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October 19, 1994, Vol 272, No. 15 >
ARTICLE | October 19, 1994

Weight Cycling FREE

Richard L. Atkinson, MD; William H. Dietz, MD, PhD; John P. Foreyt, PhD; Norma J. Goodwin, MD; James O. Hill, PhD; Jules Hirsch, MD; F. Xavier Pi-Sunyer, MD; Roland L. Weinsier, MD, DrPH; Rena Wing, PhD; Jay H. Hoofnagle, MD; James Everhart, MD; Van S. Hubbard, MD, PhD; Susan Zelitch Yanovski, MD
[+] Author Affiliations

Reprint requests to Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg 31, Room 9A23, Bethesda, MD 20892 (Susan Zelitch Yanovski, MD).


JAMA. 1994;272(15):1196-1202. doi:10.1001/jama.1994.03520150064038
Text Size: A A A
Published online
Article
References

Objective.  —To address concerns about the effects of weight cycling and to provide guidance on the risk-to-benefit ratio of attempts at weight loss, given current scientific knowledge.

Data Sources.  —Original reports obtained through MEDLINE and psychological abstracts searches for 1966 through 1994 on weight cycling, "yo-yo dieting," and weight fluctuation, supplemented by a manual search of bibliographies.

Study Selection.  —English-language articles that evaluated the effects of weight change or weight cycling on humans or animals.

Data Extraction.  —Studies were reviewed by experts in the fields of nutrition, obesity, and epidemiology to evaluate study design and the validity of the authors' conclusions based on published data.

Data Synthesis.  —The majority of studies do not support an adverse effect of weight cycling on metabolism. Many observational studies have shown an association between variation in body weight and increased morbidity and mortality. However, most of these studies did not examine intentional vs unintentional weight loss, nor were they designed to determine the effects of weight cycling in obese, as opposed to normal-weight, individuals.

Conclusions.  —The currently available evidence is not sufficiently compelling to override the potential benefits of moderate weight loss in significantly obese patients. Therefore, obese individuals should not allow concerns about hazards of weight cycling to deter them from efforts to control their body weight. Although conclusive data regarding long-term health effects of weight cycling are lacking, non-obese individuals should attempt to maintain a stable weight. Obese individuals who undertake weight loss efforts should be ready to commit to lifelong changes in their behavioral patterns, diet, and physical activity.(JAMA. 1994;272:1196-1202)

REFERENCES

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Rovney S.  Yo-yo dieting: worse than being overweight. Washington Post . (December 13) , 1988;;health section:16.
2 +
Brody JE.  For most trying to lose weight, dieting only makes things worse. New York Times . (November 23) , 1992;:A1.
3 +
Phillips WG.  Obesity and weight cycling. J Med Assoc Ga . 1993;;82:537-540.
4 +
Brownell KD, Rodin J.  Medical, metabolic, and psychological effects on weight cycling. Arch Intern Med . 1994;;154:1325-1330.
5 +
Davis J, Sherer K. Applied Nutrition and Diet Therapy for Nurses . 2nd ed. Philadelphia, Pa: WB Saunders; 1994;:590.
6 +
Williams SR. Nutrition and Diet Therapy. 7th ed. St Louis, Mo: Mosby-Year Book; 1993;:169.
7 +
Garner DM, Wooley SC.  Confronting the failure of behavioral and dietary treatments for obesity. Clin Psychol Rev . 1991;;11:729-780.
8 +
McCargar L, Taunton J, Birmingham CL, Pare S, Simmons D.  Metabolic and anthropometric changes in female weight cyclers and controls over a one year period. J Am Dietetic Assoc . 1993;;93: 1025-1030.
9 +
Williamson PS, Levy BT.  Long-term body weight fluctuation in an overweight population. Int J Obes . 1988;;12:579-583.
10 +
Brownell KD, Greenwood MRC, Stellar E, Shrager EE.  The effects of repeated cycles of weight loss and regain in rats. Physiol Behav . 1986;;38:459-464.
