Association of Weight Loss Between Early Adulthood and Midlife With All-Cause Mortality Risk in the US | Lifestyle Behaviors | JAMA Network Open | JAMA Network
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1.
Flegal  KM, Carroll  MD, Ogden  CL, Curtin  LR.  Prevalence and trends in obesity among US adults, 1999-2008.   JAMA. 2010;303(3):235-241. doi:10.1001/jama.2009.2014 PubMedGoogle ScholarCrossref
2.
NCD Risk Factor Collaboration (NCD-RisC).  Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants.   Lancet. 2016;387(10026):1377-1396. doi:10.1016/S0140-6736(16)30054-X PubMedGoogle ScholarCrossref
3.
Lee  JM, Pilli  S, Gebremariam  A,  et al.  Getting heavier, younger: trajectories of obesity over the life course.   Int J Obes (Lond). 2010;34(4):614-623. doi:10.1038/ijo.2009.235 PubMedGoogle ScholarCrossref
4.
Aune  D, Sen  A, Prasad  M,  et al.  BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants.   BMJ. 2016;353:i2156. doi:10.1136/bmj.i2156PubMedGoogle ScholarCrossref
5.
Cohen  SS, Signorello  LB, Cope  EL,  et al.  Obesity and all-cause mortality among black adults and white adults.   Am J Epidemiol. 2012;176(5):431-442. doi:10.1093/aje/kws032 PubMedGoogle ScholarCrossref
6.
Flegal  KM, Graubard  BI, Williamson  DF, Gail  MH.  Excess deaths associated with underweight, overweight, and obesity.   JAMA. 2005;293(15):1861-1867. doi:10.1001/jama.293.15.1861 PubMedGoogle ScholarCrossref
7.
Whitlock  G, Lewington  S, Sherliker  P,  et al; Prospective Studies Collaboration.  Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.   Lancet. 2009;373(9669):1083-1096. doi:10.1016/S0140-6736(09)60318-4 PubMedGoogle ScholarCrossref
8.
Afshin  A, Forouzanfar  MH, Reitsma  MB,  et al; GBD 2015 Obesity Collaborators.  Health effects of overweight and obesity in 195 countries over 25 years.   N Engl J Med. 2017;377(1):13-27. doi:10.1056/NEJMoa1614362 PubMedGoogle ScholarCrossref
9.
Zheng  Y, Manson  JE, Yuan  C,  et al.  Associations of weight gain from early to middle adulthood with major health outcomes later in life.   JAMA. 2017;318(3):255-269. doi:10.1001/jama.2017.7092 PubMedGoogle ScholarCrossref
10.
Shimazu  T, Kuriyama  S, Ohmori-Matsuda  K, Kikuchi  N, Nakaya  N, Tsuji  I.  Increase in body mass index category since age 20 years and all-cause mortality: a prospective cohort study (the Ohsaki Study).   Int J Obes (Lond). 2009;33(4):490-496. doi:10.1038/ijo.2009.29 PubMedGoogle ScholarCrossref
11.
Adams  KF, Leitzmann  MF, Ballard-Barbash  R,  et al.  Body mass and weight change in adults in relation to mortality risk.   Am J Epidemiol. 2014;179(2):135-144. doi:10.1093/aje/kwt254 PubMedGoogle ScholarCrossref
12.
Chen  C, Ye  Y, Zhang  Y, Pan  X-F, Pan  A.  Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study.   BMJ. 2019;367:l5584. doi:10.1136/bmj.l5584 PubMedGoogle ScholarCrossref
13.
Goldstein  DJ.  Beneficial health effects of modest weight loss.   Int J Obes Relat Metab Disord. 1992;16(6):397-415.PubMedGoogle Scholar
14.
Corrada  MM, Kawas  CH, Mozaffar  F, Paganini-Hill  A.  Association of body mass index and weight change with all-cause mortality in the elderly.   Am J Epidemiol. 2006;163(10):938-949. doi:10.1093/aje/kwj114 PubMedGoogle ScholarCrossref
15.
Pamuk  ER, Williamson  DF, Serdula  MK, Madans  J, Byers  TE.  Weight loss and subsequent death in a cohort of U.S. adults.   Ann Intern Med. 1993;119(7, pt 2):744-748. doi:10.7326/0003-4819-119-7_Part_2-199310011-00023PubMedGoogle ScholarCrossref
16.
Hirko  KA, Kantor  ED, Cohen  SS, Blot  WJ, Stampfer  MJ, Signorello  LB.  Body mass index in young adulthood, obesity trajectory, and premature mortality.   Am J Epidemiol. 2015;182(5):441-450. doi:10.1093/aje/kwv084 PubMedGoogle ScholarCrossref
17.
Lee  I-M, Paffenbarger  RS  Jr.  Is weight loss hazardous?   Nutr Rev. 1996;54(4, pt 2):S116-S124. doi:10.1111/j.1753-4887.1996.tb03906.xPubMedGoogle ScholarCrossref
18.
Peeters  A, Barendregt  JJ, Willekens  F, Mackenbach  JP, Al Mamun  A, Bonneux  L; NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group.  Obesity in adulthood and its consequences for life expectancy: a life-table analysis.   Ann Intern Med. 2003;138(1):24-32. doi:10.7326/0003-4819-138-1-200301070-00008 PubMedGoogle ScholarCrossref
