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Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File



The aim of this longitudinal study is to examine the relationship between weight loss from maximum body weight, body mass index (BMI), and mortality in a nationally representative sample of men and women.


Longitudinal cohort study.


In all, 6117 whites, blacks, and Mexican-Americans 50 years and over at baseline who survived at least 3 years of follow-up, from the Third National Health and Nutrition Examination Survey Linked Mortality Files (1988–1994 with passive mortality follow-up through 2000), were included.


Measured body weight and self-reported maximum body weight obtained at baseline. Weight loss (maximum body weight minus baseline weight) was categorized as <5%, 5–<15%, and 15%. Maximum BMI (reported maximum weight (kg)/measured baseline height (m)2) was categorized as healthy weight (18.5–24.9), overweight (25.0–29.9), and obese (30.0).


In all, 1602 deaths were identified. After adjusting for age, race, smoking, health status, and preexisting illness, overweight men with weight loss of 15% or more, overweight women with weight loss of 5–<15%, and women in all BMI categories with weight loss of 15% or more were at increased risk of death from all causes compared with those in the same BMI category who lost <5%; hazard ratios ranged from 1.46 to 2.70. Weight loss of 5–<15% reduced risk of death from cardiovascular diseases among obese men.


Weight loss of 15% or more from maximum body weight is associated with increased risk of death from all causes among overweight men and among women regardless of maximum BMI.

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  1. Pamuk ER, Williamson DF, Madans J, Serdula MK, Kleinman JC, Byers T . Weight loss and mortality in a national cohort of adults, 1971–1987. Am J Epidemiol 1992; 136: 686–697.

    CAS  Article  Google Scholar 

  2. Williamson DF, Pamuk ER . The association between weight loss and increased longevity: a review of the evidence. Ann Intern Med 1993; 119: 731–736.

    CAS  Article  Google Scholar 

  3. Andres R, Muller DC, Sorkin JD . Long-term effects of change in body weight on all-cause mortality: a review. Ann Intern Med 1993; 119: 737–743.

    CAS  Article  Google Scholar 

  4. Pamuk ER, Williamson DF, Serdula MK, Madans J, Byers TE . Weight loss and subsequent death in a cohort of US adults. Ann Intern Med 1993; 119: 744–748.

    CAS  Article  Google Scholar 

  5. Lee IM, Paffenbarger Jr RS . Is weight loss hazardous? Nutr Rev 1996; 54: S116–S124.

    CAS  Article  Google Scholar 

  6. Mikkelsen KL, Heitmann BL, Keiding N, Sorensen TI . Independent effects of stable and changing body weight on total mortality. Epidemiology 1999; 10: 671–678.

    CAS  Article  Google Scholar 

  7. Allison DB, Zannolli R, Faith MS, Heo M, Pietrobelli A, VanItallie TB et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. Int J Obes Relat Metab Disord 1999; 23: 603–611.

    CAS  Article  Google Scholar 

  8. Wannamethee SG, Shaper AG, Walker M . Weight change, weight fluctuation, and mortality. Arch Intern Med 2002; 162: 2575–2580.

    Article  Google Scholar 

  9. Breeze E, Clarke R, Shipley MJ, Marmot MG, Fletcher AE . Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants. Int J Epidemiol 2006; 35: 169–178.

    Article  Google Scholar 

  10. Myrskyla M, Chang VW . Weight change, initial BMI, and mortality among middle- and older-aged adults. Epidemiology 2009; 20: 840–848.

    Article  Google Scholar 

  11. Flegal KM, Graubard BI, Williamson DF, Gail MH . Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861–1867.

    CAS  Article  Google Scholar 

  12. National Task Force on the Prevention Treatment of Obesity. Overweight, obesity, and health risk. Arch Int Med 2000; 160: 898–904.

    Article  Google Scholar 

  13. Pi-Sunyer FX . A review of long-term studies evaluating the efficacy of weight loss in ameliorating disorders associated with obesity. Clin Ther 1996; 18: 1006–1035.

    CAS  Article  Google Scholar 

  14. Goldstein DJ . Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992; 16: 397–415.

    CAS  PubMed  Google Scholar 

  15. Yaari S, Goldbourt U . Voluntary and involuntary weight loss: associations with long term mortality in 9228 middle-aged adult and elderly men. Am J Epidemiol 1998; 148: 546–555.

    CAS  Article  Google Scholar 

  16. Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C . Prospective study of intentional weight loss and mortality in never-smoking overweight white US women aged 40–64 years. Am J Epidemiol 1995; 141: 1128–1141.

    CAS  Article  Google Scholar 

  17. Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C . Prospective study of intentional weight loss and mortality in overweight white men aged 40–64 years. Am J Epidemiol 1999; 149: 491–503.

    CAS  Article  Google Scholar 

  18. Williamson DF, Thompson TJ, Thun M, Flanders D, Pamuk E, Byers T . Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care 2000; 23: 1499–1504.

    CAS  Article  Google Scholar 

  19. Gregg EW, Gerzoff RB, Thompson TJ, Williamson DF . Intentional weight loss and death in overweight and obese US adults 35 years of age and older. Ann Intern Med 2003; 138: 383–389.

    Article  Google Scholar 

  20. Sorensen TI, Rissanen A, Korkeila M, Kaprio J . Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med 2005; 2: e171.

    Article  Google Scholar 

  21. Sorensen TI . Weight loss causes increased mortality: pros. Obes Rev 2003; 4: 3–7.

    CAS  Article  Google Scholar 

  22. Courcoulas AP, Flum DR . Filling in the gaps in bariatric surgical research. JAMA 2005; 294: 1957–1960. [Erratum, JAMA 2005; 294:2848].

    CAS  Article  Google Scholar 

  23. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Eng J Med 2007; 357: 741–752.

    Article  Google Scholar 

  24. Yang D, Fontaine KR, Wang C, Allison DB . Weight loss causes increased mortality: cons. Obes Rev 2003; 4: 9–16.

    CAS  Article  Google Scholar 

  25. Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005; 293: 1868–1874.

    CAS  Article  Google Scholar 

  26. National Center for Health Statistics. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–94. National Center for Health Statistics: Hyattsville, MD, 1994. Vital Health Stat 1 (32), 1994.

  27. National Center for Health Statistics. The Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality File: Matching Methodology. (Accessed on 21 May 2008).

  28. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults, the evidence report. Publisher: National Institutes of Health: Bethesda, MD, 1998. NIH Publication no. 98-4083. Available from:

  29. Research Triangle Institute. SUDAAN Language Manual, Release 10.0. Research Triangle Institute: Research Triangle Park, NC, 2008.

  30. Perry GS, Byers TE, Mokdad AH, Serdula MK, Williamson DF . The validity of self-reports of past body weights by US adults. Epidemiology 1995; 6: 61–66.

    CAS  Article  Google Scholar 

  31. Newman AB, Yamez D, Harris T, Duxbury A, Enright PL, Fried LB . Weight change in old age and its association with mortality. J Am Geriatr Soc 2001; 49: 1309–1318.

    CAS  Article  Google Scholar 

  32. Wannamathee SG, Shaper G, Whincup PH, Walker M . Characteristics of older men who lose weight intentionally or unintentionally. Am J Epidemiol 2000; 151: 667–675.

    Article  Google Scholar 

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We thank Elsie Pamuk and Katherine Flegal for their insightful comments and suggestions during preparation of this manuscript.

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Correspondence to D D Ingram.

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Ingram, D., Mussolino, M. Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File. Int J Obes 34, 1044–1050 (2010).

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  • follow-up studies
  • longitudinal studies
  • proportional hazards models
  • men
  • women

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