11 +
Reed GW, Hill JO.  Weight cycling: a critical review of the animal literature. Obes Res . 1993;;1: 392-402.
12 +
Bell RR, McGill TJ.  Body composition in mice maintained with cyclic periods of food restriction and refeeding. Nutr Res . 1987;;7:173-182.
13 +
Graham B, Chang S, Lin D, Yakubu F, Hill JO.  The effects of weight cycling on susceptibility to dietary obesity. Am J Physiol . 1990;;259:R1096-R1102.
14 +
Gray DS, Fisler JS, Bray GA.  Effects of repeated weight loss and regain on body composition in obese rats. Am J Clin Nutr . 1988;;47:393-399.
15 +
Hill JO, Thacker S, Newby D, Nickel M, DiGirolamo M.  A comparison of constant feeding with bouts of fasting-refeeding at three levels of nutrition in the rat. Int J Obes . 1987;;11:201-212.
16 +
Hill JO, Thacker S, Newby D, Sykes MN, DiGirolamo M.  Influence of food restriction coupled with weight cycling on carcass energy restoration during ad-libitum refeeding. Int J Obes . 1988;;12: 547-555.
17 +
Jebb SA, Goldberg GR, Coward WA, Murgatroyd PR, Prentice AM.  Effects of weight cycling caused by intermittent dieting on metabolic rate and body composition in obese women. Int J Obes . 1991;;15:367-374.
18 +
van Dale D, Saris WHM.  Repetitive weight loss and weight regain: effects on weight reduction, resting metabolic rate, and lipolytic activity before and after exercise and/or diet treatment. Am J Clin Nutr . 1989;;49:409-416.
19 +
Beeson V, Ray C, Coxon RA, Kreitzman S.  The myth of the yo-yo: consistent rate of weight loss with successive dieting by VLCD. Int J Obes . 1989;; 13( (suppl 2) ):135-139.
20 +
Blackburn GL, Wilson GT, Kanders BS, et al.  Weight cycling: the experience of human dieters. Am J Clin Nutr . 1989;;49:1105-1109.
21 +
Smith DE, Wing RR.  Diminished weight loss and behavioral compliance during repeated diets. Health Psychol . 1991;;10:378-383.
22 +
Wadden TA, Bartlett S, Letizia KA, et al.  Relationship of dieting history to resting metabolic rate, body composition, eating behavior, and subsequent weight loss. Am J Clin Nutr . 1992;;56:2065-2115.
23 +
Melby CL, Sylliaasen S, Rhodes T.  Diet-induced weight loss and metabolic changes in obese women with high versus low prior weight loss/regain. Nutr Res . 1991;;11:971-978.
24 +
Steen SN, Oppliger RA, Brownell KD.  Metabolic effects of repeated weight loss and regain in adolescent wrestlers. JAMA . 1988;;260:47-50.
25 +
Melby CL, Schmidt WD, Corrigan D.  Resting metabolic rate in weight-cycling collegiate wrestlers compared with physically active noncycling control subjects. Am J Clin Nutr . 1990;;52:409-414.
26 +
Schmidt WD, Corrigan D, Melby CL.  Two seasons of weight cycling does not lower resting metabolic rate in college wrestlers. Med Sci Sports Exerc . 1993;;25:613-619.
27 +
McCargar LJ, Crawford SM.  Metabolic and anthropometric changes with weight cycling in wrestlers. Med Sci Sports Exerc . 1992;;24:1270-1275.
28 +
McCargar LJ, Simmons D, Craton N, Tauton JE, Birmingham CL.  Physiological effects of weight cycling in female lightweight rowers. Can J Appl Physiol . 1993;;18:291-303.
29 +
Rebuffé-Scrive M, Hendler R, Bracero N, Cummings N, McCarthy S, Rodin J.  Biobehavioral effects of weight cycling. Int J Obes . In press.
30 +
Manore MM, Berry TE, Skinner JS, Carroll SS.  Energy expenditure at rest and during exercise in nonobese female cyclical dieters and in nondieting control subjects. Am J Clin Nutr . 1991;;54:41-46.
