Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the 'repeated overshoot' theory

A novel weight suppression score associates with distinct eating disorder and ultra-processed food symptoms compared to the traditional weight suppression measure among adults seeking outpatient nutrition counseling

BACKGROUND

Weight suppression has been defined as diet-induced weight loss, traditionally operationalized as the difference between one's highest and current weight. This concept has been studied in the context of eating disorders, but its value in predicting treatment outcomes has been inconsistent, which may be partially attributed to its calculation.

METHOD

The current study operationalizes a novel weight suppression score, reflecting the midpoint between the lowest and highest adult weights among adults (N = 287, ages 21-75, 73.9% women) seeking outpatient treatment for disordered eating. This report compared the traditional weight suppression calculation to the novel weight suppression score in a simulated dataset to model their differential distributions. Next, we analyzed shared and distinct clinical correlates of traditional weight suppression versus the novel weight suppression score using clinical intake data.

RESULTS

The novel weight suppression score was significantly associated with meeting criteria for both eating disorders and ultra-processed food addiction and was more sensitive to detecting clinically relevant eating disorder symptomatology. However, the novel weight suppression score (vs. traditional weight suppression) was associated with fewer ultra-processed food addiction symptoms.

CONCLUSION

The novel weight suppression score may be particularly relevant for those with eating disorders and ultra-processed food addiction, with more relevance to individual eating disorder compared to ultra-processed food addiction symptoms. Consideration of the novel weight suppression score in future research on eating behaviors should extend beyond just those with diagnosed eating disorders.

Effects of repeated weight cycling on non-alcoholic steatohepatitis in diet-induced obese mice

Lifestyle interventions remain the treatment of choice for patients with obesity and metabolic complications, yet are difficult to maintain and often lead to cycles of weight loss and regain (weight cycling). Literature on weight cycling remains controversial and we therefore investigated the association between weight cycling and metabolic complications using preexistent obese mice. Ldlr-/-.Leiden mice received a high-fat diet (HFD) for 20 weeks to induce obesity. Subsequently, weight-cycled mice were switched between the healthy chow diet and HFD for four 2-week periods and compared to mice that received HFD for the total study period. Repeated weight cycling tended to decrease body weight and significantly reduced fat mass, whereas adipose tissue inflammation was similar relative to HFD controls. Weight cycling did not significantly affect blood glucose or plasma insulin levels yet significantly reduced plasma free fatty acid and alanine transaminase/aspartate transaminase levels. Hepatic macrovesicular steatosis was similar and microvesicular steatosis tended to be increased upon weight cycling. Weight cycling resulted in a robust decrease in hepatic inflammation compared to HFD controls while hepatic fibrosis and atherosclerosis development were not affected. These results argue against the postulate that repeated weight cycling leads to unfavorable metabolic effects, when compared to a continuous unhealthy lifestyle, and in fact revealed beneficial effects on hepatic inflammation, an important hallmark of non-alcoholic steatohepatitis.

Weight regain, but not weight loss exacerbates hepatic fibrosis during multiple weight cycling events in male mice

PURPOSE

Weight cycling is a phenomenon characterized by fluctuating body weight that is commonly observed in individuals employing intentional weight loss methods. Despite its prevalence, the impact of weight cycling on health remains equivocal. The current investigation aimed to examine the effects of weight cycling on liver health.

METHODS

The weight cycling model was established by switching the feeding method of mice between ad libitum (AL) and restricted intake (DR or 60% of AL) of the breeding diet to cause weight gain and weight loss, respectively. The weight cycling model comprised two and a half cycles, with one group terminating the experience during the weight-gain period (S-AL) and the other during the weight-loss period (S-DR). Liver tissue was collected to investigate morphology alterations, apoptosis, lipid metabolism, and mitochondrial homeostasis.

RESULTS

The results demonstrated that the termination point of weight cycling affected body weight and hepatic steatosis. All parameters examined in the S-DR mice exhibited a comparable trend to those observed in the DR mice. Notably, S-AL mice showed a significant increase in lipid metabolism-related proteins in the liver compared to AL-fed mice, along with reduced lipid droplets. Moreover, hepatic apoptosis and fibrosis were exacerbated in the S-AL mice compared to AL mice, whereas mitochondrial fusion, biogenesis, and mitophagy were decreased in the S-AL mice.

CONCLUSION

Weight cycling ending in weight gain exacerbated hepatic fibrosis, potentially by inducing apoptosis or disrupting mitochondrial homeostasis. Conversely, weight cycling ending in weight loss demonstrated beneficial effects on hepatic health.

Long-Term Body Mass Index Variability and Adverse Cardiovascular Outcomes

Importance

Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is a commonly used estimate of obesity, which is a complex trait affected by genetic and lifestyle factors. Marked weight gain and loss could be associated with adverse biological processes.

Objective

To evaluate the association between BMI variability and incident cardiovascular disease (CVD) events in 2 distinct cohorts.

Design, Setting, and Participants

This cohort study used data from the Million Veteran Program (MVP) between 2011 and 2018 and participants in the UK Biobank (UKB) enrolled between 2006 and 2010. Participants were followed up for a median of 3.8 (5th-95th percentile, 3.5) years. Participants with baseline CVD or cancer were excluded. Data were analyzed from September 2022 and September 2023.

Exposure

BMI variability was calculated by the retrospective SD and coefficient of variation (CV) using multiple clinical BMI measurements up to the baseline.

Main Outcomes and Measures

The main outcome was incident composite CVD events (incident nonfatal myocardial infarction, acute ischemic stroke, and cardiovascular death), assessed using Cox proportional hazards modeling after adjustment for CVD risk factors, including age, sex, mean BMI, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking status, diabetes status, and statin use. Secondary analysis assessed whether associations were dependent on the polygenic score of BMI.

Results

Among 92 363 US veterans in the MVP cohort (81 675 [88%] male; mean [SD] age, 56.7 [14.1] years), there were 9695 Hispanic participants, 22 488 non-Hispanic Black participants, and 60 180 non-Hispanic White participants. A total of 4811 composite CVD events were observed from 2011 to 2018. The CV of BMI was associated with 16% higher risk for composite CVD across all groups (hazard ratio [HR], 1.16; 95% CI, 1.13-1.19). These associations were unchanged among subgroups and after adjustment for the polygenic score of BMI. The UKB cohort included 65 047 individuals (mean [SD] age, 57.30 (7.77) years; 38 065 [59%] female) and had 6934 composite CVD events. Each 1-SD increase in BMI variability in the UKB cohort was associated with 8% increased risk of cardiovascular death (HR, 1.08; 95% CI, 1.04-1.11).

Conclusions and Relevance

This cohort study found that among US veterans, higher BMI variability was a significant risk marker associated with adverse cardiovascular events independent of mean BMI across major racial and ethnic groups. Results were consistent in the UKB for the cardiovascular death end point. Further studies should investigate the phenotype of high BMI variability.

The association of long-term trajectories of BMI, its variability, and metabolic syndrome: a 30-year prospective cohort study

Background

Limited data exists on how early-life weight changes relate to metabolic syndrome (MetS) risk in midlife. This study examines the association between long-term trajectories of body mass index (BMI), its variability, and MetS risk in Chinese individuals.

Methods

In the Hanzhong Adolescent Hypertension study (March 10, 1987-June 3, 2017), 1824 participants with at least five BMI measurements from 1987 to 2017 were included. Using group-based trajectory modeling, different BMI trajectories were identified. BMI variability was assessed through standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Logistic regression analyzed the relationship between BMI trajectory, BMI variability, and MetS occurrence in midlife (URL: https://www.clinicaltrials.gov; Unique identifier: NCT02734472).

Findings

BMI trajectories were categorized as low-increasing (34.4%), moderate-increasing (51.8%), and high-increasing (13.8%). Compared to the low-increasing group, the odds ratios (ORs) [95% CIs] for MetS were significantly higher in moderate (4.27 [2.63-6.91]) and high-increasing groups (13.11 [6.30-27.31]) in fully adjusted models. Additionally, higher BMI variabilities were associated with increased MetS odds (ORs for SDBMI, VIMBMI, and ARVBMI: 2.30 [2.02-2.62], 1.22 [1.19-1.26], and 4.29 [3.38-5.45]). Furthermore, BMI trajectories from childhood to adolescence were predictive of midlife MetS, with ORs in moderate (1.49 [1.00-2.23]) and high-increasing groups (2.45 [1.22-4.91]). Lastly, elevated BMI variability in this period was also linked to higher MetS odds (ORs for SDBMI, VIMBMI, and ARVBMI: 1.24 [1.08-1.42], 1.00 [1.00-1.01], and 1.21 [1.05-1.38]).

