Intended for healthcare professionals

CCBYNC Open access

Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study

BMJ 2019; 367 doi: (Published 16 October 2019) Cite this as: BMJ 2019;367:l5584

Linked opinion

The timing of excess weight gain in our lifecycle matters

  1. Chen Chen, masters student1 2,
  2. Yi Ye, PhD student1 2,
  3. Yanbo Zhang, PhD student1 2,
  4. Xiong-Fei Pan, postdoc researcher1 2,
  5. An Pan, professor1 2
  1. 1Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
  2. 2Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
  1. Correspondence to: An Pan panan{at}
  • Accepted 29 August 2019


Objective To investigate the association between weight changes across adulthood and mortality.

Design Prospective cohort study.

Setting US National Health and Nutrition Examination Survey (NHANES) 1988-94 and 1999-2014.

Participants 36 051 people aged 40 years or over with measured body weight and height at baseline and recalled weight at young adulthood (25 years old) and middle adulthood (10 years before baseline).

Main outcome measures All cause and cause specific mortality from baseline until 31 December 2015.

Results During a mean follow-up of 12.3 years, 10 500 deaths occurred. Compared with participants who remained at normal weight, those moving from the non-obese to obese category between young and middle adulthood had a 22% (hazard ratio 1.22, 95% confidence interval 1.11 to 1.33) and 49% (1.49, 1.21 to 1.83) higher risk of all cause mortality and heart disease mortality, respectively. Changing from obese to non-obese body mass index over this period was not significantly associated with mortality risk. An obese to non-obese weight change pattern from middle to late adulthood was associated with increased risk of all cause mortality (1.30, 1.16 to 1.45) and heart disease mortality (1.48, 1.14 to 1.92), whereas moving from the non-obese to obese category over this period was not significantly associated with mortality risk. Maintaining obesity across adulthood was consistently associated with increased risk of all cause mortality; the hazard ratio was 1.72 (1.52 to 1.95) from young to middle adulthood, 1.61 (1.41 to 1.84) from young to late adulthood, and 1.20 (1.09 to 1.32) from middle to late adulthood. Maximum overweight had a very modest or null association with mortality across adulthood. No significant associations were found between various weight change patterns and cancer mortality.

Conclusions Stable obesity across adulthood, weight gain from young to middle adulthood, and weight loss from middle to late adulthood were associated with increased risks of mortality. The findings imply that maintaining normal weight across adulthood, especially preventing weight gain in early adulthood, is important for preventing premature deaths in later life.


  • Contributors: CC, XFP, and AP conceived the study design. CC and YY did the statistical analysis. CC and AP wrote the manuscript. All authors provided critical revisions of the draft and approved the submitted draft. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. AP is the guarantor.

  • Funding: This study was supported by grants from the National Key Research and Development Program of China to AP (2017YFC0907504) and the China Postdoctoral Science Foundation (No 176596) and International Postdoctoral Exchange Fellowship of the China Postdoctoral Council (No 20180062) to XFP. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than those described above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Approval of the study from the National Center of Health and Statistics Research ethics review board was waived because the research relied on publicly used, de-identified secondary data.

  • Transparency declaration: The manuscript’s guarantor affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: No additional data available.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text