Weight Trajectory Impacts Risk for Ten Distinct Cardiometabolic Diseases.

Context: Repetitive bouts of weight loss and regain, termed weight cycling, may exaggerate risk for cardiometabolic disease. We previously identified that weight cyclers were likely to have prescribed medications for hypertension, dyslipidemia, and diabetes - suggesting high prevalence of cardiometabolic disease.

Objective: No prior study has compared relationships between longitudinal weight trajectory (weight stable, weight gainer, weight loser, or weight cycler) and commonly occurring specific cardiometabolic diseases among persons with similar high baseline BMI.

Methods: Using de-identified electronic health record data from all adults treated at Vanderbilt University Medical Center between 1997 to 2020 and a landmark approach, we developed multivariate cox proportional hazards regression models to determine relationships between weight trajectory and risk for ten highly prevalent cardiometabolic diseases.

Results: Compared to weight stability, weight cycling associated with almost 30% increased risk for obstructive sleep apnea (HR 1.28; 95% CI 1.15-1.42), MASLD (HR 1.28; 95% CI 1.08-1.51), and T2DM (HR 1.23; 95% CI 1.10-1.38). Weight cycling also associated with more than 50% increased risk for heart failure (HR 1.54; 95% CI 1.31-1.82), although both weight gain and weight loss also showed increased risk for HF (HR 1.29; 95% CI 1.08-1.55 and HR 1.32; 95% CI 1.10-1.58, respectively).

Conclusions: The relationship between weight cycling and cardiometabolic disease risk was independent of having high baseline BMI, which was similar among weight trajectory groups. The present findings support promoting either weight stability at high BMI or weight loss if able to be maintained to prevent the incidence of a variety of cardiometabolic diseases.