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January 16, 1987, Vol 257, No. 3 >
ARTICLE | January 16, 1987

Body Weight and Longevity: Title and subTitle BreakA Reassessment FREE

JoAnn E. Manson, MD; Meir J. Stampfer, MD; Charles H. Hennekens, MD; Walter C. Willett, MD
[+] Author Affiliations

Reprint requests to 180 Longwood Ave, Boston, MA 02115 (Dr Manson).


JAMA. 1987;257(3):353-358. doi:10.1001/jama.1987.03390030083026
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References

Conflicting results have been reported concerning the association between body weight and longevity. The shape of the curve relating weight to all-cause mortality has been variously described as linear, J-shaped, and even U-shaped. To assess the validity of the evidence for optimal weight recommendations, we examined the 25 major prospective studies on the subject. Each study had at least one of three major biases: (1) failure to control for cigarette smoking, (2) inappropriate control of biologic effects of obesity, such as hypertension and hyperglycemia, and (3) failure to control for weight loss due to subclinical disease. The presence of these biases leads to a systematic underestimate of the impact of obesity on premature mortality. Although these biases preclude a valid assessment of optimal weight from existing data, available evidence suggests that minimum mortality occurs at relative weights at least 10% below the US average.

(JAMA 1987;257:353-358)

REFERENCES

1 +
Van Itallie TB:  Obesity: Adverse effects on health and longevity . Am J Clin Nutr 1979;;32: 2723-2733.
2 +
Bierman EL, Hirsch J:  Obesity , in Williams RH (ed): Textbook of Endocrinology . Philadelphia, WB Saunders Co, 1981;, pp 906-921.
3 +
Mann GV:  The influence of obesity on health . N Engl J Med 1974;;291:178-185, 226-232.
4 +
Build and Blood Pressure Study, 1959 . Chicago, Society of Actuaries, 1959;.
5 +
Build Study 1979 . Chicago, Society of Actuaries and Association of Life Insurance Medical Directors of America, 1980;.
6 +
Keys A:  Overweight, obesity, coronary heart disease and mortality . Nutr Rev 1980;;38:297-307.
7 +
Keys A:  Is overweight a risk factor for coronary heart disease? Cardiovasc Med 1979;;1233-1243.
8 +
Andres R:  Effect of obesity on total mortality . Int J Obes 1980;;4:381-386.
9 +
National Institutes of Health Consensus Development Panel:  Health implications of obesity: National Institutes of Health consensus development conference statement . Ann Intern Med 1985;;103: 1073-1077.
10 +
Lew EA, Garfinkel L:  Variations in mortality by weight among 750 000 men and women . J Chronic Dis 1979;;32:563-576.
11 +
Keys A: Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease . Cambridge, Mass, Harvard University Press, 1980;.
12 +
Rosenman RH, Brand RJ, Sholtz RI, et al:  Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study . Am J Cardiol 1976;;37: 903-910.
13 +
Dyer AR, Stamler J, Berkson DM, et al:  Relationship of relative weight and body mass index to 14-year mortality in the Chicago Peoples Gas Company Study . J Chronic Dis 1975;;28:109-123.
14 +
