Tuesday, May 8, 2012

Why Stopping Weight Gain is More Important Than Losing Weight

Yesterday, I posted on the notion that simply removing the cause of weight gain does not directly translate into weight loss.

In fact, I have previously posted on the idea that the first sign of success in weight management is the prevention of further weight gain.

For those of us in clinical practice, this idea raises several important questions:

1) Is everyone at risk of weight gain?

2) Does is matter when or how fast this weight is gained?

3) Is there a sub group of individuals in whom prevention of weight gain may be more important than in others?

This is where, in a discussion with my former student Tobias Pischon (now Professor for Molecular Epidemiology at the Max-Delbrueck Centre in Berlin), he pointed me to a study by Anja Schienkiewitz and colleagues from the German Institute of Human Nutrition Potsdam-Rehbrücke, published in the American Journal of Clinical Nutrition back in 2006.

The study examined the relationship between the history of weight gain and risk of type 2 diabetes in 7720 men and 10,371 women from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study with information on weight history.

In both men and women, weight gain during the ages 25 and 40 was a far greater risk factor for developing type 2 diabetes than weight gain between the ages 40 and 55.

While this is an important observation, I was far more interested in the data on the temporal patterns of weight gain in this population.

The researchers divided the patients into those who were weight stable (less than 1 point increase in BMI) and those, who experienced moderate (a 1-4 point increase in BMI) or severe (a greater than 4 point BMI increase) between the ages of 25-40, 40-55, or both.

Interestingly enough, only about 15% of men and women remained weight stable over the 30 years of observation!

Of those, who experienced moderate (~50%) or severe (~12%) weight gain between age 25-40, about 30% remained weight stable, while 40% continued to experience moderate and 30% experienced more severe weight gain over the next 15 years.

Similarly, of those individuals, who experienced severe weight gain between age 25-40, about 30% continued to experience moderate weight again, while about 35% continued to experience severe weight gain.

Not surprisingly, the latter group – those with severe weight gain both between ages 25-40 and 40-55, were at an almost 20-fold higher risk of diabetes than those who stayed weight stable over the entire 30 years – their total weight gain between age 25-55 was almost 15 BMI points.

Those who had moderate or severe weight gain between ages 25-40 but managed to not gain weight between ages 40-55 had only about half the diabetes risk of the continuous gainers.

Most interestingly, however, those who were weight stable between 25-40 but experienced moderate or severe weight gain between 40-55 had less than 10% the risk of the continuous gainers.

Several lessons are evident from this:

At least when it comes to diabetes, weight gain in early adulthood, particularly when this weight gain continues into middle-age, is of far greater significance than gaining weight after the age of 40, even if this later weight gain is quite severe.

Thus, it is evident that weight management strategies are perhaps best targeted at younger adults, particularly with the aim of preventing continuing weight gain into middle age.

In a tightly strapped health care system, one would perhaps want to identify younger adults between the ages of 25-40 with rapid weight gain (about 12% of the total population) as the majority of these will continue gaining considerable weight as they get older – this ‘highest risk’ group makes up about 6% of the total population.

In contrast, it may make far less sense to target weight gain in those who are weight stable (even if obese) or those who are only gaining moderate amounts of weight, especially later in life.

This is of critical importance when thinking about health care systems: while it may be neither feasible nor affordable to address obesity in the entire population, identifying and better managing those at the highest risk, namely, those who are experiencing considerable weight gain in early adulthood, and especially those, in whom this weight gain continues into later years, may be both feasible and affordable.

This is probably the group where simply stopping weight gain may be more important than getting everyone, especially those who are weight stable or have gained weight only after the age of 40, to lose weight.

AMS
Lyon, France

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7 Responses to “Why Stopping Weight Gain is More Important Than Losing Weight”

  1. DebraSY says:

    Okay. The thing that jumps out at me: Age 25-40. Isn’t that the period of time when roughly 50% of the population gives birth? Nothing rocks the hormones like a pregnancy!! Methinks these stats need to be parsed by sex to better interpret them.

    In terms of clinical focus, since most women will tell you that their most dramatic gains are tied to when they carried each child, it seems to make sense to put the big money on prenatal care for women. And let me be clear: NOT more of the current simplistic messaging regarding pregnancy weight gain that is just shame and blame, and no tangible help.

