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Original Investigation
July 18, 2017

Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life

Author Affiliations
  • 1Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Now with Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
  • 3Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 4Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 5Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 6Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 7Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 8Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 9Section of Rheumatology, VA Boston Healthcare System, Boston, Massachusetts
JAMA. 2017;318(3):255-269. doi:10.1001/jama.2017.7092
Key Points

Question  What is the association of weight gain from early to middle adulthood with health outcomes later in life?

Findings  During a follow-up of 18 years in 92 837 US women and 15 years in 25 303 US men, compared with participants who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg), those who gained a moderate amount of weight (≥2.5-<10.0 kg) had increased incidence of type 2 diabetes (absolute rate difference/100 000 person-years of 98 in women and 111 in men), cardiovascular disease (61 in women), obesity-related cancer (37 in women and 42 in men), and mortality (51 among women who never smoked).

Meaning  Among women and men, moderate weight gain from early to middle adulthood was associated with significantly increased risk of major chronic diseases and mortality.

Abstract

Importance  Data describing the effects of weight gain across adulthood on overall health are important for weight control.

Objective  To examine the association of weight gain from early to middle adulthood with health outcomes later in life.

Design, Setting, and Participants  Cohort analysis of US women from the Nurses’ Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years).

Exposures  Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years).

Main Outcomes and Measures  Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment.

Results  A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to <10 kg) vs 110 among women who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg) (absolute rate difference [ARD] per 100 000 person-years, 98; 95% CI, 72 to 127) and 258 vs 147, respectively, among men (ARD, 111; 95% CI, 58 to 179); hypertension: 3415 vs 2754 among women (ARD, 662; 95% CI, 545 to 782) and 2861 vs 2366 among men (ARD, 495; 95% CI, 281 to 726); cardiovascular disease: 309 vs 248 among women (ARD, 61; 95% CI, 38 to 87) and 383 vs 340 among men (ARD, 43; 95% CI, −14 to 109); obesity-related cancer: 452 vs 415 among women (ARD, 37; 95% CI, 4 to 73) and 208 vs 165 among men (ARD, 42; 95% CI, 0.5 to 94). Among those who gained a moderate amount of weight, 3651 women (24%) and 2405 men (37%) achieved the composite healthy aging outcome. Among those who maintained a stable weight, 1528 women (27%) and 989 men (39%) achieved the composite healthy aging outcome. The multivariable-adjusted odds ratio for the composite healthy aging outcome associated with moderate weight gain was 0.78 (95% CI, 0.72 to 0.84) in women and 0.88 (95% CI, 0.79 to 0.97) in men. Higher amounts of weight gain were associated with greater risks of major chronic diseases and lower likelihood of healthy aging.

Conclusions and Relevance  In these cohorts of health professionals, weight gain during adulthood was associated with significantly increased risk of major chronic diseases and decreased odds of healthy aging. These findings may help counsel patients regarding the risks of weight gain.

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