Weight Trajectory Impacts Risk for 10 Distinct Cardiometabolic Diseases

CONTEXT: Repetitive bouts of weight loss and regain, termed weight cycling, may exaggerate the risk for cardiometabolic disease. We previously identified that weight cyclers were likely to have prescribed medications for hypertension, dyslipidemia, and diabetes-suggesting a 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 body mass index (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 10 highly prevalent cardiometabolic diseases. RESULTS: Compared to weight stability, weight cycling associated with an almost 30% increased risk for obstructive sleep apnea [hazard ratio (HR) 1.28; 95% confidence interval (CI) 1.15-1.42], metabolic dysfunction-associated steatotic liver disease (HR 1.28; 95% CI 1.08-1.51), and type 2 diabetes (HR 1.23; 95% CI 1.10-1.38). Weight cycling also associated with a 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 heart failure (HR 1.29; 95% CI 1.08-1.55 and HR 1.32; 95% CI 1.10-1.58, respectively). CONCLUSION: 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.