Diet and physical activity behaviors among Americans trying to lose weight: 2000 Behavioral Risk Factor Surveillance System

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 > or =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, approximately 19% of women and 22% of men reported using fewer calories and > or =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.     

Attitudes and behaviors related to weight control in two diverse populations

BACKGROUND: Researchers have found that African-American women have concerns about their weight, but are less successful in their weight loss efforts compared to Caucasian women. Reasons for this disparity have not been explored in great detail. Identifying specific attitudes and behaviors that contribute to obesity in these subpopulations will help inform the design of interventions. METHODS: This report compares specific attitudes and behaviors related to diet and exercise in two groups who are trying to lose weight: African-American women in Indianapolis (n = 80) and Caucasian women from the rural Midwest (n = 45). Data are from surveys that shared many common measures, but were otherwise not related to one another. The choice of measures was guided by a conceptual framework of self-management processes. RESULTS: Compared to women in the urban study, women in the rural study report greater social support for behavior change, greater self-efficacy, and outcome expectations, and greater use of every strategy measured. CONCLUSIONS: While there is room for improvement in both groups, these results contribute to our understanding of subgroup differences and similarities in the complex behavioral issues surrounding successful weight management. Larger studies with more representative samples are needed to confirm these findings and inform future interventions.     

Healthy eating and exercise: strategies for weight management in the rural midwest.

Obesity prevalence has increased dramatically in the United States. Rural areas have been especially affected, yet few weight management studies have been conducted in these populations. This study was designed to assess weight management attitudes and strategies used when rural adults in particular attempt to lose weight, employing measures that are more specific than those reported in similar studies. The survey was completed by 123 adults aged 19 to 71, with a 29% response rate. Scales demonstrated good to excellent internal consistency, and test-retest reliability. Persons currently trying to lose weight were more likely to report self-monitoring behaviors and goal setting but no more likely to report use of specific behavioral strategies compared to persons not trying to lose weight. The results suggest considerable interest in weight management among rural adults and provide a starting point for planning future weight management interventions in this and similar populations.     

Attempting to lose weight: specific practices among U.S. adults

BACKGROUND: Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight. METHODS: Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003. RESULTS: Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m(2)) people (6% men, 24% women) than overweight (BMI>/=25 to 30 kg/m(2)) people (28%, 49%) or obese (BMI>/=30 kg/m(2)) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for >/=24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more. CONCLUSIONS: Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity.     

Individual,social and environmental factors and their association with weight in rural‐dwelling women

Objective: Obesity is a major public health concern and women living in rural settings present a high‐risk group. With contributing factors poorly explored, we evaluated their association with weight in rural Australian women. Methods: Women aged 18–50 years of any body mass index (BMI) were recruited between October 2012 and April 2013 as part of a larger, randomised controlled trial within 42 rural towns. Measured weight and height as well as self‐reported measures of individual health, physical activity, dietary intake, self‐management, social support and environmental perception were collected. Statistical analysis included linear regression for continuous variables as well as chi‐squared and logistic regression for categorical variables with all results adjusted for clustering. Results: 649 women with a mean baseline age and BMI of 39.6±6.7 years and 28.8±6.9 kg/m 2 respectively, were studied. Overall, 65% were overweight or obese and 60% overall reported recent weight gain. There was a high intention to self‐manage weight, with 68% attempting to lose weight recently, compared to 20% of women reporting health professional engagement for weight management. Obese women reported increased weight gain, energy intake, sitting time and prevalence of pre‐existing health conditions. There was an inverse relationship between increased weight and scores for self‐management, social support and health environment perception. Conclusions: Many women in rural communities reported recent weight gain and were attempting to self‐manage their weight with little external support. Implications for public health: Initiatives to prevent weight gain require a multifaceted approach, with self‐management strategies and social support in tandem with building a positive local environmental perception.     