Interpretation

Our study suggests that both early-life BMI trajectories and BMI variability could be predictive of incident MetS in midlife.

Funding

This work was supported by the National Natural Science Foundation of China No. 82070437 (J.-J.M.), the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University of China (No. XJTU1AF-CRF-2022-002, XJTU1AF2021CRF-021, and XJTU1AF-CRF-2023-004), the Key R&D Projects in Shaanxi Province (Grant No. 2023-ZDLSF-50), the Chinese Academy of Medical Sciences & Peking Union Medical College (2017-CXGC03-2), and the International Joint Research Centre for Cardiovascular Precision Medicine of Shaanxi Province (2020GHJD-14).

A Qualitative Model of Weight Cycling

Weight cycling is a likely consequence of striving to lose weight after internalizing body image ideals, making upward social comparisons, and experiencing weight stigma. Despite weight cycling's potential physical and psychological consequences, the interplay of weight cycling, social pressures, and experienced and internalized stigma have not been qualitatively explored. Thus, through in-depth interviews of 36 weight-cycling adults, this study sought to understand how people negotiate weight cycling. Interviews informed the development of a qualitative model of weight cycling, which was derived from a theory-neutral inductive analysis. The model's stages included entering the cycle, undergoing the cycle, and challenging the cycle. Participants were triggered to enter the cycle due to weight stigma caused by social pressures. Within the cycle, interviewees internalized weight stigma and engaged in disordered weight management behaviors. Some participants challenged the cycle by becoming more self-aware and mitigating their toxic dieting behaviors. However, it was very difficult, if not impossible, for many to fully exit weight cycling and the restraints of previous weight management thinking and patterns. Our investigation underscores the seriousness of weight cycling and suggests ways to combat weight cycling on both macro and individual levels. It may also be useful to consider weight cycling as disordered eating in hopes of shifting society's dangerous focus on rapid weight loss.

Association between weight variability, weight change and clinical outcomes in hypertension

Objective

The effect of body weight variability (BWV) and body weight change (BWC) in high-risk individuals with hypertension, but without diabetes mellitus (DM) remains unclear. We examined the effect of BWV and BWC on the primary outcome [the composite of myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure (HF), or cardiovascular (CV) death] and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT).

Methods

In this post-hoc analysis, we used multivariate Cox regression models to examine the risk associated with BWV and BWC for the primary outcome in SPRINT. BWV was defined as the intra-individual average successive variability (ASV). BWC was defined as baseline weight minus final weight.

Results

A total of 8714 SPRINT participants (mean age 67.8 ± 9.4 years, 35.1 % women, 58.9 % Whites) with available data on body weight were included. The median follow-up was about 3.9 years (IQR, 3.3-4.4). In multivariable-adjusted Cox models, each 1 unit standard deviation (SD) of BWV was significantly associated with a higher risk for the primary outcome, all-cause mortality, HF, MI, and stroke [HR(95 % CI)]: 1.13 (1.07-1.19; p < 0.0001), 1.22 (1.14-1.30; p < 0.0001), 1.16 (1.07-1.26; p < 0.001), 1.10 (1.00-1.20; p = 0.047), and 1.15 (1.05-1.27; p = 0.005), respectively. Similarly, each 1 unit SD of BWC was significantly associated with a higher risk of the primary outcome, all-cause mortality, MI, and HF: 1.11(1.02-1.21; p = 0.017), 1.44 (1.26-1.65; p < 0.0001), 1.16 (1.01-1.32; p = 0.041) and 1.19 (1.02-1.40; p = 0.031) respectively. However, there was no significant association with CV death (for both BWV and BWC) or stroke (BWC).

Conclusion

In high-risk hypertension, BWV and BWC were both associated with higher risk of the primary outcome and all-cause mortality. These results further stress the clinical importance of sustained weight loss and minimizing fluctuations in weight in hypertension.

Effects of body weight variability on risks of macro- and microvascular outcomes in individuals with type 2 diabetes: The Rio de Janeiro type 2 diabetes cohort

AIMS

To investigate the effects of body weight variability (BWV) on macro- and microvascular outcomes in a type 2 diabetes cohort.

METHODS

BWV parameters were assessed in 684 individuals. Multivariable Cox regressions examined associations between BWV parameters and cardiovascular outcomes (total cardiovascular events [CVEs], major CVEs [MACEs], cardiovascular deaths),all-cause mortality and microvascular outcomes. Interaction/subgroup analyses were performed according to being physically-active/sedentary and having/not lost ≥ 5 % of weight.

RESULTS

Median follow-up was 11 years over which 194 total CVEs (174 MACEs), and 223 all-cause deaths (110 cardiovascular), occurred. There were 215 renal, 152 retinopathy and 167 peripheral neuropathy development/worsening outcomes. In general, increased BWV was associated with higher risks of CVEs, MACEs, all-cause mortality, advanced renal failure and peripheral neuropathy outcomes, but not of microalbuminuria and retinopathy outcomes. On interaction/subgroup analyses, increased BWV was associated with higher risks of outcomes in sedentary individuals and in those who did not lose ≥ 5 % of body weight. In physically-active participants or in those who lost ≥ 5 % weight, the adjusted risks were null or protective.

CONCLUSIONS

Increased BWV was associated with most adverse outcomes; however, in those who were physically-active or consistently losing weight, it was not hazardous and might be even beneficial.

Premature Death in Bodybuilders: What Do We Know?

Premature deaths in bodybuilders regularly make headlines and are cited as evidence that bodybuilding is a dangerous activity. A wealth of research has revealed elite athletes typically enjoy lower mortality rates than non-athletes, but research on bodybuilder lifespan is surprisingly limited. Anabolic androgenic steroid (AAS) use is commonly cited as a key contributor to morbidity and premature mortality in bodybuilders, but this area of research is highly nuanced and influenced by numerous confounders unique to bodybuilding. It is quite possible that bodybuilders are at elevated risk and that AAS use is the primary reason for this, but there remains much unknown in this realm. As global participation in bodybuilding increases, and healthcare providers play a more active role in monitoring bodybuilder health, there is a need to identify how numerous factors associated with bodybuilding ultimately influence short- and long-term health and mortality rate. In this Current Opinion, we discuss what is currently known about the bodybuilder lifespan, identify the nuances of the literature regarding bodybuilder health and AAS use, and provide recommendations for future research on this topic.

Weight management behaviours mediate the relationship between weight cycling, BMI and diet quality among US Army Soldiers

Weight cycling is prevalent in sports/professions with body composition standards, and has been associated with weight management behaviours that may contribute to suboptimal diet quality and weight gain. US Army Soldiers may be at increased risk of weight cycling relative to civilians due to mandated body composition standards. However, the relationship between weight cycling, weight management behaviours, BMI and diet quality among Soldiers is unknown. In this cross-sectional study, 575 Soldiers (89 % enlisted, 90 % male, 23 ± 4 years) at Army installations at Joint Base Elmendorf-Richardson, AK, Joint-Base Lewis McChord, WA, and Fort Campbell, KY completed questionnaires on food frequency, health-related behaviours and history of weight cycling (≥ 3 weight fluctuations ≥ 5 % body weight). Weight cycling was reported by 33 % of Soldiers. Those who reported weight cycling reported higher BMI (27 ± 4 v. 25 ± 3 kg/m², P < 0·001) and higher prevalence of engaging in weight management behaviours prior to body weight screening but did not report lower dietary quality (Healthy Eating Index-2015 (HEI) scores 59 ± 10 v 59 ± 11, P = 0·46) relative to those who did not report weight cycling. Results of mediation analyses suggested that weight cycling may affect BMI both directly (c' = 1·19, 95 % CI: 0·62, 1·75) and indirectly (ab = 0·45, 95 % CI: 0·19, 0·75), and HEI scores indirectly (ab = 0·69, 95 % CI: 0·20, 1·35) through the adoption of weight management behaviours. Weight cycling is common in Soldiers and is associated with higher BMI and higher prevalence of engaging in weight management behaviours that mediate associations between weight cycling, BMI and diet quality.