31 +
Lissner L, Andres R, Muller DC, Shimokata H.  Body weight variability in men: metabolic rate, health and longevity. Int J Obes . 1990;;14:373-383.
32 +
Prentice AM, Jebb SA, Goldberg GR, et al.  Effects of weight cycling on body composition. Am J Clin Nutr . 1992;;56:209S-216S.
33 +
Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C.  Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis . 1990;;10:497-511.
34 +
Rodin J, Radke-Sharpe N, Rebuffé-Scrive M, Greenwood MRC.  Weight cycling and fat distribution. Int J Obes . 1990;;14:303-310.
35 +
Bouchard C, Despres JP, Mauriege P.  Genetic and nongenetic determinants of regional fact distribution. Endocr Rev . 1993;;14:72-93.
36 +
van der Kooy K, Leenen R, Seidell JC, Deurenberg P, Visser M.  Abdominal diameters as indicators of visceral fat: comparison between magnetic resonance imaging and anthopometry. Br J Nutr . 1993;;70:47-58.
37 +
van der Kooy K, Leenen R, Seidell JC, Deurenberg P, Droop A, Bakker CJG.  Waist-hip ratio is a poor predictor of changes in visceral fat. Am J Clin Nutr . 1993;;57:327-333.
38 +
van der Kooy K, Leenen R, Seidell J, Deurenberg P, Hautvast JG.  Effect of a weight cycle on visceral fat accumulation. Am J Clin Nutr . 1993;; 58:853-857.
39 +
Wing RR.  Weight cycling in humans: a review of the literature. Ann Behav Med . 1992;;14:113-119.
40 +
Lissner L, Odell PM, D'Agostino RB, et al.  Variability of body weight and health outcomes in the Framingham population. N Engl J Med . 1991;; 324:1839-1844.
41 +
Lissner L, Bengtsson C, Lapidus L, Larsson B, Bengtsson B, Brownell K.  Body weight variability and mortality in the Gothenburg Prospective Studies of men and women.  In: Björntorp P, Rossner S, eds. Obesity in Europe 88: Proceedings of the First European Congress on Obesity . London, England: Libbey; 1989;:55-60.
42 +
Hamm P, Shekelle RB, Stamler J.  Large fluctuations in body weight during young adulthood and twenty-five year risk of coronary death in men. Am J Epidemiol . 1989;;129:312-318.
43 +
Blair SN, Shaten J, Brownell K, Collins G, Lissner L.  Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Ann Intern Med . 1993;;119:749-757.
44 +
Stevens J, Lissner L.  Body weight variability and mortality in the Charleston Heart Study. Int J Obes . 1990;;14:385-386.
45 +
Pamuk ER, Williamson DF, Serdula MK, Madans J, Byers TE.  Weight loss and subsequent death in a cohort of US adults. Ann Intern Med . 1993;;119:744-748.
46 +
Higgins M, D'Agostino R, Kannel W, Cobb J.  Benefits and adverse effects of weight loss: observations from the Framingham Study. Ann Intern Med . 1993;;119:758-763.
47 +
Lee IM, Paffenbarger RS.  Change in body weight and longevity. JAMA . 1992;;268:2045-2049.
48 +
Kushner RF.  Body weight and mortality. Nutr Rev . 1993;;51:127-136.
49 +
Bouchard C.  Is weight fluctuation a risk factor? N Engl J Med . 1991;;324:1887-1889.
50 +
DiPietro L, Anda RF, Williamson DF, Stunkard AJ.  Depressive symptoms and weight change in a national cohort of adults. Int J Obes . 1992;;16:745-753.
51 +
Rumpel C, Ingram DD, Harris TB, Madans J.  The association between weight change and psychological well-being in women. Int J Obes . 1994;; 18:179-183.
52 +
Ernsberger P, Koletsky RJ.  Weight cycling and mortality: support from animal studies. JAMA . 1993;; 269:116.
