Re: Re: Study Says Weight Loss May Raise Risk of Death

[Guest guest]

Also, not mentioned are weight loss methods such as, for example, how many

went on some sort of diet craze such as Atkins.

Note that underlying disease issues also were not accounted for in the

study.

Another confusing message for the public.

on 6/28/2005 10:59 AM, citpeks at citpeks@... wrote:

> We have previously discussed about fat-soluble toxins released into

> the bloodstream from fatty tissue during weight reduction. (BT120YD

> pp. 78-80). I don't think that the Finland study took this into

> consideration.

>

> Tony

[Guest guest]

Their discussion included some of those ideas, but the one piece of evidence lacking is: did any of the losers gain it back after 5 years? Most people, having lost gain it back.

Did I misread this in the study?

Regards.

----- Original Message -----

From: Rodney

Sent: Tuesday, June 28, 2005 2:28 PM

Subject: [ ] Re: Study Says Weight Loss May Raise Risk of Death

Hi folks:I do not have a view on this issue. I do not have enough data to justify one. But I do have a point to raise.The majority of the populations of industrialized countries are over weight and trying to lose weight. But overwhelmingly the majority of those trying to lose weight do no succeed. EVERYONE seems to agree that losing weight is incredibly difficult. One supposedly serious (university) authority recently said that it is realistically impossible to lose weight, seemingly implying that even bothering to make the attempt is a waste of effort.So perhaps we ought to ask a question about the people in these studies who succeeded in losing weight. Why were a few successful while the vast majority never are?Possibly, for many of those who succeeded in losing weight there was a reason beyond just 'rugged determination'. And that reason, whatever it was, may also be the reason for the increased incidence of death in the weight loss group.We are not talking large numbers of people here. Of the 2957 total people studied, 268 died - or 9.1%. These were divided among six groups (both 'intending to lose' and 'intending to be stable' were each divided into 'actually increased', 'actually stable', and 'actually lost').So the explanation may be that of the people 'intending to lose' who succeeded in losing weight - just one of the six groups - (the abstract does not tell us how many there were but suppose 65% of the 2957 were intending to lose, and 10% of them succeeded in losing weight, then we are talking about 192 people in this group) perhaps 20 to 25 of them died. Now ask yourself, is it too extreme to suppose that, say, fifteen to twenty of those 20 to 25 had underlying sickness that CAUSED them both to succeed in losing weight and eventually to die? While the other five to ten did it by 'rugged determination' and remained alive at the end of the study?If 65% that were trying to lose weight among the 2957 being studied the total number of those trying to lose weight was 1922. Fifteen to twenty out of 1922 is not a large number. And remember, Clinton's coronary artery was 90% occluded before he noticed symptons notable enough to visit his doctor. So I really doubt the study's authors were able to weed out all cases where the people would eventually lose weight some time in the next twenty years, just because they were sick). And **ALL** cases of weight-loss-sickness among the 1922 will fall into the 'succeeded in losing weight' category.If we believe the propaganda, we know that, for almost everyone, losing weight is simply beyond their capabilities. Pretty much the only people who can lose weight are those who have a poor appetite. And the reason for the poor appetite that enables them to succeed in losing weight is ................ ?????This is simply a question. Without access to much more data than I currently have I cannot have a strong view about this.But PERHAPS the headline should have read: "Study Says Weight Loss Is Dead Easy. All That is Needed is to Be Sick Before Yer Start".If the above does explain the data these studies found, then the conclusions do not apply to healthy people.Rodney.> Recognize that this group is me - probably 95% were hypertensives - the one disease not excluded. If they had, they wouldn't have had many subjects. > It does provide 5 refs> > 1.. Lee IM, Paffenbarger RS (1992) Change in body weight and longevity. JAMA 268: 2045-2049. Find this article online > 2.. Andres R, Muller DC, Sorkin JD (1993) Long-term effects of change in body weight on all-cause mortality. Ann Int Med 119: 737-743. Find this article online > 3.. Yaari S, Goldburt U (1998) Voluntary and involuntary weight loss: Associations with long term mortality in 9,228 middle-aged and elderly men. Am J Epidemiol 148: 546-555. Find this article online > 4.. Mikkelsen KL, Heitmann BL, Keiding N, Sørensen TIA (1999) Independent effects of stable and changing body weight on total mortality. Epidemiology 10: 671-678. Find this article online> that may provide more insight.> > Regards.

