When Are Fluctuations in Weight Unhealthy?

Summary and Comment |
April 5, 2017

When Are Fluctuations in Weight Unhealthy?

  1. Harlan M. Krumholz, MD, SM

A post hoc analysis links weight fluctuations to risk for coronary events, but only in overweight or obese people.

  1. Harlan M. Krumholz, MD, SM

Patients commonly receive advice about their body weight, and fluctuations in weight are a typical occurrence for many people as they cycle through various diets. To examine the relationship between weight fluctuations and risks for cardiovascular events, investigators in a manufacturer-funded study analyzed data on 9509 people from the Treating to New Targets (TNT) trial, which tested atorvastatin in patients with established coronary artery disease.

The authors defined body-weight fluctuations as intraindividual variability in weight between study visits, which occurred every 3 months in the first year and every 6 months thereafter. Mean baseline weight was 85 kg. During a median follow-up of 4.7 years, participants had a median of 12 weight measurements and a median body-weight variability of 1.8 kg.

With each increase in body-weight variability of one standard deviation (1.5–1.9 kg), the risk for any coronary event increased by 4%. Participants in the highest quintile of variability, compared with those in the lowest, had a 64% higher relative risk for any coronary event. The association was not significant for those with a normal weight. Mean weight was not significantly associated with coronary events in a model fully adjusting for demographics, comorbidities, and other factors.

Comment

This provocative, post hoc study of a trial population suggests that body-weight fluctuations over 5 years predict elevated risk in those who are overweight and obese — and mean weight itself does not predict events. These findings need further validation. The reason for them is not clear, and the relationship may not be causal. For now, however, the results bring into question the wisdom of interventions that may result in weight fluctuations.

Editor Disclosures at Time of Publication

  • Disclosures for Harlan M. Krumholz, MD, SM at time of publication Consultant / Advisory board United Healthcare (Advisory Board); Element Science (Consultant) Equity ImageCor; Hugo PHR Grant / Research support Agency for Healthcare Research and Quality; Food and Drug Administration; National Heart, Lung, and Blood Institute; Robert Wood Johnson Foundation; Medtronic; Johnson & Johnson; Chinese National Center for Cardiovascular Disease; Centers for Medicare & Medicaid Services Editorial boards BMJ.com/US; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Circulation: Cardiovascular Quality and Outcomes; Circulation (Associate Editor)

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