19.
Stokes  A, Preston  SH.  How dangerous is obesity? issues in measurement and interpretation.   Popul Dev Rev. 2016;42(4):595-614. doi:10.1111/padr.12015 PubMedGoogle ScholarCrossref
20.
National Center for Health Statistics. The linkage of National Center for Health Statistics survey data to the National Death Index—2015 Linked Mortality File (LMF): methodology overview and analytic considerations. Updated April 11, 2019. Accessed March 22, 2019. https://www.cdc.gov/nchs/data/datalinkage/LMF2015_Methodology_Analytic_Considerations.pdf
21.
World Health Organization. Obesity. Accessed November 25, 2019. https://www.who.int/topics/obesity/en/
22.
Schoenfeld  D.  Partial residuals for the proportional hazards regression model.   Biometrika. 1982;69(1):239–241. doi:10.1093/biomet/69.1.239 Google ScholarCrossref
23.
Stokes  A, Collins  JM, Grant  BF,  et al.  Obesity progression between young adulthood and midlife and incident diabetes: a retrospective cohort study of US adults.   Diabetes Care. 2018;41(5):1025-1031. doi:10.2337/dc17-2336 PubMedGoogle ScholarCrossref
24.
Newson  RB.  Attributable and unattributable risks and fractions and other scenario comparisons.   The Stata Journal. 2013;13(4):672–98. doi:10.1177/1536867X1301300402 Google ScholarCrossref
25.
Nilsson  PM, Nilsson  J-Å, Hedblad  B, Berglund  G, Lindgärde  F.  The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese.   J Intern Med. 2002;252(1):70-78. doi:10.1046/j.1365-2796.2002.01010.x PubMedGoogle ScholarCrossref
26.
Alley  DE, Metter  EJ, Griswold  ME,  et al.  Changes in weight at the end of life: characterizing weight loss by time to death in a cohort study of older men.   Am J Epidemiol. 2010;172(5):558-565. doi:10.1093/aje/kwq168 PubMedGoogle ScholarCrossref
27.
Myrskylä  M, Chang  VW.  Weight change, initial BMI, and mortality among middle- and older-aged adults.   Epidemiology. 2009;20(6):840-848. doi:10.1097/EDE.0b013e3181b5f520 PubMedGoogle ScholarCrossref
28.
Kuh  D, Ben-Shlomo  Y, Lynch  J, Hallqvist  J, Power  C.  Life course epidemiology.   J Epidemiol Community Health. 2003;57(10):778-783. doi:10.1136/jech.57.10.778 PubMedGoogle ScholarCrossref
29.
Abdullah  A, Wolfe  R, Stoelwinder  JU,  et al.  The number of years lived with obesity and the risk of all-cause and cause-specific mortality.   Int J Epidemiol. 2011;40(4):985-996. doi:10.1093/ije/dyr018 PubMedGoogle ScholarCrossref
30.
Everhart  JE, Pettitt  DJ, Bennett  PH, Knowler  WC.  Duration of obesity increases the incidence of NIDDM.   Diabetes. 1992;41(2):235-240. doi:10.2337/diab.41.2.235 PubMedGoogle ScholarCrossref
31.
Stokes  A, Ni  Y.  Validating a summary measure of weight history for modeling the health consequences of obesity.   Ann Epidemiol. 2016;26(12):821-826.e2. doi:10.1016/j.annepidem.2016.10.005 PubMedGoogle ScholarCrossref
32.
Casey  VA, Dwyer  JT, Berkey  CS, Coleman  KA, Gardner  J, Valadian  I.  Long-term memory of body weight and past weight satisfaction: a longitudinal follow-up study.   Am J Clin Nutr. 1991;53(6):1493-1498. doi:10.1093/ajcn/53.6.1493 PubMedGoogle ScholarCrossref
33.
Perry  GS, Byers  TE, Mokdad  AH, Serdula  MK, Williamson  DF.  The validity of self-reports of past body weights by US adults.   Epidemiology. 1995;6(1):61-66. doi:10.1097/00001648-199501000-00012 PubMedGoogle ScholarCrossref
34.
Norgan  NG, Cameron  N.  The accuracy of body weight and height recall in middle-aged men.   Int J Obes Relat Metab Disord. 2000;24(12):1695-1698. doi:10.1038/sj.ijo.0801463 PubMedGoogle ScholarCrossref
35.
Olivarius  NF, Andreasen  AH, Løken  J.  Accuracy of 1-, 5- and 10-year body weight recall given in a standard questionnaire.   Int J Obes Relat Metab Disord. 1997;21(1):67-71. doi:10.1038/sj.ijo.0800365 PubMedGoogle ScholarCrossref
36.
Berrington de Gonzalez  A, Hartge  P, Cerhan  JR,  et al.  Body-mass index and mortality among 1.46 million white adults.   N Engl J Med. 2010;363(23):2211-2219. doi:10.1056/NEJMoa1000367 PubMedGoogle ScholarCrossref
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    Original Investigation
    Public Health
    August 14, 2020

