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Keywords:

  • BMI;
  • overweight;
  • physician advice;
  • recommendation;
  • use

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgement
  8. References

Objective: To examine the prevalence and correlates of trying to lose weight among U.S. adults, describe weight loss strategies, and assess attainment of recommendations for weight control (eating fewer calories and physical activity).

Research Methods and Procedures: This study used the Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults ≥18 years of age (N = 184, 450) conducted in the 50 states, the District of Columbia, and Puerto Rico in 2000.

Results: The prevalence of trying to lose weight was 46% (women) and 33% (men). Women reported trying to lose weight at a lower BMI than did men; 60% of overweight women were trying to lose weight, but men did not reach this level until they were obese. Adults who had a routine physician checkup in the previous year and reported medical advice to lose weight vs. checkup and no medical advice to lose weight had a higher prevalence of trying to lose weight (81% women and 77% men vs. 41% women and 28% men, respectively). The odds of trying to lose weight increased as years of education increased. Among respondents who were trying to lose weight, ∼19% of women and 22% of men reported using fewer calories and ≥150 min/wk leisure-time physical activity.

Discussion: A higher percentage of women than men were trying to lose weight; both sexes used similar weight loss strategies. Education and medical advice to lose weight were strongly associated with trying to lose weight. Most persons trying to lose weight were not using minimum recommended weight loss strategies.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgement
  8. References

Weight loss is a common concern for many Americans (1); in 1998, about one-third of Americans reported that they were trying to lose weight (2,3). Despite these efforts, U.S. obesity rates increased from 23% (1988 to 1994) to 31% (1999 to 2000) (4). Because of this increase, physicians and other medical professionals can expect to encounter overweight or obese persons in clinical settings (5).

Decreased calorie intake and increased physical activity are the cornerstones of weight control (6,7,8). Overweight and obese individuals are advised to reduce energy intake levels by 500 to 1000 kcal/d to lose weight (6,9). Reduced calorie intake is the most important dietary component for weight loss; reducing dietary fat alone without reducing calories is not shown to be effective (6,10,11).

The physical activity level recommended to lose weight or prevent weight gain varies. In 1998, the National Heart, Lung and Blood Institute (NHLBI)1 advised 30 to 45 minutes of moderate physical activity 3 to 5 d/wk for weight loss and maintenance, with a long-term goal of achieving ≥30 minutes on most, preferably all, days of the week (≥150 min/wk) (6). In 2001, the American College of Sports Medicine (ACSM) advised eventual progression to 200 to 300 min/wk of moderate exercise for long-term weight loss and maintenance (9). In 2002, the Institute of Medicine (IOM) recommended 60 minutes daily (420 min/wk) of moderate-intensity physical activity to prevent weight gain (12).

An analysis of Behavioral Risk Factor Surveillance System (BRFSS) data from 1996 found that only one-fifth of Americans who were trying to lose weight used the recommended minimal combination of reducing calories and participating in ≥150 min/wk of leisure-time physical activity (1), and only 42% of obese adults who had visited a physician in the previous 12 months for a routine checkup reported being advised to lose weight by their health care provider (13).

The objectives of this study, which used data from the 2000 BRFSS, were to examine the prevalence and correlates of trying to lose weight, describe weight control strategies among U.S. adults who reported trying to lose weight, and assess attainment of combined dietary and physical activity recommendations for weight loss and weight gain prevention among U.S. adults who reported that they were trying to lose weight.

Research Methods and Procedures

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgement
  8. References

The BRFSS is a telephone survey conducted by state health departments. Each state, the District of Columbia, and Puerto Rico selected an independent probability sample of non-institutionalized residents ≥18 years of age. In 2000, 184, 450 persons responded to the BRFSS survey; descriptions of BRFSS survey methods have been previously published (14). The median 2000 Council of American Survey Research Organizations response rate was 48.9% (range, 28.8% to 71.8%) (15).

Respondents were asked, “Are you now trying to lose weight?” Those who answered yes were asked, “Are you eating either fewer calories or less fat to lose weight?” Response options were 1) “Yes, fewer calories”; 2) “Yes, less fat”; 3) “Yes, fewer calories and less fat”; or 4) “No.” We defined respondents who followed the minimal dietary recommendation for weight loss as those who reported consuming fewer calories (1 or 3 above). We did not consider those who answered “Yes, less fat” as meeting the weight loss dietary recommendation.

