Marisa A Bittoni, Wendy E Barrington, Michael Hendryx, Juhua Luo, Erin S LeBlanc, Sylvia Wassertheil-Smoller, Rowan T Chlebowski, Molly E Waring, Robert J Ostfeld, JoAnn E Manson, Jackie Gofshteyn Herold
Journal: JAMA network open 2025;8(3):e250609
PMID: 40048162
Weight loss in older adults is sometimes linked to poor health, especially when it happens without trying. However, it is not always clear whether intentional weight loss carries the same risks. This cohort study was carried out to understand better whether intentional weight loss and a reduction in waist size are linked to a lower or higher risk of death in postmenopausal women.
The results showed that women who intentionally lost weight had a lower risk of death compared to those whose weight remained stable. A reduction in waist circumference was also linked to lower mortality risk. In contrast, unintentional weight loss was associated with a higher risk of death. These findings suggest that losing weight on purpose, particularly reducing abdominal fat, may have long-term health benefits for postmenopausal women.
The study concluded that intentional weight loss and waist size reduction are associated with improved survival in this group. Healthcare professionals can use this information to reassure postmenopausal women that planned, healthy weight loss, especially when focused on reducing central fat, may reduce long-term health risks. It also highlights the importance of identifying unintentional weight loss, which may signal underlying illness.
None
Intentional weight loss that occurs with WC reductions is associated with reduced mortality risk in postmenopausal women across all causes, cancer and cardiovascular disease.
Intentional weight loss without WC reductions is associated with lower mortality from cardiovascular disease only.
Clinicians can use this research to support monitoring of reductions in WC during intentional weight loss programmes with postmenopausal women, whilst ensuring adequate protein in diets and the addition of strength training for maintenance of muscle mass.
Introduction
Studies on the impact of intentional weight loss among older adults and risk of mortality are inconsistent, with both increased and decreased risks being reported. Waist circumference (WC), which may be a stronger indicator of risk of mortality than body mass index (BMI), is often not taken into consideration. The aim of this study was to investigate whether an intentional reduction in weight and/or WC were associated with a lower risk of mortality in postmenopausal women.
Methods
• N=58961 US-based women, aged 50-79 years from the Women’s Health Initiative were included in this cohort study. Mean baseline BMI = 27 and WC 84.1cm.
• Women with intentional or unintentional weight loss changes of 5 pounds or more, and a reduction in WC between baseline and year 3 weight, were followed up annually for an average of 18.6 years.
• Measurement outcomes included mortality from cardiovascular disease (CVD), cancer and all other causes, as reported on death certificates, medical (and other, such as autopsy) records and the National Death Index.
Results
• Lower risk of all-cause mortality was found in women who intentionally lost 5 pounds or more (95% CI) and had a reduction in WC
• Intentional weight loss alone was associated with a lower risk of mortality from CVD only.
• Unintentional weight loss and/or a reduction in WC were associated with a higher risk of mortality from all causes (CI 95%).
Conclusion
Intentional weight loss, together with a reduction in WC were associated with a decreased risk of mortality from CVD, cancer and all other causes. These findings suggest that adherence to diet and exercise strategies that support a reduction in abdominal adiposity should be encouraged in overweight or obese postmenopausal women.
• Monitoring of both weight loss and reductions in WC should be considered in overweight and obese postmenopausal women seeking to lose weight. The focus on weight loss together with WC reduction mitigates the risk of weight loss from muscle loss alone.
• Dietary changes should include adequate protein intake and physical activity to include strength training in order to support the maintenance of muscle mass and reduce risk of sarcopenia.
• Unintentional weight loss could be linked to underlying chronic disease or as an adverse side effect of treatment.
• Further research into weight loss combined with WC reduction in other demographic groups in relation to mortality would add value i.e. in younger women or in men
• Research into WC reductions, irrespective of weight loss, as a means to lower mortality rates would be of interest
IMPORTANCE
Research investigating weight loss and mortality risk often fails to differentiate between intentional and unintentional weight loss and typically uses body mass index (BMI) as the measure of excess body weight.
OBJECTIVE
To evaluate associations between weight loss and waist circumference (WC) reduction and mortality, considering weight loss intentionality.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used data from the Women's Health Initiative Observational Study, which had a prospective cohort with mean follow-up of 18.6 years ending in February 2023. The study included women aged 50 to 79 years at 40 clinical centers in the US. Women with missing data, cancer at baseline, or considered underweight at baseline were excluded. Data were collected from September 1993 to February 2023 and were analyzed from June to December 2024.
EXPOSURES
Measured weight loss and WC reduction between baseline and year 3, stratified by women who reported intentional weight loss or not.
MAIN OUTCOMES AND MEASURES
Outcomes included adjudicated all-cause, cancer, cardiovascular, and other mortality through the end of follow-up. Cox proportional hazards regression models were used to evaluate the associations (hazard ratios [HRs] and 95% CIs) between weight loss, WC reduction, and mortality over 18.6 years of follow-up.
RESULTS
This study included 58 961 women at baseline (mean [SD] age, 63.3 [7.2] years; mean [SD] BMI, 27.0 [5.6]; mean [SD] WC, 84.1 [13.0] cm). As of February 28, 2023, 29 183 women (49.5%) died from all causes. Intentional weight loss measured by questionnaire was associated with lower subsequent mortality rates for all-cause mortality (HR, 0.88; 95% CI, 0.86-0.90), cancer mortality (HR, 0.87; 95% CI, 0.82-0.92), cardiovascular mortality (HR, 0.87; 95% CI, 0.83-0.91), and other mortality (HR, 0.89; 95% CI, 0.86-0.92), comparing loss of 5 pounds or more to stable weight. Reported intentional weight loss coupled with actual weight reduction of 5% or more was associated only with lower cardiovascular mortality (HR, 0.90; 95% CI, 0.81-0.99). Reported intentional weight loss coupled with measured WC loss was associated with lower rates of all-cause mortality (HR, 0.91; 95% CI, 0.86-0.95), cancer mortality (HR, 0.85; 95% CI, 0.76-0.95), and cardiovascular mortality (HR, 0.79; 95% CI, 0.72-0.87). Unintentional weight loss or unintentional WC loss were each associated with increased mortality risk for all groups, as were weight gain and WC gain.
CONCLUSIONS AND RELEVANCE
In this cohort study, reported intentional weight loss efforts that were coupled with measured WC reductions were associated with lower risk of all-cause, cancer, and cardiovascular mortality. Attention to diet and exercise that promote reductions in central adiposity should be encouraged.
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