 1, 2003; 26(11): 3153 - 3159. [Abstract] [Full Text] [PDF]

				S. Wong and D. Ciliska Intentional weight loss was associated with lower mortality, whereas unintentional weight loss was associated with increased mortality Evid. Based Nurs., October 1, 2003; 6(4): 121 - 121. [Full Text] [PDF]