Endocrine Abstracts

Introduction: The prevalence of obesity is still increasing and is accompanied by significant health problems. High exposure to glucocorticoids, including the stress hormone cortisol, has been suggested to play a role in the development of obesity and associated cardiometabolic derangements. We previously showed that obese persons are exposed to high long-term cortisol levels as measured in scalp hair. It is not known whether these elevated cortisol levels decrease with weight loss. In order to further investigate this relationship, we assessed the longitudinal effects of a combined lifestyle intervention (CLI), on anthropometric parameters and long-term cortisol in obese patients.

Methods: We enrolled 106 adult obese patients (mean age 42.2 years, 73.6% female, mean BMI 40.3 kg/m²) who were treated at the Obesity Center CGG (Centrum Gezond Gewicht) between October 2011 and March 2016, and had at least one obesity-related comorbidity. All patients underwent CLI, consisting of guided exercising, dietetics, and cognitive behavioural therapy. Anthropometric parameters (weight, BMI, waist circumference) and hair samples (long-term cortisol) were assessed at intake, after 10 intensive weeks, and at the end of the intervention at 75 weeks. Repeated measures ANOVAs were performed to calculate the change over time in weight, BMI, waist circumference and long-term cortisol.

Results: After 10 weeks of intensive CLI, a significant decrease in weight (−6.01 kg (5.1%), P<0.001), BMI (−2.05 kg/m², P<0.001), and waist circumference (−6.76 cm, P<0.001) was found. The decline persisted over time and patients were in general able to sustain the loss at the end of the intervention (weight −6.52 kg (5.5%), BMI −2.21 kg/m², and waist circumference −7.28 cm, all P<0.001). Long-term cortisol levels decreased from 5.31 pg/mg (95% CI 3.88, 6.74) at baseline to 4.59 pg/mg (95% 3.54, 5.63) at 10 weeks, and to 2.87 (95% CI 2.02, 3.72) at 75 weeks. The decrease in long-term cortisol levels after 75 weeks was significant (P<0.001).

Conclusions: After a CLI, which yielded sustained weight loss and a decrease in abdominal fat in patients with obesity, long-term cortisol levels significantly decreased. Further research is needed to investigate whether this decrease in long-term cortisol levels is caused by CLI per se, or due to the reduction in weight and whether this decrease is related to cardiometabolic improvements.