Prospective Study of Intentional Weight Loss and Mortality in Never-Smoking Overweight US White Women Aged 40–64 Years

Abstract

Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of < 20 lb (< 9.1 kg) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.

Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice

“…94,95 The impact of weight loss on cardiovascular risk factors is greatest in subjects with impaired glucose tolerance, type 2 diabetes, or hypertension, because changes in risk factors are more likely in subjects with abnormal baseline levels, and this is consistent with findings from observational studies that intentional weight loss is associated with increased longevity but only in people with pre-existing disease. 96,97 We found, however, that these improvements may be intervention specific. Orlistat therapy was associated with a 5-10% decrease in LDL levels, which is comparable to a cholesterol-lowering diet.…”

Sustained improvement in blood lipids, coagulation, and fibrinolysis after major weight loss in obese subjects

“…In one large American observational cohort study, women with BMI around 30 kgam 2 had a relative risk (RR) of CHD death that was only 20% lower than that of women with BMI of around 35 kgam 2 (Manson et al, 1995). Another epidemiological study suggested that an intentional weight loss of 9.1 kg was associated with a 25% reduction in cardiovascular mortality (Williamson et al, 1995). The true CHD risk reduction caused by the average 13.6 kg weight loss of our volunteers might lie somewhere between 20 and 50%.…”

Recommendations for the nutritional management of patients with diabetes mellitus

“…Technical Review ± Nutritional management of diabetes mellitus TKK Ha and MEJ Lean Williamson et al, 1995). Longitudinal and actuarial evidence from diabetic individuals is not available to indicate an acceptable weight range different from the general population.…”