The pursuit of weight loss is a common goal, often driven by the desire to improve health and well-being. Obesity is associated with insulin resistance, Type 2 diabetes, and other metabolic complications. Weight loss can lead to improvements in many of these metabolic complications and even remission of Type 2 diabetes. However, the path to sustained weight management is fraught with challenges. Weight maintenance is challenging following weight loss, and weight regain is common. The pattern of weight loss and regain is often termed “yo-yo dieting” or weight cycling. This article explores the potential health risks associated with yo-yo dieting, also known as weight cycling, examining its impact on various aspects of health, from metabolism to cardiovascular function.
What is Yo-Yo Dieting?
Yo-yo dieting, or weight cycling, describes the pattern of losing weight, regaining it, and then dieting again. It’s a process that causes weight to go up and down. This type of dieting is common - 10% of men and 30% of women have done it. Weight cycling is a common occurrence in overweight and obese populations. Survey data indicated that 25% of men and 27% of women trying to lose weight have made long-term attempts. It has also been shown that 7% of men and 10% of women can be classified as severe weight cyclers (intentionally lost at least 5 kg and regained at least three different times), while 11% of men and 19% of women are mild weight cyclers (lost and regained at least 5 kg on one or two occasions).
The Allure and Illusion of Dieting
For many people, a new year means a renewed effort to lose weight. If this sounds familiar, you could be yo-yo dieting. Many individuals embark on restrictive diets with the hope of achieving rapid weight loss. Atkins. Paleo. Whole360. Fruitarian. Skip gluten on Wednesdays unless it’s a full moon. No matter which diet your try, the data is in. And the message is clear: Diets don’t work. At least not in the long run. Sure, you can lose weight, but after a year, at least 1 in 3 of us gain it back. After 5 years? Almost no one keeps it off. While initial weight loss can be motivating, the body's complex physiological responses often lead to weight regain, perpetuating the yo-yo cycle.
Metabolic Consequences
Increased Appetite and Fat Storage
During dieting, fat loss leads to decreased levels of the hormone leptin, which normally helps you feel full. Under normal circumstances, your fat stores release leptin into the bloodstream. This tells the body that energy stores are available, and signals you to eat less. As you lose fat, leptin decreases and appetite increases. This leads to increased appetite as the body tries to resupply depleted energy stores.
In addition, the loss of muscle mass during dieting causes the body to conserve energy. This drive to eat causes a hyperphagic response when free access to food is allowed and when paired with suppressed lipid utilization, weight regain is often rapid and efficient. When most people use a short-term diet to lose weight, they will regain 30-65% of that lost weight within one year. Moreover, one in three dieters ends up heavier than before they dieted. Losing weight causes the body to increase appetite and cling to its energy storage. As a result, some yo-yo dieters gain back more weight than they lost.
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Higher Body Fat Percentage and Muscle Loss
In some studies, yo-yo dieting has led to an increased percentage of body fat. During the weight gain phase of yo-yo dieting, fat is regained more easily than muscle mass. This can result in your body fat percentage increasing over multiple yo-yo cycles.
In one review, 11 out of 19 studies found that a history of yo-yo dieting predicted higher body fat percentage and greater belly fat. This is more pronounced following a weight loss diet than with more subtle and sustainable lifestyle changes, and may be responsible for the yo-yo effect. A majority of studies show yo-yo dieting leads to a higher body fat percentage. This can lead to other changes that make it harder to lose weight.
During weight loss diets, the body loses muscle mass as well as body fat. Because fat is regained more easily than muscle after weight loss, this can lead to more loss of muscle over time. Muscle loss during dieting also leads to decreased physical strength. Weight loss can lead to muscle loss, and this can deplete your muscle mass over yo-yo dieting cycles.
Fatty Liver
Fatty liver is when the body stores excess fat inside the liver cells. Obesity is a risk factor for developing a fatty liver, and gaining weight puts you particularly at risk.
Fatty liver is associated with changes in the way the liver metabolizes fats and sugars, increasing the risk of type 2 diabetes. It can also occasionally lead to chronic liver failure, also known as cirrhosis. A study in mice showed that several cycles of weight gain and weight loss caused fatty liver. Another mouse study showed that fatty liver led to liver damage in weight-cycling mice. Weight gain leads to fatty liver, which can cause liver disease. In mice, this is exacerbated by weight cycling, though human studies are needed.
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Insulin Resistance
Yo-yo dieting may increase insulin resistance, a condition that occurs when your body can’t efficiently use the insulin it naturally produces. Insulin resistance can lead to type 2 diabetes; for those who already have diabetes, it makes the condition far more difficult to manage. Having a higher percentage of body fat increases insulin resistance and slows your metabolism. Because muscle burns more calories than fat, your body isn’t burning as many calories. So not only are you setting yourself up for high blood glucose, but you’re also more likely to hang on to the pounds you gained back.
Increased Risk of Diabetes
Yo-yo dieting is associated with a higher chance of developing type 2 diabetes, although not all studies found evidence for this. A review of several studies showed that a history of yo-yo dieting predicted type 2 diabetes in four out of 17 studies.
A study of 15 adults showed that when participants regained weight after 28 days of weight loss, it was mostly belly fat. Belly fat is more likely to lead to diabetes than fat stored in other locations, such as the arms, legs or hips. One study showed increased insulin levels in rats that went through 12 months of weight cycling, compared to those that gained weight consistently. Increased insulin levels like these can be an early sign of diabetes.
In a few studies, yo-yo dieting increased the risk of diabetes. The risk is greatest in those who end up at a higher weight than before their diet.
