Difference of body compositional changes according to the presence of weight cycling in a community-based weight control program

The Physiological Effects of Weight-Cycling: A Review of Current Evidence

PURPOSE OF REVIEW

There is a common perception among the public that yo-yo dieting, defined as repeated cycles of weight loss followed by weight regain, results in accumulation of fat in the body and lower metabolic rate, thus hindering subsequent attempts to lose weight. We evaluated the effects of weight-cycling on body weight and body mass index (BMI), body composition including fat mass (FM) and lean body mass (LBM), and resting metabolic rate (RMR), by systematically reviewing existing scientific literature.

RECENT FINDINGS

Twenty-three cross-sectional and cohort studies (including subjects with a history of weight-cycling compared to those without such history) and interventional studies (evaluating physiological effects during one or more cycles of weight loss and regain) were identified, conducted in generally healthy adults across various age groups, races, and both genders, who had normal weight, overweight, or obesity. Eighteen studies investigated the association between weight-cycling and body weight or BMI, and thirteen of them found no significant association. Fifteen out of twenty studies also found no increase in FM, and none of eighteen studies found a decrease in LBM. Twelve out of fourteen studies reported no adverse changes in RMR either. The overwhelming majority of evidence suggests that weight-cycling (yo-yo effect) is not associated with any adverse effects in body weight, body composition, and metabolic rate. Accordingly, healthy individuals who struggle with overweight or obesity should not be discouraged from repeated attempts to lose the excess weight.

Variability of body mass index and risks of prostate, lung, colon, and ovarian cancers

Objective

We investigated the association between cancer incidence and body mass index (BMI) variability calculated from the recall of weight at decades of age by participants in the USA Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

Methods

A total of 89,822 individuals' BMI were recorded as recalled the participant's aged 30, 40, 50, 60, 70 years, and baseline. BMI variability was assessed using four indices: SD, coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). The multivariate Cox regression analysis was performed to calculate hazard ratios (HRs) of these measures for incident cancers and corresponding 95% CIs.

Results

During the median follow-up of 11.8 years, there were newly diagnosed 5,012 cases of prostate cancer, 792 cases of lung cancer, 994 cases of colon cancer, and 132 cases of ovarian cancer. Compared with the lowest quartile (Q1) group, the highest quartile (Q4) group of BMI variability indices was associated with increased lung cancer risk, including BMI_SD (HR, 1.58; 95% CI, 1.17-2.12), BMI_CV (HR, 1.46; 95% CI, 1.10-1.94), BMI_VIM (HR, 1.73; 95% CI, 1.33-2.25), and BMI_ARV (HR, 2.17; 95% CI, 1.62-2.91). Associations between BMI variability and prostate, colon, and ovarian cancer incidences were of limited significance.

Conclusion

The findings imply that maintaining a stable weight across adulthood is associated with a decreased incidence of lung cancer.

Body weight variability and cancer incidence in men aged 40 years and older-Korean National Insurance Service Cohort

Repeated weight fluctuation has been proposed as a potential risk factor for increasing morbidity and mortality including cancer. We aimed to investigate the association between body weight variability (BWV) and all cancer and site-specific cancer incidence and the impact of smoking on these associations. A total of 1,759,848 cancer-free male subjects who had their weight measured at least 5 times from the National Health Insurance Service-Health Screening Cohort from 2002 to 2011 were included and followed up until 2015. BWV was defined as the average absolute difference between successive values (ASV). The risk of cancer and site-specific cancer from BWV was identified using Cox proportional hazards regression analysis using hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for potential confounders including weight, and stratified analysis was also conducted according to smoking status. During the 7,015,413 person-years of follow-up, 11,494 patients (0.65%) developed new-onset cancers. BWV was associated with a higher risk of all cancers after adjustment for confounders. The highest BWV quintile group compared to the lowest had greater risks of all cancers and site-specific cancers including lung, liver, and prostate cancer (HR 1.22, 95% CI 1.15–1.30; HR 1.22, 95% CI 1.07–1.39; HR 1.46, 95% CI 1.19–1.81; HR 1.36, 95% CI 1.15–1.62, in all cancers, lung, liver and prostate cancer, respectively). Due to small number of cancer occurrence, the risk of kidney cancer was increased, but statistically insignificant (HR 1.38, 95% CI 0.91–2.10). Similar results were observed in noncurrent smokers. However, in current smokers, the risks of all cancers and only prostate cancer were significantly increased in the highest BWV quintile group (HR 1.19, 95% CI 1.09–1.31; HR 1.51, 95% CI 1.08–2.11). The risk of kidney cancer also increased in this group, although the finding was not statistically significant (HR 1.77, 95% CI 0.87–3.63) This study suggested BWV is an independent risk factor for cancer in men, especially in lung, liver, and prostate cancer, but evidence was weaker in kidney cancer. This association remained significant only in prostate cancer in current smokers.

