Reduction in Waist Circumference Led to Lower All-Cause Mortality
Among postmenopausal women, researchers explored associations between intentional weight loss and waist circumference (WC) reduction and mortality.
The intentional weight-loss efforts of postmenopausal women were associated with a reduction in all-cause mortality risk, according to data published in JAMA Network Open.1 With waist circumference (WC) reduction being the key indicator of lower mortality in the study, researchers suggested that weight may not be the preferred measurement for older women’s bodies.
“Globally, 2.6 billion people live with overweight or obesity,” wrote authors of the study. “In the United States, the age-adjusted prevalence of obesity among adults is 42%, and it is 44% among women 60 years or older. The increasing prevalence of obesity is concerning because obesity raises the risk of type 2 diabetes, cardiovascular disease (CVD), certain cancers, reduces quality of life, and shortens life expectancy.”
Previous studies have shown a significant association between obesity and menopause. Women’s menopausal transitions, which begin at age 51 on average,2 have been known to lead to increased visceral and abdominal obesity in those with normal weight and obesity.3
READ MORE: Obesity Management Resource Center
Decreases in WC on its own led to lower mortality risk across all types. | image credit: Pungu x / stock.adobe.com
There is also a plethora of literature explaining obesity’s link to increased mortality and various comorbidities. However, there have been some inconsistent findings where some studies have reported that weight loss increased mortality risk.1 Researchers have also found that intentional weight loss led to decreased mortality, highlighting contradictory findings and a need for more research regarding intentional and unintentional weight loss.
On top of inconsistent literature, some of the most notable experts on obesity guidelines are rethinking how it is measured, suggesting that WC, waist-to-height ratio, or waist-to-hip ratio be measured in addition to body mass index (BMI).4 Among a vast collection of previous knowledge, researchers decided to steer their focus of the study toward postmenopausal women intentionally trying to lose weight.
“The uncertainty surrounding the benefits of intentional weight loss, and how it should be measured, obscure a potentially compelling public health message that older people with overweight or obesity could reduce their mortality risk by losing weight,” they continued.1 “To address this, we examined associations between changes in weight and in WC throughout a 3-year period corresponding to intentional vs unintentional efforts to lose weight and subsequent all-cause, cancer, and CVD mortality during the next 18.6 years.”
In search of an association between intentional weight loss and mortality risk, researchers explored data from the Women’s Health Initiative Observational Study, which ended in 2023 and consisted of a mean follow-up length of 18.6 years. All women were aged 50 to 79 years old and were examined at 40 clinics across the US. Data collection lasted from September 1993 to February 2023.
The study population included a total of 58,961 women at baseline (mean age, 63.3 years; mean BMI, 27). By the end of the 30-year follow-up period, 29,183 women died from all causes (49.5%); 9113 died from CVD (15.5%); 5927 died from cancer (10.1%); and 14,143 died from other causes (24.0%).1
“The findings of this study demonstrated that intentionality of weight loss was strongly associated with subsequent mortality in postmenopausal women,” they wrote. “Mortality reductions were observed when intentional weight loss was accompanied by reduced WC. Conversely, weight gain and unintentional weight loss were associated with increased mortality risk as expected, and unintentional WC loss was also associated with higher mortality risk.”
Participants that reported intentional weight loss of at least 5 pounds had significantly lower risk of all-cause, CVD, cancer, and other mortality. Compared with this group, those who lost weight unintentionally had significantly higher mortality risks, highlighting the benefits of intentional weight loss over unintentional weight loss.
Furthermore, decreases in WC on its own also led to lower mortality risk across all types. On the other hand, unintentional WC loss and increased WC both led to significantly higher mortality risks when compared with participants who saw intentionally decreased WC. And finally, intentional weight loss solely measured by body weight—and not reductions in WC—were only associated with decreased CVD mortality.
With a clear shift in how health care experts look at obesity, as well as further evidence regarding obesity’s link to mortality, future research should continue to focus on other measurements like WC, waist-to-height ratio, or waist-to-hip ratio.
“Our findings add to the evidence base that weight may not be the preferred measure for assessing body composition among older women. Our results also suggested that older women with overweight or obesity should not be discouraged from attempting weight loss if they wish to lose weight. 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,” concluded authors of the study.1
READ MORE: Women's Health Resource Center
Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.