Respondents were asked, “Are you using physical activity or exercise to lose weight?” Those trying to lose weight who answered yes were categorized as “using physical activity or exercise” for weight loss. To determine weekly minutes of leisure-time physical activity, participants were asked if they had participated in physical activity or exercises during the past month and were questioned further to determine the type, duration, and frequency of the two leisure-time physical activities they had participated in most frequently during the preceding month. Based on four recommended physical activity levels from national organizations, leisure-time physical activity was categorized into four levels (≥150, ≥200, ≥300, and, ≥420 min/wk). These categories are not mutually exclusive.

At the end of the interview, respondents were asked to report their current height and weight without shoes. We calculated BMI as weight (kilograms) divided by height (meters squared) and grouped respondents in the following three categories: normal weight (<25.0 kg/m2), overweight (25.0 to 29.9 kg/m2), and obese (≥30.0 kg/m2) (6).

Age in years, race/ethnicity, education level, and smoking status were determined by survey question responses (16). Medical advice regarding weight was determined by asking, “About how long has it been since you last visited a doctor for a routine checkup?” Respondents were later asked, “In the past 12 months, has a doctor, nurse, or other health professional given you advice about your weight?” Responses were categorized as 1) Yes, lose weight; 2) Yes, maintain weight; or 3) No advice. A fourth category, 4) No doctor seen in past 12 months, was defined for respondents who indicated that they had not seen a physician in the past 12 months when they answered the question about how long it had been since they visited a doctor.

Individuals were excluded from analysis if they did not report height and/or weight (n = 8268); did not report weight control behaviors (n = 2348), age, race/ethnicity, or education (n = 1692); were pregnant (n = 2218); were outside sex-specific reference values from the Third National Health and Nutrition Examination Survey 1989 to 1994 (17) for height, weight, or BMI (n = 141); did not report components used to determine weekly leisure-time physical activity minutes (n = 88); did not report smoking status (n = 431); were missing information about their last routine checkup (n = 1732); were missing information about medical advice regarding weight in the past 12 months (n = 199); or reported advice to gain weight (n = 3018). Failure to report height and weight occurred more frequently than any other data omission and accounted for loss of ∼4% of the sample. The 99.9th percentile cut-point for leisure-time physical activity represented respondents who either reported or had data entered as ≥7.14 h/d (3000 min/wk). We determined this level of leisure-time physical activity to be excessive and also excluded these observations from analysis (n = 128). The final analytic sample consisted of 164, 187 respondents.

Analysis of eating fewer calories and weekly minutes of leisure-time physical activity as indicators of attainment of weight loss recommendations was limited to respondents who answered yes to the question “Are you now trying to lose weight?” (n = 64, 799).

We used SAS (version 8.02; SAS Institute, Cary, NC) and SUDAAN (version 8.02; Research Triangle Institute, Research Triangle Park, NC) for statistical analysis to account for the complex sampling design. Because of potential differing effects by sex and weight, all analyses were stratified by sex and BMI. Key independent variables of interest were age, race/ethnicity, education, smoking status, and medical advice regarding weight. χ2 tests were used to test between-group differences for proportions. We set statistical significance at p < 0.05 for all comparisons.

Variables associated with trying to lose weight were determined using logistic regression to estimate prevalence odds ratios for trying to lose weight (n = 64, 799) vs. doing nothing about weight (n = 40, 919). Respondents who reported trying to maintain weight (n = 58, 469) were excluded from this analysis. Variables associated with weight loss strategies among those trying to lose weight were determined using logistic regression to estimate prevalence odds ratios for those who were eating vs. not eating fewer calories, using vs. not using exercise or physical activity, and combining vs. not combining fewer calories and ≥150 min/wk of leisure-time physical activity.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgement
  8. References

The majority of respondents were non-Hispanic whites between 24 and 54 years of age who had completed high school. Fifty-eight percent of respondents were women, 37% were overweight, and another 20% were obese.

The overall prevalence of trying to lose weight was higher among women (46%) than among men (33%; Table 1). The prevalence of trying to lose weight increased from a low of 6% for men with BMI <25 kg/m2 who were current smokers to highs of 83% for overweight women and 81% for obese men who were advised to lose weight by a medical professional. Women and men who reported medical advice to lose weight had the highest prevalence of trying to lose weight. This category was also the most consistent across all BMI categories and ranged from 71% to 83% among women and from 60% to 81% among men.

