A review and meta-analysis of the effect of weight loss on all-cause mortality risk
Open accessAbstract
Overweight and obesity are associated with increased morbidity and mortality, although the range of body weights that is optimal for health is controversial. It is less clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goal for all individuals who are overweight (normally defined as BMI>25 kg/m 2 ). The purpose of the present review was to examine the evidence base for recommending weight loss by diet and lifestyle change as a means of prolonging life. An electronic search identified twenty-six eligible prospective studies that monitored subsequent mortality risk following weight loss by lifestyle change, published up to 2008. Data were extracted and further analysed by meta-analysis, giving particular attention to the influence of confounders. Moderator variables such as reason for weight loss (intentional, unintentional), baseline health status (healthy, unhealthy), baseline BMI (normal, overweight, obese), method used to estimate weight loss (measured weight loss, reported weight loss) and whether models adjusted for physical activity (adjusted data, unadjusted data) were used to classify subgroups for separate analysis. Intentional weight loss per se had a neutral effect on all-cause mortality (relative risk (RR) 1·01; P = 0·89), while weight loss which was unintentional or ill-defined was associated with excess risk of 22 to 39 %. Intentional weight loss had a small benefit for individuals classified as unhealthy (with obesity-related risk factors) (RR 0·87 (95 % CI 0·77, 0·99); P = 0·028), especially unhealthy obese (RR 0·84 (95 % CI 0·73, 0·97); P = 0·018), but appeared to be associated with slightly increased mortality for healthy individuals (RR 1·11 (95 % CI 1·00, 1·22); P = 0·05), and for those who were overweight but not obese (RR 1·09 (95 % CI 1·02, 1·17); P = 0·008). There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does not support solely advising overweight or obese individuals who are otherwise healthy to lose weight as a means of prolonging life. Other aspects of a healthy lifestyle, especially exercise and dietary quality, should be considered. However, well-designed intervention studies are needed clearly to disentangle the influence of physical activity, diet strategy and body composition, in order to define appropriate advice to those populations that might be expected to benefit.
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A recent meta-analysis of cohort studies concluded that moderate intentional weight loss was associated with reduced mortality in "unhealthy" individuals, which included individuals with diabetes.
“A recent meta-analysis4 of cohort studies concluded that moderate intentional weight loss was associated with reduced mortality in “unhealthy” individuals, which included individuals with diabetes.”
From Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes (2013) · cites this paper as [4]
The Main findings section reports about 13% lower mortality among unhealthy adults, defined to include people with diabetes or obesity-related conditions. The Abstract describes a meta-analysis of prospective studies. However, the reported result concerns intentional weight loss generally; our copy does not establish that the reduction was specific to moderate weight loss. (LLM, conf=0.84)
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- Authors
- Harrington, M., Gibson, S., & Cottrell, R. C.
- Affiliations
- World Sugar Research Organisation (GB)
- Corresponding author
- Cottrell, Richard C.
- ORCID
- Gibson, Sigrid
- Venue
- Nutrition Research Reviews
- Publisher
- Cambridge University Press (CUP)
- Published
- 2009-06
- Volume
- 22
- Issue
- 1
- Pages
- 93-108
- ISSN
- 0954-4224 (ISSN-L)
- 1475-2700
- OpenAlex
- W1975604425
- Cited by
- 249
- References
- 5
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 9 · 2023: 8 · 2022: 17 · 2021: 22 · 2020: 16 · 2019: 15 · 2018: 14 · 2017: 20 · 2016: 17 · 2015: 18 · 2014: 16 · 2013: 19 · 2012: 14
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nutrition Research Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- weight loss, all-cause mortality, obesity, overweight, intentional weight loss, unintentional weight loss, lifestyle intervention, diet, physical activity, body mass index, longevity, healthy lifestyle, diet quality, weight loss interventions, mortality risk reduction, metabolically healthy obesity
- MeSH terms
- Humans, Life Style, Longevity, Obesity, Weight Loss, Intention, Overweight
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