(12-06-13) Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men

Dariush Mozaffarian, M.D., Dr.P.H., Tao Hao, M.P.H., Eric B. Rimm, Sc.D.,
Walter C. Willett, M.D., Dr.P.H., and Frank B. Hu, M.D., Ph.D.

From the Division of Cardiovascular Medicine
(D.M.) and Channing Laboratory
(D.M., E.B.R., W.C.W., F.B.H.), Brigham
and Women’s Hospital and Harvard Medical
School; and the Departments of Epidemiology
(D.M., T.H., E.B.R., W.C.W.,
F.B.H.) and Nutrition (D.M., E.B.R.,
W.C.W., F.B.H.), Harvard School of Public
Health — all in Boston. Address reprint
requests to Dr. Mozaffarian at 665 Huntington
Ave., Bldg. 2-319, Boston, MA
02115, or at [email protected].
N Engl J Med 2011;364:2392-404.
Copyright © 2011 Massachusetts Medical Society.

ABSTR ACT
Background
Specific dietary and other lifestyle behaviors may affect the success of the straightforward-
sounding strategy “eat less and exercise more” for preventing long-term
weight gain.
Methods
We performed prospective investigations involving three separate cohorts that included
120,877 U.S. women and men who were free of chronic diseases and not obese
at baseline, with follow-up periods from 1986 to 2006, 1991 to 2003, and 1986 to 2006.
The relationships between changes in lifestyle factors and weight change were evaluated
at 4-year intervals, with multivariable adjustments made for age, baseline bodymass
index for each period, and all lifestyle factors simultaneously. Cohort-specific
and sex-specific results were similar and were pooled with the use of an inversevariance–
weighted meta-analysis.
Results
Within each 4-year period, participants gained an average of 3.35 lb (5th to 95th
percentile, −4.1 to 12.4). On the basis of increased daily servings of individual dietary
components, 4-year weight change was most strongly associated with the intake of
potato chips (1.69 lb), potatoes (1.28 lb), sugar-sweetened beverages (1.00 lb), unprocessed
red meats (0.95 lb), and processed meats (0.93 lb) and was inversely associated
with the intake of vegetables (−0.22 lb), whole grains (−0.37 lb), fruits (−0.49 lb), nuts
(−0.57 lb), and yogurt (−0.82 lb) (P≤0.005 for each comparison). Aggregate dietary
changes were associated with substantial differences in weight change (3.93 lb across
quintiles of dietary change). Other lifestyle factors were also independently associated
with weight change (P<0.001), including physical activity (−1.76 lb across quintiles);
alcohol use (0.41 lb per drink per day), smoking (new quitters, 5.17 lb; former smokers,
0.14 lb), sleep (more weight gain with <6 or >8 hours of sleep), and television
watching (0.31 lb per hour per day).
Conclusions
Specific dietary and lifestyle factors are independently associated with long-term weight
gain, with a substantial aggregate effect and implications for strategies to prevent obesity.
(Funded by the National Institutes of Health and others.)


Source: N Engl J Med 2011;364:2392-404.
Copyright © 2011 Massachusetts Medical Society.

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