53 +
Jeffery RW, Wing RR, French SA.  Weight cycling and cardiovascular risk factors in obese men and women. Am J Clin Nutr . 1992;;55:641-644.
54 +
Schotte DE, Cohen E, Singh SP.  Effects of weight cycling on metabolic control in male outpatients with non-insulin dependent diabetes mellitus. Health Psychol . 1990;;9:599-605.
55 +
Holbrook TL, Barrett-Connor E, Wingard DL.  The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. Int J Obes . 1989;;13:723-729.
56 +
Drewnowski A, Holden-Wiltse J.  Taste responses and food preferences in obese women: effects of weight cycling. Int J Obes . 1992;;16:639-648.
57 +
Williamson DF, Serdula MK, Anda RF, Levy A, Byers T.  Weight loss attempts in adults: goals, duration, and rate of weight loss. Am J Public Health . 1992;;82:1251-1257.
58 +
National Institutes of Health.  Methods for voluntary weight loss and control: Technology Assessment Conference Panel statement. Ann Intern Med . 1992;;116:942-949.
59 +
Foreyt JP, Brunner RL, Goodrick GK, Cutter G, Brownell KD, St. Jeor ST.  Psychological correlates of weight fluctuation. Int J Eating Disord . In press.
60 +
Kuehnel RH, Wadden TA.  Binge eating disorder, weight cycling, and psychopathology. Int J Eating Disord . 1994;;15:321-329.
61 +
National Institutes of Health.  Health implications of obesity: National Institutes of Health Consensus Development Conference statement. Ann Intern Med . 1985;;103:1073-1077.
62 +
Hubert HB, Feinleib M, McNamara PM, Castelli WP.  Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation . 1983;;67:968-977.
63 +
Manson JE, Colditz GA, Stampfer MJ, et al.  A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med . 1990;;322: 882-889.
64 +
Kanders BS, Blackburn GL.  Reducing primary risk factors by therapeutic weight loss.  In: Wadden TA, VanItallie TB, eds. Treatment of the Seriously Obese Patient . New York, NY: Guilford; 1992;;213-230.
65 +
Goldstein DJ.  Beneficial health effects of modest weight loss. Int J Obes . 1992;;16:379-415.
66 +
Hubbard VS.  Overview of obesity and its health implications.  In: Enwonwu CO, ed. Annual Nutrition Workshop Series, Volume 5: Health Implications of Obesity . Nashville, Tenn: Meharry; 1992;: 1-13.
67 +
VanItallie TB, Lew EA.  Assessment of morbidity and mortality risk in the overweight patient.  In: Wadden TA, VanItallie TB, eds. Treatment of the Seriously Obese Patient . New York, NY: Guilford; 1992;:3-32.
68 +
Colditz GA.  Economic costs of obesity. Am J Clin Nutr . 1992;;55( (suppl) ):503S-507S.
69 +
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH.  Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard growth study of 1922-1935. N Engl J Med . 1992;; 327:1350-1355.
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Ogden J.  The measurement of restraint: confounding success and failure? Int J Eating Disord . 1993;;13:69-76.
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Chen Z, Cunnane SC.  Weight cycling does affect body composition. Am J Clin Nutr . 1993;;58: 242.
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Phinney SD.  Weight cycling and cardiovascular risk in obese men and women. Am J Clin Nutr . 1992;;56:781.
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Saris WHM.  Physiological aspects of exercise in weight cycling. Am J Clin Nutr . 1989;;49:1099-1104.
75 +
Dietary Guidelines for Americans . 3rd ed. Washington, DC: US Dept of Agriculture and US Dept of Health and Human Services; 1990;. Publication GPO-273-930.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Rovney S.  Yo-yo dieting: worse than being overweight. Washington Post . (December 13) , 1988;;health section:16.
2 +
Brody JE.  For most trying to lose weight, dieting only makes things worse. New York Times . (November 23) , 1992;:A1.
3 +
Phillips WG.  Obesity and weight cycling. J Med Assoc Ga . 1993;;82:537-540.
