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Fewer adults with obesity report trying to lose weight
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Adults in the United States continue to gain weight, yet fewer overweight or obese adults report attempting to lose weight, prompting a need for more rigorous discussions of weight issues between primary care providers and patients, according to research published in JAMA.
“Socially acceptable body weight is increasing,” Kassandra R. Snook, MPH, of Jiann-Ping Hsu College of Public Health at the Georgia Southern University, and colleagues wrote. “If more individuals who are overweight or obese are satisfied with their weight, fewer might be motivated to lose unhealthy weight.”
Snook and colleagues used data from the National Health and Nutrition Examination Survey to evaluate the trend in the proportion of adults with overweight or obesity trying to lose weight over three periods: 1988 to 1994, 1999 to 2004 and 2009 to 2014. A total of 27,350 participants aged 20 to 59 years who were overweight (BMI, 25 kg/m2 to <30 kg/m2) or obese (BMI, 30 kg/m2), were enrolled in the study; a majority of whom were white. Participants reported whether they tried to lose weight over the past 12 months. The researchers used modified Poisson regression to determine percentage ratios, as well as compare the percentage of overweight or obese adults with attempting to lose with over each period.
Results showed that the prevalence of overweight and obesity grew throughout the study from 52.72% (95% CI, 50.76-54.68) in 1988 to 1994, to 65.58% (95% CI, 63.53-67.63) in 2009 to 2014, while the percentage of adults with overweight and obesity trying to lose weight declined from 55.65% (95% CI, 53.61-57.69) in 1988-1994, to 49.17% (95% CI, 47.49-50.85) in 2009 to 2014. Black women had the highest prevalence of obesity (55.32%; 95% CI, 51.21-59.43) in 2009 to 2014), yet also had the largest decline in reporting efforts to lose weight (65.5% [95% CI, 62.73-68.26] in 1988 to 1994 vs. 54.88% [95% CI, 52.55-57.2] in 2009 to 2014), which according to the researchers is “especially concerning.” Among white men (P = .04) and women (P = .003) and black women (P = .002), there was a significantly declining trend in trying to lose weight.
These findings “may be due to body weight misperception reducing motivation to engage in weight loss efforts or primary care clinicians not discussing weight issues with patients,” Snook and colleagues concluded. “The chronicity of obesity may also contribute. 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.” – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Caroline M. Apovian, MD, FACP, FACN
This is an interesting analysis of adults who are overweight or obese over three time points during which overweight and obesity increased in prevalence in this country. While overweight/obesity prevalence increased, those adults with overweight or obesity who were trying to lose weight decreased. This analysis does not discern whether it was the BMI group in the overweight category vs. higher BMIs that experienced the decline in persons trying to lose weight. It is less concerning if it were those in the overweight category reporting the decline in efforts to lose weight rather than the obese category for obvious reasons. If it was those in the obese or extremely obese categories who experienced the decline in efforts to lose weight, then it can be hypothesized that there may be a sense of giving up that is permeating this population. Adults in the obese and extremely obese category suffer discrimination and social bias from being obese and may disproportionately become depressed without motivation to embark on lifestyle changes that might improve their health. Even more concerning would be the declining efforts in the black female population with overweight and obesity, since these groups are often challenged socioeconomically and are among our underserved populations. This is the segment that according to this study experienced the most precipitous decline in those trying to lose weight. A future study that would be important to perform in follow up would be an analysis of the decline in those trying to lose weight, stratified by BMI category: overweight, obese, and extremely obese. This study asks more questions than it answers at a time when we are at a crossroads of removing the stigmatization of obesity and supporting prevention and treatment efforts.
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