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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    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.


    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.