4 +
Brownell KD, Rodin J.  Medical, metabolic, and psychological effects on weight cycling. Arch Intern Med . 1994;;154:1325-1330.
5 +
Davis J, Sherer K. Applied Nutrition and Diet Therapy for Nurses . 2nd ed. Philadelphia, Pa: WB Saunders; 1994;:590.
6 +
Williams SR. Nutrition and Diet Therapy. 7th ed. St Louis, Mo: Mosby-Year Book; 1993;:169.
7 +
Garner DM, Wooley SC.  Confronting the failure of behavioral and dietary treatments for obesity. Clin Psychol Rev . 1991;;11:729-780.
8 +
McCargar L, Taunton J, Birmingham CL, Pare S, Simmons D.  Metabolic and anthropometric changes in female weight cyclers and controls over a one year period. J Am Dietetic Assoc . 1993;;93: 1025-1030.
9 +
Williamson PS, Levy BT.  Long-term body weight fluctuation in an overweight population. Int J Obes . 1988;;12:579-583.
10 +
Brownell KD, Greenwood MRC, Stellar E, Shrager EE.  The effects of repeated cycles of weight loss and regain in rats. Physiol Behav . 1986;;38:459-464.
11 +
Reed GW, Hill JO.  Weight cycling: a critical review of the animal literature. Obes Res . 1993;;1: 392-402.
12 +
Bell RR, McGill TJ.  Body composition in mice maintained with cyclic periods of food restriction and refeeding. Nutr Res . 1987;;7:173-182.
13 +
Graham B, Chang S, Lin D, Yakubu F, Hill JO.  The effects of weight cycling on susceptibility to dietary obesity. Am J Physiol . 1990;;259:R1096-R1102.
14 +
Gray DS, Fisler JS, Bray GA.  Effects of repeated weight loss and regain on body composition in obese rats. Am J Clin Nutr . 1988;;47:393-399.
15 +
Hill JO, Thacker S, Newby D, Nickel M, DiGirolamo M.  A comparison of constant feeding with bouts of fasting-refeeding at three levels of nutrition in the rat. Int J Obes . 1987;;11:201-212.
16 +
Hill JO, Thacker S, Newby D, Sykes MN, DiGirolamo M.  Influence of food restriction coupled with weight cycling on carcass energy restoration during ad-libitum refeeding. Int J Obes . 1988;;12: 547-555.
17 +
Jebb SA, Goldberg GR, Coward WA, Murgatroyd PR, Prentice AM.  Effects of weight cycling caused by intermittent dieting on metabolic rate and body composition in obese women. Int J Obes . 1991;;15:367-374.
18 +
van Dale D, Saris WHM.  Repetitive weight loss and weight regain: effects on weight reduction, resting metabolic rate, and lipolytic activity before and after exercise and/or diet treatment. Am J Clin Nutr . 1989;;49:409-416.
19 +
Beeson V, Ray C, Coxon RA, Kreitzman S.  The myth of the yo-yo: consistent rate of weight loss with successive dieting by VLCD. Int J Obes . 1989;; 13( (suppl 2) ):135-139.
20 +
Blackburn GL, Wilson GT, Kanders BS, et al.  Weight cycling: the experience of human dieters. Am J Clin Nutr . 1989;;49:1105-1109.
21 +
Smith DE, Wing RR.  Diminished weight loss and behavioral compliance during repeated diets. Health Psychol . 1991;;10:378-383.
22 +
Wadden TA, Bartlett S, Letizia KA, et al.  Relationship of dieting history to resting metabolic rate, body composition, eating behavior, and subsequent weight loss. Am J Clin Nutr . 1992;;56:2065-2115.
23 +
Melby CL, Sylliaasen S, Rhodes T.  Diet-induced weight loss and metabolic changes in obese women with high versus low prior weight loss/regain. Nutr Res . 1991;;11:971-978.
24 +
Steen SN, Oppliger RA, Brownell KD.  Metabolic effects of repeated weight loss and regain in adolescent wrestlers. JAMA . 1988;;260:47-50.
