Yo-Yo Diets Linked to Poorer CV Health in Women

Losing and gaining the same 10 pounds over and over again—also known as yo-yo dieting—is common among women of all ages, but a new study suggests it can increase the risk of cardiovascular disease, possibly due to frequent fluctuations in clinical risk factors.

“Over 70% of our sample reported that they had weight cycled at least once in their lifetime,” senior study author Brooke Aggarwal, EdD (Columbia University, New York, NY), said in an interview. Compared with women who did not weight cycle, those who did had lower cardiovascular health scores as measured by the American Heart Association’s Life Simple 7, which in addition to weight, incorporates behaviors such as smoking, eating, physical activity, blood pressure, cholesterol, and glucose.

Women who weight cycled also were 82% less likely than those who did not to achieve a body mass index considered ideal (18.5-25 kg/m2).

“I think the takeaways are that it's important to try to achieve a healthy weight according to national cardiovascular disease prevention guidelines, but maybe we need more focus on how we do that so we're not promoting any type of rapid loss, which has been shown to lead to rapid weight regain . . . and setting women up for that pattern of weight cycling,” Aggarwal said. The findings were presented today at the American Heart Association (AHA) Epidemiology and Prevention|Lifestyle and Cardiometabolic Health Scientific Sessions 2019 in Houston, TX.

Small, Sustainable Changes May Be Best

The study followed 485 women ages 20 to 79 who participated in the AHA Go Red for Women Strategically Focused Research Network. The Columbia location is one of five AHA-funded research institutes studying a range of women’s health issues.

To TCTMD, Aggarwal said the women represent a diverse cohort, with half identifying as a racial or ethnic minority. Overall, women who reported one or more episodes of weight cycling were less likely than those who did not to meet either the moderate composite score on Life’s Simple 7 (OR 0.18; 95% CI 0.09-0.37) or the optimal score (OR 0.35; 95% CI 0.19-0.66). Additionally, as reported episodes of weight cycling increased, composite Life’s Simple 7 scores decreased.

When the researchers stratified women by pregnancy history and menopausal status, they found that those who had never been pregnant were most impacted by weight cycling, having the lowest odds of meeting a high score on Life’s Simple 7.

Aggarwal said a potential explanation for the findings lies in the “overshoot theory,” whereby losing and regaining weight causes clinical risk factors to “inch up” each time the weight is regained, putting additional stress on the cardiovascular system and preventing women from ever getting them fully under control enough to fall into an ideal range. Another possible connection is that bodyweight that is lost, especially if it is lost quickly, may be in the form of muscle as opposed to fat. But weight that is gained is nearly always fat, so those shifting and redistributing patterns of fat may account for some of the increased risk as well, Aggarwal noted.

From a real-world perspective, she said the findings suggest that for many women “it may be better to maintain whatever weight you are, rather than lose weight and risk gaining it back.” She also suggested that physicians should talk with their female patients more openly about types and frequency of dieting and encourage small, sustainable changes that they can live with and incorporate into a healthy lifestyle.