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Cited by 2,527Obesity, Physical Activity, DietNutritional Studies and DietNutrition, Health and Food Behavior

Changes in diet and lifestyle and long-term weight gain in women and men

Open access
Mozaffarian, Dariush, Hao, Tao, Rimm, Eric B., Willett, Walter C., Hu, Frank B.·2011·New England Journal of Medicine
DOI 10.1056/nejmoa1014296PMC PMC3151731
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Abstract

BACKGROUND: Specific dietary and other lifestyle behaviors may affect the success of the straightforward-sounding strategy "eat less and exercise more" for preventing long-term weight gain. METHODS: We performed prospective investigations involving three separate cohorts that included 120,877 U.S. women and men who were free of chronic diseases and not obese at baseline, with follow-up periods from 1986 to 2006, 1991 to 2003, and 1986 to 2006. The relationships between changes in lifestyle factors and weight change were evaluated at 4-year intervals, with multivariable adjustments made for age, baseline body-mass index for each period, and all lifestyle factors simultaneously. Cohort-specific and sex-specific results were similar and were pooled with the use of an inverse-variance-weighted meta-analysis. RESULTS: Within each 4-year period, participants gained an average of 3.35 lb (5th to 95th percentile, -4.1 to 12.4). On the basis of increased daily servings of individual dietary components, 4-year weight change was most strongly associated with the intake of potato chips (1.69 lb), potatoes (1.28 lb), sugar-sweetened beverages (1.00 lb), unprocessed red meats (0.95 lb), and processed meats (0.93 lb) and was inversely associated with the intake of vegetables (-0.22 lb), whole grains (-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt (-0.82 lb) (P≤0.005 for each comparison). Aggregate dietary changes were associated with substantial differences in weight change (3.93 lb across quintiles of dietary change). Other lifestyle factors were also independently associated with weight change (P<0.001), including physical activity (-1.76 lb across quintiles); alcohol use (0.41 lb per drink per day), smoking (new quitters, 5.17 lb; former smokers, 0.14 lb), sleep (more weight gain with <6 or >8 hours of sleep), and television watching (0.31 lb per hour per day). CONCLUSIONS: Specific dietary and lifestyle factors are independently associated with long-term weight gain, with a substantial aggregate effect and implications for strategies to prevent obesity. (Funded by the National Institutes of Health and others.).

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Registry

Crossref · 10.1056/nejmoa1014296

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 76 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Each additional daily serving of yogurt was associated with −0.82 lb of four-year weight change.

    “yogurt (−0.82 lb)”
    Quote in the paperSubstantial claim
  • Findingown data

    Each extra hour of television watched daily was independently linked to weight gain (0.31 lb, P<0.001).

    “Increases in time spent watching television (per hour per day) were independently associated with weight gain (0.31 lb, P<0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    Each additional daily serving of french fries was associated with 3.35 lb of four-year weight gain.

    “french fries (3.35 lb)”
    Quote in the paperSubstantial claim
  • Findingown data

    Each additional daily serving of unprocessed red meats was associated with 0.95 lb of four-year weight gain.

    “unprocessed red meats (0.95 lb)”
    Quote in the paperSubstantial claim
  • Findingown data

    Combined dietary changes showed a dose-dependent link, with 3.93 lb more gain across quintiles.

    “Aggregate dietary changes were associated with substantial differences in weight change (3.93 lb across quintiles of dietary change).”
    • Also stated in: § RELATIONSHIPS BETWEEN DIETARY CHANGES AND WEIGHT CHANGES · plain
      “with a 3.93-lb greater weight gain across quintiles (Table 3).”
    Quote in the paperSubstantial claim
  • May combine two claims. 38
  • The quote only partly states this claim. 4
  • Classified as probably not a substantial claim. 29

  • May combine two claims.

    Findingown data

    With finer categories, every lower decile of dietary change showed more weight gain than the top decile, following a dose-response pattern.

    “As compared with participants in the top decile, participants in each lower decile of dietary change had greater weight gain, in a dose-dependent fashion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Stratifying by age or baseline BMI (<25 or 25-30) left most lifestyle results similar, though overweight people tended to show larger weight changes.