Efficacy and safety of HT048 and HT077 for body fat and weight loss in overweight adults: A study protocol for a double-blind, randomized, placebo-controlled trial

BACKGROUND

The prevalence of excessive body weight has rapidly increased worldwide over the past decades; however, medications are intended for moderately and severely obese patients and are associated with side effects. As an alternative approach, the use of traditional herbal medicines has gained increasing popularity among overweight individuals in recent years in East Asia. HT048 is an herbal extract of Citrus unshiu and Crataegus pinnatifida, and HT077 is an herbal extract of Nelumbo nucifera and Prunus persica. These 4 herbs have been used widely for body weight reduction in China and Korea. The aims of this trial are to investigate whether HT048 and HT077 are effective at reducing body fat and weight in overweight adults, and to determine the safety of HT048 and HT077.

METHODS/DESIGN

A double-blind, randomized, placebo-controlled, 3-arm parallel group trial will be conducted in adults with a body mass index (BMI) of 25 to <30 kg/m. A total of 120 eligible participants will be randomized in a 1:1:1 ratio to receive either HT048 (1000 mg), HT077 (400 mg), or matching placebo twice daily for 12 weeks, and will be monitored for an additional 4-week follow-up period after the treatment. All participants will be assessed for efficacy and safety of the investigational product at baseline and weeks 4, 8, 12, and 16. The primary endpoint is the change in body fat mass and percent body fat measured by dual-energy X-ray absorptiometry at week 12 from the baseline. The secondary efficacy variables are abdominal fat area measured by computed tomography, body fat mass and percent body fat measured by bioelectrical impedance analysis, body weight, BMI, and serum lipids and adipocytokines concentrations. Safety will be evaluated on the basis of reported adverse events, abnormal laboratory results, vital signs, and physical examination findings.

DISCUSSION

This is a first-in-human trial of HT048 and HT077 to assess the efficacy and safety in overweight subjects. The results will provide high-quality evidence of the therapeutic benefits of HT048 and HT077 for weight management and the prevention of obesity.

TRIAL REGISTRATION

Korean Clinical Research Information Service (KCT0004271) Registered September 2, 2019.

Weight Fluctuation and Cancer Risk in Postmenopausal Women: The Women's Health Initiative

Background: Weight cycling, defined by an intentional weight loss and subsequent regain, commonly occurs in overweight and obese women and is associated with some negative health outcomes. We examined the role of various weight-change patterns during early to mid-adulthood and associated risk of highly prevalent, obesity-related cancers (breast, endometrial, and colorectal) in postmenopausal women.Methods: A total of 80,943 postmenopausal women (age, 63.4 ± 7.4 years) in the Women's Health Initiative Observational Study were categorized by self-reported weight change (weight stable; weight gain; lost weight; weight cycled [1-3, 4-6, 7-10, >10 times]) during early to mid-adulthood (18-50 years). Three site-specific associations were investigated using Cox proportional hazard models [age, race/ethnicity, income, education, smoking, alcohol, physical activity, hormone therapy, diet, and body mass index (BMI)].Results: A total of 7,464 (breast = 5,564; endometrial = 788; and colorectal = 1,290) incident cancer cases were identified between September 1994 and August 2014. Compared with weight stability, weight gain was significantly associated with risk of breast cancer [hazard ratio (HR), 1.11; 1.03-1.20] after adjustment for BMI. Similarly, weight cycling was significantly associated with risk of endometrial cancer (HR = 1.23; 1.01-1.49). Weight cycling "4 to 6 times" was most consistently associated with cancer risk, showing a 38% increased risk for endometrial cancer [95% confidence interval (CI), 1.08-1.76] compared with weight stable women.Conclusions: Weight gain and weight cycling were positively associated with risk of breast and endometrial cancer, respectively.Impact: These data suggest weight cycling and weight gain increase risk of prevalent cancers in postmenopausal women. Adopting ideal body-weight maintenance practices before and after weight loss should be encouraged to reduce risk of incident breast and endometrial cancers. Cancer Epidemiol Biomarkers Prev; 26(5); 779-86. ©2017 AACR.