Table 1A. . Prevalence of trying to lose weight
 Women
 Total (n = 94, 536)BMI ≥ 30 kg/m2 (n = 19, 455)BMI 25 to 29.9 kg/m2 (n = 27, 666)BMI < 25 kg/m2 (n = 47, 415)
Characteristicsn*Percentagen*Percentagen*Percentagen*Percentage
Overall42, 77646.313, 42570.016, 11759.913, 23428.9
Age (years)        
 18 to 297, 02545.61, 66878.52, 29571.53, 06231.0
 30 to 399, 43651.42, 76976.23, 35067.93, 31734.0
 40 to 499, 88451.33, 14471.13, 60366.53, 13732.4
 50 to 597, 78351.42, 77870.83, 06261.01, 94331.7
 60 to 694, 77043.41, 78164.12, 01151.597823.2
 ≥703, 87829.81, 28555.71, 79639.679713.0
Race or ethnicity        
 Non-Hispanic white32, 95945.69, 55569.412, 40860.910, 99629.5
 Non-Hispanic black3, 73346.21, 90468.41, 33247.949720.0
 Hispanic4, 16850.91, 45873.41, 66362.81, 04729.5
 Other1, 91644.650876.671467.069429.0
Education        
 Less than high school4, 45942.72, 09162.51, 57149.479719.7
 High school graduate13, 53545.54, 70069.85, 23356.73, 60226.5
 Some college or technical school12, 98749.13, 94773.34, 93063.84, 11031.7
 College graduate11, 79546.02, 68773.64, 38366.54, 72531.2
Smoking status        
 Current8, 41442.02, 41969.53, 10457.52, 89126.3
 Former10, 33151.73, 32870.93, 98262.83, 02133.6
 Never24, 03145.97, 67869.89, 03159.57, 32228.4
Medical advice regarding weight        
 Yes, lose weight8, 93980.85, 27981.02, 92883.373270.8
 Yes, maintain weight66334.214440.524239.627729.2
 No advice24, 76740.65, 63463.59, 77355.29, 36027.4
 No doctor seen in past 12 months8, 40745.72, 36869.13, 17461.32, 86529.4
Men
Total (n = 69, 651)BMI ≥ 30 kg/m2 (n = 14, 593)BMI 25 to 29.9 kg/m2 (n = 32, 069)BMI < 25 kg/m2 (n = 22, 989)
n*Percentagen*Percentagen*Percentagen*Percentage
  • *

    Unweighted number.

  • Percentage is weighted to be nationally representative.

22, 02332.88, 93562.811, 08635.92, 0029.5
        
3, 12927.31, 11363.01, 55036.84668.4
4, 47830.81, 87460.72, 24431.63607.7
5, 29535.92, 27862.62, 58536.743210.5
4, 47141.01, 92666.02, 18540.736014.6
2, 81437.01, 15563.11, 46038.419911.3
1, 83626.458960.51, 06231.31857.5
        
17, 52532.86, 96063.59, 01336.31, 5529.1
1, 35130.975164.252428.2766.3
1, 98734.583060.495735.220011.8
1, 16032.139454.759245.517413.4
        
2, 08228.11, 02055.388928.91737.5
6, 10730.42, 76859.92, 88031.54597.2
        
5, 91132.42, 51063.12, 91935.44829.0
7, 92337.42, 63770.14, 39842.888812.6
        
3, 89824.51, 57356.01, 95829.13675.8
7, 77638.83, 25166.33, 95540.257011.1
10, 34933.44, 11163.35, 17336.31, 06510.9
        
        
5, 01376.83, 20380.61, 67272.113859.6
27422.77140.515725.34613.5
10, 01328.03, 17355.45, 73633.31, 1048.8
        
6, 72328.92, 48857.43, 52133.17148.8
        

Among women and men, the adjusted odds of trying to lose weight vs. doing nothing about weight was generally lower at older ages, higher with higher education status, lower for current smokers, generally higher for former smokers, and higher for those advised by a medical professional to lose weight (Table 2). Overall, women had 6 times the odds of trying to lose weight when advised to lose weight (vs. no advice) and men had 10 times the odds of trying to lose weight when advised to lose weight. The odds of trying to lose weight among women and men advised vs. not advised to lose weight decreased as BMI increased, and the odds ratios were highest for normal weight respondents.