The quantity and quality of physical activity among those trying to lose weight

BACKGROUND: Regular exercise to elicit caloric expenditure is an important component for achieving weight loss. The Healthy People 2000 objectives recommend regular sustained physical activity lasting 30 minutes, five days per week (Objective 1.3) particularly for weight loss. Moreover, this recommendation has been restated for weight loss and overall health benefits in the Centers for Disease Control and Prevention / American College of Sports Medicine (CDC/ACSM) statement and Surgeon General's Report (SGR) on Physical ActivitY and Health. Thus, we sought to identify the relative quality, and quantity of physical activity among people trying to lose weight. DESIGN: Cross-sectional self-reported data from the West Virginia Behavioral Risk Factor Surveillance System (BRFSS) were used. The BRFSS is a state-based telephone survey of adults that uses a multistage cluster design based on the Waksberg method of random-digit dialing. Data froM 2769 men and 4490 women were obtained from the 1992, 1994, and 1996 surveys. RESULTS: Half (49.6%) of individuals trying to lose weight did not engage in any physical activity. Further, only 15% of respondents trying to lose weight reported exercising regularly. Nevertheless, those trying to lose weight were more likely (OR [odds ratio] = 1.3; 95% CI [confidence interval], 1.14, 1.51, p < 0.001) to exercise regularly than those not trying to lose weight. In particular, women trying to lose weight were significantly more likely (OR = 1.45; 95% CI, 1.22,1.74, p < 0.001) to exercise regularly than women not trying to lose weight. Conversely, men trying to lose weight were no more likely to exercise regularly (p = .23) than men not trying to lose weight. Among respondents who were using exercise for weight loss, only 14.7% were expending > or =1000 kcal/week and 18.2% were expending > or =500 kcal/week. Weekly expenditure rates of > or =1000 kcal/week were more likely to occur among men (17%) than women (13.8%), in younger age groups, and among those with higher educational attainment. CONCLUSION: These data suggest that while certain individuals trying to lose weight are more likely to engage in regular physical activity, most persons trying to lose weight have not adopted regular physical activity as part of their weight loss practice. These results suggest that public health efforts to effectively integrate physical activity into weight control practices of West Virginians have been minimally successful.     

Interaction of body mass index and attempt to lose weight in a national sample of US adults: association with reported food and nutrient intake,and biomarkers

OBJECTIVE: This study examined the interaction between body mass index (BMI) and attempting to lose weight for reporting of: (1) macro- and micronutrient intake; (2) intake of low-nutrient-density foods; and (3) serum biomarkers of dietary exposure and cardiovascular disease risk. METHODS: Dietary, anthropometric and biochemical data were from the third National Health and Nutrition Examination Survey (1988-1994), n=13 095. Multiple regression methods were used to examine the independent associations of BMI, trying to lose weight, or the interaction of BMI-trying to lose weight with reported intakes of energy, nutrients, percentage energy from low-nutrient-density foods (sweeteners, baked and dairy desserts, visible fats and salty snacks), and serum concentrations of vitamins, carotenoids and lipids. RESULTS: BMI was an independent positive predictor (P<0.05) of percentage of energy from fat, saturated fat, but a negative predictor of the ratio of reported energy intake to estimated expenditure for basal needs (EI/BEE), percentage of energy from carbohydrate and alcohol (men only), and serum concentrations of folate, vitamin C, vitamin E and most carotenoids in both men and women. Trying to lose weight was a negative predictor (P<0.05) of EI/BEE, intake of energy, and energy density, but not micronutrient intake. Higher mean serum ascorbate, vitamin E, lutein/zeaxanthin, and other carotenoids (men only) concentrations were associated with trying to lose weight (P<0.05) in both men and women. Few adverse BMI-trying to lose weight interaction effects were noted. CONCLUSIONS: There was little evidence of increased nutritional risk in those reportedly trying to lose weight irrespective of weight status.     

Effects of body image on dieting,exercise, and anabolic steroid use in adolescent males

This cross-sectional survey study examined body image, dieting and exercise variables, and steroid use in 2,088 high-school graduates aged 18 years. In contrast to women, more men wished to gain (46%) rather than lose weight (32%). Men who wished to gain weight were more satisfied with their body shape, showed no fear of fatness, and dieted and exercised less frequently than did men who wished to lose weight. The prevalence of dieting was low (4%), even among men who wished to lose weight (9%), and physical exercise was more likely to be used for both weight loss and weight gain. Contrary to expectations, anabolic steroid use was rare (0.6%) and was not associated with a desire for weight gain. Steroid users were more likely to engage in running and swimming than football. The data did not support the notion that anabolic steroid use is widespread among high-school males. © 1995 by John Wiley & Sons, Inc.     

