Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study
Weight loss is crucial for disease prevention among individuals with overweight or obesity. This study aimed to examine associations of weight loss strategies (WLSs) with weight change and type 2 diabetes (T2D) risk among US health professionals. This study included 93,110 participants (24 to 60 yea...
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description | Weight loss is crucial for disease prevention among individuals with overweight or obesity. This study aimed to examine associations of weight loss strategies (WLSs) with weight change and type 2 diabetes (T2D) risk among US health professionals.
This study included 93,110 participants (24 to 60 years old; 11.6% male) from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS) cohorts who were free of T2D, cardiovascular disease, and cancer at baseline (1988 for NHS/HPFS and 1989 for NHSII) for analyses of weight change and 104,180 (24 to 78 years old; 14.2% male) for T2D risk assessment. WLSs used to achieve an intentional weight loss of 4.5+ kg were collected in 1992 (NHS/HPFS)/1993 (NHSII) and grouped into 7 mutually exclusive categories, including low-calorie diet, exercise, low-calorie diet and exercise, fasting, commercial weight loss program (CWLP), diet pills, and FCP (selected at least 2 methods from fasting, CWLP, and pill). The reference group was participants who did not attempt to lose weight. Generalized estimating equations and Cox regression were applied to estimate up to 10-year weight change trajectory and incident T2D risk through 2016 (NHS/HPFS)/2017 (NHSII), respectively. The associations of WLSs with weight change and T2D risk were differential by baseline body weight (Pinteraction < 0.01). Among individuals with obesity, all WLSs tended to associate with less weight gain [ranging from -4.2% (95% confidence interval (CI), -5.1% to -3.2%; P < 0.001) for exercise to -0.3% (-1.2% to 0.7%; P > 0.99) for FCP] and a lower T2D risk [hazard ratios (HRs) ranging from 0.79 (0.66 to 0.95; P = 0.04) for exercise to 0.87 (0.66 to 1.13; P = 0.30) for pill]. Such a pattern was less clear among overweight individuals: the difference of weight change varied from -2.5% (-3.0% to -2.1%; P < 0.001) for exercise to 2.0% (1.3% to 2.7%; P < 0.001) for FCP, and HRs of T2D varied from 0.91 (0.77 to 1.07; P = 0.29) for exercise to 1.42 (1.11 to 1.81; P = 0.02) for pill. The pattern was further inverted among lean individuals in that weight change ranged from -0.4% (-0.6% to -0.1%; P = 0.02) for exercise to 3.7% (3.1% to 4.3%; P < 0.001) for FCP, and the HRs of T2D ranged from 1.09 (0.91 to 1.30; P = 0.33) for exercise to 1.54 (1.13 to 2.10; P = 0.008) for pill. Approximately 15.6% to 46.8% of the association between WLSs and the T2D risk was attributed to weight changes. This study was limited by a single assessment of WLSs, het |
doi_str_mv | 10.1371/journal.pmed.1004094 |
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This study included 93,110 participants (24 to 60 years old; 11.6% male) from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS) cohorts who were free of T2D, cardiovascular disease, and cancer at baseline (1988 for NHS/HPFS and 1989 for NHSII) for analyses of weight change and 104,180 (24 to 78 years old; 14.2% male) for T2D risk assessment. WLSs used to achieve an intentional weight loss of 4.5+ kg were collected in 1992 (NHS/HPFS)/1993 (NHSII) and grouped into 7 mutually exclusive categories, including low-calorie diet, exercise, low-calorie diet and exercise, fasting, commercial weight loss program (CWLP), diet pills, and FCP (selected at least 2 methods from fasting, CWLP, and pill). The reference group was participants who did not attempt to lose weight. Generalized estimating equations and Cox regression were applied to estimate up to 10-year weight change trajectory and incident T2D risk through 2016 (NHS/HPFS)/2017 (NHSII), respectively. The associations of WLSs with weight change and T2D risk were differential by baseline body weight (Pinteraction < 0.01). Among individuals with obesity, all WLSs tended to associate with less weight gain [ranging