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Benefits and Adverse Effects of Weight Loss: Observations from the Framingham Study

Millicent Higgins, MD; Ralph D'Agostino, MD; William Kannel, MD; and Janet Cobb, MD
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From the National Heart, Lung, and Blood Institute, Bethesda, Maryland; and Boston University, Boston, Massachusetts. Requests for Reprints: Millicent Higgins, MD, Department of Epidemiology and Biometry, National Heart, Lung, and Blood Institute, 2C08 Federal Building, 7550 Wisconsin Avenue, Bethesda, MD 20892.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(7_Part_2):758-763. doi:10.7326/0003-4819-119-7_Part_2-199310011-00025
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Objective: To identify the benefits and adverse effects of weight loss.

Design: Longitudinal, epidemiologic study in a defined population.

Participants: Men and women (n = 2500) who were between 35 and 54 years old at baseline, followed for 20 years in Framingham, Massachusetts.

Measurements: Height, weight, lipid levels, blood pressure, smoking status, diet, physical activity, prevalent and incident cardiovascular disease, diabetes, other diseases, and mortality rate were assessed.

Results: Compared with those whose body mass index (BMI) or weight changed least, men and women who lost weight during a 10-year period were older, heavier, and had higher blood pressures and cholesterol levels initially but had the smallest gains in blood pressure and cholesterol levels. However, rates of cigarette smoking were higher, and rates of smoking cessation were lower. During 20 years of further follow-up, death rates were highest in those whose BMI decreased and in those with the highest BMI at study entry. Relative risks for death from cardiovascular disease, coronary heart disease, and all causes were significantly greater by 33% to 61% in men whose BMI decreased after adjusting for age and risk factors for cardiovascular disease. In women, weight loss and weight gain were associated with higher relative risks for cardiovascular disease and coronary heart disease, but only the 38% increase in total mortality rate among women who lost weight was statistically significant after adjusting for age.

Conclusions: Weight loss was associated with improvements in blood pressure and cholesterol levels but also with continued cigarette smoking, prevalent and incident cardiovascular disease, diabetes mellitus, other diseases, and higher death rates. Leanness and maintenance of stable weight were beneficial to risk factors, and to the prevention of morbidity, and death.


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Figure 1.
Mean body mass index at examinations 1 through 18.

Framingham men and women between 35 and 54 years old at examination 4. *Age-specific measure.

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Figure 2.
Death rates by body mass index over time and at baseline.

Framingham men and women between 35 and 54 years old at baseline. CHD = coronary heart disease; CVD = cardiovascular disease. Tertile 1 (hatched), tertile 2 (black), tertile 3 (shaded).

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