Cardiovascular Health Concerns
Research shows yo-yo dieting, also called weight cycling, can stress your heart. But a recent study published in the journal Nutrients says, while heart health worsens if you go back to unhealthy eating, it improves again if you restart the healthy diet.
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Increased Risk of Heart Disease
Weight cycling has been associated with coronary artery disease, a condition in which the arteries that supply the heart become narrow. Weight gain, even more than being overweight, increases the risk of heart disease. According to a study of 9,509 adults, the increase in the risk of heart disease depends on the size of the swing in weight - the more weight lost and regained during yo-yo dieting, the greater the risk. One review of several studies concluded that large variations in weight over time doubled the odds of death from heart disease. The risk of heart disease increases with weight gain and fluctuating weight. The greater the change in weight, the greater the risk.
Increased Blood Pressure
Weight gain, including rebound or yo-yo weight gain after dieting, is also linked to increased blood pressure. Making matters worse, yo-yo dieting may blunt the healthy effect of weight loss on blood pressure in the future.
A study of 66 adults found that those with a history of yo-yo dieting had less improvement in blood pressure while losing weight. A longer-term study found that this effect may fade after 15 years, suggesting that weight cycling during youth may not affect the risk of heart disease in middle age or later. A third, long-term study also found the harmful associations of prior yo-yo dieting were strongest when yo-yo dieting had occurred more recently, rather than decades prior.
Weight gain, including rebound weight gain in yo-yo dieting, increases blood pressure. This effect can linger for years, but appears to fade over time.
Psychological and Behavioral Effects
Frustration and Loss of Control
It can be very frustrating to see the hard work you put into losing weight vanish during the rebound weight gain of yo-yo dieting. In fact, adults with a history of yo-yo dieting report feeling dissatisfied with their lives and health. Yo-yo dieters also report poor self-efficacy regarding their body and health. In other words, they feel a sense of being out of control. Yo-yo dieting can make you feel out of control, but it’s not a sign of personal weakness.
Disordered Eating Patterns
Yo-yo dieting can lead to disordered eating habits and long-term struggles with weight. Engaging in unhealthy eating behaviors can have serious consequences, including an unhealthy relationship with food.
Not everyone who yo-yo diets ends up bingeing, but it can set you up for it. It’s like stretching a rubber band too tight. When you finally let go of all the tension around short-term, gotta-lose-weight-now thinking, it’s a perfect storm to let loose. And it’s very harmful for young people, especially girls. Teens and preteens who call themselves dieters are more likely to binge eat and become overweight.
Is Yo-Yo Dieting Worse Than Staying Overweight?
Losing weight if you’re overweight improves your heart health, reduces your risk of diabetes and boosts your physical fitness. Losing weight can also reverse fatty liver, improve sleep, reduce the risk of cancer, improve mood and extend the length and quality of your life. In contrast, weight gain leads to the opposite of all these benefits.
Yo-yo dieting is somewhere in between. It’s not as harmful as gaining weight, but it is definitely worse than losing weight and keeping it off. It’s unclear from the available research whether it’s better to yo-yo or stay overweight. What is clear is that making small, permanent healthy lifestyle changes is the best option.
Breaking the Cycle: A Sustainable Approach
Shift Your Mindset
Diets suck you into short-term thinking, and they can mess with your feelings around food. So it helps to step back and reset. Why do you diet? If you want to be healthier, it’s really about changing how you eat for the long term. You’ll also need to exercise regularly to keep the pounds off. So ditch the idea of a quick fix and think about how to make changes that can really work for you.
Focus on Lifestyle Changes
To break the cycle of temporary changes producing temporary success, stop thinking in terms of a diet and start thinking in terms of a lifestyle. A large study of more than 120,000 adults in the United States found that several habits could help gradually decrease and maintain weight over several years. Yo-yo dieting is a cycle of temporary changes producing temporary results. To break the cycle, start thinking in terms of permanent lifestyle changes.
Here are some of the behaviors it found worked for long-term weight loss:
- Eating healthy foods: Such as yogurt, fruits, vegetables and tree nuts (not peanuts).
- Avoiding junk foods: Such as potato chips and sugary beverages.
- Limiting starchy foods: Using starchy foods like potatoes in moderation.
- Exercising: Find something active that you enjoy doing.
- Getting good sleep: Get 6-8 hours of sleep each night.
- Limiting television viewing: Limit your TV time or exercise while you watch.
By making permanent lifestyle changes that promote a healthy weight, you can have permanent success and break the yo-yo cycle.
Set Realistic Goals
To get healthy, you need a plan that fits your life. Set goals that are small, clear, and doable. Instead of aiming to lose 20 pounds, maybe start with a pound a week. Or practice mindful eating for a week. Notice when you feel hungry or full, chew with attention, and savor your food. Start small and add more goals as you go along. It’s easier to stay motivated when you set yourself up for success.
Get Team Support
It’s not a matter of willpower. Your body doesn’t want to shed the weight, and it’s got all kinds of ways to hang on to it. That means you, too, need to pull hard. Gather up a team. Talk to your doctor and a dietitian. Get friends and family involved, or find an online community. You’ll need them.
Consistency in Diabetes Management
Another consequence for people with diabetes is that it disrupts your blood glucose management. “Consistency is a key factor for diabetes management,” says Toby Smithson, RDN, CDCES, a spokesperson for the Association of Diabetes Care & Education Specialists and coauthor of Diabetes Meal Planning & Nutrition for Dummies. Drastically cutting back on calories can lead to dangerously low blood glucose, for instance, and overeating after weeks of deprivation can raise your levels.