[Guest guest]

more data:

Reasons for intentional weight loss, unintentional weight loss, and mortality in older men.Arch Intern Med. 2005 May 9;165(9):1035-40. PMID: 15883243

Abstract

Background: We have examined the relationship between intentional and unintentional weight loss and the reasons underlying intention to lose weight and all-cause mortality and mortality due to cardiovascular disease (CVD) and non-CVD causes in older men.

Methods: Prospective study of 4869 men aged 56 to 75 years drawn from general practices in 24 British towns, who in 1996 completed questionnaires about intentional and unintentional weight loss over the preceding 4 years and were followed up for a subsequent 7 years.

Results: Unintentional but not intentional weight loss was associated with a significant increase in risk of all-cause mortality compared with men who reported no weight change, even after adjustment for lifestyle characteristics and preexisting disease (adjusted relative risk [RR], 1.71; 95% confidence interval [CI], 1.33–2.19; and RR, 1.00; 95% CI, 0.91–1.10, respectively). Men who lost weight intentionally as a result of personal choice showed significant benefit in all-cause mortality (RR, 0.59; 95% CI, 0.34–1.00; P = .05), which was largely owing to a significant reduction in mortality from non-CVD causes (RR, 0.36; 95% CI, 0.15–0.87). The benefit in these men was most apparent in markedly overweight men (BMI [calculated as weight in kilograms divided by the square of height in meters] >=28) and in younger men (age <65 years). Men who lost weight intentionally owing to ill health or physician's advice showed an increased risk of all-cause mortality (RR, 1.37; 95% CI, 0.96–1.94). No harm or benefit was seen for CVD mortality, irrespective of reasons for intentional weight loss.

Conclusion: Intentional weight loss carried out for personal reasons is associated with a significant reduction in all-cause mortality in markedly overweight men, and the data suggest that the earlier the intervention, the greater the chance of benefit.

http://www.annals.org/cgi/content/abstract/138/5/383

Conclusions: Attempted weight loss is associated with lower all-cause mortality, independent of weight change. Self-reported intentional weight loss is associated with lower mortality rates, and weight loss is associated with higher mortality rates only if it is unintentional.

Intentional Weight Loss and Death in Overweight and Obese U.S. Adults 35 Years of Age and Older

Abstract

Background: Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates.

Objective: To examine the relationships among intention to lose weight, weight loss, and all-cause mortality.

Design: Prospective cohort study using a probability sample of the U.S. population.

Setting: Interviewer-administered survey.

Participants: 6391 overweight and obese persons (body mass index >= 25 kg/m2) who were at least 35 years of age.

Measurements: Intention to lose weight and weight change during the past year were assessed by self-report in 1989. Vital status was followed for 9 years. Hazard rate ratios (HRRs) were adjusted for age, sex, ethnicity, education, smoking, health status, health care utilization, and initial body mass index.

Results: Compared with persons not trying to lose weight and reporting no weight change, those reporting intentional weight loss had a 24% lower mortality rate (HRR, 0.76 [95% CI, 0.60 to 0.97]) and those with unintentional weight loss had a 31% higher mortality rate (HRR, 1.31 [CI, 1.01 to 1.70]). However, mortality rates were lower in persons who reported trying to lose weight than those in not trying to lose weight, independent of actual weight change. Compared with persons not trying to lose weight and reporting no weight change, persons trying to lose weight had the following HRRs: no weight change, 0.80 (CI, 0.65 to 0.99); gained weight, 0.94 (CI, 0.65 to 1.37); and lost weight, 0.76 (CI, 0.60 to 0.97).

Conclusions: Attempted weight loss is associated with lower all-cause mortality, independent of weight change. Self-reported intentional weight loss is associated with lower mortality rates, and weight loss is associated with higher mortality rates only if it is unintentional.

Volume 138(5) 4 March 2003 p I56

The Relationship between Intentional Weight Loss and Mortality

What are the implications of the study?