Table 2. . Odds of trying to lose weight vs. nothing
 Women
 Total (n = 61, 546)BMI ≥ 30 kg/m2 (n = 15, 841)BMI 25 to 29.9 kg/m2 (n = 19, 991)BMI < 25 kg/m2 (n = 25, 714)
CharacteristicOR*95% CIOR*95% CIOR*95% CIOR*95% CI
Age (years)        
 18 to 291.00 1.00 1.00 1.00 
 30 to 391.161.04 to 1.290.900.66 to 1.220.760.56 to 1.041.060.93 to 1.21
 40 to 491.201.08 to 1.340.800.59 to 1.080.850.63 to 1.150.970.85 to 1.12
 50 to 591.020.91 to 1.150.640.47 to 0.870.510.37 to 0.690.910.77 to 1.07
 60 to 690.690.61 to 0.770.550.40 to 0.750.370.27 to 0.510.490.41 to 0.59
 ≥700.320.28 to 0.360.400.29 to 0.550.190.14 to 0.260.190.16 to 0.22
Race or ethnicity        
 Non-Hispanic white1.00 1.00 1.00 1.00 
 Non-Hispanic black0.670.61 to 0.750.880.71 to 1.070.480.40 to 0.580.350.28 to 0.42
 Hispanic0.910.80 to 1.031.170.88 to 1.560.760.59 to 0.960.740.62 to 0.89
 Other0.750.63 to 0.891.100.72 to 1.691.180.76 to 1.820.660.52 to 0.83
Education        
 Less than high school0.820.74 to 0.910.640.52 to 0.790.630.51 to 0.780.700.59 to 0.84
 High school graduate1.00 1.00 1.00 1.00 
 Some college or technical school1.181.09 to 1.281.060.88 to 1.291.321.12 to 1.541.311.17 to 1.46
 College graduate1.181.09 to 1.291.170.92 to 1.491.581.32 to 1.881.441.28 to 1.62
Smoking status        
 Current0.590.54 to 0.630.820.67 to 1.010.650.54 to 0.760.580.52 to 0.65
 Former1.391.28 to 1.511.150.95 to 1.391.471.25 to 1.731.401.24 to 1.59
 Never1.00 1.00 1.00 1.00 
Medical advice regarding weight        
 Yes, lose weight6.245.50 to 7.092.432.02 to 2.924.053.13 to 5.239.876.83 to 14.26
 Yes, maintain weight1.251.00 to 1.571.130.66 to 1.940.910.56 to 1.481.801.33 to 2.43
 No advice1.00 1.00 1.00 1.00 
 No doctor seen in past 12 months0.970.90 to 1.050.920.75 to 1.120.990.84 to 1.170.880.79 to 0.98
Men
 Total (n = 44, 172)BMI ≥ 30 kg/m2 (n = 11, 332)BMI 25 to 29.9 kg/m2 (n = 19, 404)BMI < 25 kg/m2 (n = 13, 436)
OR*95% CIOR*95% CIOR*95% CIOR*95% CI
  • *

    OR (95% CI) of those trying to lose weight vs. doing nothing about their weight. Model adjusted for age, race/ethnicity, education, smoking status, and medical advice regarding weight.

        
1.00 1.00 1.00 1.00 
1.151.03 to 1.280.840.64 to 1.090.720.61 to 0.860.850.66 to 1.11
1.441.29 to 1.620.840.62 to 1.150.850.71 to 1.021.331.04 to 1.71
1.541.37 to 1.740.800.60 to 1.070.860.72 to 1.042.111.59 to 2.80
1.171.02 to 1.350.660.48 to 0.900.730.59 to 0.901.411.02 to 1.96
0.710.62 to 0.820.680.47 to 0.980.500.40 to 0.610.810.57 to 1.16
        
1.00 1.00 1.00 1.00 
0.930.81 to 1.051.301.02 to 1.650.690.57 to 0.850.650.43 to 0.99
1.221.06 to 1.401.030.75 to 1.420.990.81 to 1.221.521.12 to 2.05
0.950.77 to 1.170.660.44 to 0.981.320.95 to 1.841.451.00 to 2.11
        
0.810.70 to 0.930.690.52 to 0.910.770.63 to 0.950.900.64 to 1.28
1.00 1.00 1.00 1.00 
        
1.131.03 to 1.231.110.92 to 1.341.181.03 to 1.361.371.07 to 1.75
1.631.49 to 1.781.741.41 to 2.152.041.79 to 2.332.151.73 to 2.68
        
0.530.49 to 0.580.710.55 to 0.900.600.53 to 0.690.430.34 to 0.54
1.271.16 to 1.381.210.99 to 1.481.271.12 to 1.451.010.82 to 1.25
1.00 1.00 1.00 1.00 
        
        
10.138.53 to 12.033.512.76 to 4.475.914.37 to 8.0131.3117.32 to 56.59
1.280.94 to 1.750.600.31 to 1.162.401.45 to 3.981.871.06 to 3.32
1.00 1.00 1.00 1.00 
        
0.930.86 to 1.011.010.82 to 1.250.860.77 to 0.970.890.75 to 1.07
        

Next, we examined specific weight loss strategies among individuals who were trying to lose weight. Approximately 56% of women and 53% of men reported eating fewer calories (Table 3). Higher odds of eating fewer calories were observed among non-Hispanic whites, women between 30 and 69 years of age, men between 50 and 69 years of age, and, among both sexes, those with higher education and those advised to lose weight. Lower odds of eating fewer calories to lose weight were observed among women with less than a high school education and women who were current smokers. These associations generally remained constant across BMI strata (data not shown).

