By Nathan Costiuc, MSN, APRN, FNP-BC
As the dark shadow of COVID-19 begins to lift, critically-important health concerns which had previously shrunk in significance are now returning to the limelight, chief among these being obesity. Unfortunately, the transition to low-level endemicity we hope for with SARS-CoV-2 is nowhere in sight for obesity: the World Health Organization reports that obesity has nearly tripled since 1975. In 2016, more than 1.9 billion adults aged 18 years and older were overweight, and 650 million were obese.1
Research studying the interplay between sleep and BMI is an emerging subject matter, and the bulk of it thus far has focused on the negative correlation – i.e., “What effect does reduced sleep have on weight gain?” Prospective epidemiological investigations continually show that short sleep duration is linked to an increased risk of weight gain.2-4
However, understanding the inverse relationship – the effect of improved sleep on weight loss – may be of higher prescriptive pertinence for sleep clinicians and even more motivating for patients suffering sleep disturbances. A recent randomized controlled trial (RCT) published in JAMA sheds much-needed light on the subject while also implementing sleep hygiene as the driver for changes in sleep duration.5
This study looked at adults aged 21 to 40 with a body mass index between 25.0 and 29.9 and who slept less than 6.5 hours a night. After two weeks of assessing baseline sleeping patterns, participants were put into an intervention group with a goal of 8.5 sleep hours, while the control group continued at baseline.
Sleep duration was measured with wrist actigraphy while measuring “total energy expenditure and change in body energy stores using the principle of energy balance.” Intervention group participants were coached on sleep hygiene, and all participants were instructed to maintain diet and activity levels. After two weeks, the intervention group achieved 1.2 hours more sleep per night, reduced energy intake by 270 kcal per day, and lost 0.87 kg of weight on average compared to control.
While this study was conducted primarily in relation to the overall health benefits of sleep duration, weight loss, and sleep hygiene, research like this has important implications for the medical sleep community.
1. Realize your essential place in comprehensive medicine.
For many years, sleep disturbances were considered the stepchild diagnoses of modern medicine, treated as mere nuisances rather than life-changing conditions. However, this research adds to a large body of existing clinical knowledge, which shows sleep’s central position in overall health and prevention of disease, including mental health,6 reduced inflammation,7 improved cardiovascular health,8 and the list goes on.
The impact of weight loss on its own has also been shown to have wide-ranging effects on wellness. To know that both of these initiatives could serve to compound health benefits for patients should be incredibly encouraging and affirming for sleep clinicians who work hard to improve their patients’ restfulness.
2. Use the power of weight loss as a clinical motivator.
This study is one of the first to bring the power of RCT to the nascent sleep/weight field of study. And though it is low-powered, it does provide objective data suggesting that increased sleep can lead to weight loss. As such, clinicians can use this information to further motivate patients struggling to comply with treatment recommendations like CPAP. While the pursuit of restfulness is a powerful motivator on its own, you may capture additional internal motivations by apprising patients of these findings.
3. Capitalize on the importance of sleep hygiene.
For as much as the concept of “sleep hygiene” has captured the public zeitgeist, there is still little consensus on what practices or techniques this involves. The researcher in this study, however, implemented a methodical patient education approach that covered “habitual sleep-wake schedules… environmental factors (bedroom temperature, noise, ambient light), bedtime routine, television/electronic use, and physiological factors (e.g., exercise, caffeine).” Since their results suggest that those interventions significantly affect sleep duration, you may consider how a similar systematized sleep hygiene regimen could compound the benefits of other therapies you may be working through with them.
Obesity as a public health concern has not slowed down, even if it has briefly faded from the public eye. Clinical sleep disturbance treatment should consider comprehensive, integrative medicine and leverage all possible angles to optimize sleep outcomes. Perhaps if every specialty takes a fraction of ownership for obesity education (including conveying recent research to patients), we may yet see the “endemicity” we hope for.
Nathan is a Nurse Practitioner and Freelance Writer based in West Palm Beach, Florida. He sees disabled veterans struggling with sleep disturbances in the context of multiple comorbidities. You can find him at clinicious.com or on his LinkedIn profile.
- Obesity and overweight. Who.int. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Published 2022. Accessed August 11, 2022.
- Zhou Q, Zhang M, Hu D. Dose-response association between sleep duration and obesity risk: a systematic review and meta-analysis of prospective cohort studies. Sleep Breath. 2019;23(4):1035-1045. doi:10.1007/s11325-019-01824-4
- Jaiswal SJ, Quer G, Galarnyk M, Steinhubl SR, Topol EJ, Owens RL. Association of sleep duration and variability with body mass index: sleep measurements in a large US population of wearable sensor users. JAMA Intern Med. 2020;180(12):1694-1696. doi:10.1001/jamainternmed.2020.2834
- Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring). 2008;16(3):643-653. doi:10.1038/oby.2007.118
- Tasali E, Wroblewski K, Kahn E, Kilkus J, Schoeller DA. Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings: A Randomized Clinical Trial. JAMA Intern Med. 2022;182(4):365–374. doi:10.1001/jamainternmed.2021.8098
- Blackwelder A, Hoskins M, Huber L. Effect of Inadequate Sleep on Frequent Mental Distress. Prev Chronic Dis. 2021;18:E61. Published 2021 Jun 17. doi:10.5888/pcd18.200573
- Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab. 2010;24(5):775-784. doi:10.1016/j.beem.2010.08.014
- Nagai M, Hoshide S, Kario K. Sleep duration as a risk factor for cardiovascular disease- a review of the recent literature. Curr Cardiol Rev. 2010;6(1):54-61. doi:10.2174/157340310790231635