    “Findings for all lifestyle factors were generally similar in analyses stratified according to age or baseline body-mass index”
    • Also stated in: § ADDITIONAL ANALYSES · plain
      “although the magnitude of associated weight change was generally larger among overweight persons”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Alcohol's link with weight change varied by drink type and by how much and in which direction use changed.

    “heterogeneity was evident with respect to both the beverage type and the size and direction of changes in use”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Each additional daily serving of sweets and desserts was associated with 0.41 lb of four-year weight gain.

    “sweets and desserts (0.41 lb per serving per day)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Weight gain over the long term in nonobese groups is slow; in these cohorts it averaged roughly 0.8 lb yearly.

    “Average long-term weight gain in nonobese populations is gradual — in the cohorts we studied, about 0.8 lb per year”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Weight gain often occurs gradually over decades, about 1 lb per year.

  • May combine two claims.

    Findingown data

    Other lifestyle factors also had independent links to weight change, and results were similar by sex and cohort.

    “Other lifestyle behaviors were also independently related to weight change (Table 3), with similar findings in men and women and across the three cohorts.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eating less potato chips, processed meats, sugar-sweetened drinks, potatoes, or trans fat was linked to smaller weight gain.

    “less weight gain occurred with decreased consumption of potato chips, processed meats, sugar-sweetened beverages, potatoes, or trans fat”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Using percent weight change instead of absolute pounds gave similar results.

    “All results were also similar when we evaluated relative (percent) weight changes rather than absolute weight changes (not shown).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Diet changes and activity changes each had independent links to weight gain.

    “Changes in diet and physical activity were independently associated with weight gain (Fig. 2).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Each additional daily serving of refined grains was associated with 0.39 lb of four-year weight gain.

    “refined grains (0.39 lb per serving per day)”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Each additional daily serving of boiled, baked, or mashed potatoes was associated with 0.57 lb of four-year weight gain.

    “boiled, baked, or mashed potatoes (0.57 lb)”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingreasoning

    100%-fruit juice intake was linked to smaller weight gains than sugar-sweetened drinks.

    “Consumption of 100%-fruit juice was associated with weight gains of smaller magnitude”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Aggregate dietary changes accounted for substantial differences in weight gain, with additional contributions from changes in physical activity and television watching.

    “Aggregate dietary changes accounted for substantial differences in weight gain, with additional contributions from changes in physical activity and television watching”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The study provides evidence that both the duration of television viewing and changes in the duration of viewing influence weight gain in adults.

    “Our long-term prospective evaluation provides evidence that both the duration of television viewing and changes in the duration of viewing influence weight gain in adults.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Changes in these behaviors were generally not strongly correlated (r<0.05), suggesting that different behaviors are often changed relatively independently, thus minimizing potential confounding.

    “However, in contrast to prevalent behaviors, changes in these behaviors were generally not strongly correlated (r< 0.05), which suggests that different behaviors are often changed relatively independently, thus minimizing potential confounding.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The study's long-term follow-up data confirm that smoking cessation results in weight gain initially but in little weight change thereafter.

    “Our long-term follow-up data confirm prior observations that smoking cessation results in weight gain initially but in little weight change thereafter.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The inverse association of continued smoking with weight gain may have been related to undiagnosed chronic disease.

    “a finding that may have been related to undiagnosed chronic disease.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Several lifestyle changes showed independent associations with weight gain over the long term, including changes in specific foods and beverages, physical activity, alcohol use, television watching, and smoking habits.

    “We found that multiple lifestyle changes were independently associated with long-term weight gain, including changes in the consumption of specific foods and beverages, physical activity, alcohol use, television watching, and smoking habits.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Different lifestyle behaviors have often been evaluated separately, limiting relative comparisons or quantification of combined effects.
    • Rests on an assumption: Changes in behavior over time are more relevant than current behaviors for long-term weight gain and prevention.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The differences in mean weight gain among cohorts may be related to cohort-specific differences in sex and age at baseline.

    “a finding that may have been related to cohort-specific differences in sex and age at baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The smoking-initiation analysis was constrained because that behavior was rare (<0.1% of person-years).

    “but evaluation of this category was limited by its rarity in these populations (accounting for <0.1% of person-years).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Cohort results were combined using inverse-variance-weighted random-effects meta-analysis.