Trying to lose weight decreases an overweight or obese person’s risk for death, regardless of whether he or she loses weight. Losing weight is associated with dying only if the weight loss is unintentional.

Am J Epidemiol. 1999 Sep 15;150(6):573-9.

Weight cycling, weight gain, and risk of hypertension in women.

Abstract

To assess prospectively the relation between body mass index, weight gain, repeated intentional weight losses, and the risk of self-reported hypertension, the authors studied 46,224 women who were participants in the Nurses Health Study II, who were free of hypertension in 1993, and who completed questions on intentional weight losses between 1989 and 1993. Women who reported they had intentionally lost >=20 lbs (9 kg) >=3 times were classified as severe weight cyclers. Women who had intentionally lost >=10 lbs (4.5 kg) >=3 times, but who did not meet the criteria for severe weight cycling, were classified as mild weight cyclers. Between 1993 and 1995, 1,107 incident cases of diagnosed hypertension were reported. Body mass index and weight gain, but not weight cycler status, were independently associated with the development of hypertension. For each 10 lb (4.5 kg) gain in weight between 1989 and 1993, the risk of hypertension increased 20% (odds ratio (OR) = 1.20, 95% confidence interval (CI) 1.15, 1.24). After adjustment for body mass index and weight gain, the risks associated with mild weight cycling (OR = 1.15, 95% CI 1.00, 1.33) and severe weight cycling (OR = 1.13, 95% CI 0.79, 1.61) were small and not significant. Thus, the results of this study offer support for the current weight guidelines and provide further evidence of the health risks associated with excessive weight and weight gain. However, these data do not suggest an independent effect of weight cycling on risk of hypertension.PMID: 10489996

Am J Epidemiol. 1999 Mar 15;149(6):491-503.

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

Abstract

Although 25% of US men indicate that they are trying to lose weight, the association between intentional weight loss and longevity in men is unknown. The authors analyzed prospective data from 49,337 overweight (initial body mass index >=27) white men aged 40-64 years who, in 1959-1960, answered questions on weight change direction, amount, time interval, 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 status, alcohol intake, education, physical activity, health history, and physical symptoms. Among men with no reported health conditions (n = 36,280), intentional weight loss was not associated with total, cardiovascular (CVD), or 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. Among men with reported health conditions (n = 13,057), intentional weight loss had no association with total or CVD mortality, but cancer mortality increased 25% (95% confidence interval -4% to +63%) among those who lost 20 pounds or more. Diabetes-associated mortality was reduced 32% (95% confidence interval -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 (on 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-designed observational studies, as well as randomized controlled trials, are needed to determine whether intentional weight loss reduces CVD mortality.

PIP: The association between intentional weight loss and mortality is examined using data on 49,337 overweight white men aged 40-64 from the American Cancer Society's Cancer Prevention Study I. These data were originally collected in 1959-1960, and vital status reassessed in 1972. The results, along with an earlier study on women, suggest that intentional weight loss may reduce the risk of dying from diabetes, but not from cardiovascular effects. The difficulty of distinguishing between intentional and unintentional weight loss in such studies is stressed. Comments on the paper by H. Kuller are included (pp. 515-6) as well as a response from the principal author (pp. 517-8).

In summary, we found that intentional weight loss was associated with a substantial reduction in the risk of dying from diabetes in persons with reported health conditions. Otherwise, our results do not offer strong support for the contention that intentional weight loss is consistently beneficial or benign. If the associations found in this study and in our earlier study of women are causal, then it is perplexing that the results vary depending upon health status and the amount and timing of weight loss. Epidemiologic studies are needed that accurately assess participants' CVD status and also accurately measure exposure to intentional weight loss over longer, well-defined periods of life. Such studies should also attempt to accurately assess exposure to the types of weight loss methods used. These assessments, however, will be very challenging because of the complex nature of weight loss behaviors and the ability of persons to accurately recall the amounts and frequency of weight loss, as well as intention (28). It may also be that randomized controlled studies of intentional weight loss and mortality are ultimately required to answer the question of whether weight loss in obese persons increases their longevity. PMID: 10084238

Regards