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Varying adulthood weight linked to all-cause, heart disease mortality
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Weight change across adulthood, even weight loss in later life, may increase an individual’s risk for all-cause and CV-related mortality, according to a study published in BMJ.
Adults who moved from the nonobese to obese (BMI 30 kg/m2) between young adulthood (aged 25 years) and middle adulthood (10 years before baseline; all participants were aged at least 40 years at baseline) experienced a 22% greater risk for all-cause mortality (HR = 1.22; 95% CI, 1.11-1.33) and 49% greater risk for heart disease mortality (HR = 1.49; 95% CI, 1.21-1.83) compared with individuals who remained nonobese.
Researchers also found that individuals who changed from an obese to nonobese BMI during this period did not have a significant association with mortality risk.
However, changing from obese to nonobese between middle adulthood (mean age, 47 years) and late adulthood (mean age, 57 years) was associated with an increased risk for all-cause mortality (HR = 1.3; 95% CI, 1.16-1.45) and heart disease mortality (HR = 1.48; 95% CI, 1.14-1.92), but moving from nonobese to obese during this period was not significantly associated with mortality risk, according to the study.
In other findings, researchers observed that obesity throughout adulthood was consistently associated with increased risk for all-cause mortality from:
- young to middle adulthood (HR = 1.72; 95% CI, 1.52-1.95);
- young to late adulthood (HR = 1.61; 95% CI, 1.41-1.84); and
- middle to late adulthood (HR = 1.2; 95% CI, 1.09-1.32).
“Weight loss from middle age to elderly was also related to higher mortality risk. This surprised me, but it was not totally unexpected,” An Pan, PhD, professor and assistant dean of the School of Public Health at Tongji Medical College, Huazhong University of Science and Technology in Hubei, China, told Healio. “Many cohort studies have shown similar results. The weight-loss story is more complicated because we do not know whether the weight loss was intentional or unintentional. Many cases of unintentional weight loss could be due to preclinical conditions, such as cancer, diabetes, etc, which are related to higher mortality risk. Trying to lose weight and maintaining that weight loss is not easy and people may suffer from weight cycling. In addition, people may choose different ways to lose weight and some of the methods may not be healthy and could be detrimental to health. Furthermore, those who wanted to lose weight were mostly those who were overweight or obese at the younger age.”
Researchers also found that there were no significant associations between weight change across adulthood and cancer mortality, according to the study.
“Young adulthood is a critical period when weight gain (mostly with body fat increase) is common,” Pan said in an interview. “Moreover, adults gain weight more rapidly from young to middle adulthood compared with the period from middle to late adulthood, when weight begins to stabilize or even decrease. Therefore, monitoring weight change since young adulthood and preventing the middle-aged spread could have a major impact on the population health.”
Researchers analyzed all-cause and cause-specific mortality data of 36,051 individuals (mean age, 57 years; 53% women; 78% white; 20.9% current smokers; 10.3% with diabetes) from baseline until Dec. 31, 2015. Using measured body weight and height at baseline and recalled weight at young adulthood and middle adulthood, researchers aimed to determine the association between weight changes across adulthood and all-cause and cause specific mortality, using data from National Health and Nutrition Examination Survey.
“Clinicians should not only evaluate the current weight status, but also the history of weight even from young adulthood. Talk about weight change (weight gain and weight loss) with the patients and, if necessary, involve other experts, eg, nutritionists, endocrinologists and experts in lifestyle modifications,” Pan told Healio. “More studies are still needed to have more repeat measures of weight in different life periods (we only had three time points in the study), include more data regarding the reasons for weight changes, lifestyle factors and social factors, etc, to better understand the issue.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Karol Watson, MD, PhD
Some of the findings of this study were expected. Individuals who maintained normal body weight from young to middle adulthood had the best health outcomes. And individuals who were obese from young to middle adulthood had the worse outcomes. What was less expected was the finding that individuals who began young adulthood obese and lost weight (so that they were no longer obese) had worse health outcomes as well, and that individuals who moved from normal weight to obesity did not have worse health outcomes. These data support what we’re beginning to recognize: preventing obesity in the first place is the key to avoiding long-term consequences. And that, once obese, losing weight may not only not improve health outcomes but may worsen them.
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