Table 3. . Prevalence of weight loss behaviors and odds of using vs. not using specific weight loss strategies
 Women trying to lose weight
 Total (n = 42, 526)Total (n = 42, 732)Total (n = 42, 526)
 Eating fewer caloriesUsing physical activity or exerciseEating fewer calories and ≥150 min/wk leisure-time physical activity
Characteristicn*PercentageOR95% CIn*PercentageOR95% CIn*PercentageOR95% CI
Overall24, 74856.4  28, 20366.0  8, 31719.4  
Age (years)            
 18 to 293, 79251.31.00 5, 53979.61.00 1, 38719.11.00 
 30 to 395, 44656.51.191.07 to 1.326, 75370.50.570.50 to 0.641, 84819.70.990.87 to 1.14
 40 to 495, 98759.51.291.16 to 1.446, 75667.90.470.42 to 0.542, 04520.41.010.88 to 1.15
 50 to 594, 64458.91.221.08 to 1.374, 78960.20.320.28 to 0.361, 50119.00.900.78 to 1.04
 60 to 692, 77957.01.151.01 to 1.312, 66056.30.280.24 to 0.3294920.41.020.87 to 1.20
 ≥702, 10053.81.020.88 to 1.181, 70644.20.170.14 to 0.1958716.70.810.65 to 1.00
Race or ethnicity            
 Non-Hispanic white19, 54659.01.00 22, 20767.81.00 6, 69520.41.00 
 Non-Hispanic black1, 98653.70.800.72 to 0.902, 37263.20.730.65 to 0.8255516.60.800.68 to 0.95
 Hispanic2, 23446.20.650.58 to 0.742, 38157.40.590.52 to 0.6872016.60.890.75 to 1.07
 Other98250.30.690.56 to 0.851, 24369.60.950.75 to 1.1934718.00.840.63 to 1.10
Education            
 Less than high school2, 27945.40.750.67 to 0.852, 12848.50.670.59 to 0.7654012.20.680.56 to 0.82
 High school graduate7, 55355.41.00 8, 36162.71.00 2, 32117.51.00 
 Some college or technical school7, 51557.01.070.98 to 1.168, 91969.01.211.11 to 1.332, 59320.61.211.08 to 1.35
 College graduate7, 40161.91.261.15 to 1.378, 79574.41.531.40 to 1.682, 86323.81.421.28 to 1.58
Smoking status            
 Current4, 60752.70.850.78 to 0.935, 20161.70.650.59 to 0.721, 42216.60.860.77 to 0.96
 Former6, 08958.50.990.91 to 1.086, 82765.71.020.93 to 1.112, 20922.01.161.04 to 1.29
 Never14, 05256.71.00 16, 17567.51.00 4, 68619.31.00 
Medical advice regarding weight            
 Yes, lose weight5, 49260.31.251.15 to 1.375, 62462.70.940.86 to 1.041, 68519.91.040.93 to 1.17
 Yes, maintain weight37657.01.110.87 to 1.4346272.01.371.04 to 1.8014018.90.970.72 to 1.32
 No advice14, 08055.61.00 16, 63667.41.00 4, 91719.81.00 
 No doctor seen in past 12 months4, 80054.60.980.90 to 1.075, 48164.80.790.72 to 0.871, 57518.00.890.79 to 0.99
 Men trying to lose weight
 Total (n = 21, 836)Total (n = 22, 004)Total (n = 21, 836)
 Eating fewer caloriesUsing physical activity or exerciseEating fewer calories and ≥150 min/wk leisure-time physical activity
CharacteristicnPercentageOR95% CInPercentageOR95% CInPercentageOR95% CI
  • *

    Unweighted number.

  • Percentage is weighted to be nationally representative.

  • Model adjusted for age, race/ethnicity, education, smoking status, and medical advice regarding weight.

