Adding Pounds in Adulthood Ups Major Health Risks

Eleven pounds of extra weight increased risk for major chronic diseases

Gaining a small amount of weight each year during early and middle adulthood can add up to major health risks later in life, a large cohort study found.

From early adulthood to age 55, U.S. women in the study gained an average of 27.8 lbs, and men gained an average of 21.4 lbs, reported Frank Hu, MD, PhD, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues.

A gain of as little as 11 lbs during that time was associated with significantly increased risk for major chronic diseases such as type 2 diabetes, hypertension, and cardiovascular disease. Weight gain during adulthood was also associated with increased mortality risk, they wrote in JAMA.

The investigators found that, compared with maintaining a stable weight, each 5 kg (11 lbs) of weight gain during early and middle adulthood was linked with increases in risk for the following:

 ^► Type 2 diabetes: 31% (incident rate ratio 1.31, 95% CI 1.28-1.33)

 ^► Hypertension: 14% (IRR 1.14; 95% CI 1.10-1.17)

 ^► Cardiovascular disease: 8% (IRR 1.08; 95% CI 1.08-1.09)

 ^► Obesity-related cancer: 6% (IRR 1.06; 95% CI 1.02-1.09)

 ^► Mortality: 5% (IRR 1.05; 95% CI 1.04-1.07)

In addition, each gain of 5 kg was associated with a 17% decrease in the odds of healthy aging (IRR 0.83, 95% CI 0.77-0.89), a composite outcome defined as no self-reported physical limitations, cognitive decline, or history of diseases including cardiovascular disease, chronic obstructive pulmonary disease, Parkinson disease, and multiple sclerosis.

"Our study is the first of its kind to systematically examine the association of weight gain from early to middle adulthood with major health risks later in life," Hu said in a statement. "The findings indicate that even a modest amount of weight gain may have important health consequences."

Hu's group analyzed data from 118,140 study participants, including 92,837 women in the Nurses' Health Study from 1976 to 2012, and 25,303 men in the Health Professionals Follow-Up Study from 1986 to 2012. Participants in both cohorts completed a baseline questionnaire on lifestyle and medical history that included self-reported height and weight in early adulthood (age 18 for women, 21 for men).

Biennial follow-up questionnaires asked about changes in body weight as well as newly developed health problems, including type 2 diabetes, hypertension, cardiovascular disease, and cancer. The investigators assessed weight gain from early adulthood to age 55, then looked for associations between that weight gain and health problems from age 55 onward, following women for an average of 18 years and men for an average of 15 years. Deaths during follow-up were reported by next of kin, the postal system, or through the records of the National Death Index.

"By assessing weight change from the ages of 18 or 21 years to the age of 55 years, the current study attempted to capture the changes in fat mass during adulthood before the major age-related loss of muscle mass starts, and to minimize reverse causation due to ill health," the authors explained.

The analyses adjusted for potential confounders including age, race, family history of diseases, alcohol consumption and smoking status, physical activity level, use of aspirin, menopausal status and postmenopausal hormone therapy use for women, and a history of major chronic conditions reported via the regular biennial questionnaires throughout follow-up, the investigators noted.

"Excess adiposity tends to accrue during early and middle adulthood for most people," they wrote. "Among U.S. adults, the mean weight gain is 0.5 to 1.0 kg [1-2 lbs] per year from early to middle adulthood, and this modest early accumulation of weight eventually leads to obesity over time."

They pointed out that "Recommendations for preventing weight gain during adulthood are lacking in public health guidelines. Compared with studies of attained weight or BMI, an investigation of weight change may better capture the effect of excess fat because it factors in individual differences in frame size and lean mass that are difficult to measure in population studies."

Study limitations included its reliance on self-reports and that participants were mostly white healthcare professionals, so that the results may not be generalizable to other populations.

In an accompanying editorial, William Dietz, MD, PhD, of George Washington University in Washington, said, "Early adulthood is not only a period of risk for the development of obesity, but also a period of risk for excessive weight gain. A 10-year follow-up of participants included in the first NHANES [National Health and Nutrition Examination Survey] conducted between 1971 and 1975 reported that 4% of men and 8% of women gained 5 units or more in body-mass index between the ages of 25-34 years and 35-44 years.

"Efforts to prevent and control obesity in young adults should be accorded a high priority," Dietz advised. "The challenge will be that many individuals, particularly men between the ages of 20 and 39 years feel healthy, and have no medical problems that precipitate a visit to a physician."

The study was funded by the NIH and the American Diabetes Association.

Hu and co-authors disclosed no relevant relationships with industry.

Dietz disclosed relevant relationships with Weight Watchers, RTI, and Bridgespan.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

last updated 07.18.2017

Primary Source, Journal of the American Medical Association:  Zheng Y, et al "Associations of weight gain from early to middle adulthood with major health outcomes later in life" JAMA 2017; 318:255-269; DOI:doi:10.1001/jama.2017.7092.

Secondary Source, Journal of the American Medical Association: Dietz WH "Obesity and excessive weight gain in young adults: new targets for prevention" JAMA 2017; 318:241-242.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.