Body mass index trajectories and their predictors in undergraduate students from Canada: Results from the GENEiUS study

Objective: To explore the patterns and predictors of body mass index (BMI) change among undergraduate students from Ontario (Canada). Participants: 68 undergraduate students were followed longitudinally for 3 years with anthropometric data collected bi-annually. Methods: BMI measurements were plotted to generate individual BMI trajectory curves, which were categorized, based on the observed trajectory pattern. Within and between group comparisons of BMI were conducted via nonparametric paired tests. The association of baseline BMI, sex, and ethnicity with BMI trajectory type was assessed using multinomial logistic regression. Results: Four BMI trajectory types were observed: "stable weight" (n = 15, 22.1%), "weight gain" (n = 30, 44.1%), "weight loss" (n = 12, 17.6%), and "weight cycling" (n = 11, 16.2%) trajectories. Higher baseline BMI was significantly associated with the "weight gain," "weight loss," and the "weight cycling" trajectories as compared to the "stable weight" trajectory type. Conclusions: Our findings demonstrate an association between high baseline BMI and "nonstable" subsequent BMI change patterns among Canadian students.

Development and test–retest reliability of the Combat Sports Post-Career Health Questionnaire (CSPCHQ)

The long-term impact of weight cycling on health status, eating habits, physical activity and the lifestyle of former combat sports athletes is still insufficiently explored. Therefore, a novel questionnaire in English, Portuguese, Spanish and Croatian language was constructed. To determine the reliability and the content/face validity, a total of 110 participants filled the questionnaire on two occasions. With the majority of intra-class correlation coefficient values above 0·75, the questionnaire items were shown to be very stable. Additionally, according to κ values, the questionnaire has fair test–retest reliability, with only one coefficient being labelled as poor (Q40 in ESP). All questionnaire sub-scales showed moderate to very good internal consistency when the overall sample was observed (α ranging from 0·605 to 0·802). Poor α values were found only in Godin-Shephard Leisure-Time Physical Activity Questionnaire for CRO and ESP samples. Wilcoxon’s signed rank test showed significant differences only in the Mindful Eating Questionnaire sub-scale scores (overall: P = 0·002, effect size = −0·208 [moderate]; CRO: P = 0·005, effect size = 0·303 [moderate]). It can be concluded that the newly developed questionnaire had strong test–retest reliability. Further validity research in a larger sample of former combat sports athletes should be considered.

Weight Cycling and Dieting Behavior in Fitness Club Members

Background

Along with the rising prevalence of high body-mass index (BMI), there is also increased emphasis on leanness and fitness. Both these trends suggest that many individuals are concerned about weight management and may try to lose weight. Using data from the research project "Fitness clubs - a venue for public health?", we aimed to describe weight cycling and energy-restricted dieting in men and women at start-up of fitness club membership, and to investigate influencing factors [age, BMI, educational level, self-classified overweight/obesity, compliance with nutritional guidelines, unhealthy weight control strategies and self-perceived health (SPH)].

Methods

In a cross-sectional online survey, 250 men and women from 25 fitness clubs in Oslo, reported anthropometrics, self-classified weight group, weight cycling, weight loss/gain, eating habits/dieting, and background/health information. Enrollment was limited to adult (≥18 years) novice exercisers (exercising <60 min/week at a moderate or vigorous intensity or brisk walking <150 min/week, the past six months) with less than four weeks of membership. Factors associated with weight cycling were examined using simple and multiple logistic regression, separated for men and women.

Results

In both sexes (mean age: 36.4 ± 11.3, range 18-71 years), a high number reported substantial weight fluctuation (+/-5 kg) the past 12 months (men: 50% and women: 62%, mean difference 12%, 95% CI -0.3 to 23.8, p=0.056) and unhealthy weight control strategies (men: 24.8% and women: 47.2%, mean difference 22.4%, 95% CI 10.5 to 33.4, p<0.001). Weight cyclers had a higher mean BMI compared with non-cyclers (mean difference -1.5, 95% CI -2.6 to - 0.4, p= 0.003). Further, the difference in body weight was 6.7 kg (95% CI 2.2 to 10.8, p=0.004) and 10.8 kg (95% CI 5.8 to 15.8, <0.001) in men and women, respectively. Besides BMI status, self-classified overweight/obesity was the strongest predictor of reporting weight cycling (men: OR 5.54, 95% CI 2.03 to 15.12, p<0.01 and women: OR 7.17, 95% CI 2.48 to 20.68, p<0.001).

Conclusion

In novice exercisers, a large proportion reported weight cycling and unhealthy weight control strategies, and both were more prevalent in women than in men. Self-classified overweight was found to be the most important factor influencing weight cycling.

Weight cycling in combat sports: revisiting 25 years of scientific evidence

BACKGROUND

As combat sports are classified by body mass, many athletes engage in rapid weight loss (RWL) prior to competition so they can gain an advantage over lighter opponents. Following the weigh-in, athletes engage in rapid weight gain (RWG), whereby some athletes have been able to compete up to three weight categories greater than the official division weighed in at.

RESULTS

Although the impact of weight cycling on performance remains equivocal, robust scientific evidence indicates serious acute and chronic negative consequences on physiological and health-related parameters. Still, weight cycling remains highly prevalent in combat sports, and interventions to limit or stop this cultural norm are recommended.

CONCLUSIONS

Weigh-ins for combat sports should be transitioned to take place closer to the start of competition. This reduced time and access to engage in RWG will cut down, if not completely prevent, weight cycling. These rule changes that aim to benefit athlete's health and promote fairness must be made at the international level, which will promote them at those levels below, as well, given qualification protocols.

Associations of weight loss with obesity-related comorbidities in a large integrated health system

AIMS

To determine the health outcomes associated with weight loss in individuals with obesity, and to better understand the relationship between disease burden (disease burden; ie, prior comorbidities, healthcare utilization) and weight loss in individuals with obesity by analysing electronic health records (EHRs).

MATERIALS AND METHODS

We conducted a case-control study using deidentified EHR-derived information from 204 921 patients seen at the Cleveland Clinic between 2000 and 2018. Patients were aged ≥20 years with body mass index ≥30 kg/m² and had ≥7 weight measurements, over ≥3 years. Thirty outcomes were investigated, including chronic and acute diseases, as well as psychological and metabolic disorders. Weight change was investigated 3, 5 and 10 years prior to an event.

RESULTS

Weight loss was associated with reduced incidence of many outcomes (eg, type 2 diabetes, nonalcoholic steatohepatitis/nonalcoholic fatty liver disease, obstructive sleep apnoea, hypertension; P < 0.05). Weight loss >10% was associated with increased incidence of certain outcomes including stroke and substance abuse. However, many outcomes that increased with weight loss were attenuated by disease burden adjustments.

CONCLUSIONS

This study provides the most comprehensive real-world evaluation of the health impacts of weight change to date. After comorbidity burden and healthcare utilization adjustments, weight loss was associated with an overall reduction in risk of many adverse outcomes.

Changes in Circulating Metabolites during Weight Loss and Weight Loss Maintenance in Relation to Cardiometabolic Risk

(1) Background: There is a substantial lack of knowledge of the biochemical mechanisms by which weight loss and weight regain exert their beneficial and adverse effects, respectively, on cardiometabolic outcomes. We examined associations between changes in circulating metabolites and changes in cardiometabolic risk factors during diet-induced weight loss and weight loss maintenance. (2) Methods: This prospective analysis of data from the Satiety Innovation (SATIN) study involved adults living with overweight and obesity (mean age=47.5). One hundred sixty-two subjects achieving ≥8% weight loss during an initial 8-week low-calorie diet (LCD) were included in a 12-week weight loss maintenance period. Circulating metabolites (m=123) were profiled using a targeted multiplatform approach. Data were analyzed using multivariate linear regression models. (3) Results: Decreases in the concentrations of several phosphatidylcholines (PCs), sphingomyelins (SMs), and valine were consistently associated with decreases in total (TChol) and low-density lipoprotein cholesterol (LDL-C) levels during the LCD. Increases in PCs and SMs were significantly associated with increases in TChol and LDL-C during the weight loss maintenance period. Decreases and increases in PCs during LCD and maintenance period, respectively, were associated with decreases in the levels of triglycerides. (4) Conclusions: The results of this study suggest that decreases in circulating PCs and SMs during weight loss and the subsequent weight loss maintenance period may decrease the cardiovascular risk through impacting TChol and LDL-C.

Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks

We propose a weight-neutral strategy for obesity treatment on the following grounds: (1) the mortality risk associated with obesity is largely attenuated or eliminated by moderate-to-high levels of cardiorespiratory fitness (CRF) or physical activity (PA), (2) most cardiometabolic risk markers associated with obesity can be improved with exercise training independent of weight loss and by a magnitude similar to that observed with weight-loss programs, (3) weight loss, even if intentional, is not consistently associated with lower mortality risk, (4) increases in CRF or PA are consistently associated with greater reductions in mortality risk than is intentional weight loss, and (5) weight cycling is associated with numerous adverse health outcomes including increased mortality. Adherence to PA may improve if health care professionals consider PA and CRF as essential vital signs and consistently emphasize to their patients the myriad benefits of PA and CRF in the absence of weight loss.

