Intentional weight loss linked to lower mortality in postmenopausal women

Intentional weight loss linked to lower mortality in postmenopausal women | Image Credit: © Siam - © Siam - stock.adobe.com.

All-cause, cancer, and cardiovascular mortality risks are reduced by intentional weight loss efforts among postmenopausal women, according to a recent study published in JAMA Network Open.¹

The need for research on weight loss and mortality

Overweight or obesity status has been reported in 2.6 billion people worldwide, with a rate of 44% among US women aged at least 60 years. This highlights potential increased risks of adverse outcomes such as certain cancers and cardiovascular disease that shorten life expectancy.²

“Although the association between obesity and adverse health outcomes is well-established, evidence regarding the impact of weight loss on mortality remains inconsistent,” wrote investigators.¹ Additionally, investigators noted current data has not addressed the impact of waist circumference (WC) on mortality risk.

To address this research gap, investigators conducted a cohort study. Data was obtained from the Observational Study of the Women’s Health Initiative, a longitudinal prospective cohort study including 161,808 women aged 50 to 79 years. Women with cancer or underweight status at baseline were excluded from the current analysis.

Study design

All-cause, cancer, cardiovascular, and other mortality through February 28, 2023, were reported as primary outcomes. Cause of death was determined through assessments of death certificates, the National Death Index, medical records, and other records.

A trained professional measured participants’ weight and height at baseline and year 3 to determine body mass index (BMI). Weight change between baseline and year 3 was calculated to place participants in 3 potential categories: stable weight, weight loss, ad weight gain.

Patients with a 5% decrease or greater in weight were included in the weight loss group, while those with a 5% increase or greater were included in the weight gain group. Those with a change of less than 5% were included in the stable weight group.

Trained personnel also measured WC at baseline and year 3. Stable, loss, and gain categories were also used to classify WC change.

During the follow-up at year 3, patients with weight loss were asked whether they had lost 5 or more pounds on purpose to determine whether the weight loss was intentional. Women with intentional weight loss were asked about their methods for losing weight.

Common methods of weight loss included, diet, exercise, a combination of these methods, or other methods. Uncommon methods included surgery, diet pills, commercial plan, smoking, and other. Age, race and ethnicity, physical activity, BMI and WC, education level, smoking, and prior hormone use were reported as covariates.

Study results

There were 58,961 women aged a mean 63.3 years included at baseline. These patients had a mean BMI of 27 and WC of 84.1. All-cause mortality was reported in 49.5% at follow-up, cardiovascular disease mortality in 15.5%, cancer mortality in 10.1%, and mortality form other causes in 24%.

Higher baseline BMI and WC was reported in patients with intentional WC loss at follow-up vs stable. Overall, all-cause mortality was significantly reduced among women with intentional weight loss of at least 5 pounds, with a hazard ratio (HR) of 0.88.

HRs of 0.87 were reported for cancer mortality, cardiovascular disease mortality, and other mortality risks among women with intentional weight loss vs other women. However, a significantly increased risk of all-cause mortality with an HR of 1.27 was reported for women with unintentional weight loss.

Women with unintentional weight loss also had HRs of 1.25 for cancer mortality, cardiovascular mortality, and other mortality risks. Diet alone and exercise alone were both linked with reduced mortality, but the greatest reduction was from combined diet and exercise, with an HR of 0.83.

Conclusion

These mortalities were also less likely when weight loss efforts were coupled with reductions in WC. Additionally, WC gain and unintentional WC loss were linked to increased mortality risk.

“Lifestyle changes resulting in reductions in visceral adiposity should be the focus, such as encouraging physical activity that includes strength training to preserve or build muscle mass and dietary changes that promote heart-healthy diets, which may include calorie restriction but also provides adequate protein,” investigators concluded.

References

1. Hendryx M, Manson JE, Ostfeld RJ, et al. Intentional weight loss, waist circumference reduction, and mortality risk among postmenopausal women. JAMA Netw Open. 2025;8(3):e250609. doi:10.1001/jamanetworkopen.2025.0609
2. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288-298. doi:10.1038/s41574-019-0176-8. PMID: 30814686.