from -4.2% (95% confidence interval (CI), -5.1% to -3.2%; P < 0.001) for exercise to -0.3% (-1.2% to 0.7%; P > 0.99) for FCP] and a lower T2D risk [hazard ratios (HRs) ranging from 0.79 (0.66 to 0.95; P = 0.04) for exercise to 0.87 (0.66 to 1.13; P = 0.30) for pill]. Such a pattern was less clear among overweight individuals: the difference of weight change varied from -2.5% (-3.0% to -2.1%; P < 0.001) for exercise to 2.0% (1.3% to 2.7%; P < 0.001) for FCP, and HRs of T2D varied from 0.91 (0.77 to 1.07; P = 0.29) for exercise to 1.42 (1.11 to 1.81; P = 0.02) for pill. The pattern was further inverted among lean individuals in that weight change ranged from -0.4% (-0.6% to -0.1%; P = 0.02) for exercise to 3.7% (3.1% to 4.3%; P < 0.001) for FCP, and the HRs of T2D ranged from 1.09 (0.91 to 1.30; P = 0.33) for exercise to 1.54 (1.13 to 2.10; P = 0.008) for pill. Approximately 15.6% to 46.8% of the association between WLSs and the T2D risk was attributed to weight changes. This study was limited by a single assessment of WLSs, heterogeneity within each WLS, and potential misclassification of the timing of weight loss and weight regain.
The current study showed that individuals with obesity who attempted to lose weight, regardless of the WLSs used, tended to gain less body weight and have a lower diabetes risk. In contrast, lean individuals who intentionally lost weight tended to gain more weight and have a higher diabetes risk. These data support the notion that intentional weight loss may not be beneficial for lean individuals and the use of WLSs for achieving weight loss shall be guided by medical indications only.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1004094</identifier><identifier>PMID: 36166473</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Alcohol use ; Associations ; Biology and Life Sciences ; Body mass index ; Body Weight ; Body weight loss ; Cardiovascular disease ; Cardiovascular diseases ; Chronic illnesses ; Cohort analysis ; Cohort Studies ; Comparative analysis ; Complications and side effects ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - epidemiology ; Diabetes Mellitus, Type 2 - prevention & control ; Diet ; Exercise ; Fasting ; Female ; Follow-Up Studies ; Generalized linear models ; Health aspects ; Humans ; Hypocaloric diet ; Male ; Medical personnel ; Medicine and Health Sciences ; Methods ; Middle Aged ; Nurses ; Nutrient deficiency ; Obesity ; Obesity - epidemiology ; Overweight ; Physical fitness ; Physiological aspects ; Prevention ; Questionnaires ; Reducing diets ; Risk assessment ; Risk Factors ; Type 2 diabetes ; Weight control ; Weight Loss ; Young Adult</subject><ispartof>PLoS medicine, 2022-09, Vol.19 (9), p.e1004094-e1004094</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Si et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Si et al 2022 Si et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-568b87a93db9a6c363beb48865cc05caec062ec01a9d6a2879adc47f11a8502e3</citedby><cites>FETCH-LOGICAL-c764t-568b87a93db9a6c363beb48865cc05caec062ec01a9d6a2879adc47f11a8502e3</cites><orcidid>0000-0002-4436-9630 ; 0000-0003-1951-8961 ; 0000-0002-8029-1922 ; 0000-0002-8480-1563 ; 0000-0002-0200-5951 ; 0000-0002-7413-615X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514663/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9514663/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2919,23857,27915,27916,53782,53784,79361,79362</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36166473$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Popkin, Barry M.</contributor><creatorcontrib>Si, Keyi</creatorcontrib><creatorcontrib>Hu, Yang</creatorcontrib><creatorcontrib>Wang, Molin</creatorcontrib><creatorcontrib>Apovian, Caroline M</creatorcontrib><creatorcontrib>Chavarro, Jorge E</creatorcontrib><creatorcontrib>Sun, Qi</creatorcontrib><title>Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Weight loss is crucial for disease prevention among individuals with overweight or obesity. This study aimed to examine associations of weight loss strategies (WLSs) with weight change and type 2 diabetes (T2D) risk among US health professionals.