The Prognostic Significance of Body Mass Index and Metabolic Parameter Variabilities in Predialysis CKD: A Nationwide Observational Cohort Study

BACKGROUND

The association between variabilities in body mass index (BMI) or metabolic parameters and prognosis of patients with CKD has rarely been studied.

METHODS

In this retrospective observational study on the basis of South Korea's national health screening database, we identified individuals who received ≥3 health screenings, including those with persistent predialysis CKD (eGFR <60 ml/min per 1.73 m² or dipstick albuminuria ≥1). The study exposure was variability in BMI or metabolic parameters until baseline assessment, calculated as the variation independent of the mean and stratified into quartiles (with Q4 the highest quartile and Q1 the lowest). We used Cox regression adjusted for various clinical characteristics to analyze risks of all-cause mortality and incident myocardial infarction, stroke, and KRT.

RESULTS

The study included 84,636 patients with predialysis CKD. Comparing Q4 versus Q1, higher BMI variability was significantly associated with higher risks of all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [95% CI], 1.53 to 1.81), P [for trend] <0.001), KRT (HR, 1.20; 95% CI, 1.09 to 1.33; P<0.001), myocardial infarction (HR, 1.19; 95% CI, 1.05 to 1.36, P=0.003), and stroke (HR, 1.19; 95% CI, 1.07 to 1.33, P=0.01). The results were similar in the subgroups divided according to positive or negative trends in BMI during the exposure assessment period. Variabilities in certain metabolic syndrome components (e.g., fasting blood glucose) also were significantly associated with prognosis of patients with predialysis CKD. Those with a higher number of metabolic syndrome components with high variability had a worse prognosis.

CONCLUSIONS

Higher variabilities in BMI and certain metabolic syndrome components are significantly associated with a worse prognosis in patients with predialysis CKD.

Variability in Cardiometabolic and Inflammatory Parameters and Cognitive Decline

INTRODUCTION

The relationship between variability in cardiometabolic and inflammatory parameters and cognitive changes is unknown. This study investigates the association of visit-to-visit variability in BMI, mean arterial pressure, total cholesterol, triglycerides, HbA1c, high-sensitivity C-reactive protein, ferritin, and fibrinogen with cognitive decline.

METHODS

This population-based cohort study included 2,260 individuals (mean age=63.0 [SD=7.5] years) free of cognitive diseases who underwent ≥3 clinical measurements from 2004 to 2019. Variability was expressed as variability independent of the mean across visits. Participants were divided on the basis of quartiles of variability score, a scoring system generated to explore the composite effect of parameter variability (range=0-24), where 0 points were assigned for Quartile 1, 1 point was assigned for Quartile 2, 2 points were assigned for Quartile 3, and 3 points were assigned for Quartile 4, each for the variability of 8 parameters measured as variability independent of the mean. Linear mixed models evaluated the longitudinal associations with cognitive decline in memory and verbal fluency. All analyses were conducted in 2020-2021.

RESULTS

Higher BMI, mean arterial pressure, total cholesterol, HbA1c, and ferritin variability were linearly associated with cognitive decline irrespective of their mean values. In addition, participants in the highest quartile of variability score had a significantly worse cognitive decline rate in memory (-0.0224 points/year, 95% CI= -0.0319, -0.0129) and verbal fluency (-0.0088 points/year, 95% CI= -0.0168, -0.0008) than those in the lowest quartile.

CONCLUSIONS

A higher variability in cardiometabolic and inflammatory parameters was significantly associated with cognitive decline. Stabilizing these parameters may serve as a target to preserve cognitive functioning.

Contextualising Eating Disorder Concerns for Paediatric Obesity Treatment

PURPOSE OF REVIEW

Eating disorders are complex mental health conditions that share risk factors with obesity. This review outlines the context for concerns that paediatric obesity treatment presents a risk for eating disorder development.

RECENT FINDINGS

Most children and adolescents undergoing professionally supervised obesity treatment will have improvements or no change to eating disorder risk profiles. However, some may subsequently develop a clinical eating disorder, and this is proposed to relate to weight-focussed dietary interventions that are standard in paediatric obesity treatment. Nevertheless, dietary restraint may not be a strong predictor of eating disorder risk in the context of paediatric obesity treatment. Most international guidelines recommend weight maintenance or weight loss as a treatment goal, and weight loss is related to improvements in cardiometabolic health but not eating disorder risk in the short term. The risk of inducing or exacerbating an eating disorder during paediatric weight management is likely to be low; however, the serious consequences combined with increasing scale of obesity treatment, and lack of empirical evidence, are of concern. There is a need for further research to identify long-term predictors of eating disorder development for children and adolescents who seek treatment for their obesity.

The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies

AIMS

Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint.

DATA SYNTHESIS

A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved.

CONCLUSION

Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.

Weight cycling practices in sport: A risk factor for later obesity?

Weight cycling, repeated cycles of weight loss and weight regain over time, is commonplace amongst many population groups. Although the effect of weight cycling on future obesity and cardiometabolic risk is still hotly debated, evidence does indicate that individuals who were normal weight prior to weight cycling are more susceptible to its adverse consequences than those who were overweight or with obesity. Athletes, and particularly those who compete in the so-called weight-sensitive sports, are prone to dieting and weight cycling practice owing to the competitive advantage to be gained from manipulating their body weight. However, in comparison with the general population, athletes tend to be leaner and weight loss phases more rapid and superimposed on a background of a high level of physical activity. In this context, it can be questioned whether weight cycling in this subpopulation will indeed increase risk for future obesity. It is perhaps surprising that despite recognition that athletes commonly partake in weight cycling during their career, studies are scarce and firm conclusions regarding the effect of this practice on future cardiometabolic risk remain to be drawn. In this review, we examine weight cycling prevalence and strategies in athletes and the current evidence relating to its short- and long-term consequences. In addition, a conceptual framework relating the dynamics of weight loss and recovery to athlete characteristics will be discussed, highlighting the need for well-controlled, prospective studies in this specific subpopulation.

Ancel Keys: The legacy of a giant in physiology, nutrition, and public health

Ancel Keys, whose life spanned over 100 years (1904-2004), made a wealth of seminal scientific and public health contributions. As a physiologist, nutritionist, and public health scientist, he has left his mark on the 20th century by exploring different areas of physiology and nutrition, as well as by contributing to the understanding of basic public health issues. Among his major achievements one can mention in chronological order: studying adaptation to very high altitude, developing the K ration to enable the US military to survive with light but dense food, dissecting the physiology of starvation and nutritional rehabilitation to optimize recovery of functions, uncovering the link between serum cholesterol and heart disease, coordinating the first multi-country epidemiological longitudinal study in nutrition and health, coining the word "body mass index" (BMI), which he showed to be the best body weight index to predict body fat, and promoting the Mediterranean diet for a healthy life style. This review examines the historical events and scientific intrigues that have surrounded Ancel Keys's major classical studies that have ensured him a central place in the history of medical science.

Body mass index trajectories and the risk for Alzheimer's disease among older adults

The effect of body mass index (BMI) changes and variability on the risk for Alzheimer’s disease (AD) remains unclear. We analyzed 45,076 participants, whose BMI were measured on phase 1 (2002–2003), phase 2 (2004–2005), and phase 3 (2006–2007), of the Korean National Health Insurance Service-Health Screening Cohort. We evaluated the effect of 2- and 4-year BMI changes and BMI variability on the risk of AD using Cox regression models. In men, association between 2-year BMI changes, BMI variability, and the risk of AD was not significant. Risk of AD was higher in men whose BMI had decreased 10.1–15.0% over 4 years. In women, aHRs and 95% CIs for AD were 1.14 (1.02–1.29), 1.44 (1.17–1.79), and 1.51 (1.09–2.09) when 2-year BMI loss was 5.1–10.0%, 10.1–15.0%, and > 15.0%. The HRs for AD in women significantly increased when 4-year BMI loss was > 5.0%. The aHR and 95% CI for AD was 1.31 (1.17–1.46) in the 4th quartile of average successive variability (ASV) compared with the 1st quartile of ASV in women. BMI loss over 2- and 4-year period was associated with increased risk for AD, and risk increased in women with higher BMI variability. Appropriate body weight management is recommended to prevent AD.