    “Findings across cohorts were pooled by means of inverse-variance–weighted, random-effects meta-analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Trials of weight loss usually recruit people who are obese or overweight and aim for large short-term loss with special diets, so their results may not apply to nonobese groups or to gradual long-term gain.

    “Weight-loss trials1–3 have typically enrolled obese or overweight persons who attempted substantial short-term weight loss on specialized diets, thus limiting the generalizability of the findings to nonobese populations and to the factors that determine long-term, gradual weight gain.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] source

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    • cites [2] source

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    • cites [3] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    An unmeasured confounder may accompany yogurt intake.

    “It is also possible that there is an unmeasured confounding factor that tracks with yogurt consumption (e.g., people who change their yogurt consumption may have other weight-influencing behaviors that were not measured by our instruments).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    For populations, weight change is the best available measure of energy imbalance and partly reflects energy intake once expenditure determinants are adjusted for.

    “Thus, weight change is the best population metric of energy imbalance and at least partly captures energy intake after adjustment for determinants of expenditure (e.g., age, body-mass index, and physical activity).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Weight stability requires a balance between calories consumed and calories expended.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The weaker weight gain for 100%-fruit juice might reflect smaller serving sizes or different consumption patterns compared with sugar-sweetened drinks.

    “possibly because these beverages may be consumed in smaller servings than are sugar-sweetened beverages or in different patterns (i.e., single rather than multiple servings).33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Follow-up data were cut off once participants turned 65 or were diagnosed with chronic lung, kidney, or liver disease or with cancer other than nonmelanoma skin cancer; the cutoff was six years before diagnosis to account for preclinical disease.

    “we censored data for participants after they reached 65 years of age or if they received a diagnosis of chronic pulmonary, renal, or liver disease or of cancer other than nonmelanoma skin cancer (3 to 4% of participants); data were censored 6 years before diagnosis to account for preclinical disease.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Age-related loss of lean muscle mass can confound associations of lifestyle with weight gain at older ages.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Sensitivity checks used starting physical activity levels instead of changes, examined never smokers, and stratified by age and baseline BMI.

    “Sensitivity analyses were performed to evaluate absolute physical activity levels at the start of each 4-year period rather than changes during the period, data among participants who never smoked, and data stratified according to age and baseline body-mass index.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    These foods' fiber and slower digestion may increase fullness, and eating more of them may replace more processed items, offering plausible reasons for less weight gain.

    “Higher fiber content and slower digestion of these foods would augment satiety, and their increased consumption would also displace other, more highly processed foods in the diet, providing plausible biologic mechanisms whereby persons who eat more fruits, nuts, vegetables, and whole grains would gain less weight over time.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Every observed association must operate through altered energy intake, altered energy expenditure, or both.

    “All these relationships must be mediated by changes in energy intake, energy expenditure, or both.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Weight stability requires a balance between calories consumed and calories expended.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Physical activity ought to affect weight gain over years, yet support for that idea has been inconsistent.

    “Physical activity should also influence long-term weight gain, but evidence to support this expectation has been surprisingly inconsistent.11–14”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [11] source

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    • cites [12] source

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    • cites [13] source

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    • cites [14] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Why yogurt shows this link is unclear; some evidence raises the possibility that gut bacteria changes affect weight gain.

    “Potential mechanisms for these findings are unclear; intriguing evidence suggests that changes in colonic bacteria might influence weight gain.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Changing intake of a single food or beverage can alter total energy consumed, but the size of the linked weight gain differed across specific items.

    “Eating more or less of any one food or beverage may change the total amount of energy consumed, but the magnitude of associated weight gain varied for specific foods and beverages.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Variation in weight gain across specific items might stem from portion size, eating patterns, satiety effects, or replacement of other foods or drinks.

    “Differences in weight gain seen for specific foods and beverages could relate to varying portion sizes, patterns of eating, effects on satiety, or displacement of other foods or beverages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Controlled short-term trials indicate that drinks satisfy hunger less than solid foods, raising total energy intake.

    “Short-term controlled trials suggest that liquids are less satiating than solid foods, increasing the total amount of energy consumed.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Single lifestyle factors had modest links to weight change, but combined changes in diet and activity explained large differences in gain.

