Prospective study of intentional weight loss and mortality in overweight white men aged 40-64 years

Although 25% of US men indicate that they are trying to lose weight, the as sociation between intentional weight loss and longevity in men is unknown. The authors analyzed prospective data from 49,337 overweight (initial body mass index greater than or equal to 27) white men aged 40-64 years who, in 1959-1960, answered questions on weight change direction, amount, time inte rval, and intent. Vital status was determined in 1972. Proportional hazards regression estimated mortality rate ratios for men who intentionally lost weight compared with men with no weight change. Analyses were stratified by health status and adjusted for age, initial body mass index, smoking statu s, alcohol intake, education, physical activity, health history, and physic al symptoms. Among men with no reported health conditions (n = 36,280), int entional weight loss was not associated with total, cardiovascular (CVD), o r cancer mortality, but diabetes-associated mortality was increased 48% (95 % confidence interval (CI) -7% to +133%) among those who lost 20 pounds (9. 1 kg) or more; this increase was largely related to non-CVD mortality. Amon g men with reported health conditions (n = 13,057), intentional weight toss had no association with total or CVD mortality, but cancer mortality incre ased 25% (95% confidence interval -4% to +63%) among those who lost 20 poun ds or more. Diabetes-associated mortality was reduced 32% (95% confidence i nterval -52% to -5%) among those who lost less than 20 pounds and 36% (95% confidence interval -49% to -20%) among those who lost more than 20 pounds. These results and those from our earlier study in women (Williamson et al. , Am J Epidemiol 1995;141:1128-41) suggest that intentional weight loss may reduce the risk of dying from diabetes, but not from CVD. In observational studies, however, it is difficult to separate intentional weight loss from unintentional weight loss due to undiagnosed, underlying disease. Well-des igned observational studies, as well as randomized controlled trials, are n eeded to determine whether intentional weight loss reduces CVD mortality.