Achieving Healthy Sleep Durations Can Aid in Weight Loss, Reducing Caloric Intake

Esra Tasali, MD

Extending a patient’s habitual sleep period could lead to reductions in energy intake and aid in weight loss, according to results of a recent randomized clinical trial.

Results of the trial, which compared an extended sleeping period against habitual sleep routines, suggest improving and maintaining an adequate sleep schedule could reduce weight and improve outcomes of weight loss interventions among patients with overweight or obesity, with those randomized to sleep extension experiencing a mean reduction in daily energy intake of 270 kcal compared to the control group.

“This was not a weight-loss study,” said Esra Tasali, MD, Director of the UChicago Sleep Center at the University of Chicago Medicine, in a statement. “But even within just two weeks, we have quantified evidence showing a decrease in caloric intake and a negative energy balance — caloric intake is less than calories burned. If healthy sleep habits are maintained over longer duration, this would lead to clinically important weight loss over time.”

Conducted between November 1, 2014-October 30, 2020, the current study was born out of the investigator’s interest in assessing associations between sleep habits and metabolism. The current study was designed as a single-center, randomized trial enrolling adult patients aged 21-40 years with a BMI between 25-29.9 kg/m2 and mean habitual sleep duration of less than 6.5 hours per night.

Following a 2-week habitual sleep period at baseline, participants were randomized to undergo individualized sleep hygiene counseling intended to extend their bedtime to 8.5 hours or continue their habitual sleep routine. Investigators noted all participants in the trial were instructed to continue daily routine activities at home without any prescribed changes in diet or physical activity.

The primary outcome of interest was the change in energy intake from baseline, which was measured as the sum of total energy expenditure and change in body energy stores. Investigators assessed total engird expenditure through the doubly labeled water method and changes in body energy stores were computed using regression of daily home weights and body composition changes from dual-energy x-ray absorptiometry. Investigators noted sleep duration was assessed using an actigraphy and changes from baseline between the study cohorts were estimated using intention-to-treat analysis.

A total of 210 patients were assessed for eligibility, after exclusion of those not meeting inclusion criteria, those who declined further participation, and those who did not return for randomization, a cohort of 81 patients underwent randomization. Of these, 1 was considered ineligible after randomization and 40 participants randomized to each intervention group were included in the final analysis. The 80 participants included in the trial had a mean age of 29.8 (SD, 5.1) years and 51.3% were men.

During the trial, those randomized to sleep hygiene counseling increased sleep duration by 1.2 (95% CI, 1.0 to 1.4; P <.001) hours per night compared to the control group. When assessing the primary outcome, results indicated those in the sleep extension group had a significant decrease in energy intake compared with the control group (−270 kcal/d [95% CI, −393 to −147]; P <.001). Further analysis indicated a change in sleep duration was inversely correlated with change in energy intake (r=−0.41 [095% CI, −0.59 to −0.20]; P <.001) but no significant treatment effect was observed for total energy expenditure, which investigators note resulted in weight reduction among those in the sleep extension group (−0.48 kg; 95% CI, −0.85 to −0.11 kg).

“In our earlier work, we understood that sleep is important for appetite regulation,” Tasali added. “Now we’ve shown that in real life, without making any other lifestyle changes, you can extend your sleep and eat fewer calories. This could really help people trying to lose weight.”

This study, “Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings,” was published in JAMA Internal Medicine.