Given that 42% of the USA has obesity and we have just left the month of January, the traditional time to re-commit to weight loss for many people, are repeated weight loss attempts healthy when it comes to our overall health and longevity?
Epidemiological studies suggest repetitive weight loss cycling is associated with a greater risk of early mortality and poorer mental health. Still, data show that almost 80% of people who have intentionally lost weight will regain some or all of it back. It seems like a never-ending cycle, good for the diet industry’s bottom line, but is it good for your health?
This area of controversy in weight loss literature is the subject of a new paper by Erik Willis and colleagues from the U.S. Department of Health Services, published in BMC Medicine.
The paper is a prospective cohort analysis of 161,738 adults. All of them are AARP members living in one of six states, namely, California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania. Two metropolitan areas, Atlanta, Georgia, and Detriot, Michigan, were also sampled. All participants were part of AARP’s Diet and Health study conducted between 2004 and 2006. The authors used self-report methods to assess weight loss frequency, as defined by the number of attempts of losing five or more pounds over 20 years. They summed up the total numbers of weight loss attempts for each participant and then assigned them into one of seven unique weight loss categories ranging from “never” attempts to “eleven plus” attempts.
Study participants also completed detailed Risk Factor Questionnaires (RFQ) to track their health throughout the study. The age range included in the sample was 50 to 71 years old. Participants also completed follow-up questionnaires that allowed the authors to have a longitudinal view of the cohort’s health. Death was assessed by using the National Death Index.
One unique aspect of the study was 62% were male, the weight management literature tends to skew toward females, 92% were non-Hispanic white. Most participants had, on average, initiated four weight-loss attempts over twenty years, resulting in an average loss of 11 pounds. More frequent weight loss attempts participants were more likely to be female, former, or current smokers and had overweight or obesity. They also had more chronic conditions and self-reported their health to be fair or poor compared to those with fewer weight loss attempts.
When the authors examined all-cause mortality using standard statistical methods, they did not find a relationship between frequent weight loss attempts and all-cause mortality. They found that participants who lost five or more pounds were associated with lower all-cause mortality than low or never attempt weight loss categories. Those who tried weight loss more than eleven times over the 20 year period had a 9% lower risk of all-cause mortality. When the authors adjusted to weight change over 20 years, these associations remained and grew stronger in those who had successfully lost weight.
Participants who had lost weight with no intention to do so had higher all-cause mortality than those to maintained or gained weight; unexplained weight loss is often a severe illness hallmark. When the authors adjusted for weight change categories, this association went away.
Looking at these findings through a population lens, supporting individuals to lose weight in middle-age and beyond, even with the cyclical nature of gain and loss, is still a worthy endeavor. Even if they lose and regain, this can dampen the accelerated trajectory toward ill health or premature death. While this study may have biases, as it is observational, it does add more data on the value of weight loss, however modest, to overall health and longevity.
Thanks for reading – Trina
(Opinions are my own)
Willis, E.A., Huang, WY., Saint-Maurice, P.F. et al. Increased frequency of intentional weight loss associated with reduced mortality: a prospective cohort analysis. BMC Med18, 248 (2020). https://doi.org/10.1186/s12916-020-01716-5