Framingham Heart Study: limiting weight increase is tied to lowest mortality risk

  • JAMA Netw Open

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Maximum BMI over the years tracks with mortality risk.
  • People with stable BMI in normal or overweight categories had no risk difference and had the lowest mortality risk in this Framingham Heart Study analysis.

Why this matters

  • Asking about weight history rather than relying on a snapshot in time might add to the clinical picture.
  • Editorial notes the “story of BMI history and mortality is far from straightforward” and says the “bottom line is weight gain prevention.”

Key results

  • Overall: 21.9% increased risk with each 5-unit increase in maximum BMI. 
  • Mortality risk did not differ between people who remained stably normal-weight or overweight (HR, 1.04; 95% CI, 0.94-1.14).
  • Mortality risk increased with obesity:
    • Obese 1: BMI 30 to 2; HR, 1.27 (95% CI, 1.14-1.41).
    • Obese 2: BMI 35 to kg/m2; HR, 1.93 (1.68-2.20).
  • Former overweight/obesity in normal-weight tied to mortality of 47.48 and 66.67/1000 person-years, respectively, vs sustained normal weight: 27.93/1000 person-years.
  • Of note: those with weight loss more likely had history of CVD or cancer.

Study design

  • n=6197 from Framingham Heart Study cohorts (3478 deaths; mean follow-up, 17 years).
  • Outcomes: maximum BMI over time, all-cause/cause-specific mortality.
  • Funding: NIH.

Limitations

  • Reasons for weight changes unknown; reverse causality possible.
  • True BMI maximum possible missed.

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