Overall12, 06653.4  15, 00269.0  4, 86022.0  
Age (years)            
 18 to 291, 52248.51.00 2, 57083.21.00 70722.51.00 
 30 to 392, 31550.71.010.87 to 1.183, 30573.30.500.41 to 0.6093920.70.830.69 to 1.00
 40 to 492, 96353.21.090.93 to 1.283, 64167.50.360.30 to 0.441, 14020.30.780.65 to 0.94
 50 to 592, 64658.01.261.06 to 1.492, 85364.00.290.23 to 0.351, 01123.20.870.71 to 1.05
 60 to 691, 60857.11.251.04 to 1.511, 65159.70.260.21 to 0.3265423.70.940.76 to 1.16
 ≥701, 01256.31.190.97 to 1.4798253.50.190.15 to 0.2440923.90.920.72 to 1.16
Race or ethnicity            
 Non-Hispanic white9, 82055.71.00 12, 00969.31.00 4, 00623.71.00 
 Non-Hispanic black67649.00.800.67 to 0.9494470.81.090.91 to 1.3224217.80.770.62 to 0.96
 Hispanic1, 00945.90.770.65 to 0.921, 24065.70.850.70 to 1.0235917.50.850.68 to 1.07
 Other56146.60.710.52 to 0.9680971.40.880.62 to 1.2525316.90.650.46 to 0.90
Education            
 Less than high school1, 07446.30.840.70 to 1.021, 04053.50.670.55 to 0.8126911.20.520.40 to 0.67
 High school graduate3, 20451.51.00 3, 88765.11.00 1, 17520.01.00 
 Some college or technical school3, 13852.61.040.91 to 1.174, 11269.91.191.04 to 1.371, 31523.51.221.05 to 1.42
 College graduate4, 65057.61.211.08 to 1.375, 96376.11.821.60 to 2.082, 10125.81.371.19 to 1.57
Smoking status            
 Current2, 00850.20.930.81 to 1.062, 44765.60.780.68 to 0.9072718.50.910.78 to 1.08
 Former4, 29355.20.970.87 to 1.085, 08965.61.000.89 to 1.131, 80524.51.191.04 to 1.35
 Never5, 76553.41.00 7, 46672.61.00 2, 32821.61.00 
Medical advice regarding weight            
 Yes, lose weight2, 97358.71.251.11 to 1.413, 19565.30.920.81 to 1.041, 08821.90.950.83 to 1.09
 Yes, maintain weight14953.11.070.70 to 1.6419072.51.390.92 to 2.116521.90.960.55 to 1.69
 No advice5, 42852.61.00 6, 95070.01.00 2, 31622.91.00 
 No doctor seen in past 12 months3, 51651.00.970.87 to 1.094, 66770.00.830.73 to 0.931, 39121.00.910.79 to 1.03

About two-thirds of women and men trying to lose weight reported using physical activity for weight loss (Table 3). The odds of reporting the use of physical activity decreased with age and increased with education. Among women, non-Hispanic whites were more likely to report the use of physical activity to lose weight than non-Hispanic blacks and Hispanics. Among both sexes, those who had not seen a doctor in the previous 12 months had significantly lower odds of using physical activity, in contrast with individuals who received no advice about their weight but had seen a doctor. These associations generally remained constant across BMI strata (data not shown); however, non-Hispanic black men who were obese had higher odds of using physical activity for weight loss compared with non-Hispanic white men (odds ratio, 1.36; 95% confidence interval, 1.08 to 1.71).

We then examined those who met the weight loss strategy of reduced calorie consumption and ≥150 min/wk of leisure-time physical activity. Among those trying to lose weight, 46% of women and 44% of men said they were eating fewer calories and answered yes to the question “Are you using physical activity or exercise to lose weight?” (Table 4). However, only one-fifth met minimal recommendations of eating fewer calories and engaging in ≥150 min/wk of leisure-time physical activity (Table 3). In general, meeting minimal recommendations did not differ by age. Non-Hispanic black women and men had lower odds of reduced calories and ≥150 min/wk of leisure-time physical activity than non-Hispanic whites. Odds for meeting recommendations were higher with higher education status and higher for former smokers vs. never smokers. Women who had not seen a doctor in the previous 12 months had lower odds of reduced calories and minimal physical activity. Otherwise, among both sexes, medical advice to lose weight was not associated with use of the recommended combination of fewer calories and ≥150 min/wk of leisure-time physical activity (Table 3). These associations generally remained constant across BMI strata (data not shown).

Table 4. . Prevalence of attainment of dietary and physical activity recommendations among adults trying to lose weight
 Eating fewer calories and using exercise*Eating fewer calories and ≥150 min/wk leisure-time physical activityEating fewer calories and ≥200 min/wk leisure-time physical activityEating fewer calories and ≥300 min/wk leisure-time physical activityEating fewer calories and ≥420 min/wk leisure-time physical activity
 nPercentagenPercentagenPercentagenPercentagenPercentage
  • *

    Met dietary recommendation for weight loss and answered yes when asked “Are you using physical activity or exercise to lose weight?”

  • Unweighted number.

  • Percentage is weighted to be nationally representative.

  • §

    Significant difference between women and men totals (χ2 test p < 0.05).

  • Significant difference among BMI strata within sex (χ2 test p < 0.05).