    “Whereas weight changes associated with any single lifestyle factor were relatively modest in our three cohorts, in the aggregate, changes in diet and physical activity accounted for large differences in weight gain.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Energy intake, biological measures, and medications were left out of the models since they might mediate or correlate with mediators of lifestyle's effect on weight.

    “Total energy intake, biologic factors (e.g., blood pressure), and medications were not included as covariables because such factors could be mediators (in causal pathways) or direct correlates of mediators of the effects of lifestyle on weight gain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An earlier eight-year NHS II analysis found the least weight gain among women who stayed moderate drinkers.

    “In a previous analysis of alcohol consumption in relation to weight change in the NHS II cohort over a period of 8 years, the smallest weight gain was seen among women who remained moderate drinkers.36”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The models controlled for age, BMI at the start of each four-year interval, and every lifestyle factor at once.

    “Multivariable models were used to adjust for age, baseline body-mass index in each 4-year period, and all lifestyle factors simultaneously.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Sugar-sweetened drinks, sweets, and processed foods may hinder energy balance, while whole grains, fruits, and vegetables may help it.

    “the consumption of sugar-sweetened beverages, sweets, and processed foods may make it harder to do so, whereas the consumption of whole grains, fruits, and vegetables might make it easier.4–10”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [4] Ello-Martin JA, 2005, Am J Clin Nutr source

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    • cites [7] Wolff E, 2008, Medscape J Med

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    • cites [8] source

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    • cites [9] Liu S, 2003, Am J Clin Nutr source

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    • cites [10] source

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  • May combine two claims.

    Interpretationnone given

    Dietary questionnaires do not estimate total energy intake well, and that intake does not capture energy balance, which depends on expenditure as well.

    “Total energy intake is not well estimated from dietary questionnaires, nor does it reflect energy balance, which is necessarily codetermined by energy expenditure.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Earlier research on alcohol and weight gain has not given consistent results.

    “Findings have been inconsistent in prior studies of alcohol use and weight gain.34–37”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [34] Liu S, 1994, Am J Epidemiol source

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    • cites [35] Wannamethee SG, 2003, Am J Clin Nutr source

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    • cites [36] source

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    • cites [37] source

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  • May combine two claims.

    Premisecitation

    Television watching appears to encourage snacking during viewing and also influences food choices both during viewing and at other times.

    “Television watching appears to encourage snacking during viewing and also influences food choices both during viewing and at other times.46–52”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [46] source

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    • cites [47] source

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    • cites [48] source

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    • cites [49] Temple JL, 2007, Am J Clin Nutr source

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    • cites [50] source

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    • cites [51] source

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    • cites [52] source

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Food structure and processing are potentially relevant dietary metrics for future obesity prevention policies and research.

    “These results suggest that future policies and research efforts to prevent obesity should consider food structure and processing as potentially relevant dietary metrics.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Changes in lifestyle may be most relevant for weight gain, as seen in prior analyses of sugar-sweetened beverages.

    “As seen in prior analyses of sugar-sweetened beverages,33 changes in lifestyle may be most relevant for weight gain.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    How much television people watch and how long they sleep might affect energy intake, energy output, or both.

    “In addition, the duration of television viewing and of sleep may influence energy consumption, energy expenditure, or both.15–19”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [15] source

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    • cites [19] source

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  • May combine two claims.

    Interpretationreasoning

    The effects of television watching on weight gain are probably mediated by changes in diet and physical activity, and may also be mediated by changes in sleep.

    “Because these effects are probably mediated by changes in diet and physical activity, and may also be mediated by changes in sleep”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Between 1965 and 2002, U.S. beverage consumption increased from 11.8% to 21.0% of all calories consumed, an increase of 222 kcal per person per day, with sugar-sweetened beverages and alcohol accounting for 60% and 32% of the increase, respectively.

    “between 1965 and 2002, U.S. beverage consumption increased from 11.8 to 21.0% of all calories consumed — 222 more kilocalories per person per day — with sugar-sweetened beverages and alcohol accounting for 60% and 32% of the increase, respectively.39”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prior analyses of HPFS data showed associations similar to ours for overall categories of whole-fat and low-fat dairy products, but subtypes were not evaluated independently.

