Data from the first National Health and Nutrition Examination Survey Epidemiologic Followup Survey were used to examine whether weight change was associated with an increased relative risk of nursing care facility admission. Hazard ratios were calculated with Cox proportional hazards models and stratified by overweight status at baseline. Moderate and large weight loss was associated with an increased risk of nursing care facility admission in overweight and non-overweight subjects. Large weight gain was associated with an increased relative risk in only overweight subjects. In the process of functional decline that results in nursing care facility admission, weight loss may be a sign of acute illness, starvation, or aging. Preventing weight loss may help delay this process of decline. In overweight subjects, preventing weight gain may also be important in delaying this process of decline.