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Weight gain during adulthood worsens health outcomes later in life

Weight gain from early to middle adulthood was associated with increased risk for morbidity and mortality, and decreased the odds of healthy aging, according to new findings published in JAMA.

“It is unclear how weight gain during the transition from early to middle adulthood, when most weight gain occurs, relates to subsequent health consequences. Recommendations for preventing weight gain during adulthood are lacking in public health guidelines,” Yan Zheng, MD, PhD, from the department of nutrition at Harvard T.H. Chan School of Public Health, and colleagues wrote. “Compared with studies of attained weight or BMI, an investigation of weight change may better capture the effect of excess fat because it factors in individual differences in frame size and lean mass that are difficult to measure in population studies.”

To determine the link between weight gain from early to middle adulthood and health outcomes later in life, researchers performed a cohort analysis of 92,837 women enrolled in the Nurses’ Health Study and 25,303 men enrolled in the Health Professionals Follow-Up Study. The researchers asked men to recall weight at age 21 years and women to recall weight at age 18 years, and also report weight during middle adulthood at age 55 years.

Zheng and colleagues then followed participants beginning at age 55 years for incident disease outcomes, using medical records or National Death Index to confirm cardiovascular disease, cancer and death. Healthy aging outcome was defined as living without 11 chronic diseases, cognitive decline and physical limitations.

For type 2 diabetes, the adjusted incidence per 100,000 person-years was 207 among women who gained a moderate amount of weight compared with 110 among women who maintained a stable weight (absolute rate difference [ARD] per 100,000 person-years = 98; 95% CI, 72-127), and 258 compared with 147 among men (ARD = 111; 95% CI, 58-179).

For hypertension, the incidence was 3,415 among women who gained weight compared with 2,754 among women with stable weight (ARD = 662; 95% CI, 545-782) and 2,861 compared with 2,366 among men (ARD = 495; 95% CI, 281-726); for cardiovascular disease, the incidence was 309 vs. 248 among women (ARD = 61; 95% CI, 38-87) and 383 vs. 340 among men (ARD = 43; 95% CI, 14 to 109); for obesity-related cancer, the incidence was 452 vs. 415 among women (ARD = 37; 95% CI, 4-73) and 208 vs. 165 among men (ARD = 42; 95% CI, 0.5-94).

Analysis showed that among participants who gained a moderate amount of weight, 3,651 women (24%) and 2,405 men (37%) reached the healthy aging outcome, and 1,528 women (27%) and 989 men (39%) who maintained a stable weight achieved the healthy aging outcome. The more weight a person gained during adulthood, the more likely their risk for major chronic diseases and the less likely their odds for healthy aging later in life.

“In two large, long-term cohorts, weight gain from early to middle adulthood was associated with increased risk of morbidity and mortality, and decreased odds of achieving the composite healthy aging outcome among women and men, independent of weight at early adulthood,” Zheng and colleagues wrote. “These findings may help counsel patients regarding the risks of weight gain.”

In a corresponding editorial, William H. Dietz, MD, PhD, from Redstone Global Center for Prevention and Wellness at George Washington University’s Milken Institute School of Public Health, noted that in response to the increased risk of morbidity and mortality associated with weight gain among young adults, obesity prevention and control methods are necessary in this population. Although young adulthood is a period of risk for excessive weight gain, the challenge lies in diagnosing and implementing intervention because individuals aged 20 to 39 years “feel healthy: and thus do not always consider visiting a physician, he wrote.

“Reducing and preventing obesity and excessive weight gain in young adults provide a new target, and one that could offer an effective transgenerational approach for prevention,” Dietz wrote. – by Savannah Demko

Disclosure s: Zheng and colleagues report no relevant financial disclosures. Dietz reports serving on a scientific advisory board for Weight Watchers, serving as a consultant to RTI and receiving grant support from Bridgespan.