Physiological Responses of Post-Dietary Effects: Lessons from Pre-Clinical and Clinical Studies

Dieting regimens such as calorie restriction (CR) are among the most commonly practiced interventions for weight management and metabolic abnormalities. Due to its independence from pharmacological agents and considerable flexibility in regimens, many individuals turn to dieting as a form of mitigation and maintenance of metabolic health. While metabolic benefits of CR have been widely studied, weight loss maintenance and metabolic benefits are reported to be lost overtime when the diet regimen has been terminated—referred to as post-dietary effects. Specifically, due to the challenges of long-term adherence and compliance to dieting, post-dietary repercussions such as body weight regain and loss of metabolic benefits pose as major factors in the efficacy of CR. Intermittent fasting (IF) regimens, which are defined by periodic energy restriction, have been deemed as more flexible, compliant, and easily adapted diet interventions that result in many metabolic benefits which resemble conventional CR diets. Many individuals find that IF regimens are easier to adhere to, resulting in fewer post-dietary effects; therefore, IF may be a more effective intervention. Unfortunately, there is a severe gap in current research regarding IF post-dietary effects. We recognize the importance of understanding the sustainability of dieting; as such, we will review the known physiological responses of CR post-dietary effects and its potential mechanisms through synthesizing lessons from both pre-clinical and clinical studies. This review aims to provide insight from a translational medicine perspective to allow for the development of more practical and effective diet interventions. We suggest more flexible and easily practiced dieting regimens such as IF due to its more adaptable and practical nature.

Weight trajectories and abdominal adiposity in COVID-19 survivors with overweight/obesity

BACKGROUND

COVID-19 is associated with unintentional weight loss. Little is known on whether and how patients regain the lost weight. We assessed changes in weight and abdominal adiposity over a three-month follow-up after discharge in COVID-19 survivors.

METHODS

In this sub-study of a large prospective observational investigation, we collected data from individuals who had been hospitalized for COVID-19 and re-evaluated at one (V1) and three (V2) months after discharge. Patient characteristics upon admission and anthropometrics, waist circumference and hunger levels assessed during follow-up were analyzed across BMI categories.

RESULTS

One-hundred-eighty-five COVID-19 survivors (71% male, median age 62.1 [54.3; 72.1] years, 80% with overweight/obesity) were included. Median BMI did not change from admission to V1 in normal weight subjects (-0.5 [-1.2; 0.6] kg/m², p = 0.08), but significantly decreased in subjects with overweight (-0.8 [-1.8; 0.3] kg/m², p < 0.001) or obesity (-1.38 [-3.4; -0.3] kg/m², p < 0.001; p < 0.05 vs. normal weight or obesity). Median BMI did not change from V1 to V2 in normal weight individuals (+0.26 [-0.34; 1.15] kg/m², p = 0.12), but significantly increased in subjects with overweight (+0.4 [0.0; 1.0] kg/m², p < 0.001) or obesity (+0.89 [0.0; 1.6] kg/m², p < 0.001; p = 0.01 vs. normal weight). Waist circumference significantly increased from V1 to V2 in the whole group (p < 0.001), driven by the groups with overweight or obesity. At multivariable regression analyses, male sex, hunger at V1 and initial weight loss predicted weight gain at V2.

CONCLUSIONS

Patients with overweight or obesity hospitalized for COVID-19 exhibit rapid, wide weight fluctuations that may worsen body composition (abdominal adiposity). CLINICALTRIALS.

GOV REGISTRATION

NCT04318366.

Intuitive eating as a counter-cultural process towards self-actualisation: An interpretative phenomenological analysis of experiences of learning to eat intuitively

This research presents an in-depth idiographic study that illustrates how learning to eat intuitively involves socio-cultural challenges, strategies of resistance and self-actualising processes. Interviews were conducted with eight women who had been practising intuitive eating (IE) for at least 1.5 years. Data was analysed using IPA and four themes were drawn inductively from the data: IE as an ongoing process, perceived judgement of others, strategies of resistance and processes of self-actualisation. Further research is needed to explore experiences of learning to eat intuitively amongst different samples and with different cultures, and to further investigate the relationship between IE and the actualising tendency.

Variabilities in Weight and Waist Circumference and Risk of Myocardial Infarction, Stroke, and Mortality: A Nationwide Cohort Study

BACKGROUND

Evidence regarding the association between variabilities in obesity measures and health outcomes is limited. We aimed to examine the association between variabilities in obesity measures and cardiovascular outcomes and all-cause mortality.

METHODS

We identified 4,244,460 individuals who underwent health examination conducted by the Korean National Health Insurance Service during 2012, with ≥3 anthropometric measurements between 2009 and 2012. Variabilities in body weight (BW) and waist circumference (WC) were assessed using four indices including variability independent of the mean (VIM). We performed multivariable Cox proportional hazards regression analyses.

RESULTS

During follow-up of 4.4 years, 16,095, 18,957, and 30,200 cases of myocardial infarction (MI), stroke, and all-cause mortality were recorded. Compared to individuals with the lowest quartiles, incrementally higher risks of study outcomes and those of stroke and all-cause mortality were observed among individuals in higher quartiles of VIM for BW and VIM for WC, respectively. The multivariable adjusted hazard ratios and 95% confidence intervals comparing the highest versus lowest quartile groups of VIM for BW were 1.17 (1.12 to 1.22) for MI, 1.20 (1.16 to 1.25) for stroke, and 1.66 (1.60 to 1.71) for all-cause mortality; 1.07 (1.03 to 1.12) for stroke and 1.29 (1.25 to 1.33) for all-cause mortality regarding VIM for WC. These associations were similar with respect to the other indices for variability.

CONCLUSION

This study revealed positive associations between variabilities in BW and WC and cardiovascular outcomes and allcause mortality. Our findings suggest that variabilities in obesity measures are associated with adverse health outcomes in the general population.

Dynamic prediction model to identify young children at high risk of future overweight: Development and internal validation in a cohort study

BACKGROUND

Primary prevention of overweight is to be preferred above secondary prevention, which has shown moderate effectiveness.

OBJECTIVE

To develop and internally validate a dynamic prediction model to identify young children in the general population, applicable at every age between birth and age 6, at high risk of future overweight (age 8).

METHODS

Data were used from the Prevention and Incidence of Asthma and Mite Allergy birth cohort, born in 1996 to 1997, in the Netherlands. Participants for whom data on the outcome overweight at age 8 and at least three body mass index SD scores (BMI SDS) at the age of ≥3 months and ≤6 years were available, were included (N = 2265). The outcome of the prediction model is overweight (yes/no) at age 8 (range 7.4-10.5 years), defined according to the sex- and age-specific BMI cut-offs of the International Obesity Task Force.

RESULTS

After backward selection in a Generalized Estimating Equations analysis, the prediction model included the baseline predictors maternal BMI, paternal BMI, paternal education, birthweight, sex, ethnicity and indoor smoke exposure; and the longitudinal predictors BMI SDS, and the linear and quadratic terms of the growth curve describing a child's BMI SDS development over time, as well as the longitudinal predictors' interactions with age. The area under the curve of the model after internal validation was 0.845 and Nagelkerke R² was 0.351.

CONCLUSIONS

A dynamic prediction model for overweight was developed with a good predictive ability using easily obtainable predictor information. External validation is needed to confirm that the model has potential for use in practice.

Body Weight Variability Increases Dementia Risk Among Older Adults: A Nationwide Population-Based Cohort Study

Background: Recent growing evidences suggest that body weight (Bwt) variability, a repeated loss and regain of weight within a specific period, causes metabolic disturbances and can be a marker for poor homeostasis. Although there have been many studies about the association between Bwt variability and various health status, its association with the incidence of dementia among elderly people has not been examined. Methods: We performed a retrospective elderly cohort study from 19,987 participants with mean age 73 years old in the Korean National Health Insurance Service. We examined the risk of incident dementia, including Alzheimer's dementia and vascular dementia, according to the quartile of Bwt variability, represented as coefficient of variation (Bwt-CV), SD (Bwt-SD), and variability independent of the mean (Bwt-VIM). Results: In fully adjusted model, the group with the highest Bwt variability (Bwt-VIM Q4) showed an increased risk of all-cause dementia (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.206-1.603) and Alzheimer's dementia (HR 1.46, CI 1.240-1.724) compared to the lowest quartile (Bwt-VIM Q1). We also found that subjects with the highest Bwt variability (Q4) and underweight BMI had a significantly increased risk of developing dementia (HR 1.994, 95% CI 1.302-3.054), while subjects with low Bwt variability (Q1 and Q2) and obese BMI had decreased risk of dementia (HR 0.664, 95% CI 0.505-0.872 and HR 0.648, 95% CI 0.493-0.852, respectively) compared to reference group (lowest Bwt variability (Q1) with normal baseline BMI). The effect of Bwt variability on the incidence of dementia was more prominent in subjects <75 years old and abnormal BMI groups (P for interaction < 0.05). Conclusion: The present study revealed that high Bwt variability was associated with an increased risk of dementia in the elderly.