25 +
Melby CL, Schmidt WD, Corrigan D.  Resting metabolic rate in weight-cycling collegiate wrestlers compared with physically active noncycling control subjects. Am J Clin Nutr . 1990;;52:409-414.
26 +
Schmidt WD, Corrigan D, Melby CL.  Two seasons of weight cycling does not lower resting metabolic rate in college wrestlers. Med Sci Sports Exerc . 1993;;25:613-619.
27 +
McCargar LJ, Crawford SM.  Metabolic and anthropometric changes with weight cycling in wrestlers. Med Sci Sports Exerc . 1992;;24:1270-1275.
28 +
McCargar LJ, Simmons D, Craton N, Tauton JE, Birmingham CL.  Physiological effects of weight cycling in female lightweight rowers. Can J Appl Physiol . 1993;;18:291-303.
29 +
Rebuffé-Scrive M, Hendler R, Bracero N, Cummings N, McCarthy S, Rodin J.  Biobehavioral effects of weight cycling. Int J Obes . In press.
30 +
Manore MM, Berry TE, Skinner JS, Carroll SS.  Energy expenditure at rest and during exercise in nonobese female cyclical dieters and in nondieting control subjects. Am J Clin Nutr . 1991;;54:41-46.
31 +
Lissner L, Andres R, Muller DC, Shimokata H.  Body weight variability in men: metabolic rate, health and longevity. Int J Obes . 1990;;14:373-383.
32 +
Prentice AM, Jebb SA, Goldberg GR, et al.  Effects of weight cycling on body composition. Am J Clin Nutr . 1992;;56:209S-216S.
33 +
Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C.  Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis . 1990;;10:497-511.
34 +
Rodin J, Radke-Sharpe N, Rebuffé-Scrive M, Greenwood MRC.  Weight cycling and fat distribution. Int J Obes . 1990;;14:303-310.
35 +
Bouchard C, Despres JP, Mauriege P.  Genetic and nongenetic determinants of regional fact distribution. Endocr Rev . 1993;;14:72-93.
36 +
van der Kooy K, Leenen R, Seidell JC, Deurenberg P, Visser M.  Abdominal diameters as indicators of visceral fat: comparison between magnetic resonance imaging and anthopometry. Br J Nutr . 1993;;70:47-58.
37 +
van der Kooy K, Leenen R, Seidell JC, Deurenberg P, Droop A, Bakker CJG.  Waist-hip ratio is a poor predictor of changes in visceral fat. Am J Clin Nutr . 1993;;57:327-333.
38 +
van der Kooy K, Leenen R, Seidell J, Deurenberg P, Hautvast JG.  Effect of a weight cycle on visceral fat accumulation. Am J Clin Nutr . 1993;; 58:853-857.
39 +
Wing RR.  Weight cycling in humans: a review of the literature. Ann Behav Med . 1992;;14:113-119.
40 +
Lissner L, Odell PM, D'Agostino RB, et al.  Variability of body weight and health outcomes in the Framingham population. N Engl J Med . 1991;; 324:1839-1844.
41 +
Lissner L, Bengtsson C, Lapidus L, Larsson B, Bengtsson B, Brownell K.  Body weight variability and mortality in the Gothenburg Prospective Studies of men and women.  In: Björntorp P, Rossner S, eds. Obesity in Europe 88: Proceedings of the First European Congress on Obesity . London, England: Libbey; 1989;:55-60.
42 +
Hamm P, Shekelle RB, Stamler J.  Large fluctuations in body weight during young adulthood and twenty-five year risk of coronary death in men. Am J Epidemiol . 1989;;129:312-318.
43 +
Blair SN, Shaten J, Brownell K, Collins G, Lissner L.  Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Ann Intern Med . 1993;;119:749-757.
44 +
Stevens J, Lissner L.  Body weight variability and mortality in the Charleston Heart Study. Int J Obes . 1990;;14:385-386.
45 +
Pamuk ER, Williamson DF, Serdula MK, Madans J, Byers TE.  Weight loss and subsequent death in a cohort of US adults. Ann Intern Med . 1993;;119:744-748.
