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

Abstract

In people trying to lose weight, there are often repeated cycles of weight loss and regain. Weight cycling is, however, not limited to obese adults but affects people of normal weight, particularly young women, who are unhappy with their appearance. Furthermore, the onset of a pattern of weight cycling is shifting towards younger ages, owing to the increasing prevalence of overweight and obesity in children and adolescents, and the pressure from the media and society for a slim image even for normal weight children. Although there is still controversy whether weight cycling promotes body fat accumulation and obesity, there is mounting evidence from large population studies for increased cardiovascular risks in response to a behavior of weight cycling. Potential mechanisms by which weight cycling contributes to cardiovascular morbidity include hypertension, visceral fat accumulation, changes in adipose tissue fatty acid composition, insulin resistance and dyslipidemia. Moreover, fluctuations in blood pressure, heart rate, sympathetic activity, glomerular filtration rate, blood glucose and lipids that may occur during weight cycling -with overshoots above normal values during weight regain periods -put an additional load on the cardiovascular system, and may be easily overlooked if humans or animals are studied during a state of relatively stable weight. Overshoot of those risks factors, when repeated over time, will stress the cardiovascular system and probably contribute to the overall cardiovascular morbidity of weight cycling.

How dieting makes some fatter: from a perspective of human body composition autoregulation

“…This contention is in line with prospective studies indicating more consistent association with increased risks for major weight gain in initially normal-weight subjects than in initially overweight and obese subjects attempting to lose weight (16,24) . With the prevalence of dieting increasing among individuals in the normal-weight range (due to pressure for a slim image, body dissatisfaction or athletic performance) and accumulating evidence suggesting increased cardiometabolic risks associated with weight fluctuations in the non-obese population groups (4,63) , the notion that dieting makes some fatter warrants greater experimental scrutiny and deserves greater public health concern than so far acknowledged.…”

“…Despite these failures, national surveys in Europe and North America indicate that 30-50 % women and 10-30 % men are currently or have recently attempted dieting to lose weight (5)(6)(7) . With studies of the long-term outcomes of energy-restricting diets showing that at least one-third of dieters regain more weight than they lost (8) , together with population groups as diverse as obese and lean, young and old, sedentary and athletes attempting to lose weight on some form of diet therapy (4,5) , there is concern as to whether dieting may paradoxically be promoting exactly the opposite of what it is intended to achieve. To put it bluntly, does dieting make people fatter as proposed nearly three decades ago by Cannon and Einzig (9) in a book entitled Dieting makes you fat.…”

“…Weight regain is generally the rule, with long-term follow-up studies indicating that one-third to two-thirds of the weight lost is regained within 1 year and almost all is regained within 5 years (3) . Repeated cycles of weight loss and weight regain, referred to as weight cycling or yo-yo dieting are a frequent occurrence, with the potential for increased cardiovascular risks (4) . Despite these failures, national surveys in Europe and North America indicate that 30-50 % women and 10-30 % men are currently or have recently attempted dieting to lose weight (5)(6)(7) .…”

Weight fluctuations and risk for metabolic syndrome in an adult cohort

“…4,5 Although there is a general agreement that modest weight loss has beneficial health effects in obese patients, 6 there are some hypotheses that suggest that weight cycling could be damaging particularly for CVD risk. 7,8 However, studies investigating the effect of weight variability on CVD risk have shown controversial results. Some studies indicated that the overall weight trend had a greater deleterious effect on CVD risk than weight fluctuation (WF) (that is the WF effect was not significant after adjustment for weight change), [9][10][11] whereas others concluded that WF had an independent effect.…”

“People don't care as much about their health as they do about their looks”: Personal trainers as intermediaries between aesthetic and health-based discourses of exercise participation and weight management

“…In addition to the considerable problems with establishing the efficacy of weight loss programs, there is the potential for iatrogenic effects of deliberate weight loss attempts. For example, evidence suggests that the weight-cycling that frequently results from repeated attempts to lose weight is itself more harmful to cardiovascular and metabolic health than maintaining a high body weight (e.g., Lissner et al, 1991;Montani et al, 2006;Strohacker & McFarlin, 2010), and that weight loss and appearance management reasons for exercise are associated with higher levels of self-objectification, disordered eating, and body dissatisfaction than are reasons based on health or enjoyment (e.g., Prichard & Tiggemann, 2005). Research also suggests that although weight loss goals may motivate initial engagement in exercise programs, these same goals can undermine sustained engagement with exercise and physical activity by promoting the conclusion that exercise is "not working" if weight loss does not occur, despite other substantial benefits to health (Robison, 2005;Teixeira, Silva, Mata, Palmeira, & Markland, 2012a).…”