Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 2;166(9):613-620.
doi: 10.7326/M16-1390. Epub 2017 Apr 4.

Weight History and All-Cause and Cause-Specific Mortality in Three Prospective Cohort Studies

Edward Yu  1 , Sylvia H Ley  1 , JoAnn E Manson  1 , Walter Willett  1 , Ambika Satija  1 , Frank B Hu  1 , Andrew Stokes  1
Affiliations

Weight History and All-Cause and Cause-Specific Mortality in Three Prospective Cohort Studies

Edward Yu et al. Ann Intern Med. .

Abstract

Background: The relationship between body mass index (BMI) and mortality is controversial.

Objective: To investigate the relationship between maximum BMI over 16 years and subsequent mortality.

Design: 3 prospective cohort studies.

Setting: Nurses' Health Study I and II and Health Professionals Follow-Up Study.

Participants: 225 072 men and women with 32 571 deaths observed over a mean of 12.3 years of follow-up.

Measurements: Maximum BMI over 16 years of weight history and all-cause and cause-specific mortality.

Results: Maximum BMIs in the overweight (25.0 to 29.9 kg/m2) (multivariate hazard ratio [HR], 1.06 [95% CI, 1.03 to 1.08]), obese I (30.0 to 34.9 kg/m2) (HR, 1.24 [CI, 1.20 to 1.29]), and obese II (≥35.0 kg/m2) (HR, 1.73 [CI, 1.66 to 1.80]) categories were associated with increases in risk for all-cause death. The pattern of excess risk with a maximum BMI above normal weight was maintained across strata defined by smoking status, sex, and age, but the excess was greatest among those younger than 70 years and never-smokers. In contrast, a significant inverse association between overweight and mortality (HR, 0.96 [CI, 0.94 to 0.99]) was observed when BMI was defined using a single baseline measurement. Maximum overweight was also associated with increased cause-specific mortality, including death from cardiovascular disease and coronary heart disease.

Limitation: Residual confounding and misclassification.

Conclusion: The paradoxical association between overweight and mortality is reversed in analyses incorporating weight history. Maximum BMI may be a useful metric to minimize reverse causation bias associated with a single baseline BMI assessment.

Primary funding source: National Institutes of Health.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Graph comparing hazard ratios for maximum BMI with 16 years of weight history and baseline BMI among all individuals.
FIGURE 2
FIGURE 2
Graph comparing hazard ratios for maximum BMI with 16 years of weight history and baseline BMI among never-smokers.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Jama. 2013;309(1):71–82. - PMC - PubMed
    1. FB Hu. Obesity Epidemiology. USA: Oxford University Press; 2008.
    1. Lawlor DA, Hart CL, Hole DJ, Davey Smith G. Reverse causality and confounding and the associations of overweight and obesity with mortality. Obesity (Silver Spring) 2006;14(12):2294–304. - PubMed
    1. Flegal KM, Kalantar-Zadeh K. Perspective: Overweight, mortality and survival. Obesity (Silver Spring, Md) 2013;21(9):1744–5. - PMC - PubMed
    1. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, et al. General and Abdominal Adiposity and Risk of Death in Europe. New England Journal of Medicine. 2008;359(20):2105–20. - PubMed