Date of Graduation

Summer 8-10-2018

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies


Background: Obesity, a growing epidemic worldwide, has been linked to several comorbid conditions including, but not limited to, heart disease, type 2 diabetes mellitus, and certain types of cancer. To both prevent and treat obesity-associated comorbidities, it is common practice for healthcare providers to prescribe weight loss as a medical intervention. Unfortunately, many individuals who lose weight are unable to maintain it long-term. Therefore, people who are obese commonly experience several weight loss and regain cycles over the course of their lives. The question this review aims to answer is whether these weight fluctuations have an adverse effect on middle-aged individuals’ lifespans and, if so, what can be done to achieve improved weight maintenance.

Methods: An exhaustive search of available medical literature was performed using CINAHL, MEDLINE, and Web of Science. Key terms included: weight fluctuation and mortality. The quality of eligible studies was assessed using GRADE guidelines.

Results: The literature search yielded 33 studies, 4 of which were relative to the clinical question while meeting eligibility criteria. One of the 4 studies was a randomized control trial while the remaining 3 were observational studies. Each of the 4 studies found that weight fluctuations in middle-aged populations are linked to a significant increase in mortality. However, unlike the other studies, the Wannamethee et al study stated these results were markedly attenuated when accounting for other morbidities. While these results are thought-provoking and potentially practice-changing, the quality of the evidence was not shown to be strong. Per the GRADE guidelines, the quality of the randomized control trial was moderate while the quality of the 3 observational studies was very low.

Conclusion: Weight fluctuations in middle-aged populations may be associated with an increased risk of mortality. However, to obtain a more definitive answer, future studies should avoid self-reported data. Additionally, forthcoming research might consider looking at the degree of weight fluctuation to determine if there is a dose-response gradient. Lastly, a distinction between intentional versus unintentional weight fluctuations should be accounted for in subsequent studies. Being that there may be an association between weight fluctuations and increased risk of mortality in middle-aged populations, healthcare providers using weight loss as an intervention to prevent or treat comorbid conditions associated with obesity must be prepared to provide ongoing encouragement and support of weight loss maintenance.

Keywords: Weight fluctuations, mortality, middle-aged populations