    Association of Weight Loss Between Early Adulthood and Midlife With All-Cause Mortality Risk in the US

    Author Affiliations
    • 1Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
    • 2University of North Carolina Gillings School of Public Health, Chapel Hill
    • 3Epidemiology, Medical Devices, Johnson & Johnson Inc, New Brunswick, New Jersey
    • 4Ethicon Inc, Cincinnati, Ohio
    • 5Population Studies Center, University of Pennsylvania, Philadelphia
    • 6Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
    • 7Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
    JAMA Netw Open. 2020;3(8):e2013448. doi:10.1001/jamanetworkopen.2020.13448
    Key Points español 中文 (chinese)

    Question  Is weight loss between early adulthood and midlife associated with reduced mortality risk later in life compared with persistent obesity?

    Findings  In this combined, repeated cross-sectional analysis of a nationally representative cohort of 24 205 US adults followed up for a mean of 10.7 years, participants who lost weight from an obese body mass index in early adulthood to overweight in midlife had a 54% reduction in mortality risk relative to those who maintained an obese body mass index. An estimated 3.2% of early deaths could have been avoided if those who maintained an obese BMI instead lost weight to an overweight BMI by midlife.

    Meaning  Findings from this study suggest that population-based approaches to preventing weight gain and treating obesity early in life may have important mortality reduction benefits.

    Abstract

    Importance  Describing potential mortality risk reduction associated with weight loss between early adulthood and midlife is important for informing primary and secondary prevention efforts for obesity.

    Objective  To examine the risk of all-cause mortality among adults who lost weight between early adulthood and midlife compared with adults who were persistently obese over the same period.

    Design, Setting, and Participants  Combined repeated cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey III (1988-1994) and continuous waves collected in 2-year cycles between 1999 and 2014. The data analysis was conducted from February 10, 2019, to April 20, 2020. Individuals aged 40 to 74 years at the time of survey (baseline) were included in the analyses (n = 24 205).

    Exposures  Weight history was assessed by self-reported weight at age 25 years, at 10 years before baseline (midlife: mean age, 44 years; interquartile range, 37-55), and measured weight at baseline. Body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) at each time was categorized as normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Weight change patterns were assessed from age 25 years (early adulthood) to 10 years before baseline (midlife).

    Main Outcomes and Measures  Incident all-cause mortality using linked data from the National Death Index.

    Results  Of the 24 205 participants, 11 617 were women (49.0%) and 11 567 were non-Hispanic White (76.9%). The mean (SD) BMI was 29.0 (6.1) at baseline. During a mean (SD) follow-up of 10.7 (7.2) years, 5846 deaths occurred. Weight loss from obese to overweight was associated with a 54% (hazard ratio, 0.46; 95% CI, 0.27-0.77) reduction in mortality risk compared with individuals with stable obesity between early adulthood and midlife. An estimated 3.2% (95% CI, 1.6%-4.9%) of early deaths could have been avoided if those who maintained an obese BMI instead lost weight to an overweight BMI by midlife. Overall, an estimated 12.4% (95% CI, 8.1%-16.5%) of early deaths may be attributable to having weight in excess of the normal BMI range at any point between early and mid-adulthood.

    Conclusions and Relevance  In this study, weight loss from obesity to overweight between early adulthood through midlife appeared to be associated with a mortality risk reduction compared with persistent obesity. These findings support the importance of population-based approaches to preventing weight gain across the life course and a need for greater emphasis on treating obesity early in life.

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