Edward W. Gregg, PhD; Robert B. Gerzoff, MS; Theodore J. Thompson, MS; David F. Williamson, PhD
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, firstname.lastname@example.org.
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.
Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates.
To examine the relationships among intention to lose weight, weight loss, and all-cause mortality.
Prospective cohort study using a probability sample of the U.S. population.
6391 overweight and obese persons (body mass index 25 kg/m2) who were at least 35 years of age.
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.
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).
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.
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.
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.
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.
Table 1. Characteristics of 6391 Overweight Persons, according to Weight Loss Intention and Reported Weight Change
Table 2. Hazard Rate Ratio of All-Cause Mortality by Weight Loss Intent and Actual Weight Loss
Eight-year cumulative mortality rates and corresponding hazard rate ratios by amount of intentional and unintentional weight loss.
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Gregg EW, Gerzoff RB, Thompson TJ, Williamson DF. Intentional Weight Loss and Death in Overweight and Obese U.S. Adults 35 Years of Age and Older. Ann Intern Med. 2003;138:383-389. doi: 10.7326/0003-4819-138-5-200303040-00007
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Published: Ann Intern Med. 2003;138(5):383-389.
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