This study included 93,110 participants (24 to 60 years old; 11.6% male) from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS) cohorts who were free of T2D, cardiovascular disease, and cancer at baseline (1988 for NHS/HPFS and 1989 for NHSII) for analyses of weight change and 104,180 (24 to 78 years old; 14.2% male) for T2D risk assessment. WLSs used to achieve an intentional weight loss of 4.5+ kg were collected in 1992 (NHS/HPFS)/1993 (NHSII) and grouped into 7 mutually exclusive categories, including low-calorie diet, exercise, low-calorie diet and exercise, fasting, commercial weight loss program (CWLP), diet pills, and FCP (selected at least 2 methods from fasting, CWLP, and pill). The reference group was participants who did not attempt to lose weight. Generalized estimating equations and Cox regression were applied to estimate up to 10-year weight change trajectory and incident T2D risk through 2016 (NHS/HPFS)/2017 (NHSII), respectively. The associations of WLSs with weight change and T2D risk were differential by baseline body weight (Pinteraction < 0.01). Among individuals with obesity, all WLSs tended to associate with less weight gain [ranging from -4.2% (95% confidence interval (CI), -5.1% to -3.2%; P < 0.001) for exercise to -0.3% (-1.2% to 0.7%; P > 0.99) for FCP] and a lower T2D risk [hazard ratios (HRs) ranging from 0.79 (0.66 to 0.95; P = 0.04) for exercise to 0.87 (0.66 to 1.13; P = 0.30) for pill]. Such a pattern was less clear among overweight individuals: the difference of weight change varied from -2.5% (-3.0% to -2.1%; P < 0.001) for exercise to 2.0% (1.3% to 2.7%; P < 0.001) for FCP, and HRs of T2D varied from 0.91 (0.77 to 1.07; P = 0.29) for exercise to 1.42 (1.11 to 1.81; P = 0.02) for pill. The pattern was further inverted among lean individuals in that weight change ranged from -0.4% (-0.6% to -0.1%; P = 0.02) for exercise to 3.7% (3.1% to 4.3%; P < 0.001) for FCP, and the HRs of T2D ranged from 1.09 (0.91 to 1.30; P = 0.33) for exercise to 1.54 (1.13 to 2.10; P = 0.008) for pill. Approximately 15.6% to 46.8% of the association between WLSs and the T2D risk was attributed to weight changes. This study was limited by a single assessment of WLSs, heterogeneity within each WLS, and potential misclassification of the timing of weight loss and weight regain.
The current study showed that individuals with obesity who attempted to lose weight, regardless of the WLSs used, tended to gain less body weight and have a lower diabetes risk. In contrast, lean individuals who intentionally lost weight tended to gain more weight and have a higher diabetes risk. These data support the notion that intentional weight loss may not be beneficial for lean individuals and the use of WLSs for achieving weight loss shall be guided by medical indications only.</description><subject>Adult</subject><subject>Aged</subject><subject>Alcohol use</subject><subject>Associations</subject><subject>Biology and Life Sciences</subject><subject>Body mass index</subject><subject>Body Weight</subject><subject>Body weight loss</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Chronic illnesses</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comparative analysis</subject><subject>Complications and side effects</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - prevention & control</subject><subject>Diet</subject><subject>Exercise</subject><subject>Fasting</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Generalized linear models</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Hypocaloric diet</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Nurses</subject><subject>Nutrient deficiency</subject><subject>Obesity</subject><subject>Obesity - epidemiology</subject><subject>Overweight</subject><subject>Physical fitness</subject><subject>Physiological aspects</subject><subject>Prevention</subject><subject>Questionnaires</subject><subject>Reducing