Weight-control practices of adults in a rural community

Abstract: Obesity is recognised as a significant public health problem, and health authorities are concerned with promoting a healthy weight for all adults. However, there is a paucity of data about community weight-control practices. We surveyed weight-control behaviour, strategies and goals in a population-based sample of 1342 adults living in rural Victoria. In addition to the 20 per cent of adults who were attempting to lose weight, 22 per cent were actively trying to maintain their present weight or to avoid weight gain. Those taking action for their weight most often did so for health-related reasons, and most of the strategies used were those recommended by health authorities. However, some adults, particularly women, adopted potentially unhealthy weight-control practices. One in four women whose weight was acceptable was trying to lose weight, and 14 per cent of women had a weight goal that was below the acceptable range. Conversely, 50 per cent of men had a weight goal higher than that currently considered acceptable. Additional research is required to assess more accurately the specific nature of community weight-control practices     

Peer Reviewed: Dietary Practices, Dining Out Behavior, and Physical Activity Correlates of Weight Loss Maintenance

Introduction

Loss of excess weight can improve blood lipids, insulin sensitivity, and blood pressure. However, data are scant on behavioral strategies related to maintenance of weight loss. We examined dietary practices, physical activity, and self-efficacy among adults self-reported to be successful at maintaining weight loss.

Methods

Using the 2004 Styles survey, a mailed survey of U.S. adults aged 18 years or older, we examined behaviors associated with weight loss maintenance among people who reported trying to lose weight. We analyzed data on number of daily fruit and vegetable servings, minutes per week of physical activity, dining out behavior, and confidence in one''s ability to engage in behavioral strategies. We conducted frequency and multivariable logistic regression analyses.

Results

More men (35.5%) than women (27.7%) were classified as successful weight loss maintainers. Compared with adults who reported eating at a fast-food restaurant two or more times per week, adults who reported not eating at fast-food restaurants were more successful at weight loss maintenance (odds ratio, 1.62; 95% confidence interval, 1.09–2.42). Compared with adults who consumed fewer than five fruit and vegetable servings per day and were sedentary, adults who consumed fewer than five fruit and vegetable servings per day and accrued 420 minutes or more per week of physical activity or consumed five or more fruit and vegetable servings and accrued 150 minutes or more per week of activity were more successful at weight loss maintenance.

Conclusion

The behavioral strategy of reducing consumption of fast foods could assist people in keeping weight off. The combined approach of consuming five or more fruit and vegetable servings per day and attaining 150 minutes or more per week of physical activity was a common strategy among adults successful at weight loss maintenance.     

Lean and weight stable: behavioral predictors and psychological correlates

OBJECTIVE: To examine behavioral characteristics associated with being lean and weight stable during adulthood. RESEARCH METHODS AND PROCEDURES: Participants included 165 white married couples who were part of a larger longitudinal study. Participants' height and weight were measured on three occasions at 2-year intervals. Men and women were classified as being lean and weight stable (the target group) if they had a BMI < 25 at baseline and maintained their weight within 5% of baseline at 2nd and 4th year follow-up. Individuals not fulfilling these criteria were included in the comparison group. Group differences in background characteristics including childhood weight status, BMI at each occasion, dieting history, and mental and physical health history were examined. In addition, multiple measures of dietary intake and physical activity were obtained and used to predict the likelihood of being in the target group. RESULTS: Men (N = 22) and women (N = 36) in the target group had lower mean BMI scores at each occasion, were less overweight during childhood, were less likely to have dieted in the past year, and rated themselves as being more healthy than men and women in the comparison group. No differences were identified in mental health. Relative to the comparison group, women in the target group reported higher levels of physical activity and higher levels of physical activity among their spouses, and men in the target group reported healthier dietary patterns. DISCUSSION: Results from this study suggest that being lean and weight stable in adulthood is linked to childhood weight status in combination with dietary and activity patterns during adulthood.     

Weight control practices in adults: results of a multistate telephone survey.