Women trying to lose weight          
 Total16, 90446.1§8, 30819.4§5, 43412.9§3, 0297.2§1, 5883.8§
 BMI ≥ 30 kg/m24, 82843.72, 08815.91, 3369.97996.14173.0
 BMI 25 to 29.9 kg/m26, 50747.43, 22819.82, 11113.11, 1527.26104.1
 BMI < 25 kg/m25, 56946.82, 99222.51, 98715.51, 0788.35614.2
Men trying to lose weight          
 Total8, 33644.24, 85222.03, 51116.22, 19110.41, 3356.7
 BMI ≥ 30 kg/m23, 30444.91, 85321.31, 35216.084710.25206.4
 BMI 25 to 29.9 kg/m24, 26444.22, 53622.81, 81616.21, 11610.46856.9
 BMI < 25 kg/m276842.146321.634316.622810.81306.9

In light of varying physical activity recommendations related to weight control and general health, we assessed combinations of eating fewer calories with increasing physical activity levels. These leisure-time physical activity recommendations ranged from ≥150 to ≥420 min/wk. The prevalence of women who reported eating fewer calories and reported using physical activity to lose weight was significantly higher than men, but attainment of recommended levels of leisure-time physical activity was significantly higher for men than for women (Table 4). Among women, the prevalence of eating fewer calories and engaging in ≥150 min/wk of leisure-time physical activity was 19%, but decreased to 4% when leisure-time physical activity recommendations were increased to ≥420 min/wk. Among men, these prevalences were 22% and 7%, respectively. Attainment of both diet and leisure-time physical activity recommendations was significantly different by BMI among women; however, this was not observed among men.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgement
  8. References

We found that, in 2000, 46% of U.S. women and 33% of U.S. men reported trying to lose weight. The prevalence of trying to lose weight was slightly higher than that previously reported using the 1996 BRFSS, which indicated that 44% of women and 29% of men reported trying to lose weight (1). Although women were more likely to be trying to lose weight, their strategies were not very different from those of men. Women reported trying to lose weight at lower BMI levels than did men. Whereas 60% of overweight women were trying to lose weight, men did not reach this level until they were obese.

About one-half of respondents reported using fewer calories, and two-thirds reported using physical activity as weight loss strategies. We found, however, that only one-fifth of individuals trying to lose weight used a combination of reduced calories and the minimal recommended physical activity level of ≥150 min/wk. The percentage fell to 13% for women and 16% for men who combined reduced calories with the lower bound of the ACSM physical activity recommendation of 200 min/wk for weight loss and maintenance, and 7% of women and 10% of men combined reduced calories with the upper bound of the ACSM recommendation of 300 min/wk of physical activity. Thus, only a small fraction of those trying to lose weight attained recommended leisure-time physical activity levels combined with reduced calories for weight loss. Weight loss maintenance is critical for long-term success. Few individuals (4% of women and 7% of men) reduced calories and met the 420 min/wk or more of physical activity recommended by the IOM for preventing weight gain.

Education was the most consistently associated characteristic with trying to lose weight and with attainment of recommended strategies for weight loss. These associations were noted in a dose—response fashion, with increased prevalence and odds found as educational level increased. These associations have been previously reported (3). Education is frequently used as a covariate when assessing associations among health behaviors but rarely as the independent characteristic of interest. Our results indicate that respondents with less than a high school education consistently reported the lowest level of trying to lose weight and the lowest odds of using recommended strategies for weight loss. It may be helpful to tailor weight loss messages for this population.

Consistent with an earlier study (13), medical advice to lose weight was highly associated with reportedly trying to lose weight, even in those with BMI <25 kg/m2. In contrast with those who had not received advice, women who had received advice were ∼6 times more likely to report trying to lose weight and men were ∼10 times more likely. Because medical advice is strongly associated with trying to lose weight, clinicians should assess their patients’ risk of obesity-related conditions through anthropometric measurements (i.e., BMI, waist circumference) and identification of obesity-related comorbidities, and advise those who are overweight or obese to lose weight. From NHLBI clinical guidelines for the treatment of overweight and obesity (6), Serdula et al. (5) summarized a weight-loss counseling tool that uses the five As: 1) assess obesity risk, 2) ask about readiness to lose weight, 3) advise in designing a weight-control program, 4) assist in establishing appropriate intervention, and 5) arrange for follow-up. Counseling to help set realistic lifestyle change goals for calorie reduction (i.e., deficit of 500 to 1000 kcal/d from baseline), physical activity, and weight loss was encouraged and was based on the NHLBI guidelines (6).

Although advice was important in both sexes, women who had been advised to lose weight had lower odds of trying to lose weight than men for all BMI strata. Because women report trying to lose weight more frequently than men, it is likely that they have attempted weight loss during their lives, and medical advice to lose weight may not motivate women to the same degree as men.