Kozarević D, Pirc Z, Račić Z, et al:  The Yugoslavia Cardiovascular Disease Study: II. Factors in the incidence of coronary heart disease . Am J Epidemiol 1976;;104:133-140.
15 +
Böttiger LE, Carlson LA:  Risk factors for ischemic vascular death for men in the Stockholm Prospective Study . Atherosclerosis 1980;;36:389-408.
16 +
Tibblin G, Wilhelmsen L, Werkö L:  Risk factors for myocardial infarction and death due to ischemic heart disease and other causes . Am J Cardiol 1975;;35:514-522.
17 +
Noppa H, Bengtsson C, Wedel H, et al:  Obesity in relation to morbidity and mortality from cardiovascular disease . Am J Epidemiol 1980;;111:682-692.
18 +
Rose G, Hamilton PS, Keen H, et al:  Myocardial ischemia, risk factors and death from coronary heart disease . Lancet 1977;;1:105-109.
19 +
Chapman JM, Massey FJ:  The interrelationship of serum cholesterol, hypertension, body weight, and risk of coronary disease, results of the first ten years' follow-up in the Los Angeles Heart Study . J Chronic Dis 1964;;17:933-949.
20 +
Westlund K, Nicolaysen R:  Ten-year mortality and morbidity related to serum cholesterol: A follow-up of 3751 men aged 40-49 . Scand J Clin Lab Invest 1972;;30( (suppl 127) ):1-24.
21 +
Borhani NO, Hechter HH, Breslow L:  Report of a ten-year follow-up of the San Francisco long-shoremen . J Chronic Dis 1963;;16:1251-1266.
22 +
Hubert HB, Feinleib M, McNamara PM, et al:  Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study . Circulation 1983;; 67:968-977.
23 +
Garrison RJ, Feinleib M, Castelli WP, et al:  Cigarette smoking as a confounder of the relationship between relative weight and long-term mortality: The Framingham Heart Study . JAMA 1983;;249:2199-2203.
24 +
Paul O, Lepper MH, Phelan WH, et al:  A longitudinal study of coronary heart disease . Circulation 1963;;28:20-31.
25 +
Keys A, Taylor HL, Blackburn H, et al:  Mortality and coronary heart disease among men studied for 23 years . Arch Intern Med 1971;;128: 201-214.
26 +
Pyörälä K, Savolainen E, Lehtovirta E, et al:  Glucose tolerance and coronary heart disease: Helsinki policemen study . J Chronic Dis 1979;;32: 729-745.
27 +
 Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the pooling project . J Chronic Dis 1978;;31:201-306.
28 +
Rhoads GG, Kagan A:  The relation of coronary disease, stroke, and mortality to weight in youth and middle age . Lancet 1983;;1:492-495.
29 +
Rabkin SW, Mathewson FAL, Hsu PH:  Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: The Manitoba Study . Am J Cardiol 1977;;39:452-458.
30 +
Comstock GW, Kendrick MA, Livesay VT:  Subcutaneous fatness and mortality . Am J Epidemiol 1966;;83:548-563.
31 +
Vandenbroucke JP, Mauritz BJ, de Bruin A, et al:  Weight, smoking, and mortality . JAMA 1984;;252:2859-2860.
32 +
Waaler HT:  Height, weight and mortality: The Norwegian experience . Acta Med Scand Suppl 1984;;679:1-56.
33 +
 New weight standards for men and women . Stat Bull NY Metropolitan Life Insurance Co 1959;;40:1-4.
34 +
 1983 Metropolitan height and weight tables . Stat Bull NY Metropolitan Life Insurance Co 1983;;64:2-9.
35 +
