OBJECTIVE: The aim of this study was to examine the relationships between intention to lose weight, actual weight loss, and all-cause mortality among overweight individuals with diabetes. RESEARCH DESIGN AND METHODS: We performed a prospective analysis among 1,401 overweight diabetic adults aged > or =35 years sampled in the National Health Interview Survey. The previous year intention to lose weight and weight change were assessed by self-report. Nine-year mortality rates were examined according to intent to lose weight and weight loss, which were adjusted for age, sex, education, ethnicity, smoking, initial body weight, and diabetes complications. RESULTS: Individuals trying to lose weight had a 23% lower mortality rate (hazard rate ratio [HRR] 0.77, 95% CI 0.61-0.99) than those who reported not trying to lose weight. This association was as strong for those who failed to lose weight (0.72, 0.55-0.96) as for those who succeeded in losing weight (0.83, 0.63-1.08). Trying to lose weight was beneficial for overweight (BMI 25-30 kg/m2) individuals (0.62, 0.46-0.83) but not for obese (BMI>30) individuals (1.17, 0.72-1.92). Overall weight loss, without regard to intent, was associated with an increase of 22% (1.22, 0.99-1.50) in the mortality rate. This increase was largely explained by unintentional weight loss, which was associated with a 58% (1.58, 1.08-2.31) higher mortality rate. CONCLUSIONS: Overweight diabetic adults trying to lose weight have a reduced risk of all-cause mortality, independent of whether they lose weight. Actual weight loss is associated with increased mortality only if the weight loss is unintentional.
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