The association between sleep health and weight change during a 12-month behavioral weight loss intervention
Open accessAbstract
Background Prior research on the relationship between sleep and attempted weight loss failed to recognize the multidimensional nature of sleep. We examined the relationship between a composite measure of sleep health and change in weight and body composition among adults in a weight loss intervention.Methods Adults (N = 125) with overweight or obesity (50.3 ± 10.6 years, 91% female, 81% white) participated in a 12-month behavioral weight loss intervention, with assessments of sleep, weight, fat mass, and fat-free mass at baseline, 6 months, and 12 months. Six sleep dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) were categorized as "good" or "poor" using questionnaires and actigraphy. A composite score was calculated by summing the number of "good" dimensions. Obstructive sleep apnea (OSA) was assessed in a subsample (n = 117), using the apnea-hypopnea index (AHI) to determine OSA severity. Linear mixed modeling was used to examine the relationships between sleep health and outcomes of percent weight, fat mass, or fat-free mass change during the subsequent 6-month interval, adjusting for age, sex, bed partner, and race; an additional model adjusted for AHI.Results Mean baseline and 6-month sleep health was 4.5 ± 1.1 and 4.5 ± 1.2, respectively. Mean weight, fat mass, and fat-free mass changes from 0 to 6 months were -9.3 ± 6.1%, -16.9 ± 13.5%, and -3.4 ± 3.4%, respectively, and 0.4 ± 4.8%, -0.3 ± 10.3%, and 0.7 ± 4.1% from 6 to 12 months. Better sleep health was associated with greater subsequent weight loss (P = 0.016) and fat loss (P = 0.006), but not fat-free mass loss (P = 0.232). Following AHI adjustment, the association between sleep health and weight loss was attenuated (P = 0.102) but remained significant with fat loss (P = 0.040). Regularity, satisfaction, timing, and efficiency were each associated with weight and/or fat loss (P ≤ 0.041).Conclusions Better sleep health was associated with greater weight and fat loss, with associations attenuated after accounting for OSA severity. Future studies should explore whether improving sleep health, OSA, or the combination improves weight loss.
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In longer observations, a favorable sleep profile that included adequate duration, regularity, quality, and efficiency correlated with greater reductions in body weight and fat mass during a 12 months weight loss program independently of obstructive sleep apnea.
“In longer observations a favorable sleep profile that included adequate duration, regularity, quality, and efficiency correlated with greater reductions in body weight and fat mass during a 12 months weight loss program independently of the presence of obstructive sleep apnea [120].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [120]
A favorable sleep profile, including adequate length, regularity, quality, and efficiency, has been associated with greater weight and fat tissue loss and a lower risk of weight regain.
“A favorable sleep profile, including adequate length, regularity, quality, and efficiency, has been associated with greater weight and fat tissue loss [120] and a lower risk of weight regain [121].”
From Dietary and Behavioral Strategies for Weight Loss and Weight Loss Maintenance: A Narrative Review (2025) · cites this paper as [120]
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Tasali, E., Wroblewski, K., Kahn, E., Kilkus, J., & Schoeller, D. A. (2022) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.8098 · Cited by 159 · see citing works
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- Authors
- Kline, C. E., Chasens, E. R., Bizhanova, Z., Sereika, S. M., Buysse, D. J., Imes, C. C., Kariuki, J. K., Mendez, D. D., Cajita, M. I., Rathbun, S. L., & Burke, L. E.
- Affiliations
- University of Pittsburgh (US)
- University of Illinois Chicago (US)
- University of Georgia (US)
- Corresponding author
- Kline, Christopher E.
- ORCID
- Venue
- International Journal of Obesity
- Published
- 2021-01-07
- Volume
- 45
- Issue
- 3
- Pages
- 639-649
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- PMC
- PMC7914147
- OpenAlex
- W3119457911
- Cited by
- 56
- References
- 75
- Citations by year
- 2026: 15 · 2025: 12 · 2024: 12 · 2023: 4 · 2022: 9 · 2021: 4
- FWCI
- 7.00
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL107370, K23HL118318)
- National Institute of Nursing Research (K24NR016685)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep health, weight loss, obesity, overweight, body composition, fat loss, fat-free mass, sleep regularity, sleep satisfaction, sleep timing, sleep efficiency, obstructive sleep apnea, apnea-hypopnea index, behavioral weight loss, actigraphy, sleep duration, weight regain
- MeSH terms
- Adult, Behavior Therapy, Body Weight, Female, Humans, Male, Middle Aged, Obesity, Prospective Studies, Sleep, Weight Loss, Sleep Apnea, Obstructive, Weight Reduction Programs
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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