diets</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><subject>Type 2 diabetes</subject><subject>Weight control</subject><subject>Weight Loss</subject><subject>Young Adult</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk12L1DAUhoso7rr6D0QDC6KwMyZNkzReCMPix8DiguvqZUjT0zZLpxmbVJ1_b8bpLlOZC6WQhpPnvDkfOUnylOA5oYK8vnFD3-l2vl5BOScYZ1hm95JjwjI5I1zw-3v7o-SR9zcYpxJL_DA5opxwngl6nMA3sHUTUOu8Rz70OkBtwZ-hnzu7aXRXwxnSXYnCZg0oRaXVBQTwyHbo-go1oNvQoHXvKvDeuhiTf4MWyLjG9SFqDuXmcfKgimZ4Mv5Pkuv3776cf5xdXH5Yni8uZkbwLMwYz4tcaEnLQmpuKKcFFFmec2YMZkaDwTyNC9Gy5DrNhdSlyURFiM4ZToGeJM93uuuYjxor5FUqUpYKxhmOxHJHlE7fqHVvV7rfKKet-mNwfa10H6xpQWFSshxyBkKLrMi5BEEIrZisqkpoY6LW2_G2oYhNMNDF-rUT0elJZxtVux9KMpJxTqPAy1Ggd98H8EGtrDfQtroDN2zjJjmnGcFpRE__Qg9nN1K1jgnYrnLxXrMVVQuREsGwoDJSswNUDR3EIF0HlY3mCT8_wMevhJU1Bx1eTRwiE-BXqPXgvVpeff4P9tO_s5dfp-yLPXb3SL1rhxBfqJ-C2Q40fZyBHqq7BhKstpN2W2m1nTQ1Tlp0e7bf_Dun29GivwGk3SGi</recordid><startdate>20220927</startdate><enddate>20220927</enddate><creator>Si, Keyi</creator><creator>Hu, Yang</creator><creator>Wang, Molin</creator><creator>Apovian, Caroline M</creator><creator>Chavarro, Jorge E</creator><creator>Sun, Qi</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-4436-9630</orcidid><orcidid>https://orcid.org/0000-0003-1951-8961</orcidid><orcidid>https://orcid.org/0000-0002-8029-1922</orcidid><orcidid>https://orcid.org/0000-0002-8480-1563</orcidid><orcidid>https://orcid.org/0000-0002-0200-5951</orcidid><orcidid>https://orcid.org/0000-0002-7413-615X</orcidid></search><sort><creationdate>20220927</creationdate><title>Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study</title><author>Si, Keyi ; Hu, Yang ; Wang, Molin ; Apovian, Caroline M ; Chavarro, Jorge E ; Sun, Qi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-568b87a93db9a6c363beb48865cc05caec062ec01a9d6a2879adc47f11a8502e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Alcohol use</topic><topic>Associations</topic><topic>Biology and Life Sciences</topic><topic>Body mass index</topic><topic>Body Weight</topic><topic>Body weight loss</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Chronic illnesses</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Comparative analysis</topic><topic>Complications and side effects</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - prevention & control</topic><topic>Diet</topic><topic>Exercise</topic><topic>Fasting</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Generalized linear models</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Hypocaloric diet</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Nurses</topic><topic>Nutrient deficiency</topic><topic>Obesity</topic><topic>Obesity - epidemiology</topic><topic>Overweight</topic><topic>Physical fitness</topic><topic>Physiological aspects</topic><topic>Prevention</topic><topic>Questionnaires</topic><topic>Reducing diets</topic><topic>Risk assessment</topic><topic>Risk Factors</topic><topic>Type 2 diabetes</topic><topic>Weight control</topic><topic>Weight Loss</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Si, Keyi</creatorcontrib><creatorcontrib>Hu, Yang</creatorcontrib><creatorcontrib>Wang, Molin</creatorcontrib><creatorcontrib>Apovian, Caroline M</creatorcontrib><creatorcontrib>Chavarro, Jorge E</creatorcontrib><creatorcontrib>Sun, Qi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Si, Keyi</au><au>Hu, Yang</au><au>Wang, Molin</au><au>Apovian, Caroline M</au><au>Chavarro, Jorge E</au><au>Sun, Qi</au><au>Popkin, Barry M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2022-09-27</date><risdate>2022</risdate><volume>19</volume><issue>9</issue><spage>e1004094</spage><epage>e1004094</epage><pages>e1004094-e1004094</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Weight loss is crucial for disease prevention among individuals with overweight or obesity. This study aimed to examine associations of weight loss strategies (WLSs) with weight change and type 2 diabetes (T2D) risk among US health professionals.
