Elsevier

Metabolism

Volume 62, Issue 1, January 2013, Pages 127-136
Metabolism

Clinical Science
History of weight cycling does not impede future weight loss or metabolic improvements in postmenopausal women

https://doi.org/10.1016/j.metabol.2012.06.012Get rights and content

Abstract

Objective

Given that the repetitive loss and regain of body weight, termed weight cycling, is a prevalent phenomenon that has been associated with negative physiological and psychological outcomes, the purpose of this study was to investigate weight change and physiological outcomes in women with a lifetime history of weight cycling enrolled in a 12-month diet and/or exercise intervention.

Methods

439 overweight, inactive, postmenopausal women were randomized to: i) dietary weight loss with a 10% weight loss goal (N = 118); ii) moderate-to-vigorous intensity aerobic exercise for 45 min/day, 5 days/week (n = 117); ii) both dietary weight loss and exercise (n = 117); or iv) control (n = 87). Women were categorized as non-, moderate- (≥ 3 losses of ≥ 4.5 kg), or severe-cyclers (≥ 3 losses of ≥ 9.1 kg). Trend tests and linear regression were used to compare adherence and changes in weight, body composition, blood pressure, insulin, C-peptide, glucose, insulin resistance (HOMA-IR), C-reactive protein, leptin, adiponectin, and interleukin-6 between cyclers and non-cyclers.

Results

Moderate (n = 103) and severe (n = 77) cyclers were heavier and had less favorable metabolic profiles than non-cyclers at baseline. There were, however, no significant differences in adherence to the lifestyle interventions. Weight-cyclers (combined) had a greater improvement in HOMA-IR compared to non-cyclers participating in the exercise only intervention (P = .03), but no differences were apparent in the other groups.

Conclusion

A history of weight cycling does not impede successful participation in lifestyle interventions or alter the benefits of diet and/or exercise on body composition and metabolic outcomes.

Introduction

The repetitive loss and regain of body weight, referred to as weight cycling, appears to be a prevalent phenomenon. No uniform definition exists; however, estimates commonly range from 10% to 40% of the population in Westernized countries [1], [2], [3], [4], [5].

Repetitive weight loss followed by regain has been associated with unfavorable physiological and psychological outcomes including effects on body composition, metabolic rate, immune function, and lower body esteem [4], [6], [7], [8], [9], [10], [11]. However, the degree to which repetitive fluctuations in body weight represent an independent risk factor for adverse health outcomes, including successful future weight loss, is not clear. Studies have reported mixed findings on behavioral and physiological changes over successive weight loss attempts, including worse compliance [12] and effects on body fat distribution, energy expenditure, and specific comorbidities [13], [14]. It has been suggested that weight cycling may increase preference for dietary fat [15] and the likelihood of weight gain over time [2], [16], [17], [18]. Repeated unsuccessful attempts at weight loss maintenance may therefore affect future weight loss through metabolic adaptation or factors related to program adherence [14]. However, few studies have been able to examine this, and it remains unclear whether repetitive cycles of weight loss and regain have any significant effect on subsequent success in achieving weight loss, or on the metabolic changes that typically accompany it.

Given the well-documented difficulty of maintaining weight loss [19], [20], the potentially deleterious effects of weight cycling would be an important consideration in formulating treatment recommendations and population-based approaches to address obesity. The purpose of this study was to explore whether postmenopausal women with a lifetime history of repetitive weight cycling exhibit different body composition or physiologic responses to 12 months of diet and/or exercise intervention compared to non-cyclers.

Section snippets

Methods

The Nutrition and Exercise in Women (NEW) study, conducted from 2005 to 2009, was a 12-month randomized controlled trial to test the effects of dietary weight loss and/or exercise on circulating hormones and other variables [21]. Study procedures were reviewed and approved by the Fred Hutchinson Cancer Research Center Institutional Review Board in Seattle, WA, and all participants provided informed consent.

Results

At 12 months, 398 of 438 participants completed physical exams and provided blood samples, 397 underwent a DXA scan, and 371 completed a maximal treadmill test; 39 women did not complete the study (diet = 13, exercise = 12, diet + exercise = 7, controls = 7) (Fig. 1).

Discussion

In this study of overweight postmenopausal women, a history of weight cycling did not appear to impede successful participation in diet and/or exercise interventions or alter their benefits on body composition and physiological outcomes. Although weight cyclers had less favorable metabolic profiles at baseline compared with non-cyclers, these differences could be accounted for by differences in body composition (higher BMI, larger waist circumference, and greater % body fat) rather than any

Author contributions

Drs Mason and McTiernan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis. Study concept and design: Mason, Foster-Schubert, Wang, Alfano, Ulrich, Blackburn, McTiernan; Acquisition of data: Kong, Campbell, Blackburn, McTiernan; Analysis and interpretation of data: Mason, Xiao, Alfano, McTiernan; Drafting of the manuscript: Mason; Critical revision of the manuscript for important intellectual content: Imayama,

Funding

This work was supported by the National Cancer Institute at the National Institutes of Health (grant number: R01 CA102504, U54-CA116847, 5KL2RR025015-03 to K.F.S, R25 CA94880 and 2R25CA057699-16 to A.K.); and the Canadian Institutes of Health Research (Fellowship to CM & K.L.C). None of the funding agencies were involved in the trial design or conduct. While working on the trial, Dr. Alfano was employed at The Ohio State University, and located to NCI following completion of her effort on the

Conflict of interest

The authors have no disclosures.

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    Trial registration: clinicaltrials.gov Identifier NCT00470119.

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