Health Risks of Weight Cycling

"Yo-yo dieting" and "weight cycling" are terms that refer to intentional weight loss followed by unintentional weight gain. This back-and-forth can be common for people trying to lose weight, particularly women. In addition to being a frustrating situation for clients and practitioners, weight cycling may also be risky business for long-term physical and mental health.Why Weight CyclesSustaining weight loss is difficult. When weight is lost, changes in fat hormones, energy expense, and gut peptides may lead to weight regain to a very regulated set point. When weight is lost, appetite is increased, making it difficult to limit food intake. Frustration with the scale may lead to feelings of failure, which can set up a cycle of "diet, cheat, repent, repeat."In addition, long-term habit change is difficult. Keeping weight off is a lifelong commitment. According to the National Weight Control Registry, people who successfully maintain weight loss typically engage in at least 60 minutes of regular exercise most days of the week, keep calorie intake limited, and avoid certain foods.A Weighty MatterAlthough weight loss may benefit body composition and improve lipids, blood pressure, and/or blood sugar, researchers suggest that regained weight may lead to increased fat gain and increases in cardiometabolic markers.Observational studies have evaluated the link between weight cycling and health outcomes. A modest association between yo-yo dieting and type 2 diabetes and dyslipidemia has been observed in women. High blood pressure, cardiovascular events, and increased overall cancer risk have not been seen.A recent meta-analysis of 127 articles* related to weight cycling evaluated the risk of endometrial cancer. These included traditional weight loss methods as well as bariatric surgery. Using statistical analysis, the review revealed that, compared with stable weight, self-reported weight loss was associated with a lower risk of endometrial cancer, while self-reported weight cycling was linked with a higher risk of endometrial cancer. After bariatric surgery, the risk of endometrial cancer dropped by 59%.What Can Be Done?Given the rising rates of overweight and obesity in the US, we don’t want to ignore the issue of weight loss when it’s indicated. We also don’t want to raise the risk of eating disorders, depression, or the unwanted side effects that accompany fad diets and restrictive methods.Below are some tips for practitioners working with weight loss clients:

1. Focus on healthy habits, not weight. When the number on the scale is the only measure of success, it’s difficult for clients to recognize that small changes move the needle.
2. Be realistic with clients. Advise them that a small weight loss of 5 to 7% may still reduce their risk for diabetes and hypertension.
3. Provide practical solutions for meal planning. Ask detailed questions about budget, grocery shopping, label reading, cooking skills, strategies when dining out, and beverage consumption. All of these are pertinent when it comes to sustainable habit change.
4. Encourage regular exercise. While exercise alone may not result in weight loss, it can aid in maintaining muscle mass, improving sleep, and reducing stress, all of which may impact food intake and weight.
5. Refer to mental health experts. Chronic dieting can take a toll on mental health too! It can lead to low self-esteem, depression, binge eating, or other issues. Counseling, group therapy, or medications for depression, stress, and anxiety may be indicated. 

By Lisa Andrews, MEd, RD, LDReferences:

1. Carey KJ, Vitek W. Weight Cycling in Women: Adaptation or Risk? Semin Reprod Med. 2020 Dec 7
2. National Weight Control Registry (nwcr.ws)
3. Zhang X, Rhoades J, Caan BJ, Cohn DE, Salani R, Noria S, Suarez AA, Paskett ED, Felix AS. Intentional weight loss, weight cycling, and endometrial cancer risk: a systematic review and meta-analysis. Int J Gynecol Cancer. 2019 Nov;29(9):1361-1371. doi: 10.1136/ijgc-2019-000728. Epub 2019 Aug 26. PMID: 31451560; PMCID: PMC6832748.
4. Ozemek C, Tiwari S, Sabbahi A, Carbone S, Lavie CJ. Impact of therapeutic lifestyle changes in resistant hypertension. Prog Cardiovasc Dis. 2020 Jan-Feb;63(1):4-9. doi: 10.1016/j.pcad.2019.11.012.
5. Quinn DM, Puhl RM, Reinka MA. Trying again (and again): Weight cycling and depressive symptoms in U.S. adults. PLoS One. 2020 Sep 11;15(9):e0239004.

Handout:The Dangers of Weight Cycling*13 different studies were reviewed.