Despite Rising Obesity, Fewer Are Trying to Lose Weight

Marlene Busko

March 07, 2017

Over the past 20 years, the percentage of American adults who are overweight or obese has slowly crept up, but at the same time, fewer people report that they are trying to lose weight, according to a new study.

Moreover, it is "especially concerning" that obesity rates are now highest among black women, yet rates of weight-loss attempts are also declining rapidly in this population segment, Kassandra R Snook, MPH, from Georgia Southern University, in Statesboro, and colleagues write in a research letter published in the March 7 issue of the Journal of the American Medical Association.

They also suggest a few clinical, society, and patient factors that might explain the results.

Ms Snook and colleagues analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1988–1994, 1999–2005, and 2009–2014.

They identified 27,350 participants who were 20 to 59 years old, overweight (body mass index [BMI] >25 to <30 kg/m2) or obese (BMI >30 kg/m2), and had replied to the question: "During the past 12 months, have you tried to lose weight?"

During 1988–1994, 1999–2005, and 2009–2014, the prevalence of overweight and obesity increased stepwise from 53% to 62% to 66%.

However, the percentage of individuals with excess weight who were trying to lose weight dropped and plateaued, going from 56% to 47% to 49%.

Delving deeper showed that "black women bear a disproportionate burden of excess body weight and associated morbidity," but they also had one of the greatest declines in rate of attempting to lose weight, Ms Snook and colleagues observe.

In 2009–2014, more than half of black women (55%) were obese, and the percentage of overweight or obese black women who were attempting to lose weight fell by 11% from 1988–1994 to 2009–2014 (P for trend < .01).

Rates Overweight or Obese Adults Trying to Lose Weight, Obesity Rates

  Trying to lose weight in 1988–1994, %* Trying to lose weight in 2009–2014, %* Obese in 2009–2014, %
Total sample 56 49 34
White men 46 39 32
Black men 38 41 35
Mexican American men 36 34 38
White women 73 62 32
Black women 66 55 55
Mexican American women 59 57 48
*Rates among overweight or obese adults aged 20 to 59

After adjustment for family income, age, and body weight, black women were not the only group in which there was a significant trend for a decline in self-reported efforts to lose weight (P for trend = 0.002); this was also the case for white women (P = .003) and white men (P for trend = .04).

Among possible study limitations was the fact that the sample did not include older adults, and some survey respondents may have falsely said they were trying to lose weight since this would be perceived more favorably (social desirability bias).

Potential Explanations

The decrease in attempts to lose weight in an increasingly overweight or obese general population might be due to several clinician, society, and patient factors, Ms Snook and colleagues speculate — for example, perhaps "primary-care clinicians [are] not discussing weight issues with patients?"

Or excess weight may be becoming more "socially acceptable," and "more individuals who are overweight or obese are satisfied with their weight, [so] fewer might be motivated to lose unhealthy weight," they suggest.

Or people may have lost and regained weight many times over the past two decades.

"The longer adults live with obesity, the less they may be willing to attempt weight loss, in particular if they had attempted weight loss multiple times without success," the researchers conclude.

The authors disclose that they have no relevant financial relationships.

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JAMA. Published online March 7, 2017. Article

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