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Intentional weight loss, weight cycling, and endometrial cancer risk: a systematic review and meta-analysis
  1. Xiaochen Zhang1,2,
  2. Jennifer Rhoades2,
  3. Bette J Caan3,
  4. David E Cohn4,
  5. Ritu Salani4,
  6. Sabrena Noria5,
  7. Adrian A Suarez6,
  8. Electra D Paskett1,2 and
  9. Ashley S Felix2
  1. 1 Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
  2. 2 Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
  3. 3 Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
  4. 4 Division of Gynecologic Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  5. 5 Center for Minimally Invasive Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
  6. 6 Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  1. Correspondence to Dr Ashley S Felix; felix.20{at}


Purpose Weight cycling, defined as intentional weight loss followed by unintentional weight regain, may attenuate the benefit of intentional weight loss on endometrial cancer risk. We summarized the literature on intentional weight loss, weight cycling after intentional weight loss, bariatric surgery, and endometrial cancer risk.

Methods A systematic search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases published between January 2000 and November 2018. We followed Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines. We qualitatively summarized studies related to intentional weight loss and weight cycling due to the inconsistent definition, and quantitatively summarized studies when bariatric surgery was the mechanism of intentional weight loss.

Results A total of 127 full-text articles were reviewed, and 13 were included (bariatric surgery n=7, self-reported intentional weight loss n=2, self-reported weight cycling n=4). Qualitative synthesis suggested that, compared with stable weight, self-reported intentional weight loss was associated with lower endometrial cancer risk (RR range 0.61–0.96), whereas self-reported weight cycling was associated with higher endometrial cancer risk (OR range 1.07–2.33). The meta-analysis yielded a 59% lower risk of endometrial cancer following bariatric surgery (OR 0.41, 95% CI 0.22 to 0.74).

Conclusions Our findings support the notion that intentional weight loss and maintenance of a stable, healthy weight can lower endometrial cancer risk. Strategies to improve awareness and maintenance of weight loss among women with obesity are needed to reduce endometrial cancer risk.

  • intentional weight loss
  • weight cycling
  • endometrial cancer risk
  • systematic review and meta-analysis

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  • Contributors XZ, JR, and ASF conceived of the study design. XZ and JR conducted the literature search, screening, and data extraction. XZ and ASF analyzed the data. XZ, BJC, EDP and ASF wrote the first draft of the study. DEC, RS, SN, and AAS helped interpret data and provided critical revisions of the manuscript. All authors reviewed and approved the manuscript.

  • Funding This work was supported by the National Cancer Institute (K01CA21845701A1 to ASF) and Susan G. Komen Foundation (GTDR15334082 to XZ).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.