Associations of weight cycling with cardiovascular health using American Heart Association's Life's Simple 7 in a diverse sample of women

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Most women reported history of weight cycling (range: 0–20 episodes).

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Any history of weight cycling was associated with poorer cardiovascular health.

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Associations were stronger in pre-menopausal and women with no pregnancy history.

Prior research shows that weight cycling is associated with poorer cardiovascular health (CVH). Women experience unique life events (e.g. pregnancy, menopause) which may make them more prone to weight cycling. Examining the influence of weight cycling history (HWC) on CVH, quantified using the American Heart Association’s Life’s Simple 7 (LS7), may provide novel targets to improve CVH. A cross-sectional sample of 485 women at Columbia University Irving Medical Center (2016–2018) were scored on each LS7 metric (BMI, blood pressure, fasting cholesterol and glucose, physical activity, diet, and smoking): 0 (low), 1 (moderate) or 2 (high). Metric points were summed into a composite LS7 score as a measure of CVH: 0–8 (low), 9–10 (moderate), 11–14 (high). Multivariable-adjusted logistic and linear regression models were used for the associations between HWC and CVH. Most women (73%) reported HWC (range: 0–20); 26% had low CVH and 74% moderate/high CVH. Logistic models showed HWC was associated with higher odds of having poor CVH [OR (95%CI): 2.39 (1.36–4.20)]. Linear models showed each additional weight cycling episode was associated with lower LS7 scores [ß(SE): −0.37 (0.07); p < 0.01]. Associations between HWC and odds of having poor CVH were stronger among pre-menopausal women and those with no pregnancy history (p-interaction = 0.009, 0.004, respectively). In conclusion, HWC was associated with higher odds of poorer CVH with stronger associations seen in pre-menopausal and women with no pregnancy history. These findings suggest that in addition to having a healthy weight, maintaining a consistent weight may be important for achieving optimal CVH, but warrant prospective confirmation.

Incidência de ganho de peso em trabalhadores de um hospital: análise de sobrevivência

Resumo O ganho de peso na vida adulta pode ser responsável por doenças crônicas, e seu acompanhamento pode ser um subsídio para evitar esses agravos. O objetivo foi analisar o ganho de peso e fatores associados em trabalhadores de um hospital privado no município do Rio de Janeiro. Trata-se de uma coorte retrospectiva com 686 trabalhadores, que realizaram ao menos dois exames de saúde ocupacionais (admissional e periódico) entre os anos de 2010 e 2015. O método de Kaplan-Meier e o modelo de regressão semiparamétrico de riscos proporcionais de Cox foram utilizados. A incidência de ganho de peso dos trabalhadores do hospital foi de 22 casos/100 pessoas-ano. O ganho de peso nos trabalhadores com mais de 30 anos foi 35% menor (p < 0,001), quando comparado ao ganho de peso naqueles de até 30 anos. Em relação à escolaridade, as taxas de incidência de ganho de peso nos trabalhadores de níveis fundamental e médio se apresentaram maiores, com magnitude de até 61%, comparadas aos de nível superior completo (p < 0,001); e no setor de trabalho considerado fechado foi 63% maior quando comparada ao setor aberto (p < 0,001). Ganho de peso é um fenômeno multifacetado e complexo, podendo os setores de trabalho de uma unidade hospitalar contribuir fortemente para a ocorrência do mesmo.

Weight Cycling as a Risk Factor for Low Muscle Mass and Strength in a Population of Males and Females with Obesity

OBJECTIVE

This study aimed to determine whether multiple weight cycles in adulthood are an independent predictor of lower muscle mass and reduced strength, with potential implication for sarcopenia in adults with obesity.

METHODS

A total of 60 males and 147 females with obesity were included, with a mean BMI of 37.9 ± 6.0 kg/m² and a mean age of 52.6 ± 12.4 years. Muscle strength was evaluated with handgrip and appendicular skeletal muscle mass was measured with dual-energy x-ray absorptiometry.

RESULTS

Participants were categorized into the following three groups: non-weight cyclers, mild weight cyclers, and severe weight cyclers. From a binary logistic regression that considered muscle mass categories as a dependent variable and weight cycling categories, age, and sex as independent variables, severe weight cyclers showed a 3.8-times increased risk of low muscle mass (95% CI: 1.42-10.01). Considering handgrip strength categories as a dependent variable and weight cycling categories, age, sex, and BMI as independent variables, severe weight cycling was associated with an increased risk of low muscle mass (about 6.3 times, 95% CI: 1.96-20.59). Severe weight cyclers showed a 5.2-times greater risk of developing sarcopenia.

CONCLUSIONS

In adults with obesity, weight cycling is associated with lower muscle mass and strength and a greater likelihood of developing sarcopenic obesity.

Association of Variability in Body Mass Index and Metabolic Health With Cardiometabolic Disease Risk

Background Metabolic syndrome is associated with high risk of cardiovascular disease, although risk may differ according to the specific conditions present and variability in those conditions. Methods and Results We defined obesity (body mass index [BMI] ≥30 kg/m2) and metabolic health (<2 nonobesity National Cholesterol Education Program Adult Treatment Panel III conditions) among 3632 Framingham Heart Study offspring cohort participants (mean age, 50.8 years; 53.8% women) who were followed up from 1987 to 2014. We defined participants whose variance independent of the mean for a metabolic syndrome-associated measure was in the top quintile as being "variable" for that measure. Variable metabolic health was defined as ≥2 variable nonobesity metabolic syndrome components. We investigated the interaction between obesity and metabolic health in their associations with cardiometabolic disease and cardiovascular disease using Cox proportional hazards regression. In addition, we estimated the associations of BMI variability and variable metabolic health with study outcomes within categories of obesity and metabolic health status, respectively. We observed 567 incident obesity (41 439 person-years), 771 incident metabolically unhealthy state (25 765 person-years), 272 incident diabetes mellitus (56 233 person-years), 503 incident hypertension (12 957 person-years), 589 cardiovascular disease (60 300 person-years), and 195 chronic kidney disease (47 370 person-years) events on follow-up. Obesity and being metabolically unhealthy were independently and positively associated with all outcomes. BMI variability, compared with stable BMI, was associated with 163%, 67%, 58%, and 74% higher risks of having obesity, becoming metabolically unhealthy, having diabetes mellitus, and having hypertension, respectively, among nonobese participants. Variable metabolic health, compared with stable metabolic health, was associated with a 28% higher risk of cardiovascular disease, among metabolically healthy participants. Conclusions We did not observe evidence for a positive interaction between obesity and metabolic health status with regard to study outcomes. BMI and metabolic health variability are associated with adverse health outcomes.

Metabolic dysfunction following weight regain compared to initial weight gain in a high-fat diet-induced obese mouse model

Diet-induced weight loss and regain leads to physiological and metabolic changes, some of which are potentially harmful. However, the specific metabolic processes and dysfunctions associated with weight regain, and how they differ from initial weight gain, remain unclear. Thus, we examined the metabolic profiles of mice following weight regain compared to initial weight gain. Mice were fed a normal diet or a high-fat diet or were cycled between the two diets to alternate between obese and lean states. Liver samples were collected and hepatic metabolites were profiled using nuclear magnetic resonance (NMR). The identified metabolites associated with weight regain were quantified using gas chromatography/mass spectrometry (GC/MS) and lipid profiles were assessed using ultra-high-performance liquid chromatography-quadrupole time-of-flight MS (UPLC-QTOF-MS). In addition, changes in expression of pro-inflammatory cytokines and gluconeogenic enzymes were investigated using polymerase chain reaction (PCR) and western blotting, respectively. Hepatic levels of several amino acids were reduced in mice during weight regain compared with initial weight gain. In addition, gluconeogenic enzyme levels were increased following weight regain, indicating an up-regulation of gluconeogenesis. Lipidomic profiling revealed that levels of ceramide and sphingomyelin, which are related to obesity-induced inflammation, were significantly increased during weight regain compared to initial weight gain. Moreover, tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) levels were significantly up-regulated during weight regain. In this study, weight regains lead to an up-regulation of gluconeogenesis and aggravated inflammation. Additionally, weight regain can worsen the metabolic dysfunction associated with obesity.