Abraham S: Weight by Height and Age for Adults 18-74 Years: United States, 1971-74 , US Dept of Health, Education, and Welfare publication (PHS) 79-1656. Hyattsville, Md, National Center for Health Statistics, 1979;.
36 +
Brozek J:  Review of build and blood pressure study . Hum Biol 1960;;32:320-323.
37 +
Simopoulos AP, Van Itallie TB:  Body weight, health, and longevity . Ann Intern Med 1984;;100:285-295.
38 +
Seltzer CC:  Some re-evaluations of the build and blood pressure study 1959 as related to ponderal index, somatotype, and mortality . N Engl J Med 1966;;274:254-259.
39 +
Stavig GR, Leonard AR, Igra A, et al:  Indices of relative body weight and ideal weight charts . J Chronic Dis 1984;;37:255-262.
40 +
Keys A, Fidanza F, Karvonen MJ, et al:  Indices of relative weight and obesity . J Chronic Dis 1972;;25:329-343.
41 +
 Measurement of overweight . Stat Bull NY Metropolitan Life Insurance Co 1984;;65:20-23.
42 +
Lee J, Kolonel LN:  Are body mass indices interchangeable in measuring obesity-disease associations? Am J Public Health 1984;;74:376-377.
43 +
Russell RM, McGandy RB, Jelliffe D:  Reference weights: Practical considerations . Am J Med 1984;;76:767-769.
44 +
Borkan GA, Hults DE, Gerzof SG, et al:  Age changes in body composition revealed by computed tomography . J Gerontol 1983;;38:673-677.
45 +
Kleinbaum DG, Kupper LL, Morganstern H: Epidemiologic research: Principles and quantitative methods . Belmont, Calif, Lifetime Learning Publications, 1982;, pp 223-224.
46 +
Wack JT, Rodin J:  Smoking and its effects on body weight and the systems of caloric regulation . Am J Clin Nutr 1982;;35:366-380.
47 +
Glauser SC, Glauser AM, Reidenberg MM, et al:  Metabolic changes associated with the cessation of cigarette smoking . Arch Environ Health 1970;; 20:377-381.
48 +
Hofstetter A, Schutz Y, Jéquier E, et al:  Increased 24-hour energy expenditure in cigarette smokers . N Engl J Med 1986;;314:79-82.
49 +
Abraham S, Carroll M, Najjar MF, et al: Obese and Overweight Adults in the United States , US Dept of Health and Human Services publication (PHS) 83-1680. Hyattsville, Md, National Center for Health Statistics, 1983;.
50 +
Marton KI, Sox HC, Krupp JR:  Involuntary weight loss: Diagnostic and prognostic significance . Ann Intern Med 1981;;95:568-574.
51 +
Lew EA:  Mortality and weight: Insured lives and the American Cancer Society studies . Ann Intern Med 1985;;103:1024-1029.
52 +
Andres R:  Mortality and obesity: The rationale for age-specific height-weight tables , in Andres R, Bierman EL, Hazzard WR (eds): Principles of Geriatric Medicine . New York, McGraw-Hill International Book Co, 1985;:311-318.
53 +
Andres R, Elahi D, Tobin JD, et al:  Impact of age on weight goals . Ann Intern Med 1985;;103: 1030-1033.
54 +
Kissebah AH, Vydelingum N, Murray R, et al:  Relation of body fat distribution to metabolic complications of obesity . J Clin Endocrinol Metab 1982;;54:254-260.
55 +
Krotkiewski M, Björntorp P, Sjöström L, et al:  Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution . J Clin Invest 1983;;72:1150-1162.
56 +
Björntorp P:  Regional patterns of fat distribution . Ann Intern Med 1985;;103:994-995.

