Journal of Community Health

, Volume 30, Issue 3, pp 153–165 | Cite as

THE ASSOCIATION BETWEEN WEIGHT FLUCTUATION AND MORTALITY: RESULTS FROM A POPULATION-BASED COHORT STUDY

  • Vanessa A. Diaz
  • Arch G. Mainous
  • Charles J. Everett
Article

Abstract

Previous studies evaluating the association between weight fluctuation and mortality are limited and have conflicting results. This study will further evaluate the association between weight fluctuation and mortality in a nationally representative cohort by performing survival analysis of NHANES I and NHANES I Epidemiologic Follow-up Study (n=8479; weighted sample=68,200,905). This cohort was followed from 1971 to 1992 and categorized using weight change over five time points into stable non-obese, stable obese, weight gain, weight loss and weight fluctuation groups. All-cause mortality (ACM) and cardiovascular mortality (CM) were evaluated. Respondents with weight fluctuation had higher ACM (HR: 1.83, 95% CI: 1.25–2.69) and CM hazards ratios (HR: 1.86, 95% CI: 1.10–3.15) than the stable non-obese group, even after controlling for pre-existing disease, initial BMI and excluding those in poor health or incapacitated. Increased mortality was also seen in the weight loss group (ACM HR: 3.36, 95% CI: 2.47–4.55), (CM HR 4.22, 95% CI: 2.60–6.84). The stable obese group did not have increased ACM, but did have increased CM prior to the exclusion of those in poor health or incapacitated. (HR: 2.17, 95% CI: 1.10–4.28). Weight fluctuation is associated with a higher risk of all-cause and cardiovascular disease mortality in the US population, even after adjustment for pre-existing disease, initial BMI and the exclusion of those in poor health or incapacitated. Thus, health care providers should promote a commitment to maintaining weight loss to avoid weight fluctuation and consider patients’ weight histories when assessing their risk status.

