Increased risk of diabetes development in individuals with weight cycling over 4 years: The Kangbuk Samsung Health study



      Weight cycling is defined as cyclical loss and gain of weight and recent studies suggest deleterious effects of weight cycling on cardiometabolic health. We aimed to analyze the risk for diabetes development in association with weight cycling over 4 years of follow-up.


      A retrospective study performed in 4,818 non-diabetic participants (mean age 43 years, 78.3% men) in a health screening program in whom serial health examinations were performed in 5 consecutive years from 2010 to 2014. Average successive variability of weight (ASVW) was defined by the amount of body weight change in absolute value between the successive years over 5 years summed and divided by four. The subjects were divided into two groups according to body mass index (BMI), normal weight (<23 kg/m2) and overweight (≥23 kg/m2).


      Over 4 years, 3.2% developed diabetes. When the subjects were divided into 3 groups according to tertile groups of ASVW, those in the highest tertile showed significantly increased risk for diabetes development compared to those with the lowest tertile {odds ratio (OR) 1.860; 95% CI 1.130–3.063}. When similar analyses were performed according to the 4 groups divided by baseline body weight and ASVW over four years, those who were more than overweight at baseline with high ASVW showed significantly increased risk of diabetes development compared to those had normal weight and low ASVW (OR 2.266; 95% 1.123–4.572). When the subjects were divided into six group according to weight change and ASVW, those with increased weight over 4 years and high ASVW showed the highest risk for diabetes development among the groups compared to those with stable weight and low ASVW over four years (OR 3.660; 95% CI 1.402–9.553).


      Those with high ASVW showed significantly increased risk for diabetes development over four years compared with those who had low ASVW. Weight cycling was significantly associated with increased risk for diabetes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Available at

      2. Jarolimova J, Tagoni J, Stern TA. Obesity: its epidemiology, comorbidities, and management. Prim Care Companion CNS Disord 2013; 15.

        • Gallagher E.J.
        • LeRoith D.
        Obesity and diabetes: the increased risk of cancer and cancer-related mortality.
        Physiol Rev. 2015; 95: 727-748
      3. Available at (Lastly accessed on August 2nd, 2017).

        • Montani J.P.
        • Schutz Y.
        • Dulloo A.G.
        Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk?.
        Obes Rev. 2015; 16: 7-18
        • Foreyt J.P.
        • Brunner R.L.
        • Goodrick G.K.
        • Cutter G.
        • Brownell K.D.
        • St Jeor S.T.
        Psychological correlates of weight fluctuation.
        Int J Eat Disord. 1995; 17: 263-275
        • Field A.E.
        • Byers T.
        • Hunter D.J.
        • Laird N.M.
        • Manson J.E.
        • Williamson D.F.
        • et al.
        Weight cycling, weight gain, and risk of hypertension in women.
        Am J Epidemiol. 1999; 150: 573-579
      4. Weight cycling. National task force on the prevention and treatment of obesity. JAMA 1994; 272: 1196–1202.

        • Byrne N.M.
        • Weinsier R.L.
        • Hunter G.R.
        • Desmond R.
        • Patterson M.A.
        • Darnell B.E.
        • et al.
        Influence of distribution of lean body mass on resting metabolic rate after weight loss and weight regain: comparison of responses in white and black women.
        Am J Clin Nutr. 2003; 77: 1368-1373
        • Peters E.T.
        • Seidell J.C.
        • Menotti A.
        • Arayanis C.
        • Dontas A.
        • Fidanza F.
        • et al.
        Changes in body weight in relation to mortality in 6441 European middle-aged men: the Seven Countries Study.
        Int J Obes (Lond). 1995; 19: 862-868
        • American Diabetes Association
        2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018.
        Diabetes Care. 2018; 41: S13-S27
      5. List of NGSP Certified Methods. Available at (Lastly accessed 5th, January 2018).

        • Schwartz K.L.
        • Monsur J.C.
        • Bartoces M.G.
        • West P.A.
        • Neale A.V.
        Correlation of same-visit HbA1c test with laboratory-based measurements: a MetroNet study.
        BMC Fam Pract. 2005; 6: 28
      6. Kim MK, Lee WY, Kang JH, Kang JH, Kim BT, Kim SM, et al. Committee of Clinical Practice Guidelines, Korean Society for the Study of Obesity. 2014 Clinical Practice Guidelines for Overweight and Obesity in Korea. Endocrinol Metab 2014; 29: 405–409.