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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Van Itallie TB:  Obesity: Adverse effects on health and longevity . Am J Clin Nutr 1979;;32: 2723-2733.
2 +
Bierman EL, Hirsch J:  Obesity , in Williams RH (ed): Textbook of Endocrinology . Philadelphia, WB Saunders Co, 1981;, pp 906-921.
3 +
Mann GV:  The influence of obesity on health . N Engl J Med 1974;;291:178-185, 226-232.
4 +
Build and Blood Pressure Study, 1959 . Chicago, Society of Actuaries, 1959;.
5 +
Build Study 1979 . Chicago, Society of Actuaries and Association of Life Insurance Medical Directors of America, 1980;.
6 +
Keys A:  Overweight, obesity, coronary heart disease and mortality . Nutr Rev 1980;;38:297-307.
7 +
Keys A:  Is overweight a risk factor for coronary heart disease? Cardiovasc Med 1979;;1233-1243.
8 +
Andres R:  Effect of obesity on total mortality . Int J Obes 1980;;4:381-386.
9 +
National Institutes of Health Consensus Development Panel:  Health implications of obesity: National Institutes of Health consensus development conference statement . Ann Intern Med 1985;;103: 1073-1077.
10 +
Lew EA, Garfinkel L:  Variations in mortality by weight among 750 000 men and women . J Chronic Dis 1979;;32:563-576.
11 +
Keys A: Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease . Cambridge, Mass, Harvard University Press, 1980;.
12 +
Rosenman RH, Brand RJ, Sholtz RI, et al:  Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study . Am J Cardiol 1976;;37: 903-910.
13 +
Dyer AR, Stamler J, Berkson DM, et al:  Relationship of relative weight and body mass index to 14-year mortality in the Chicago Peoples Gas Company Study . J Chronic Dis 1975;;28:109-123.
14 +
Kozarević D, Pirc Z, Račić Z, et al:  The Yugoslavia Cardiovascular Disease Study: II. Factors in the incidence of coronary heart disease . Am J Epidemiol 1976;;104:133-140.
15 +
Böttiger LE, Carlson LA:  Risk factors for ischemic vascular death for men in the Stockholm Prospective Study . Atherosclerosis 1980;;36:389-408.
16 +
Tibblin G, Wilhelmsen L, Werkö L:  Risk factors for myocardial infarction and death due to ischemic heart disease and other causes . Am J Cardiol 1975;;35:514-522.
17 +
Noppa H, Bengtsson C, Wedel H, et al:  Obesity in relation to morbidity and mortality from cardiovascular disease . Am J Epidemiol 1980;;111:682-692.
18 +
Rose G, Hamilton PS, Keen H, et al:  Myocardial ischemia, risk factors and death from coronary heart disease . Lancet 1977;;1:105-109.
19 +
Chapman JM, Massey FJ:  The interrelationship of serum cholesterol, hypertension, body weight, and risk of coronary disease, results of the first ten years' follow-up in the Los Angeles Heart Study . J Chronic Dis 1964;;17:933-949.
20 +
Westlund K, Nicolaysen R:  Ten-year mortality and morbidity related to serum cholesterol: A follow-up of 3751 men aged 40-49 . Scand J Clin Lab Invest 1972;;30( (suppl 127) ):1-24.
21 +
Borhani NO, Hechter HH, Breslow L:  Report of a ten-year follow-up of the San Francisco long-shoremen . J Chronic Dis 1963;;16:1251-1266.
22 +
Hubert HB, Feinleib M, McNamara PM, et al:  Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study . Circulation 1983;; 67:968-977.
23 +
Garrison RJ, Feinleib M, Castelli WP, et al:  Cigarette smoking as a confounder of the relationship between relative weight and long-term mortality: The Framingham Heart Study . JAMA 1983;;249:2199-2203.
24 +
Paul O, Lepper MH, Phelan WH, et al:  A longitudinal study of coronary heart disease . Circulation 1963;;28:20-31.
25 +
Keys A, Taylor HL, Blackburn H, et al:  Mortality and coronary heart disease among men studied for 23 years . Arch Intern Med 1971;;128: 201-214.
26 +
Pyörälä K, Savolainen E, Lehtovirta E, et al:  Glucose tolerance and coronary heart disease: Helsinki policemen study . J Chronic Dis 1979;;32: 729-745.
27 +
 Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the pooling project . J Chronic Dis 1978;;31:201-306.
28 +