Lifestyle and weight predictors of a healthy overweight profile over a 20-year follow-up

OBJECTIVE

To examine whether changes in modifiable risk factors [physical activity, cardiorespiratory fitness (CRF), body weight, and diet composition] are associated with the transition to metabolically healthy overweight/obese (MHOW) versus metabolically abnormal overweight/obese.

METHODS

Analysis included 1,358 adults [aged 25.0 (3.5) years] from the CARDIA study who were healthy at baseline and had overweight/obesity at follow-up. Participants with zero or one of the following six risk factors were classified as MHOW: elevated triglycerides, LDL, blood pressure, fasting glucose, and HOMA-insulin resistance and low HDL.

RESULTS

Over the 20-year follow-up, the sample gained weight (BMI 24.5 to 31.1 kg/m(2) ), and the prevalence of MHOW was 47% at follow-up. After adjusting for changes in CRF, diet, and weight change, physical activity and macronutrient intake were not independently associated with MHOW (P > 0.05), while changes in CRF [fit-unfit: RR (95%) = 0.58, 0.52-0.66; unfit-unfit: RR = 0.67, 0.58-0.76, versus fit-fit] and weight [gain: RR (95%) = 0.54, 0.43-0.67; cycle: RR = 0.74, 0.57-0.94, versus stable] were independently associated with MHOW.

CONCLUSIONS

Focusing on high CRF and strategies to limit weight gain may be important for individuals with overweight and obesity in early to mid-adulthood to maintain a metabolically healthy profile.

Consequences of obesity and weight loss: a devil's advocate position

Obesity is associated with multiple negative health consequences and current weight management guidelines recommend all obese persons to lose weight. However, recent evidence suggests that not all obese persons are negatively affected by their weight and that weight loss does not necessarily always improve health. The purpose of this review is not to trivialize the significant health risks associated with obesity, but to discuss subpopulations of obese people who are not adversely affected, or may even benefit from higher adiposity, and in who weight loss per se may not always be the most appropriate recommendation. More specifically, this review will take a devil's advocate position when discussing the consequences of obesity and weight loss for adults with established cardiovascular disease and type 2 diabetes, weight cyclers, metabolically healthy obese adults, youth, older adults and obese individuals who are highly fit.

Impact of weight cycling on risk of morbidity and mortality

Unintentional weight gain is commonly observed in adult humans, often provoking intentional weight loss attempts followed by unintentional weight regain. This episodic variation in body weight over a period of time has been referred to as 'weight cycling'. Over the last two decades, weight cycling has been associated with a number of morbid health conditions and increased mortality. This article provides a comprehensive evaluation of recent weight-cycling evidence, looks to understand design differences between studies and study outcomes, assesses the need for further research on particular health outcomes, and proposes alternative methodologies that will bridge the needs and capabilities of research. Searches were conducted per PRISMA guidelines. Articles on weight cycling in the literature were initially identified using search strings in PubMed. Eligibility assessment of the remaining articles was performed independently by three reviewers to identify publications that presented direct evidence. Twenty human studies (in addition to seven animal studies) were selected and retained; 12 accounted for the intentionality of weight loss. Although weight regain following successful weight loss remains one of the most challenging aspects of body-weight regulation, evidence for an adverse effect of weight cycling appears sparse, if it exists at all.

The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.