Short-Term Effects of Healthy Eating Pattern Cycling on Cardiovascular Disease Risk Factors: Pooled Results from Two Randomized Controlled Trials

Adherence to healthy eating patterns (HEPs) is often short-lived and can lead to repetitive attempts of adopting—but not maintaining—HEPs. We assessed effects of adopting, abandoning, and readopting HEPs (HEP cycling) on cardiovascular disease risk factors (CVD-RF). We hypothesized that HEP cycling would improve, worsen, and again improve CVD-RF. Data were retrospectively pooled for secondary analyses from two randomized, crossover, controlled feeding trials (n = 60, 52 ± 2 years, 30.6 ± 0.6 kg/m²) which included two 5–6 week HEP interventions (Dietary Approaches to Stop Hypertension-style or Mediterranean-style) separated by a four-week unrestricted eating period. Ambulatory and fasting blood pressures (BP), fasting serum lipids, lipoproteins, glucose, and insulin were measured before and during the last week of HEP interventions. Fasting systolic BP and total cholesterol decreased (−6 ± 1 mm Hg and −19 ± 3 mg/dL, respectively, p < 0.05), returned to baseline, then decreased again (−5 ± 1 mm Hg and −13 ± 3 mg/dL, respectively, p < 0.05) when adopting, abandoning, and readopting a HEP; magnitude of changes did not differ. Ambulatory and fasting diastolic BP and high-density lipoprotein cholesterol concentrations followed similar patterns; glucose and insulin remained unchanged. Low-density lipoprotein cholesterol concentrations decreased with initial adoption but not readoption (−13 ± 3 and −6 ± 3, respectively, interaction p = 0.020). Healthcare professionals should encourage individuals to consistently consume a HEP for cardiovascular health but also encourage them to try again if a first attempt is unsuccessful or short-lived.

Psychometric Summary of the Technology-Delivered Tension Scales for Weight Management

The purpose of this article is to summarize the psychometric results from studies of the last 25 years of the Overeating Tension Scale, Exercise Tension Scale, Feelings Tension Scale, and Feelings About Weight Tension Scale. These reliable and valid technology-delivered weight management scales can be used by clinicians independently or in combination to longitudinally identify specific triggers of overeating, skipping exercise, feeling low or down, and strong feelings about one's body weight; motivational states, and related tension levels. Through cognitive behavior therapy, individuals can learn to shift to another motivational state and employ healthy coping mechanisms to avoid related negative behaviors. Psychometric results from seven developmental studies are described, including technology-delivery adaptation results from the original paper and pencil versions. Future tension scale development priorities also are discussed.

Fatness and Fluctuating Body Weight: Effect on Central Vasculature

Weight Cycling (WC) is a prevalent behavior associated with adverse cardiovascular (CV) health. However, a 2010 review on the effects of WC and blood pressure (BP) determined that there was not enough evidence to draw definitive conclusions. Central BP is the principal predictor of CV risk compared to peripheral BP. The influence that WC may have specifically on central BP is unknown. Cross-sectional observation of self-reported history of WC on measures of CV health was undertaken. Seventy-five women completed a Weight and Lifestyle Inventory questionnaire, which is considered a reliable index of WC (r = 0.87, p < 0.001). Measures of visceral fat, BP, arterial stiffness, and VO2peak were taken. Regression equations were used to assess primary predictors of these outcomes. Seventy-five middle aged (39 ± 11 years), obese (32 ± 7 kg/m2), and relatively unfit (24 ± 8 ml·kg-1 min-1) women completed the study. Visceral fat was the strongest predictor of brachial systolic blood pressure (SBP; r2 = 0.283), brachial diastolic blood pressure (DBP; r2 = 0.176), central SBP (r2 = 0.375), and augmentation index (AIx; r2 = 0.535, all p < 0.001). VO2peak was the strongest predictor of central DBP (r2 = 0.062, p = 0.036) and augmentation pressure (AP; r2 = 0.491, p < 0.001). Weight cycling index was associated with visceral fat (r = 0.521, p < 0.001). Visceral fat was a mediator between WC and central SBP (confidence interval [CI] = 0.0053-0.0602), AP (CI = 0.0507-0.4915), AIx (CI = 0.0025-0.0699), and carotid-femoral pulse wave velocity (CI = 0.0115-0.1227; all p < 0.05). WC may increase visceral fat accumulation, which was associated with increased central SBP and measures of arterial stiffness.

Weight Cycling and Its Cardiometabolic Impact

Dieting has multiple meanings including "intentional weight loss" or "a specific eating pattern." Although obesity is considered a deleterious health problem worldwide, there are many problems caused by "too strict" weight control and the need for excessive leanness. Many people with normal weight want to lose weight, and they repeat losing and gaining weight multiple times through their lives. This is called "weight cycling." Recent studies report not just the negative impact of being obese, but also the danger of weight cycling for cardiometabolic health. Many experimental studies support that weight cycling might cause fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, sympathetic activity, and circulating levels of glucose, lipids and insulin. These repeated overshoots above normal values during periods of weight regain put an additional stress on the cardiovascular system. This paper reviews current evidence for the effects of weight cycling on cardiometabolic health.

Acute changes in blood lipid profiles and metabolic risk factors in collegiate elite taekwondo athletes after short-term de-training: a prospective insight for athletic health management

BACKGROUND

This study used a short-term de-training model to mimic the physiological weight changes during the early retirement stage in Taekwondo (TKD) athletes. This study investigates whether the negative changes in body composition, blood lipid profiles, and metabolic biomarkers occur in elite collegiate TKD athletes when experiencing a two-months de-training period.

METHODS

Fourteen collegiate Division Ι elite TKD athletes (age: 21.1 ± 0.2 years, BMI: 22.3 ± 1.1 kg/m2; 10 males and 4 females) participated in this study. The body composition, blood lipid profiles, atherogenic dyslipidemia indexes, metabolic biomarkers and baseline systemic inflammation states were measured before and after two-months de-training.

RESULTS

The body weight and BMI did not change after de-training in these elite TKD athletes. The total muscle mass displayed a significant decline after de-training (-2.0%, p = 0.019), with an increase in fat mass (+24.3%, p < 0.01). The blood triglyceride did not change, but the total cholesterol was higher after de-training (+8.3%, p = 0.047). The CHOL-to-HDL and LDL-to-HDL ratios increased by 12.4% (p < 0.001) and 13.2% (p = 0.002) after de-training, respectively. The blood platelet number, plateletcrit, and platelet-to-lymphocyte ratio increased significantly by 5.0% (p = 0.013), 7.3% (p = 0.009), and 20.6% (p = 0.018) after de-training, respectively. The McAuley's Index decreased (-6.9%, p = 0.025) after de-training.

CONCLUSION

We demonstrated that a two-months de-training period resulted in adverse effects on early atherogenic dyslipidemia development, progressing insulin resistance, low-grade inflammation, and visceral adiposity in young elite TKD athletes. Our findings provide clear insights into the possible deleterious impacts at early stage retirement in former combative sports athletes.

A role for leukocyte integrins and extracellular matrix remodeling of adipose tissue in the risk of weight regain after weight loss

Background: Weight loss (WL) is often followed by weight regain after an energy-restricted dietary intervention (DI). When people are following a diet, the volume of an adipocyte decreases by loss of triglycerides, which creates stress between the cell contents and the surrounding extracellular matrix (ECM). Previously, we observed that genetic variations in ECM genes are associated with an increased risk of weight regain.Objective: We investigated the relation between the expression of ECM genes during WL and a period of weight stabilization (WS) and the risk of weight regain.Design: In this randomized controlled trial, 61 healthy overweight or obese participants followed either a 5-wk very-low-calorie diet (VLCD; 500 kcal/d) or a 12-wk low-calorie diet (1250 kcal/d) (WL period) with a subsequent 4-wk WS period and a 9-mo follow-up. The WL and WS periods combined were considered the DI. Abdominal subcutaneous adipose tissue biopsy samples were collected for microarray analysis. Gene expression changes for a broad set of ECM-related genes were correlated with the weight-regain percentage (WR%).Results: A total of 26 of the 277 genes were significantly correlated with WR% during WL, WS, or the DI periods. Most correlations were observed in the VLCD group during the WS period. Four genes code for leukocyte-specific receptors. These and other genes belong to a group of 26 genes, among which the expression changes were highly correlated (r ≥ 0.7, P ≤ 0.001). This group could be divided into 3 subclusters linking to 2 biological processes-leukocyte integrin gene activity and ECM remodeling-and a link to insulin sensitivity was also apparent.Conclusions: Our present findings indicate the importance of adipose tissue leukocytes for the risk of weight regain. ECM modification also seems to be involved, and we observed a link to insulin sensitivity. This trial was registered at clinicaltrials.gov as NCT01559415.

