Researchers in Finland who tracked the health of over 1,000 men from middle age into old age found that being overweight and having high risk of cardiovascular disease in middle age followed by weight loss as they got older put them at a higher risk of illness and death later in life.

The study was the work of lead author Timo Strandberg, a Professor in the Institute of Health Sciences/Geriatrics at the University of Oulu, Finland, and colleagues, and was published earlier this month in the European Heart Journal.

Strandberg and colleagues set out to examine the extent to which cardiovascular disease risk contributes to the “obesity paradox”.

The obesity paradox is that despite much research showing that in the main being obese is bad for health, there is some evidence that in certain cases it may actually protect people from early death.

For example a recent review of the literature on the obesity paradox (published in the May issue of Journal of the American College of Cardiology) suggests that overweight and obese coronary heart disease patients have a lower risk of death compared with patients who are underweight or of normal weight, and compared with patients of normal weight who have recently undergone revascularization procedures.

For this study, Strandberg and colleagues looked at cardiovascular disease (CVD) risk and body mass index (BMI) data on 1,114 men who were healthy in middle age (1974). The data covered mean ages from 25, through 47 to 73 (in 2000).

The results showed that:

  • 188 of the men died between 2000 and 2006.

  • 494 (44.3 per cent) of the men were constantly overweight from 1974 to 2000.

  • 345 (31 per cent) were constantly of normal weight from 1974 to 2000.

  • 136 (12.2 per cent) moved from normal to overweight, and 139 (12.5 per cent) moved from overweight to normal during 1974 to 2000.

  • The men who moved from overweight to normal had the highest CVD risk in midlife, and in late life had higher risk of illnesses and greatest risk of death.

  • The adjusted hazard ratio for mortality was 2.0, compared to the normal weight group as the standard (95 per cent confidence interval ranged from 1.3 to 3.0), and this did not change significantly when adjusting for prevalent diseases in 2000.

Overweight was defined as BMI of over 25 kg/m2.

The authors concluded that:

“In old age, both normal weight and overweight men are a mixture of individuals with different weight trajectories during their life course. Overweight and high-CVD risk in midlife with subsequent weight decrease predict the worst prognosis in late life.”

Speaking in an interview earlier this month with Helsingin Sanomat, Scandinavia’s biggest daily subscription newpaper, Strandberg said men should shed excess weight before retirement.

Reducing weight in old age is more dangerous because you could lose muscle instead of fat, which leads to frailty. The focus should be on increased exercise, said Strandberg.

“Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men.”
Timo E. Strandberg , Arto Y. Strandberg , Veikko V. Salomaa , Kaisu H. Pitkälä , Reijo S. Tilvis , Jonne Sirola , and Tatu A. Miettinen.
European Heart JournalAdvance Access published on May 9, 2009
DOI 10.1093/eurheartj/ehp162.

Additional sources: theheart.org, Helsingin Sanomat.

Written by: Catharine Paddock, PhD