Whole-body cryotherapy does not enhance weight loss in adults with obesity

Whole-body cryotherapy (WBC) in combination with a conventional obesity management intervention falls short of improving weight loss relative to intervention alone in adults with obesity, a recent study has shown.

“Secondary outcomes showed largely similar body composition and metabolic responses between the two groups,” the investigators said. “Specifically, the hypothesized role of WBC in activating brown adipose tissue (BAT) was not supported.”

Nineteen adults with obesity were assigned to either a 12-month lifestyle-based obesity management intervention with 28 WBC sessions (−110°C, 3–4 min, ~2 × week) over the first 5 months (WBC group; n=10) or intervention with no WBC (control group; n=9).

Weight loss (5 and 12 months) was the primary outcome, while secondary outcomes were BAT glucose uptake and whole-body energy expenditure during cold stimulation (5 months), clinical parameters, subcutaneous adipose tissue transcriptomics, and skeletal muscle proteomics (5 and 12 months).

Weight loss was similar between groups: 11.9 percent at 5 months and 9.9 percent at 12 months in the WBC group and 11.5 percent and 8.0 percent, respectively, in the control group (p≥0.54 for between-group differences). [Obesity 2025;33:2112-2127]

No significant differences were also observed in BAT glucose uptake, energy expenditure, adipose tissue transcriptomics, or skeletal muscle proteomics changes between the WBC and control groups. However, participants who underwent WBC demonstrated greater reductions in fasting glucose (0.41 mmol/L; p=0.026) and low-density lipoprotein (LDL) cholesterol (0.44 mmol/L; p=0.034) at 5 months.

“While WBC may lower fasting glucose and LDL cholesterol, these results need further confirmation,” the investigators said. “These findings apply only to WBC and should not be generalized to other cold exposure methods.”

Glucose metabolism

Improvements seen in fasting glucose were consistent with previous findings. An earlier study found a greater decline in healthy men without obesity after nine sessions of WBC relative to control participants. [Sci Rep 2021;11:7097]

Improvements in glucose metabolism following cold exposure are usually associated with increased BAT activation, but the more likely cause is skeletal muscle adaptations, according to a previous study. [Nat Metab 2023;5:1074-1077]

“We observed a decline in deltoid muscle glucose uptake in the [control] group compared with the [WBC] group, possibly because WBC prevented dieting-induced adaptations,” the investigators said.

“However, since the deltoid is a nonshivering muscle with minimal increases in glucose uptake or oxygen consumption during cold stimulation, this finding may not be relevant,” they added. [Obesity 2013;21:2279-2287; Eur J Nucl Med Mol Imaging 2016;43:1878-1886]

Likewise, previous studies partially supported the improvements seen in LDL cholesterol. [Complement Ther Med 2020;55:102568]

An earlier study in mice showed lower circulating cholesterol with cold-induced BAT activation, which enhanced triglyceride uptake from very LDL particles. This promoted faster remnant formation and clearance by the liver. [Nat Comm 2015;6:6356]

“However, a previous 1-month cold exposure trial that increased BAT activation did not observe significant reductions in LDL cholesterol levels,” the investigators said. [Diabetes 2014;63:3686-3698]