Weight cycling poses threat to kidney health in people with T1D

For people with type 1 diabetes (T1D), repeated cycles of losing weight and regaining it—known as weight cycling or yoyo dieting—appear to significantly raise the risk of adverse kidney events, regardless of body mass index, according to a study.

Retrospective analysis of data from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) studies showed that participants with greater weight fluctuations, as indicated by a high body weight variability independent of the mean, were significantly more likely to experience a 40-percent decline in eGFR from baseline values (hazard ratio [HR], 1.25, 95 percent confidence interval [CI], 1.09–1.41; p=0.001). [J Clin Endocrinol Metab 2025;doi:10.1210/clinem/dgae852]

Additionally, participants with greater weight fluctuations had heightened risks of a doubling of baseline serum creatinine (HR, 1.34, 95 percent CI, 1.13–1.57; p=0.001), chronic kidney disease (CKD) stage 3 (HR, 1.36, 95 percent CI, 1.12–1.63; p=0.002), and a rapid decline in eGFR (>3 mL/min/m² per year; odds ratio, 1.49, 95 percent CI, 1.15–1.93, p=0.003).

The analyses were controlled for CKD risk factors at baseline and follow-up, as well as for the use of nephroprotective drugs. Furthermore, similar results were obtained for the other indices of weight cycling.

“We showed that high body-weight variability is associated with increased risk of different outcomes of diabetic kidney disease progressions in people with T1D, independently of traditional diabetic kidney disease risk factors,” said first study author Dr Marion Camoin of the Centre Hospitalier Universitaire de Bordeaux, France. “To our knowledge, this is the first study showing this association.”

Camoin underscored the finding’s significance as the practice of weight cycling is quite common in the general population, with a prevalence of approximately 35 percent in men and 55 percent in women. More importantly, cyclical weight loss and regain strain can take a toll on the heart and lead to vascular damage, she added.

How weight cycling can contribute to the risk of adverse renal events is not fully understood, but Camoin and colleagues pointed to the potential involvement of insulin therapy through its anabolic effects. “Weight loss can result from suboptimal insulin therapy, while weight gain is commonly associated with improved glycaemic control. Additionally, the hypoglycaemia risk associated with insulin use may lead to defensive snacking and reduced physical activity.”

The authors stressed the need to reduce the prevalence of weight cycling or yo-yo dieting and consequently lower the risk of kidney disease in people with T1D. “Strategies aimed at weight reduction in [this population] should focus on promoting long-term weight maintenance, as weight stability may have a positive impact on health outcomes.”

The study included 1,432 individuals who participated in DCCT/EDIC. Those in the highest vs lowest tertile for weight fluctuations tended to be younger (25 vs 29 years), female (59 percent vs 35 percent), and have a lower baseline BMI (23.1 vs 23.5 kg/m²), higher HbA1c (9.1 percent vs 8.7 percent), and higher eGFR (129 vs 124 mL/min/1.73 m²).