Stigma in Practice: Barriers to Health for Fat Women

In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.

Metabolic dysfunction following weight cycling in male mice

Background

Combatting over-weight or obesity can lead to large fluctuations in an individual’s body weight, often referred to as weight cycling or “yo-yo” dieting. Current evidence regarding the potentially damaging effects of these changes is conflicting.

Methods

Here, we assess the metabolic effects of weight cycling in a murine model, comprising three dietary switches to normal or high fat diets at 6 week intervals; male C57BL/6 mice were fed either a control (C) or high fat (F) diet for 6 weeks (n=140/group). C and F groups were then either maintained on their initial diet (CC and FF respectively) or switched to a high fat (CF) or control (FC) diet (n=35/group). For the final 6 week interval, CC and CF groups were returned to the control diet (CCC and CFC groups) while FC and FF groups were placed on a high fat diet (FCF and FFF) (n=28/group).

Results

For the majority of metabolic outcomes changes aligned with dietary switches; however assessment of neuropeptides and receptors involved in appetite regulation and reward signalling pathways reveal variable patterns of expression. Furthermore, we demonstrate that multiple cycling events leads to a significant increase in internal fat deposition, even when compared to animals maintained on a high fat diet (Internal Fat: FCF: 7.4 ± 0.2g vs. FFF: 5.6 ± 0.2g; p<0.01).

Conclusions

Increased internal adipose tissue is strongly linked to the development of metabolic syndrome associated conditions such as type 2 diabetes, cardiovascular disease and hypertension. While further work will be required to elucidate the mechanisms underlying the neuronal control of energy homeostasis, these studies provide a causative link between weight cycling and adverse health.

Association of Weight Loss Maintenance and Weight Regain on 4-Year Changes in CVD Risk Factors: the Action for Health in Diabetes (Look AHEAD) Clinical Trial

OBJECTIVE

Short-term weight loss improves cardiovascular disease (CVD) risk factors. We sought to determine the longer-term effects of maintaining weight loss or, conversely, regaining weight.

RESEARCH DESIGN AND METHODS

We used data from Action for Health in Diabetes (Look AHEAD), a randomized trial of intensive lifestyle intervention (ILI) compared to a control condition in overweight/obese individuals with type 2 diabetes. ILI participants were grouped according to weight change patterns, as follows: 1) no weight loss (±3% at years 1 and 4); 2) moderate weight loss (3-8% at years 1 and 4); 3) large weight loss (8-20% at years 1 and 4); 4) moderate loss/full regain (3-8% at year 1/±3% at year 4); 5) large loss/full regain (8-20% at year 1/± 3% year 4); and 6) large loss/partial regain (8-20% at year 1/3-8% at year 4) and changes in CVD risk factors were compared.

RESULTS

Adjusting for baseline differences and medication use, larger weight losses produced greater improvements in HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides at years 1 and 4 (all P ≤ 0.02). Despite maintenance of weight loss, HbA1c levels worsened between years 1 and 4, and remained below baseline only in those with large weight losses. We found no negative associations of losing and regaining weight relative to not having lost weight. Moreover, those who had large initial weight loss but full regain of weight had greater improvements in HbA1c levels at year 4 than those with smaller or no initial weight loss.

CONCLUSIONS

Larger initial weight loss should be encouraged in individuals with type 2 diabetes, despite the possibility of regain.

Prediction of Preadolescent Overweight and Poor Cardiometabolic Outcome in Children up to 6 Years of Age: Research Protocol

Background

Dynamic risk estimations may enable targeting primary prevention of overweight and overweight-related adverse cardiometabolic outcome in later life, potentially serving as a valuable addition to universal primary prevention. This approach seems particularly promising in young children, as body mass index (BMI) changes at a young age are highly predictive of these outcomes, and parental lifestyle interventions at a young age are associated with improved long-term outcome.

Objective

This paper describes the design of our study, which aims to develop digitized tools that can be implemented in the Dutch Child Health Care (CHC) system or by pediatricians for children up to 6 years of age. These tools will enable (1) dynamically predicting the development of overweight, hypertension or prehypertension, low high-density lipoprotein cholesterol (HDL-C) values, and high total cholesterol to HDL-C ratio by early adolescence and (2) identifying children who are likely to have poor cardiometabolic outcome by the age of 5-6 years and by the age of 10 years.

Methods

Data will be obtained from the Generation R (n=7893) and Prevention and Incidence of Asthma and Mite Allergy (PIAMA; n=3963) cohorts, two Dutch prenatally recruited cohorts. We will select candidate predictors that can be assessed during the first visit and/or during subsequent visits to the CHC center or pediatrician, including sex; parental age, education level, and BMI; smoking exposure; ethnicity; birth weight; gestational age; breastfeeding versus formula feeding; and growth data through the age of 6 years. We will design dynamic prediction models that can be updated with new information obtained during subsequent CHC visits, allowing each measurement to be added to the model. Performance of the model will be assessed in terms of discrimination and calibration. Finally, the model will be validated both internally and externally using the combined cohort data and then converted into a computer-assisted tool called ProCOR (Prediction Of Child CardiOmetabolic Risk).

Results

This is an ongoing research project financed by the Dutch government. The first results are expected in 2016.

Conclusions

This study may contribute to the national implementation of digitized tools for assessing the risk of overweight and related cardiometabolic outcome in young children, enabling targeted primary prevention, ultimately yielding relevant health gains and improved resource allocation.

The effect of rate of weight loss on long-term weight regain in adults with overweight and obesity

OBJECTIVE

To investigate the effect of rate of weight loss, with similar total weight loss, on weight regain in individuals with overweight and obesity.

METHODS

Fifty-seven participants (BMI: 28-35 kg/m(2) ) underwent a dietary intervention (DI). They were randomized to a low-calorie diet (LCD; 1250 kcal/day) for 12 weeks (slow weight loss) or a very-low-calorie diet (VLCD; 500 kcal/day) for 5 weeks (rapid weight loss) (weight loss (WL) period) followed by a 4-week weight-stable (WS) period and 9 months follow-up. Body weight and body composition (BodPod) were determined at study start and after each period.

RESULTS

Weight change was similar in both groups after WL (LCD: -8.2 kg and VLCD: -9.0 kg, P = 0.24). Weight regain after follow-up was not significantly different between groups (LCD: 4.2 kg and VLCD: 4.5 kg, P = 0.73). Percentage fat-free mass loss (%FFML) was higher in the VLCD-group compared to the LCD-group after DI (8.8% and 1.3%, respectively, P = 0.034) and was associated with weight regain during follow-up in the whole group (r = 0.325, P = 0.018).

CONCLUSIONS

The present study showed that, with similar total weight loss, rate of weight loss did not affect weight regain. However, %FFML after DI was associated with weight regain.

Predicting weight loss and maintenance in overweight/obese pediatric patients

BACKGROUND

Pediatric lifestyle interventions have positive short-term effects on obese patients. Studies on long-term effects are still scarce in Europe. We investigated long-term weight patterns and sociodemographic predictors of a weight change in a large Central European (Germany, Austria and Switzerland) overweight pediatric cohort.

METHODS

The APV (Adiposity Patients Verlaufsbeobachtung) database was retrospectively analyzed; 157 specialized childhood obesity centers contributed standardized data of 29,181 patients [body mass index (BMI) ≥ 90th percentile; 5-25 years old] presenting between 2000 and 2012. BMI standard deviation scores (BMI-SDS) were analyzed in a 2-year follow-up and grouped according to BMI-SDS changes. Multiple logistic regression analyses were conducted to assess associations between sociodemographic factors and weight patterns.

RESULTS

2-year follow-up data were available in 3,135 patients (54.6% female). Five distinct weight trajectories 'rapid weight loss' (n = 735, 23.4%), 'delayed success' (n = 697, 22.2%), 'cycling weight' (n = 43, 1.4%), 'initial weight loss' and 'weight rebound' (n = 383, 12.2%) and 'no weight loss throughout' (n = 1,277, 40.7%) best characterized long-term BMI-SDS changes. Younger and male patients were more likely to reduce weight and maintain weight loss.

CONCLUSIONS

Our results suggest that an intervention before the onset of puberty seems promising for long-term weight maintenance in overweight children. Thus, new concepts are needed to improve long-term treatment success in patients with lower success rates.