46 +
Higgins M, D'Agostino R, Kannel W, Cobb J.  Benefits and adverse effects of weight loss: observations from the Framingham Study. Ann Intern Med . 1993;;119:758-763.
47 +
Lee IM, Paffenbarger RS.  Change in body weight and longevity. JAMA . 1992;;268:2045-2049.
48 +
Kushner RF.  Body weight and mortality. Nutr Rev . 1993;;51:127-136.
49 +
Bouchard C.  Is weight fluctuation a risk factor? N Engl J Med . 1991;;324:1887-1889.
50 +
DiPietro L, Anda RF, Williamson DF, Stunkard AJ.  Depressive symptoms and weight change in a national cohort of adults. Int J Obes . 1992;;16:745-753.
51 +
Rumpel C, Ingram DD, Harris TB, Madans J.  The association between weight change and psychological well-being in women. Int J Obes . 1994;; 18:179-183.
52 +
Ernsberger P, Koletsky RJ.  Weight cycling and mortality: support from animal studies. JAMA . 1993;; 269:116.
53 +
Jeffery RW, Wing RR, French SA.  Weight cycling and cardiovascular risk factors in obese men and women. Am J Clin Nutr . 1992;;55:641-644.
54 +
Schotte DE, Cohen E, Singh SP.  Effects of weight cycling on metabolic control in male outpatients with non-insulin dependent diabetes mellitus. Health Psychol . 1990;;9:599-605.
55 +
Holbrook TL, Barrett-Connor E, Wingard DL.  The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. Int J Obes . 1989;;13:723-729.
56 +
Drewnowski A, Holden-Wiltse J.  Taste responses and food preferences in obese women: effects of weight cycling. Int J Obes . 1992;;16:639-648.
57 +
Williamson DF, Serdula MK, Anda RF, Levy A, Byers T.  Weight loss attempts in adults: goals, duration, and rate of weight loss. Am J Public Health . 1992;;82:1251-1257.
58 +
National Institutes of Health.  Methods for voluntary weight loss and control: Technology Assessment Conference Panel statement. Ann Intern Med . 1992;;116:942-949.
59 +
Foreyt JP, Brunner RL, Goodrick GK, Cutter G, Brownell KD, St. Jeor ST.  Psychological correlates of weight fluctuation. Int J Eating Disord . In press.
60 +
Kuehnel RH, Wadden TA.  Binge eating disorder, weight cycling, and psychopathology. Int J Eating Disord . 1994;;15:321-329.
61 +
National Institutes of Health.  Health implications of obesity: National Institutes of Health Consensus Development Conference statement. Ann Intern Med . 1985;;103:1073-1077.
62 +
Hubert HB, Feinleib M, McNamara PM, Castelli WP.  Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation . 1983;;67:968-977.
63 +
Manson JE, Colditz GA, Stampfer MJ, et al.  A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med . 1990;;322: 882-889.
64 +
Kanders BS, Blackburn GL.  Reducing primary risk factors by therapeutic weight loss.  In: Wadden TA, VanItallie TB, eds. Treatment of the Seriously Obese Patient . New York, NY: Guilford; 1992;;213-230.
65 +
Goldstein DJ.  Beneficial health effects of modest weight loss. Int J Obes . 1992;;16:379-415.
66 +
Hubbard VS.  Overview of obesity and its health implications.  In: Enwonwu CO, ed. Annual Nutrition Workshop Series, Volume 5: Health Implications of Obesity . Nashville, Tenn: Meharry; 1992;: 1-13.
67 +
VanItallie TB, Lew EA.  Assessment of morbidity and mortality risk in the overweight patient.  In: Wadden TA, VanItallie TB, eds. Treatment of the Seriously Obese Patient . New York, NY: Guilford; 1992;:3-32.
68 +
Colditz GA.  Economic costs of obesity. Am J Clin Nutr . 1992;;55( (suppl) ):503S-507S.
69 +
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
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NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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