        • Williamson D.F.
        • Serdula M.K.
        • Anda R.F.
        • Levy A.
        • Byers T.
        Weight loss attempts in adults: goals, duration, and rate of weight loss.
        Am J Public Health. 1992; 82: 1251-1257
        • Serdula M.K.
        • Williamson D.F.
        • Anda R.F.
        • Levy A.
        • Heaton A.
        • Byers T.
        Weight control practices in adults: results of a multistate telephone survey.
        Am J Public Health. 1994; 84: 1821-1824
        • Yaemsiri S.
        • Slining M.M.
        • Agarwal S.K.
        Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003–2008 Study.
        Int J Obes (Lond). 2011; 35: 1063-1070
        • Lahti-Koski M.
        • Seppänen-Nuijten E.
        • Männistö S.
        • Härkänen T.
        • Rissanen H.
        • Knekt P.
        • et al.
        Twenty-year changes in the prevalence of obesity among Finnish adults.
        Obes Rev. 2010; 11: 171-176
        • Julia C.
        • Péneau S.
        • Andreeva V.A.
        • Méjean C.
        • Fezeu L.
        • Galan P.
        • et al.
        Weight-loss strategies used by the general population: how are they perceived?.
        PLoS ONE. 2014; 9: e97834
        • National Institutes of Health Technology Assessment Conference Panel
        Methods for voluntary weight loss and control.
        Ann Intern Med. 1993; 119: 764-770
        • Mann T.
        • Tomiyama A.J.
        • Westling E.
        • Lew A.M.
        • Samuels B.
        • Chatman J.
        Medicare’s search for effective obesity treatments: diets are not the answer.
        Am Psychol. 2007; 62: 220-233
        • Waring M.E.
        • Eaton C.B.
        • Lasater T.M.
        • Lapane K.L.
        Incident diabetes in relation to weight patterns during middle age.
        Am J Epidemiol. 2010; 171: 550-556
        • Yokomichi H.
        • Ohde S.
        • Takahashi O.
        • Mochizuki M.
        • Takahashi A.
        • Yoda Y.
        • et al.
        Weight cycling and the subsequent onset of type 2 diabetes mellitus: 10-year cohort studies in urban and rural Japan.
        BMJ Open. 2017; 7: e014684
        • Pietiläinen K.H.
        • Saarni S.E.
        • Kaprio J.
        • Rissanen A.
        Does dieting make you fat? A twin study.
        Int J Obes (Lond). 2012; 36: 456-464
        • Yatsuya H.
        • Tamakoshi K.
        • Yoshida T.
        • Hori Y.
        • Zhang H.
        • Ishikawa M.
        • et al.
        Association between weight fluctuation and fasting insulin concentration in Japanese men.
        Int J Obes (Lond). 2003; 27: 478-483
        • Willett W.C.
        • Manson J.E.
        • Stampfer M.J.
        • Colditz G.A.
        • Rosner B.
        • Speizer F.E.
        • et al.
        Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range.
        JAMA. 1995; 273: 461-465
        • Bosy-Westphal A.
        • Kahlhöfer J.
        • Lagerpusch M.
        • Skurk T.
        • Müller M.J.
        Deep body composition phenotyping during weight cycling: relevance to metabolic efficiency and metabolic risk.
        Obes Rev. 2015; 16: 36-44
        • Cereda E.
        • Malavazos A.E.
        • Caccialanza R.
        • Rondanelli M.
        • Fatati G.
        • Barichella M.
        Weight cycling is associated with body weight excess and abdominal fat accumulation: a cross-sectional study.
        Clin Nutr. 2011; 30: 718-723
        • Bosy-Westphal A.
        • Schautz B.
        • Lagerpusch M.
        • Pourhassan M.
        • Braun W.
        • Goele K.
        • et al.
        Effect of weight loss and regain on adipose tissue distribution, composition of lean mass and resting energy expenditure in young overweight and obese adults.
        Int J Obes (Lond). 2013; 37: 1371-1377
        • Bangalore S.
        • Breazna A.
        • DeMicco D.A.
        • Wun C.C.
        Messerli FH; TNT Steering Committee and Investigators. Visit-to-visit low-density lipoprotein cholesterol variability and risk of cardiovascular outcomes: insights from the TNT trial.
        J Am Coll Cardiol. 2015; 65: 1539-1548
        • Bur A.
        • Herkner H.
        • Woisetschläger C.
        • Vlcek M.
        • Derhaschnig U.
        • Hirschl M.M.
        Is fasting blood glucose a reliable parameter for screening for diabetes in hypertension?.
        Am J Hypertens. 2003; 16: 297-301
        • Ghazanfari Z.
        • Haghdoost A.A.
        • Alizadeh S.M.
        • Atapour J.
        • Zolala F.
        A comparison of HbA1c and fasting blood sugar tests in general population.
        Int J Prev Med. 2010; 1: 187-194