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PLoS One. 2015 Mar 20;10(3):e0121993. doi: 10.1371/journal.pone.0121993. eCollection 2015.

Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials.

Author information

1
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
2
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America.
3
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
4
Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States of America.

Abstract

BACKGROUND:

Obesity is associated with increased mortality, and weight loss trials show rapid improvement in many mortality risk factors. Yet, observational studies typically associate weight loss with higher mortality risk. The purpose of this meta-analysis of randomized controlled trials (RCTs) of weight loss was to clarify the effects of intentional weight loss on mortality.

METHODS:

2,484 abstracts were identified and reviewed in PUBMED, yielding 15 RCTs reporting (1) randomization to weight loss or non-weight loss arms, (2) duration of ≥18 months, and (3) deaths by intervention arm. Weight loss interventions were all lifestyle-based. Relative risks (RR) and 95% confidence intervals (95% CI) were estimated for each trial. For trials reporting at least one death (n = 12), a summary estimate was calculated using the Mantel-Haenszel method. Sensitivity analysis using sparse data methods included remaining trials.

RESULTS:

Trials enrolled 17,186 participants (53% female, mean age at randomization = 52 years). Mean body mass indices ranged from 30-46 kg/m2, follow-up times ranged from 18 months to 12.6 years (mean: 27 months), and average weight loss in reported trials was 5.5±4.0 kg. A total of 264 deaths were reported in weight loss groups and 310 in non-weight loss groups. The weight loss groups experienced a 15% lower all-cause mortality risk (RR = 0.85; 95% CI: 0.73-1.00). There was no evidence for heterogeneity of effect (Cochran's Q = 5.59 (11 d.f.; p = 0.90); I2 = 0). Results were similar in trials with a mean age at randomization ≥55 years (RR = 0.84; 95% CI 0.71-0.99) and a follow-up time of ≥4 years (RR = 0.85; 95% CI 0.72-1.00).

CONCLUSIONS:

In obese adults, intentional weight loss may be associated with approximately a 15% reduction in all-cause mortality.

PMID:
25794148
PMCID:
PMC4368053
DOI:
10.1371/journal.pone.0121993
[Indexed for MEDLINE]
Free PMC Article

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