In this study, data collected in 1989 in a random-digit dialing telephone survey of 60,590 adults in 38 states and the District of Columbia were analyzed. Approximately 38% of women and 24% of men reported that they were currently trying to lose weight. Methods reported were counting calories (24% of women, 14% of men), participating in organized weight loss programs (10%, 3%), taking special supplements (10%, 7%), taking diet pills (4%, 2%), and fasting for 24 hours or longer (5%, 5%). Among both sexes, only half of those trying to lose weight reported using the recommended method of caloric restriction combined with physical activity.     

Obesity and weight control practices in 2000 among veterans using VA facilities

OBJECTIVE: To examine obesity prevalence and weight control practices among veterans who use Department of Veterans Affairs (VA) medical facilities (VA users). RESEARCH METHODS AND PROCEDURES: Data from the 2000 Behavioral Risk Factor Surveillance System, a telephone survey of 184,450 adults, were analyzed. Outcome measures included BMI, weight control practices (the intent to manage weight, and diet and physical activity patterns), and receipt of professional weight control advice. RESULTS: Of VA users, 44% were overweight and 25% were obese. After controlling for demographic factors, VA users were somewhat less likely to be overweight (odds ratio, 0.86; 95% confidence interval, 0.74 to 1.00) but equally likely to be obese (odds ratio, 1.08; 95% confidence interval, 0.92 to 1.27), compared with non-VA users. Among obese VA users, 75% reported trying to lose weight, and another 17% reported trying to maintain weight. Of these, only 40% decreased both calorie and fat intake. Only 27% of obese VA users who reported increasing exercise to lose weight followed recommendations for regular and sustained physical activity. Of obese VA users, 59% were inactive or irregularly active. Only 51% of obese VA users received professional advice to lose weight. Obese VA users were more likely than obese non-VA users to report trying to lose weight, modifying diet to lose weight by decreasing both calories and fat intake, and receiving professional weight control advice. DISCUSSION: Interventions for weight management programs in VA facilities need to take into account the high prevalence of overweight/obesity among VA users and should emphasize effective weight control practices.     

Weight-loss practices and asthma: findings from the behavioral risk factor surveillance system

OBJECTIVE: To describe weight-control practices and receipt of weight-loss advice among obese people with asthma. RESEARCH METHODS AND PROCEDURES: We analyzed data from the 2000 Behavioral Risk Factor Surveillance System. RESULTS: Among 13953 participants with current asthma, 27.3% had a body mass index of >or=30 kg/m2. Overall, 48.1% of participants with asthma reported trying to lose weight (64.1% among overweight or obese participants and 72.9% among obese participants). Among participants with asthma who were trying to lose or maintain weight, 74.7% reported trying to reduce their energy and/or fat intake, and 57.8% reported using physical activity. Approximately 29.7% were using the recommended combination of energy and/or fat intake reduction and physical activity of >or=150 min/wk. During the 12 months before the interview, 16.2% of overweight and 44.9% of obese participants with asthma reported receiving advice to lose weight. Among obese participants receiving weight-loss advice, 82.9% reported trying to lose weight compared to 63.8% of participants who did not receive such advice. DISCUSSION: Health professionals can play an important role in educating their patients with asthma about the importance of weight control and assisting their overweight and obese patients in setting appropriate weight goals and helping them achieve those goals.     

Sex differences in the relation of weight loss self-efficacy, binge eating, and depressive symptoms to weight loss success in a residential obesity treatment program

The aim of the current study was to examine whether weight loss self-efficacy, binge eating, and depressive symptoms predicted weight loss during treatment, and whether gender moderates these associations with prospective data from 297 participants (223 women and 74 men) enrolled in a residential obesity treatment program. Men reported higher initial levels of self-efficacy than women, whereas women reported greater pre-treatment levels of binge eating and depressive symptoms. Higher pre-treatment levels of weight control self-efficacy, binge eating, and depressive symptoms predicted greater weight loss in men, but not in women. Results suggest that certain psychological and behavioral factors should be considered when implementing weight loss interventions, and indicate a need to consider gender differences in predictors of weight loss treatment. Future research should seek to identify predictors of weight loss among women.     

