Lower weight is usually considered advantageous to health, yet weight
loss has been associated with increased mortality. An explanation for
this paradox might be that the benefits of weight loss may depend on w
hether the loss is intentional or unintentional. The authors investiga
ted whether intentional and unintentional weight loss differed in thei
r associations with known risk factors for morbidity and mortality in
a nationally representative sample of the US population, The sample co
nsisted of 9,144 persons, aged 45 years and older, who answered questi
ons regarding I-year weight change in the diabetes risk factor Current
Health Topic of the 1989 National Health interview Survey (NHIS), Sta
tistical analyses incorporated the sample weights and characteristics
of the survey design, Relative to a common referent group, the factors
associated with weight loss differed depending on whether the loss wa
s defined as intentional loss, as unintentional loss, or regardless of
intention, Restricting analysis to the 1,999 persons who lost weight,
unintentional relative to intentional weight loss was significantly (
p < 0.05) associated with older age, poorer health status, smoking, lo
wer body mass index, and, in men only, widowhood and less education, T
hus, unintentional weight loss may serve as a marker for factors that
characterize persons at greater risk of mortality than persons undergo
ing intentional weight loss, Also, intention to lose weight may help c
larify the relation between weight loss and mortality that, to this po
int, has shown counterintuitive results. Studies of the relation betwe
en weight loss and mortality should incorporate intention as a factor
in the analysis.