Rhoads GG, Kagan A:  The relation of coronary disease, stroke, and mortality to weight in youth and middle age . Lancet 1983;;1:492-495.
29 +
Rabkin SW, Mathewson FAL, Hsu PH:  Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: The Manitoba Study . Am J Cardiol 1977;;39:452-458.
30 +
Comstock GW, Kendrick MA, Livesay VT:  Subcutaneous fatness and mortality . Am J Epidemiol 1966;;83:548-563.
31 +
Vandenbroucke JP, Mauritz BJ, de Bruin A, et al:  Weight, smoking, and mortality . JAMA 1984;;252:2859-2860.
32 +
Waaler HT:  Height, weight and mortality: The Norwegian experience . Acta Med Scand Suppl 1984;;679:1-56.
33 +
 New weight standards for men and women . Stat Bull NY Metropolitan Life Insurance Co 1959;;40:1-4.
34 +
 1983 Metropolitan height and weight tables . Stat Bull NY Metropolitan Life Insurance Co 1983;;64:2-9.
35 +
Abraham S: Weight by Height and Age for Adults 18-74 Years: United States, 1971-74 , US Dept of Health, Education, and Welfare publication (PHS) 79-1656. Hyattsville, Md, National Center for Health Statistics, 1979;.
36 +
Brozek J:  Review of build and blood pressure study . Hum Biol 1960;;32:320-323.
37 +
Simopoulos AP, Van Itallie TB:  Body weight, health, and longevity . Ann Intern Med 1984;;100:285-295.
38 +
Seltzer CC:  Some re-evaluations of the build and blood pressure study 1959 as related to ponderal index, somatotype, and mortality . N Engl J Med 1966;;274:254-259.
39 +
Stavig GR, Leonard AR, Igra A, et al:  Indices of relative body weight and ideal weight charts . J Chronic Dis 1984;;37:255-262.
40 +
Keys A, Fidanza F, Karvonen MJ, et al:  Indices of relative weight and obesity . J Chronic Dis 1972;;25:329-343.
41 +
 Measurement of overweight . Stat Bull NY Metropolitan Life Insurance Co 1984;;65:20-23.
42 +
Lee J, Kolonel LN:  Are body mass indices interchangeable in measuring obesity-disease associations? Am J Public Health 1984;;74:376-377.
43 +
Russell RM, McGandy RB, Jelliffe D:  Reference weights: Practical considerations . Am J Med 1984;;76:767-769.
44 +
Borkan GA, Hults DE, Gerzof SG, et al:  Age changes in body composition revealed by computed tomography . J Gerontol 1983;;38:673-677.
45 +
Kleinbaum DG, Kupper LL, Morganstern H: Epidemiologic research: Principles and quantitative methods . Belmont, Calif, Lifetime Learning Publications, 1982;, pp 223-224.
46 +
Wack JT, Rodin J:  Smoking and its effects on body weight and the systems of caloric regulation . Am J Clin Nutr 1982;;35:366-380.
47 +
Glauser SC, Glauser AM, Reidenberg MM, et al:  Metabolic changes associated with the cessation of cigarette smoking . Arch Environ Health 1970;; 20:377-381.
48 +
Hofstetter A, Schutz Y, Jéquier E, et al:  Increased 24-hour energy expenditure in cigarette smokers . N Engl J Med 1986;;314:79-82.
49 +
Abraham S, Carroll M, Najjar MF, et al: Obese and Overweight Adults in the United States , US Dept of Health and Human Services publication (PHS) 83-1680. Hyattsville, Md, National Center for Health Statistics, 1983;.
50 +
Marton KI, Sox HC, Krupp JR:  Involuntary weight loss: Diagnostic and prognostic significance . Ann Intern Med 1981;;95:568-574.
51 +
Lew EA:  Mortality and weight: Insured lives and the American Cancer Society studies . Ann Intern Med 1985;;103:1024-1029.
52 +
Andres R:  Mortality and obesity: The rationale for age-specific height-weight tables , in Andres R, Bierman EL, Hazzard WR (eds): Principles of Geriatric Medicine . New York, McGraw-Hill International Book Co, 1985;:311-318.
53 +
Andres R, Elahi D, Tobin JD, et al:  Impact of age on weight goals . Ann Intern Med 1985;;103: 1030-1033.
54 +
Kissebah AH, Vydelingum N, Murray R, et al:  Relation of body fat distribution to metabolic complications of obesity . J Clin Endocrinol Metab 1982;;54:254-260.
55 +
Krotkiewski M, Björntorp P, Sjöström L, et al:  Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution . J Clin Invest 1983;;72:1150-1162.
56 +
Björntorp P:  Regional patterns of fat distribution . Ann Intern Med 1985;;103:994-995.

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