1985 NHIS findings: nutrition knowledge and baseline data for the weight-loss objectives

A nutrition objective for the nation is that, by 1990, 50 percent of the overweight population should have adopted weight regimens, balancing diet and physical activity. More than half of the overweight respondents in the 1985 National Health Interview Survey were trying to lose weight, and almost half of this group reported both increasing their physical activity and decreasing their intake of calories. Dietary restriction without exercise was the next most common weight-loss regimen, suggesting that educational efforts should emphasize the need to increase physical activity as part of appropriate weight-loss regimens. Attempts to lose weight were reported frequently among those of normal and lean weight as well as among those who were overweight, especially among women and the better educated. About one-fifth of already lean young women reported attempting weight loss, an indication that some inappropriate dieting is probably occurring, suggesting the need for caution in public health promotion of weight loss. Another 1990 objective is that 90 percent of adults should understand that eating fewer calories or increasing activity, or both, is essential to lose weight. More than 70 percent of adults in this survey were able to identify these as the two best ways to reduce weight, with greater proportions of the younger adults and the more highly educated being knowledgeable. The survey also provided data for an objective that targets some nutrition education and counseling as part of all routine health contacts with health professionals by 1990. Twenty-nine percent of all women and 22 percent of all men reported that eating proper foods was discussed sometimes or often in routine contacts.     

Perceived health risk of excess body weight among overweight and obese men and women: differences by sex

OBJECTIVES: To describe perceptions of health risk from excess body weight among adults, and assess if lack of perceived risk was associated with trying to lose weight. METHODS: Sex-specific logistic regression models were used to determine odds of disagreement that one's weight is a health risk and odds of trying to lose weight among overweight (BMI=25.0-29.9 kg/m(2), n=1296) and obese (BMI> or =30 kg/m(2), n=1335) adult participants in the 2004 Styles' surveys. RESULTS: Men were more likely than women to disagree their body weight was a health risk (among the overweight, 62% vs. 43%; the obese 20% vs. 14% obese). Disagreement with risk was associated with good health status and race/ethnicity among both sexes and lower education and income among women. Odds of currently trying to lose weight were significantly lower among obese men who disagreed, and overweight men and women who were neutral or disagreed that their body weight was a health risk. CONCLUSIONS: Many overweight and obese adults do not perceive their weight to be a health risk; this perception was associated with lower prevalence of trying to lose weight, particularly among men. Discussion by clinicians about the health risks of excess weight may alter perceived risk and help promote weight loss efforts.     

Goal setting frequency and the use of behavioral strategies related to diet and physical activity

Goal setting is an effective way to focus attention on behaviorchange. Theoretically, frequency of goal setting may indicatethe level of commitment to diet and physical activity behaviorchange. Yet, little is known about the association between goalsetting frequency and use of specific diet or physical activity-relatedstrategies. This study examines whether changes in goal settingfrequency predict changes in use of behavioral strategies overtime, controlling for baseline strategy use, demographics andwhether a person was trying to lose weight. Data are from abaseline and 1-year follow-up survey of adults in rural Iowa(n = 385). Overall, goal setting frequency was positively associatedwith use of the strategies measured, at baseline and overtime.Frequent goal setting that is focused specifically on diet orphysical activity was more predictive of using dietary or physicalactivity strategies, respectively, than goal setting focusedon weight loss overall. The study provides empirical supportfor what has been assumed theoretically, that is, frequent goalsetting for weight management is an indicator of use of specificbehavioral strategies. Significant challenges remain in regardto maintenance of this activity and attainment of weight lossgoals. Received on March 31, 2006; accepted on August 24, 2006     

Individual and environmental correlates of dietary fat intake in rural communities: A structural equation model analysis

Total dietary fat and saturated fat intake are associated with obesity, elevated cholesterol, and heart disease. This study tested a multi-group structural equation model to explore differences in the relative influence of individual, social, and physical environment factors on dietary fat intake amongst adults aged 40–70 years. Participants from four rural Georgia, U.S., counties (n = 527) completed a cross-sectional survey that included questions about eating patterns and individual and social influences on healthy eating. Observational measures of nutrition environments in stores and restaurants in these counties also were completed. Models for both women and men found significant positive relationships between self-efficacy for healthy eating and perceived nutrition environments and family support for healthy eating. The association between self-efficacy for eating a low-fat diet and frequency of eating out and grocery shopping was negative for both genders. The home nutrition environment was associated with dietary fat intake for women but not men. The results indicate that the influence of individual and environmental factors on dietary fat intake differs for men and women, with the home environment playing a larger role for women in rural communities.