Any studies on the tradeoff between losing weight and being less stressful?

Question

It is being constantly claimed, upheld and emphasized that being overweight or, even worse, obese, possesses many and severe health hazards. Overweight and obese people are being repeatedly urged to lose weight. That not losing excess weight is harmful for health seems certain.

However, there seems to be one more factor, which, admittedly, comes from my experience in the form of the observation of people surrounding me. Namely, I'd put a hypothesis that working to lose weight causes considerable strain on the psyche. I know a person who had been calm and happy… before she started dieting frantically to lose weight. She managed to lose most of her excess weight and works very hard to keep it that way, nonetheless seeing her as nervous and tired and humorless as she is now and comparing to how I remember her before makes me question if her efforts are worth it. Another example comes from a newspaper article (which, again, I can't now find to link it) about a talk-show host. The article snidely remarked that with her excess weight the host lost all of her funniness she had been esteemed for. Finally: I also read a newspaper article (which I, again, can't find now...) that seemed to confirm my anecdotal and intuitive observations: namely, it claimed that both hunger itself and conscious attempts to suppress hunger and restraining the urge to eat cause considerable stress and lower one's mood.

Still, in cases when both weight and stress are discussed together, it seems that it is usually in the context of excess weight causing stress because overweight people tend to have low self-esteem and they tend to be ostracized by their peers. I would, however, ask about this relationship from a different angle:

• Can working to lose weight, as opposed to neglecting this, cause considerable stress?
• Since chronic stress is also widely recognized to be a health hazard, can the costs of being more stressed outweigh the costs of not losing weight? Assume absence of other egregious lifestyle-related risks – that is, our overweight person does not smoke, has some moderate physical activity, is not being bullied for being overweight, does not mostly eat junk food, etc etc.

Answer 1

Can working to lose weight, as opposed to neglecting this, cause considerable stress?

Not necessary, according to the following review.

Diet-Induced Weight Loss Has No Effect on Psychological Stress in Overweight and Obese Adults: A Meta-Analysis of Randomized Controlled Trials (Nutrients, 2018)

This systematic review and meta-analysis of randomized controlled clinical trials showed that weight loss induced by dietary restriction in adult overweight and obese men and women does not have a beneficial or detrimental effect on self-reported psychological stress.

Still, an obese person who tries to lose weight from wrong reasons (to please someone or to reach some theoretical health goal) or in a wrong way (too fast or by some annoying method) can lose the peace of mind.

---

What is the association between obesity, weight loss and health, according to studies?

(Categorization of increased weight based on the body mass index or BMI (weight in kg/height in m squared): overweight = 25-30, grade I obesity = 30-35, grade II obesity = 35-40, grade III obesity = >40.)

Obesity as a risk factor for chronic conditions:

• All-cause mortality risk may not increase with BMI 25-30, but may increase by 30% with BMI >35 (JAMA, 2013 ; Annals of Translational Medicine, 2017).
• Hypertension risk may increase up to two-fold with BMI 25-30 and by four-fold with BMI >30 (Circulation, 2012).
• Coronary heart disease risk may increase by 20% with BMI 25-30 and by 60% with BMI >30 (The Lancet Diabetes & Endocrinology, 2015 ; Heart, 2015)
• More than 75% individuals with diabetes type 2 have BMI >25 (Current Diabetes Reviews, 2013 ; International Journal of Clinical Practice, 2007).
• The risk of some cancers (endometrial, esophageal, gastric, liver) may increase by two-fold with obesity (National Cancer Institute, 2017).
• The risk of other conditions, such as osteoarthritis, gallbladder disease, body pain and difficulty with physical functioning, sleep apnea, depression (Centers for Disease Control and Prevention, 2015), fatty liver, pancreatitis and acid reflux (Science Reference Services, 2017) also increases with obesity.

Intentional weight loss and a decreased health risk:

• All-cause mortality may decrease by up to 33% with 9-13 kg of weight loss (Diabetes Care, 2000) or by ~15% with 5.5 kg weigh loss (Plos One, 2015); see also BMJ, 2017 and The Archives of Internal Medicine, 2005).
• The risk of heart disease and diabetes type 2 may decrease by 28% with intentional weight loss (Diabetes Care, 2000).
• High blood pressure can decrease by 1 mm Hg with 1 kg loss of body weight (Journal of Human Hypertension, 1988 ; Hypertension, 2003).

Most studies about weight loss are observational, so it may be difficult to differ between intentional and unintentional weight loss - the later is typically associated with a disease. This is why in several studies weight loss is not associated with health improvement or is even associated with an increased risk of disease (The Journals of Gerontology, 2007 ; International Journal of Obesity, 2010).

The risks of intentional rapid weight loss:

• Gallstones; in one study, 500 Kcal/day diet was associated with a three-fold greater risk of symptomatic gallstones than 1,200-1,500 Kcal/day diet (International Journal of Obesity, 2014).
• Aggressive steatohepatitis (Modern Pathology, 2017)

---

Can the costs of being more stressed outweigh the costs of not losing weight?

It seems that trying to lose weight to improve the quality of life can be more beneficial than just remaining obese.

Answer 2

There a none and the reason may be that it would be a hard study to design in a way that would answer the trade-off dilemma. Some answers are so individual that designing a general population study is so difficult that it is not done.