Keywords

weight fluctuation  weight cycling  mortality  cohort NHANES 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Serdula, MK, Mokdad, AH, Williamson, DF, Galuska, DA, Mendlein, JM, Heath, GW 1999Prevalence of attempting weight loss and strategies for controlling weight.JAMA28213531358Google Scholar
  2. Wing, RR, Hill, JO 2001Successful weight loss maintenance.Annu Rev Nutr21323341Google Scholar
  3. Crawford, D, Jeffery, RW, French, SA 2000Can anyone successfully control their weight? Findings of a three year community-based study of men and womenInt J Obes Relat Metab Dis2411071110Google Scholar
  4. Morris, RD, Rimm, AA 1992Long-term weight fluctuation and non-insulin-dependent diabetes mellitus in white women.Ann Epidemiol2657664Google Scholar
  5. Lissner, L, Andres, R, Muller, D, Shimokata, H 1990Body weight variability in men: metabolic rate, health and longevity.Int J Obes14373383Google Scholar
  6. Holbrook, TL, Barrett-Connor, E, Wingard, D 1989The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community.Int J Obes13723729Google Scholar
  7. Guagnano, MT, Pace-Palatti, V, Carrabs, C, Merlitti, D, Sensi, S 1999Weight fluctuations could increase blood pressure in android obese women.Clin Sci96677680Google Scholar
  8. Guagnano, MT, Ballone, E, Pace-Palitti, V, et, al 2000Risk factors for hypertension in obese women. The role of weight cyclingEur J Clin Nutr54356360Google Scholar
  9. Olson, MB, Kelsey, SF, Bittner, V,  et al. 2000Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect: a report from the NHLBI-sponsored WISE study. Women’s Ischemia Syndrome Evaluation Study GroupJ Am Coll Cardiol3615651571Google Scholar
  10. Kajioka, T, Tsuzuku, S, Shimokata, H, Sato, Y 2002Effects of intentional weight cycling on non-obese young women.Metabolism51149154Google Scholar
  11. Dulloo, AG, Jacquet, J, Girardier, L 1997Poststarvation hyperphagia and body fat overshooting in humans: a role for feedback signals from lean and fat tissues.Am J Clin Nutr65717723Google Scholar
  12. Weyer, C, Walford, RL, Harper, IT,  et al. 2000Energy metabolism after 2 y of energy restriction: the Biosphere 2 experiment.Am J Clin Nutr72946953Google Scholar
  13. Barac-Nieto, M, Spurr, GB, Lotero, H, Maksud, MG, Dahners, HW 1997Body composition during nutritional repletion of severely undernourished men.Am J Clin Nutr65717723Google Scholar
  14. Dulloo, AG, Jacquet, J, Montani, J-P 2002Pathways from weight fluctuations to metabolic diseases: focus on maladaptive thermogenesis during catch-up fat.Int J Obes26S46S57Google Scholar
  15. Reynolds, MW, Fredman, L, Langenberg, P, Magaziner, J 1999Weight, weight change, mortality in a random sample of older community-dwelling womenJ Am Geriatr Soc4714091414Google Scholar
  16. Hanson, RL, Jacobsson, LT, McCance, DR,  et al. 1996Weight fluctuation, mortality and vascular disease in Pima Indians.Int J Obes20463471Google Scholar
  17. Blair, SN, Shaten, J, Brownell, K, Collins, G, Lissner, L 1993Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention TrialAnn Intern Med419749757Google Scholar
  18. Peters, ET, Seidell, JC, Menotti, A,  et al. 1995Changes in body weight in relation to mortality in 6441 European middle-aged men: the Seven Countries Study.Int J Obes Relat Metab Dis19862868Google Scholar
  19. Hamm, P, Shekelle, RB, Stamler, J 1989Large fluctuations in body weight during young adulthood and twenty-five-year risk of coronary death in menAm J Epidemiol129312318Google Scholar
  20. Lissner, L, Odell, PM, D’Agostino, RB,  et al. 1991Variability of body weight and health outcomes in the Framingham population.N Eng J Med32418391844Google Scholar
  21. Stevens, J, Lissner, L 1990Body weight variability and mortality in the Charleston Heart Study.(letter) Int J Obes14385386Google Scholar
  22. Iribarren, C, Sharp, DS, Burchfiel, CM, Petrovitch, H 1995Association of weight loss and weight fluctuation with mortality among Japanese American men.N Eng J Med333686692Google Scholar
  23. Wannamethee, SG, Shaper, AG, Walker, M 2002Weight change, weight fluctuation, and mortality.Arch Intern Med16225752580Google Scholar
  24. National Institute of Health1998Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence ReportUS Dept of Health and Human ServicesWashington, DC9840831998 NIH PublicationGoogle Scholar
  25. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR 1987A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis40373383CrossRefPubMedGoogle Scholar
  26. Schoenfeld, D 1982Partial residuals for the proportional hazards model.Biometrika695155Google Scholar
  27. Williamson, DF, Pamuk, E, Thun, M, Flanders, D, Byers, T, Heath, C 1995Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40–64 years.Am J Epidemiol14111281141PubMedGoogle Scholar
  28. Yaari, S, Goldbourt, U 1998Voluntary and involuntary weight loss: associations with long term mortality in 9,228 middle-aged and elderly men.Am J Epidemiol1484655Google Scholar
  29. Rhoads, GG, Kagan, A 1983The relation of coronary disease, stroke, and mortality to weight in youth and in middle age.Lancet1492495Google Scholar
  30. Nawaz, H, Chan, W, Abdulrahman, M, Larson, D, Katz, DL 2001Self-reported weight and height: implications for obesity research.Am J Prev Med20294298Google Scholar
  31. Engstrom, JL, Paterson, SA, Doherty, A, Trabulsi, M, Speer, KL 2003Accuracy of self-reported height and weight in women: an integrative review of the literature.J Midwifery Womens Health48338345Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Vanessa A. Diaz
    • 1
  • Arch G. Mainous
    • 1
  • Charles J. Everett
    • 1
  1. 1.Department of Family MedicineMedical University of South CarolinaCharlestonUSA

Personalised recommendations