Persistent Obesity Raises Mortality in Diabetes and Prediabetes

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Body weight patterns across adulthood may influence survival outcomes in people with diabetes or prediabetes. A longitudinal cohort analysis published in the Journal of Diabetes & Metabolic Disorders evaluated the associations of body mass index (BMI), patterns of weight change, and absolute weight change with mortality in adults aged 50 years or older.

The analysis included 11,518 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. BMI categories, long-term weight change patterns, and absolute weight change were examined. Weight patterns included stable normal weight, persistent overweight, transitions involving obesity, and persistent obesity. Absolute weight change was categorized as weight loss, stable weight, or weight gain. Cox proportional hazards models and restricted cubic spline analyses were used to assess associations with mortality after adjustment for covariates.

A U-shaped association was observed between BMI and mortality. Obesity was associated with higher all-cause mortality (hazard ratio [HR] 1.60; 95% CI 1.20-2.13) and diabetes-related mortality (HR 2.53; 95% CI 1.35-4.75). Persistent obesity beginning in young adulthood was associated with increased mortality risk, including a 60% increase in all-cause mortality and a 153% increase in diabetes-related mortality. In contrast, persistent overweight during later life was associated with lower mortality risk.

Analyses of absolute weight change showed that weight loss of at least 2.5 kg was associated with increased mortality risk. Moderate weight gain of 2.5-20 kg showed lower mortality risk. Sensitivity analyses produced similar findings.

These findings indicate that BMI and long-term weight trajectories are associated with mortality outcomes in older adults with diabetes or prediabetes. The analysis suggests that maintaining normal weight earlier in adulthood and avoiding persistent obesity may be important for long-term risk, while mild overweight in later life may be associated with lower mortality.

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Key highlights

Longitudinal cohort analysis included 11,518 adults aged ≥50 years with diabetes or prediabetes from NHANES 2005-2018.
Obesity was associated with higher all-cause mortality (HR 1.60, 95% CI 1.20-2.13) and diabetes-related mortality (HR 2.53, 95% CI 1.35-4.75).
Persistent obesity from young adulthood increased mortality risk, while persistent overweight in later life showed lower mortality risk.
Weight loss ≥2.5 kg was associated with higher mortality, whereas moderate weight gain of 2.5-20 kg showed lower mortality risk.

Source

Zhang Z, Gu P, Yang W, et al. Age-reversed weight-mortality links in diabetes or prediabetes: Evidence from NHANES. J Diabetes Metab Disord. Published March 13, 2026. doi:10.1007/s40200-026-01896-6.

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