The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese

Authors Department of Medicine, University Hospital, S-205 02 Malmö, Sweden (fax: +46 469 23272; e-mail:


Abstract. Nilsson PM, Nilsson J-A, Hedblad B, Berglund G, Lindgärde F. (University Hospital, Malmö, Sweden). The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese. J Intern Med 2002; 252: 70−78.

Objective. To study effects on non-cancer mortality of observational weight loss in middle-aged men stratified for body mass index (BMI), taking a wide range of possible confounders into account.

Design. Prospective, population based study.

Setting. Male population of Malmö, Sweden.

Participants. In all 5722 men were screened twice with a mean time interval of 6 years in Malmö, southern Sweden. They were classified according to BMI category at baseline (<21, 22−25, overweight: 26−30, and obesity: 30+ kg m−2) and weight change category until second screening (weight stable men defined as having a baseline BMI ± 0.1 kg m−2 year−1 at follow-up re-screening).

Main outcome measures. Non-cancer mortality calculated from national registers during 16 years of follow-up after the second screening. Data from the first year of follow-up were excluded to avoid bias by mortality caused by subclinical disease at re-screening.

Results. The relative risk (RR; 95% CI) for non-cancer mortality during follow-up was higher in men with decreasing BMI in all subgroups: RR 2.64 (1.46−4.71, baseline BMI <21 kg m−2), 1.39 (0.98−1.95, baseline BMI 22−25 kg m−2), and 1.71 (1.18−2.47, baseline BMI 26+ kg m−2), using BMI-stable men as reference group. Correspondingly, the non-cancer mortality was also higher in men with increasing BMI, but only in the obese group (baseline BMI 26+ kg m−2) with RR 1.86 (1.31−2.65). In a subanalysis, nonsmoking obese (30+ kg m−2) men with decreased BMI had an increased non-cancer mortality compared with BMI-stable obese men (Fischer's test: P=0.001). The mortality risk for nonsmoking overweight men who increased their BMI compared with BMI-stable men was also significant (P=0.006), but not in corresponding obese men (P=0.094).

Conclusions. Weight loss in self-reported healthy but overweight middle-aged men, without serious disease, is associated with an increased non-cancer mortality, which seems even more pronounced in obese, nonsmoking men, as compared with corresponding but weight-stable men. The explanation for these observational findings is still enigmatic but could hypothetically be because of premature ageing effects causing so-called weight loss of involution.