    “Prior analyses of HPFS data showed associations similar to ours for the overall categories of whole-fat and low-fat dairy products,40 but subtypes (e.g., milk, cheese, and butter) were not evaluated independently.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Rajpathak SN, 2006, Am J Clin Nutr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Limited short-term studies of dairy foods and satiety or weight change have had inconsistent results.

    “Limited short-term studies of dairy foods and satiety or weight change have had inconsistent results.44,45”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44] source

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    • cites [45] source

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  • May combine two claims.

    Study design and conductnone given

    Lifestyle changes were self-selected, and residual confounding from other lifestyle behaviors is possible.

    “Lifestyle changes were self-selected, and residual confounding from other lifestyle behaviors is possible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The typical portion size of a specific food or beverage may partly mediate its effects on weight gain.

    “The typical portion size of a specific food or beverage may therefore partly mediate its effects on weight gain (i.e., both average portion sizes and biologic effects).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Among Swedish women, higher intakes of whole milk and cheese were inversely associated with weight gain, and significant associations with weight gain were not seen for other dairy foods.

    “Among Swedish women, higher intakes of whole milk and cheese were inversely associated with weight gain; as in our study, significant associations with weight gain were not seen for other dairy foods.41”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Rosell M, 2006, Am J Clin Nutr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Residual, unmeasured differences in portion sizes among participants might account for additional independent effects on energy balance.

    “Although dietary questionnaires specified portion sizes, residual, unmeasured differences in portion sizes among participants might account for additional independent effects on energy balance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In several long-term studies, inverse associations between dairy consumption and risk of insulin resistance, metabolic syndrome, or diabetes were observed, but potential mediating effects on weight change were not evaluated.

    “In several long-term studies, inverse associations between dairy consumption and the risk of insulin resistance, the metabolic syndrome, or diabetes were observed,42,43 but potential mediating effects on weight change were not evaluated.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] source

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    • cites [43]

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Specific lifestyle changes might be prioritized in obesity-prevention strategies.

    “thus highlighting specific lifestyle changes that might be prioritized in obesity-prevention strategies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    A person's weight change could lead to changes in lifestyle rather than vice versa, and such reverse causation would generally underestimate true effects.

    “A person’s weight change could lead to changes in lifestyle rather than vice versa. Such reverse causation would generally underestimate true effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationown data

    It seems plausible that the biologic effects of many lifestyle factors would be qualitatively similar in other populations.

    “and it seems plausible that the biologic effects of many lifestyle factors would be qualitatively similar in other populations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    The study results represent the average population effect, and intraindividual variations exist.

    “As is the case with any biologic finding or medical intervention, our results represent the average population effect, and intraindividual variations exist.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Active smokers are at higher risk for cardiovascular diseases, cancer, and diabetes than are former smokers.

    “active smokers are at higher risk for cardiovascular diseases, cancer, and diabetes than are former smokers.54”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion. Women and smoking: a report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, March 2001.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Unintended weight gain occurs easily, but modest, sustained changes in lifestyle could mitigate or reverse such an energy imbalance.

    “This means that unintended weight gain occurs easily but also that modest, sustained changes in lifestyle could mitigate or reverse such an energy imbalance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The ranges of dietary intakes were broad and overlapped with national estimates.

    “Conversely, the ranges of dietary intakes were broad and overlapped with national estimates.”
    Quote in the paperNot a substantial claim
61 of 61

  • The paper relies on this without support.

    Weight stability requires a balance between calories consumed and calories expended.

    “Since weight stability requires a balance between calories consumed and calories expended”

  • The paper relies on this without support.

    Weight gain often occurs gradually over decades, about 1 lb per year.

    “weight gain often occurs gradually over decades (about 1 lb per year)”

  • The paper relies on this without support.

    Different lifestyle behaviors have often been evaluated separately, limiting relative comparisons or quantification of combined effects.

    “Different lifestyle behaviors have often been evaluated separately, thus limiting relative comparisons or the quantification of combined effects.”

  • The paper relies on this without support.

    Changes in behavior over time are more relevant than current behaviors for long-term weight gain and prevention.

    “most studies of long-term weight gain have evaluated current behaviors, but changes in behavior over time may be more relevant in terms of both their biologic effects on long-term weight gain and their translation into prevention strategies.”

  • The paper relies on this without support.