Weight cycling promotes fat gain and altered clock gene expression in adipose tissue in C57BL/6J mice

Repeated attempts to lose weight by temporary dieting may result in weight cycling, eventually further gain of body fat, and possible metabolic adaptation. We tested this with a controlled experiment in C57BL/6J mice subjected to four weight cycles (WC), continuous hypercaloric feeding (HF), or low-fat feeding (LF). To search for genes involved in an adaptive mechanism to former weight cycling and avoid acute effects of the last cycle, the last hypercaloric feeding period was prolonged by an additional 2 wk before euthanization. Total energy intake was identical in WC and HF. However, compared with HF, the WC mice gained significantly more total body mass and fat mass and showed increased levels of circulating leptin and lipids in liver. Both the HF and WC groups showed increased adipocyte size and insulin resistance. Despite these effects, we also observed an interesting maintenance of circulating adiponectin and free fatty acid levels after WC, whereas changes in these parameters were observed in HF mice. Global gene expression was analyzed by microarrays. Weight-cycled mice were characterized by a downregulation of several clock genes (Dbp, Tef, Per1, Per2, Per3, and Nr1d2) in adipose tissues, which was confirmed by quantitative PCR. In 3T3-L1 cells, we found reduced expression of Dbp and Tef early in adipogenic differentiation, which was mediated via cAMP-dependent signaling. Our data suggest that clock genes in adipose tissue may play a role in metabolic adaptation to weight cycling.

A reduced-calorie dietary pattern including a daily sweet snack promotes body weight reduction and body composition improvements in premenopausal women who are overweight and obese: a pilot study

Reduced-calorie diets are difficult to follow because they often require elimination of certain foods, leading to poor compliance and limited success. However, a low-calorie, nutrient-dense diet has the potential to accommodate a daily snack without exceeding energy requirements, even during weight loss. This pilot study evaluated the effects of a reduced-calorie diet including either a daily dark chocolate snack or a non-chocolate snack on anthropometric and body composition measurements. In a randomized clinical trial, 26 overweight and obese (body mass index ≥25 to ≤43) premenopausal women were assigned to a reduced-calorie diet that included either a daily dark chocolate snack or non-chocolate snack (n=13 per group) for 18 weeks. At baseline and end of study, body weight and waist and hip circumferences were measured along with fat mass, lean mass, and body fat percentage by dual-energy x-ray absorptiometry. Energy and macronutrient intakes were estimated from 4-day food records. Within- and between-group changes from baseline were analyzed using paired t tests and independent t tests, respectively. Women in both snack groups reduced estimated daily energy intake (P<0.001). Women in both the dark chocolate snack and non-chocolate snack groups, respectively, experienced decreases (P<0.001) in body weight (-5.1 vs -5.1 kg), hip circumference (-5.8 vs -5.4 cm), waist circumference (-5.7 vs -3.5 cm), fat mass (-3.9 vs -3.6 kg), and body fat percentage (-3.4% vs -3.1%), with no change in lean mass. Improvements in anthropometric and body composition measurements among overweight and obese premenopausal women can be achieved with a reduced-calorie diet including either a daily dark chocolate snack or non-chocolate snack.

Improvements of mean body mass index and body weight in preobese and overweight Japanese adults with black Chinese tea (Pu-Erh) water extract

Water-soluble black Chinese (Pu-Erh) tea extract (BTE), which contains high gallic acid content, has been demonstrated to elicit antiobese effects in animals. Because gallic acid is related with the reduction of visceral fat and cholesterol contents and improvement of obesity in animals, we investigated the effects of BTE intake on 36 preobese Japanese adults (body mass index [BMI], >25- <30 kg/m(2)) in a 12-week double-blind, randomized, placebo-controlled group comparison study using powdered barley tea with or without (placebo) BTE. A follow-up 4-week period after BTE intake termination was monitored to observe the withdrawal effect. All subjects ingested barley tea with or without BTE (333 mg) before each of the 3 daily meals. In the BTE-treated group, the mean pretreament values of body weight and BMI significantly decreased after intake and after BTE withdrawal. However, the corresponding values scored significant differences only from 8 weeks after intake (vs the placebo-treated group). The mean values of the waist circumference indicated a similar tendency. Furthermore, coronal navel section (same anatomical position) images of computed tomography of all BTE- and non-BTE-treated subjects revealed that the visceral fat areas (cm(2)) were significantly (P < .05) less in the former 12 weeks after BTE ingestion. Measured biochemical parameters did not indicate significant differences, and BTE-treated subjects did not complain of any adverse effects (abdominal distension, etc). Ingestion of BTE exhibited significant effects in reducing the mean waist circumference, BMI, and visceral fat values and might be useful for weight control and prevention of obesity development (or metabolic syndrome) in humans.