Will Weight Loss Save Your Life?

A recent study published in JAMA Network Open (Hendrix, et al, 2025) suggests that postmenopausal women who intentionally lost 5 pounds or more—along with a 5% reduction in waist circumference—had a “significantly lower risk of all-cause, cancer, and cardiovascular mortality.”

Essentially, the authors argue that intentional weight loss saves lives and should not be discouraged, even as other research raises doubts about the benefits of weight loss in older adults.

The authors dispute any uncertainty about the benefits of intentional weight loss, saying that it “obscures a compelling public health message that older adults with overweight or obesity could reduce their mortality risk by losing weight.”

Weight and health result from a complex interaction of biological factors and behaviors. While health behaviors like nutrition and physical activity play a role, many influences—such as genetics, early life experiences, weight stigma, unequal access to care, social isolation, food insecurity, and psychological trauma—also play a role and are often beyond an individual’s control. This complexity makes it difficult to identify a single cause or a simple solution, such as weight=health.

Nevertheless, this study provides an example of how intentional weight loss benefits are often exaggerated and misrepresented in literature, making this a good exercise for demonstrating how one might benefit from digging in and critically thinking about what the absolute numbers tell us.

A Brief Summary of the Study

The widely publicized Women’s Health Initiative study consisted of three components: a clinical trial, an observational study, and a community prevention study. The Observational Study followed over 93,000 postmenopausal women, ages 50 to 79 (average age 63), beginning in 1993 for which this study was based. Participants had their body weight and waist circumference measured at the start and again at year three, with annual follow-ups over an 18.6-year period.

The investigators calculated the weight change between baseline and year three and then categorized each woman’s change in body weight as stable (change less than 5% from baseline), weight loss (decrease of 5% or more since baseline), or weight gain (increase of 5% or more since baseline).

Similarly, waist circumference was measured and categorized in the same manner. Then, at year three, women were asked, “In the past two years, did you lose five or more pounds on purpose (or not) at any time?” This information was used to categorize any weight loss between baseline and year three as “intentional” or “unintentional.” The follow-up data collected through February 2023 was used to determine the relationship between intentional or unintentional weight loss and mortality risk in this study.

Although the authors concluded that “waist circumference reductions that occurred with intentional weight loss efforts were associated with reduced mortality risk in older women,” does the data support such a sweeping claim?

A Few Key Points

Perhaps I read and interpreted some of the data differently, but I’d like to offer an alternative perspective to the author’s conclusions.

• It appears that 44% of the women said they had intentionally lost 5 or more pounds in the past 2 years.
• However, only 6% of the women in the study (3740 out of 58,961 women) had intentional weight loss coupled with the loss of waist circumference of 5% or more when measured.
• That group of women (the 6%) were less active and had a higher baseline BMI and waist circumference than the other groups – does this matter? Maybe, maybe not, but I’ll address this shortly.
• At the end of the 18.6-year follow-up, 49.5% of the 58,961 women had died, and nearly half of those deaths (48%) were from “other causes.” With that fact in mind, the authors point out that women with intentional weight loss coupled with a reduction in waist circumference had a significantly higher risk of “other causes” of death when compared to women with a stable weight/waist circumference.
• So although the calculations of “relative risk” suggest lower mortality in the cases of cancer and cardiovascular disease, almost half of the deaths were from “other causes” that had a higher risk of mortality.
• Intentional weight loss with reduced body weight alone was associated with an increased risk of cancer and other causes of mortality. I guess women need to be sure that if they lose weight, they need to be darn sure and lose waist circumference or their outcome could be detrimental.
• Even though 26,190 women said they intentionally lost 5 pounds or more, only 3,740 had measured weight/WC loss at year three. So, what happened with the other 22,450 women? The authors speculate that this could be due to weight regain (good guess).
• Given that 86% of the women appear to have regained any intentional weight loss, the data from this study actually supports (rather than refutes) research about whether weight loss interventions are sustainable for most women in the long run.
• When looking at absolute numbers versus relative risk, the data indicates that women who experienced weight gain (26% of the women) had the lowest death rate of 44% compared to 48% for women who had intentional weight loss with reduced body weight alone.
• Women with a BMI less than 18.5 were excluded. Knowing that this group of women may actively pursue weight loss, but also are a population with increased mortality risk (similar to women with a BMI>30), how would including these participants potentially skew the mortality results?

A few more points to think about when reviewing studies refuting the risk of intentional weight loss.

Given that weight regain is common for most women (as this study suggests), it is important to consider the impact of weight cycling on mortality risk.

In a separate analysis of the same WHI Observational Study population, researchers asked women whether they had lost weight and kept it off, or experienced weight fluctuations of more than 10 pounds—and how many times their weight went up and down (Welti, et al. Cancer Epidemiol Biomarkers Prev, 2017). The results revealed a different relationship between weight loss, weight cycling, and cancer risk.