  2. Arya M. Sharma, MD says:

    @DebraSY: yup, that’s exactly what the authors say in their paper – in women much of the weight gain between 25-40 is related to pregnancies. The risk, however, is adjusted for a wide range of confounders from initial BMI to socioeconomic status – so the sex issue is already considered.

    Nevertheless, your point is well taken – prenatal care for women makes good sense – not just for obesity!

  3. Fivehundredpoundpeep says:

    How can weight gain be prevented when most of the doctors are invested in automatically telling you that it is your fault? I had a 400lb weight gain within 28 months, and almost died simply because of not being listened to. [I would hit near 700lbs, and then drop 160lbs after some medical treatment--namely thyroid pills and other, and have bounced around the 500s [way too high] for the last 10 years.

    http://fivehundredpoundpeeps.blogspot.com/search/label/My%20350-400%20Pound%20Weight%20Gain

    No one believed me, and even now getting someone to “listen” to someone who is severely obese in the medical field is very difficult.

    I totally agree about weight prevention and weight gain, but I was going to doctors even while still in the high 200s and 300s, saying “Please find out what is wrong with me” and none listened at that point either. Irony of ironies when I was in the lower more functional weights, I walked FOR FUN [2-3 miles] and had a job that was active but still it was to no avail, the weight slowed me down.

    Something needs to be done about this. Even now I can’t get the doctors to believe me about my restricted diet. The main ones admit metabolic difficulties, but what good is it to be told, that my weight is ruining the cartilage in my knees when so little has worked?

  4. Anonymous says:

    Regarding:
    “better managing those at the highest risk, namely, those who are experiencing considerable weight gain in early adulthood”

    I think it would be valuable to extend that concern to age 18 or 20.
    I wonder why the study started at age 25?
    Is that a natural physiological point, or was it just convenient for researchers?

    To target weight gain in young adults, it would make sense to consider what would trigger weight gain.
    For many young people, leaving home triggers weight gain. Consider the “Freshman 15″, the weight put on in the first year of college – not always, of course, but often enough to be recognized and nicknamed. This is especially significant because it happens in a population very concerned with image, especially weight.

    After school or apprenticeships, there are the young adult concerns of getting a job, a mate, and a home.
    This is the time when they develop their adult habits. Keeping a healthy weight, and learning to do that on your own, in new and stressful situations, is important.

    I used to think gaining weight , especially when you’re young, wasn’t a problem, because you could simply lose it later.
    After reading this blog for some time, I realize what a mistake that is.

    I would extend the public health focus on not gaining weight to age 18 or 20 – after you’ve reached your adult height, there’s no reason to keep getting heavier. (Obvious exceptions are pregnancy, or if you’re underweight, or if you are training to build muscle.) At that age, most young people are in secondary school, which makes it feasible to get the message across.
    Gaining weight should be a concern, not a joke.

  5. FiveHundredPoundPeep says:

    I’ve noted a lot of people having serious weight gains in their 20s.

    One wonders about the effects of stress on the younger population especially regarding the serious economic concerns they are facing and how those interlock together.

    How many young people who are broke, are eating poor quality food? or having serious food insecurity issues? I know the ramen noodles, and feast and famine cycles did me no favors.

    http://theeconomiccollapseblog.com/archives/53-percent-of-all-young-college-graduates-in-america-are-either-unemployed-or-underemployed

    I believe these economic issues do interplay…

  6. Susanne says:

    Hm, I gained my weight from 25-40 (BMI 22-27) and then got back to 22 BMI between 40-45. Are there any studies which look at weight loss in the post-child bearing years? On my favorite weight loss forum there are a number of women in the 40s-50s in that category.

  7. Suzan Nashashibi RNutr says:

    That s why i always say diets dont work what we need is to teach our patients step by step healthy eating habits and train them to use them on long term quick fixes will backfire for sure but if u slowly give your bidy a chance to learn and receive right control messages from the brain losing fat mass will be achieved and maintained but no magic stick tricks involved we need to tell our patients to give a chance for changes in habits and lifestyles to take over snd bevthe new norm ut can be done

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