    Age-related loss of lean muscle mass can confound associations of lifestyle with weight gain at older ages.

    “given possible confounding due to age-related loss of lean muscle mass”

  • The paper relies on this without support.

    Persons may achieve a new steady-state weight within months after a change in regular physical activity, diet, or other lifestyle habits.

    “Persons may achieve a new steady-state weight within months after a change in regular physical activity, diet, or other lifestyle habits”

  • The paper relies on this without support.

    Many prior studies of television watching and obesity have been cross-sectional, limiting the ability to make inferences about which came first.

    “Many prior studies of television watching and obesity have been cross-sectional, limiting the ability to make inferences about which came first.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Cohort and limited interventional studies link fermented food consumption with weight maintenance and lower risks of diabetes, cancer, and cardiovascular disease.

    “Large cohort studies as well as limited interventional studies have linked the consumption of fermented foods with weight maintenance and decreased diabetes, cancer, and cardiovascular disease risks (Mozaffarian et al., 2011; Díaz-López et al., 2016; Gille et al., 2018).”

    From Gut-microbiota-targeted diets modulate human immune status (2021) · cites this paper as Mozaffarian et al., 2011

  • Over 30 years of follow-up, the overall mortality risk associated with type 1 diabetes was 7 times greater than that of the general population.

    “A long-term study of patients with type 1 DM that began in 1966 showed that over 30 years of follow-up, overall risk of mortality associated with type 1 DM was 7 times greater than that of the general population.”

    From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [68]

  • During the study, the incremental mortality risk associated with type 1 diabetes declined from 9.3 to 5.6 times that of nondiabetic control subjects.

    “During the course of study, the incremental mortality risk associated with type 1 DM declined from 9.3 to 5.6 times that of nondiabetic control subjects.68”

    From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [68]

  • Females with type 1 diabetes had a 13.2-fold incremental mortality risk compared with a 5.0-fold increased risk in males.

    “Females had a 13.2-fold incremental mortality risk compared with a 5.0-fold increased risk in males.”

    From Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association (2013) · cites this paper as [68]

  • Among 28 longitudinal studies on short sleep and later obesity risk in children and adults, 22 found that short sleep was linked to greater weight gain, obesity, or fat mass after a few years.

    “Of the 28 longitudinal studies that examined the impact of short sleep on obesity risk in children and adults, 22 reported that short sleep is associated with an increased risk of weight gain or development of obesity and/or increased fat mass a few years later”

    From Sleep and metabolic function (2012) · cites this paper as [105]

Cites

Flagged first, then by citations

2 of the 58 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Wolff E, 2008, Medscape J Med, 10, 189

Cited by

Sorted by citations

Related

Authors
Mozaffarian, D., Hao, T., Rimm, E. B., Willett, W. C., & Hu, F. B.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2011-06-23
Volume
364
Issue
25
Pages
2392-2404
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1014296
PMC
PMC3151731
OpenAlex
W2160517070
Cited by
2,527
References
58
Citations by year
2026: 84 · 2025: 106 · 2024: 123 · 2023: 132 · 2022: 154 · 2021: 184 · 2020: 189 · 2019: 192 · 2018: 176 · 2017: 186 · 2016: 199 · 2015: 200 · 2014: 226 · 2013: 180 · 2012: 151
FWCI
28.83
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • Searle Scholars Program
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (HL60712, R01HL060712, R01HL035464, HL35464, HL085710, R01HL085710)
  • National Cancer Institute (R01CA095589, CA95589, CA-87969, CA-55075, P01CA087969, CA50385, P01CA055075, R01CA050385)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, P30DK046200, R01DK056690, DK58845, P30DK040561, DK46200.)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
weight gain prevention, dietary change, lifestyle factors, potato chips, sugar-sweetened beverages, red and processed meat, vegetable consumption, whole grains, fruit and vegetable intake, nuts, yogurt, physical activity, alcohol consumption, smoking, sleep duration, television viewing, obesity prevention, sex differences
MeSH terms
Adult, Alcohol Drinking, Diet, Feeding Behavior, Female, Humans, Life Style, Male, Middle Aged, Sleep, Smoking, Cohort Studies, Weight Gain, Health Behavior, Exercise, Multivariate Analysis

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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