In this study, researchers learned that 37% of women described themselves as adult weight cyclers while only 3% described losing weight and keeping it off.  Furthermore, weight cycling 4 to 6 times was consistently associated with an increased risk of breast, endometrial, or colorectal cancer with a 38% increased risk of endometrial cancer and 84% increased risk when compared to weight stability.

Since the women in the 2025 study reportedly had a lower risk of cancer, could it be because they happened to be a part of the small minority who didn’t experience any weight fluctuations? Hard to say for sure.

On the other hand, let’s consider the potential for the positive outcome of decreased mortality risk for the group of women (you know the ones with intentional weight loss of 5 or more pounds who also had a reduction in waist circumference of 5%). As I mentioned before, this group of women had the highest BMI (29.1) and waist circumference (32 inches) at baseline when compared to those with stable weight, weight gain, or unintentional weight loss.

A Case Study

So, let’s say that the average 63-year-old woman who weighs 175 pounds and is 5’5” (equivalent to BMI = 29.1) loses 6 pounds and 5% off her waistline with diet and exercise interventions. According to this study, that should be enough for improving health and reducing mortality risk, right? Perhaps she’s made meaningful behavior change and this study indicates that those results are associated with a “significantly lower risk of all-cause, cancer, and cardiovascular mortality.”

But, in today’s culture, is that really enough?

She would still be classified as “overweight” with a BMI of 28.1, and even though physicians and researchers are doing lip service to the “BMI is not the preferred measure for assessing body composition” narrative, the pressure to change a woman’s body size hasn’t shifted (at least from what I’ve seen). To this point, the authors in this study theorize that “women who successfully reduce waist circumference likely adopt dietary and exercise practices targeting abdominal fat, whereas those losing weight without reducing girth may not.”

So, hold on – what does that mean exactly?

Although the investigators asked participants how they lost weight, over half (53%) reported using a combination of diet and exercise. Given that these responses came from women in the early 1990s, this likely referred to a low-fat diet and aerobic exercise (remember step aerobics and jazzercise), which were popular at the time. So, is this how we should “target abdominal fat?”

The authors assumed that reductions in waist circumference were deliberate, but this remains uncertain since the researchers did not explicitly investigate it. Despite this uncertainty, current messaging—and the authors’ concluding remarks—tell us that the way to target visceral adiposity is with strength training to build muscle, a heart-healthy diet, possibly calorie restriction, and adequate protein. However, we lack clear evidence on what the original study participants were doing to achieve their results.

The reality is that many midlife and older women today are exercising, adding in strength training, eating high-quality protein (probably even more than they need), and carefully considering their nutrition, but are still experiencing an expanding waistline. The message that women just haven’t adopted the “right” dietary and exercise practices targeting abdominal fat is an example of gaslighting that places the blame on women for their weight change and causes women to question themselves and their behaviors.

Maybe I missed something, but I’m pretty sure we don’t know how to “spot-reduce” body fat.

Anyway, back to the case of our average 63-year-old woman. My prediction is that this woman would be told to lose more weight – that 5 pounds and 5% loss is not enough. I’ve seen this scenario repeatedly, and you probably have too. In today’s culture, she would likely be instructed to start a GLP-1 or other weight loss medication since her valiant efforts at behavior change have not been effective enough. When she expresses concern about going on medication, she will be told that without it, she will have a higher risk of cardiovascular disease, cancer, and diabetes. But, that’s not what the authors of this study said.

Does Weight = Health?

So, which is it? Should we trust our bodies at any size, or is losing weight (especially belly fat) a necessary step for better health and potentially saving your life?

The authors stated that their results suggest “older women should not be discouraged from attempting weight loss if they wish to lose weight.”

Are you kidding me? Of course, women want to lose weight! The problem is that most women have been trying to shrink their bodies for most of their lives and are extremely frustrated with the fact that “nothing works anymore.”

How about we shift to providing meaningful advice about behaviors that positively impact health and compassionate care for body acceptance?

Here’s what I want you to see.

Without considering the long-term effects of intentional weight loss—such as weight cycling, weight regain, loss of muscle and bone, and the risk of disordered eating—exaggerating benefits and overlooking the challenges of maintaining sustainable weight loss is misleading women.

There is nothing wrong with losing weight! However, there is also no special menopause diet or magical metabolic switch that peri or postmenopausal women need to track down to “spot-reduce” abdominal body fat. Maybe there’s something about the 3 to 6% of women that were successful with the life-saving efforts associated with intentional weight loss, but we certainly didn’t learn what that was from this investigation.

The problem is when women feel like “it’s” never enough or that their health is on the line if they don’t do the “right” exercise, diet, supplement, testing, or program. The pressure to lose weight – and now specifically “target abdominal body fat” without a clear, evidence-based strategy creates more unnecessary stress and anxiety.

I completely agree with the recommendation of women participating in activity that preserves muscle and adopting a heart-healthy diet. However, this may or may not result in weight loss – or a decrease in waist circumference. At this stage of life, I am advocating for helping women find a nourishing and pleasurable eating and activity pattern that they can do consistently while living and enjoying their best life in midlife and beyond.