It is noteworthy that both normal weight women and men who reported medical advice to lose weight had the highest odds of trying to lose weight. Perhaps normal weight respondents had less experience with weight loss than overweight and obese respondents; therefore, a higher proportion of normal weight respondents heeded the advice to try to lose weight. However, for a number of reasons, we caution readers when considering these high odds ratios. First, BMI strata were based on current self-reported weight at the time of survey administration, but the medical advice to lose weight may have been anytime during the prior year. Therefore, an individual could have been overweight at the time of the advice, lost or be losing weight, and had a BMI <25 kg/m2 when surveyed. Second, people tend to underreport their weight; therefore, their reported weight would place them in the normal weight strata, but their response of trying to lose weight would reflect their true weight. Finally, those who reported advice to lose weight may have solicited the advice from a medical professional based on their own feelings about their weight, regardless of what their BMI was.

Among those trying to lose weight, respondents advised to lose weight were more likely to report eating fewer calories to lose weight than those who received no such advice. Medical advice to lose weight was not associated with the use of physical activity to lose weight or with the combination of reduced calories and ≥150 min/wk leisure-time physical activity among women and men who were trying to lose weight. Thus, medical advice to lose weight was highly associated with trying to lose weight but generally not associated with meeting the minimal recommended strategies for weight loss. These results support the recommendation that weight loss counseling include advice regarding appropriate weight loss strategies (5,6,7,8,9).

Several study limitations must be considered. The cross-sectional BRFSS study design limits conclusions regarding causal relationships between characteristics such as physician counseling and weight control behaviors. A methodological limitation considered was the reliance on telephones to gather data. Persons without telephones differ from those with telephones in a number of chronic disease risk factors and are likely to be of lower socioeconomic status, more likely to report health problems that limit activities, more likely to be current smokers, and less likely to be physically active (18). Although these differences may exist, telephone-based research is unlikely to be seriously affected by coverage bias as long as telephone coverage is high (18). Poststratification weights in all analyses were used to minimize any potential coverage bias. Another limitation of this telephone-based survey is that all information is self-reported. The validity of self-reported weight and height has been studied; individuals tend to overreport their height and underreport their weight (19,20,21,22). Thus, overweight and obesity prevalence may be underestimated. Physical activity levels may be underestimated because only leisure-time activities were ascertained (no occupational or transportation activity), and in a study of the relationship between physical activity and mortality in a sample of women, the contribution of non-leisure (household chores) energy expenditure was 82% of women's total activity (23). Another limitation is that no information was collected on actual caloric consumption—eating fewer calories was not quantified, and it is not clear how many individuals who said they were eating fewer calories would actually meet the guidelines for a 500- to 1000-kcal/d reduction.

Although trying to lose weight is common among Americans, our findings suggest that few individuals who report trying to lose weight comply with even minimal dietary and physical activity recommendations for weight loss/control. A further concern is that minimal (NHLBI) dietary and physical activity recommendations are lower than recently published results of successful strategies for weight loss and maintenance (24,25). A study that illustrated successful strategies for weight loss and maintenance included random assignment to a treatment of high physical activity (∼75 min/d) or standard behavioral therapy for obesity (∼30 min/d). The high physical activity group had increased physical activity levels and greater weight loss compared with the standard behavioral therapy group (24). In a study of long-term weight loss maintenance, individuals who lost weight and kept it off used ongoing behavioral strategies of low-calorie diets (1450 kcal/d) and high levels of physical activity (>70 min/d) (25). Our study of 2000 BRFSS data found that 4% of female and 7% of male respondents who were trying to lose weight combined eating fewer calories with ≥60 min/d of leisure-time physical activity. Thus, few 2000 BRFSS survey respondents reported behaviors at the increased levels recommended by the IOM and shown to be useful for increased weight loss and prevention of weight gain.

The increasing prevalence of overweight and obesity in U.S. adults may be paralleled by increasing weight loss efforts. Findings from the study of 2000 BRFSS data indicate a slight increase from 1996 data in the prevalence of adults trying to lose weight; however, less than one-fifth met minimal recommendations for weight loss of eating fewer calories and participating in ≥150 min/wk of physical activity. Continued efforts are indicated to educate, motivate, and support overweight and obese adults to engage in the recommended weight loss behaviors of reduced calories and ≥150 min/wk of physical activity.

Footnotes
  • 1

    Nonstandard abbreviations: NHLBI, National Heart, Lung, and Blood Institute; ACSM, American College of Sports Medicine; IOM, Institute of Medicine; BRFSS, Behavioral Risk Factor Surveillance System.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgement
  8. References
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