This study included 93,110 participants (24 to 60 years old; 11.6% male) from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS) cohorts who were free of T2D, cardiovascular disease, and cancer at baseline (1988 for NHS/HPFS and 1989 for NHSII) for analyses of weight change and 104,180 (24 to 78 years old; 14.2% male) for T2D risk assessment. WLSs used to achieve an intentional weight loss of 4.5+ kg were collected in 1992 (NHS/HPFS)/1993 (NHSII) and grouped into 7 mutually exclusive categories, including low-calorie diet, exercise, low-calorie diet and exercise, fasting, commercial weight loss program (CWLP), diet pills, and FCP (selected at least 2 methods from fasting, CWLP, and pill). The reference group was participants who did not attempt to lose weight. Generalized estimating equations and Cox regression were applied to estimate up to 10-year weight change trajectory and incident T2D risk through 2016 (NHS/HPFS)/2017 (NHSII), respectively. The associations of WLSs with weight change and T2D risk were differential by baseline body weight (Pinteraction < 0.01). Among individuals with obesity, all WLSs tended to associate with less weight gain [ranging from -4.2% (95% confidence interval (CI), -5.1% to -3.2%; P < 0.001) for exercise to -0.3% (-1.2% to 0.7%; P > 0.99) for FCP] and a lower T2D risk [hazard ratios (HRs) ranging from 0.79 (0.66 to 0.95; P = 0.04) for exercise to 0.87 (0.66 to 1.13; P = 0.30) for pill]. Such a pattern was less clear among overweight individuals: the difference of weight change varied from -2.5% (-3.0% to -2.1%; P < 0.001) for exercise to 2.0% (1.3% to 2.7%; P < 0.001) for FCP, and HRs of T2D varied from 0.91 (0.77 to 1.07; P = 0.29) for exercise to 1.42 (1.11 to 1.81; P = 0.02) for pill. The pattern was further inverted among lean individuals in that weight change ranged from -0.4% (-0.6% to -0.1%; P = 0.02) for exercise to 3.7% (3.1% to 4.3%; P < 0.001) for FCP, and the HRs of T2D ranged from 1.09 (0.91 to 1.30; P = 0.33) for exercise to 1.54 (1.13 to 2.10; P = 0.008) for pill. Approximately 15.6% to 46.8% of the association between WLSs and the T2D risk was attributed to weight changes. This study was limited by a single assessment of WLSs, heterogeneity within each WLS, and potential misclassification of the timing of weight loss and weight regain.
The current study showed that individuals with obesity who attempted to lose weight, regardless of the WLSs used, tended to gain less body weight and have a lower diabetes risk. In contrast, lean individuals who intentionally lost weight tended to gain more weight and have a higher diabetes risk. These data support the notion that intentional weight loss may not be beneficial for lean individuals and the use of WLSs for achieving weight loss shall be guided by medical indications only.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36166473</pmid><doi>10.1371/journal.pmed.1004094</doi><orcidid>https://orcid.org/0000-0002-4436-9630</orcidid><orcidid>https://orcid.org/0000-0003-1951-8961</orcidid><orcidid>https://orcid.org/0000-0002-8029-1922</orcidid><orcidid>https://orcid.org/0000-0002-8480-1563</orcidid><orcidid>https://orcid.org/0000-0002-0200-5951</orcidid><orcidid>https://orcid.org/0000-0002-7413-615X</orcidid><oa>free_for_read</oa></addata></record> |
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identifier | ISSN: 1549-1676 |
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source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central |
subjects | Adult Aged Alcohol use Associations Biology and Life Sciences Body mass index Body Weight Body weight loss Cardiovascular disease Cardiovascular diseases Chronic illnesses Cohort analysis Cohort Studies Comparative analysis Complications and side effects Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - prevention & control Diet Exercise Fasting Female Follow-Up Studies Generalized linear models Health aspects Humans Hypocaloric diet Male Medical personnel Medicine and Health Sciences Methods Middle Aged Nurses Nutrient deficiency Obesity Obesity - epidemiology Overweight Physical fitness Physiological aspects Prevention Questionnaires Reducing diets Risk assessment Risk Factors Type 2 diabetes Weight control Weight Loss Young Adult |
title | Weight loss strategies, weight change, and type 2 diabetes in US health professionals: A cohort study |
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