Unfortunately, for people challenged by overweight and obesity, weight regain after intentional weight loss is the rule rather than the exception. Thus, the majority of people trying to control their weight tend to go through cycles of weight loss and weight regain.
However, whether or not people who intentionally weight cycle have a higher risk of overall weight gain and mortality has been hotly debated.
In a paper just published in the Archives of Internal Medicine, Alison Field and colleagues from Harvard Medical School, USA, analysed the relationship between weight cycling and mortality in the over 40,000 women participating in the Nurses’ Health Study who provided information on intentional weight losses between 1972 and 1992.
Women who reported they intentionally lost at least 9.1 kg at least 3 times were classified as severe weight cyclers, whereas women who intentionally lost at least 4.5 kg at least 3 times were classified as mild weight cyclers.
Between 1972 and 1992 around 10% of women were heavy cyclers, whereas 20% of women were mild cyclers. As expected, weight cycling was positively associated with BMI at baseline - thus, only 40% of noncyclers were overweight or obese compared with 74% of the mild cyclers and 87% of the severe cyclers.
During the follow-up period, weight cyclers gained significantly more weight than noncyclers (5.2 kg for severe cyclers and 4.1 kg for mild cyclers) compared with only 2.6 kg for noncyclers. In age-adjusted models, severe cyclers in early and middle adulthood had a 30% higher mortality rate than noncyclers, but this relationship was no longer significant after adjusting for BMI at age 18 years, weight change from age 18 years until 1976, physical activity, change in activity, smoking, postmenopausal HT, and alcohol intake.
This is what I take from this study: 1) severe weight cycling is associated with twice the weight gain than with noncycling; 2) the increased mortality risk of severe weight cycling is probably more related to the increased weight gain, rather than the cycling per se.
My message to patients remains the same: there is little point in losing weight if you are not going to keep it off - in the end, you are likely to simply end up being heavier than before.
In other words, as I have said before, preventing further weight gain should be the first step in obesity management - weight loss should only be encouraged by methods and programs that have a high likelihood of long-term success.
AMS
Edmonton, Alberta
In The News
May 21st, 2009 at 12:18 pm
But…there really aren’t “methods and programs that have a high likelihood of long-term success,” are there? Isn’t that one of the core issues? No one wants to gain weight back, but it happens most of the time.
May 21st, 2009 at 7:39 pm
Thank you for writing about this study. I read the abstract but couldn’t access the full text.
When you write that: “the increased mortality risk of severe weight cycling is probably more related to the increased weight gain, rather than the cycling per se.” — a long-term prospective study would be a better way to determine this.
What it didn’t show, though, was that weight cycling was better than staying the same.
I wonder if a strategy that started with attempting to slow or stop weight gain early in the game by figuring out what was happening, and then increasing physical activity and improving eating might result in much better outcomes than the “diet to lose weight” as the first approach.