Physical Activity and Health Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Chronic Disease Nutrition Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Abstract
Background
There is limited population-based data on behavioral factors found to be important for successful weight loss maintenance among adults.
Methods
Data from the 2004 Styles surveys, mailed to U.S. adults aged ≥18 years were used to examine the difference in selected weight loss strategies and attitudes among persons who reported successful weight loss attempts (lost weight and able to keep it off) and persons who were not successful (previous attempts to lose weight were unsuccessful or they could not keep the lost weight off). Behaviors examined included modification of diet, leisure-time and sports activities, and self-monitoring, and barriers to weight management.
Results
Among adults who reported losing weight or trying to lose weight, 31.0% had been successful at both losing weight and maintenance after weight loss. Successful weight loss status differed by sex, age, and current weight status. Assessment of reported weight loss strategies, found that exercising ≥30 minutes/day and adding physical activity to daily life were significantly higher among successful versus unsuccessful weight losers. Individuals who were successful at weight loss and maintenance were less likely to use over-the-counter diet products than those who were unsuccessful at weight loss. Significantly more successful versus unsuccessful weight losers reported that on most days of the week they planned meals (35.9% vs. 24.9%), tracked calories (17.7% vs. 8.8%), tracked fat (16.4% vs. 6.6%), and measured food on plate (15.9% vs. 6.7%). Successful losers were also more likely to weigh themselves daily (20.3% vs. 11.0%). There were a significantly higher proportion of successful losers who reported lifting weights (19.0%) versus unsuccessful (10.9%). The odds of being a successful weight loser were 48%–76% lower for those reporting exercise weight control barriers were influencing factors (e.g., no time, too tired to exercise, no one to exercise with, too hard to maintain exercise routine) compared to those who reported little or no influence of exercise; similarly, the odds were 48–64% lower for those who found certain dietary barriers to be influential (e.g., eat away from home too often, diet/health food costs too much).
Conclusion
Self-monitoring strategies such as weighing oneself, planning meals, tracking fat and calories, exercising 30 or more minutes daily, and/or adding physical activity to daily routine may be important in successful weight loss maintenance. Leisure-time activities such as lifting weights or cooking/baking for fun are common strategies reported by those who were successful weight losers.
Background
Almost half of Americans are trying to lose weight
For successful weight loss, The National Heart, Lung, and Blood Institute
The purpose of this descriptive paper is to examine differences in reported weight loss strategies, lifestyle activities, and perceived barriers to healthy weight among free-living adults who reported successful weight loss (lost weight and kept it off) and their counterparts who were not successful (lost weight but could not keep it off or were not able to lose weight). We describe the most common dietary practices, leisure-time physical activities, and sports, as well as self-monitoring behaviors (dietary measures and weighing oneself), and perceived barriers to weight loss, including time to exercise, cost of healthy foods, and social support.
Methods
We examined data from Styles 2004, which is based on the results of three consumer mail panel surveys administered in two waves. The sampling and data collection for Styles 2004 were conducted by Synovate, Inc. The Synovate, Inc. consumer mail panel contains approximately 600,000 potential respondents. Respondents are recruited to join the mail panel through a 4-page questionnaire. In return for their participation, respondents were given small gifts (e.g., a 20-minute calling card) and were entered into a monetary sweepstakes. Content experts from several health agencies, including the Centers for Disease Control and Prevention, assisted with the development of questions. The initial wave – ConsumerStyles – was fielded May through June 2004. Stratified random sampling was used to generate a list of 10,000 potential respondents, who received the ConsumerStyles survey. The main sample (N = 5,500) was stratified (or balanced) on region, household income, population density, age, and household size to be representative of the U.S. population. A low-income/minority supplement (N = 1,500) was used to ensure adequate representation of these groups. Finally, a households-with-children supplement (N = 3,000) was used to ensure adequate numbers of potential respondents for a separate study of children called YouthStyles (part of the second wave). In 2004, a total of 6,207 people completed the ConsumerStyles survey, yielding a response rate of 62%.
Following the loss of 32 people from the ConsumerStyles panel during July-August 2004, the remaining 6,175 households that had completed the ConsumerStyles survey were mailed the HealthStyles survey. Responses were received from 4,345 of these households, for a response rate of 70%. Data on health and lifestyle used in the present analysis were mainly from the HealthStyles survey, while demographic characteristic were obtained from the ConsumerStyles.
Definition of variables
Weight control behavior
Respondents self-identified their weight history experience. The lead-in to the questions on weight control history was: "Overall, what BEST describes your experience with your weight?" Respondents were asked to select one of the following: 1) I lost weight and have been able to keep it off, 2) I've lost weight but haven't been able to keep it off, 3) I've tried to lose weight but haven't been successful, 4) I've maintained my weight with conscious effort, 5) I've maintained my weight without effort, 6) I've gained weight and haven't tried to lose it, and 7) I pay no attention to my weight. Participants who reported that they lost weight and had been able to keep it off were defined as "successful weight losers", those who reported they had lost weight, but were unable to keep it off or had tried to lose weight but had not been successful were defined as "unsuccessful weight losers".
Weight control strategies
The 2004 Styles survey asked respondents about strategies to aid with losing weight or maintaining weight loss: "Below are some strategies people use to lose or maintain their weight. In the past 12 months, which of the following have you tried?" There were 18 strategies: 1) Reduce the amount of food you eat, 2) Exercise an average of at least 30 minutes per day, 3) Eat more fruits and vegetables, 4) Eat reduced calorie products, 5) Reduce high carbohydrate foods like bread or potatoes, 6) Eat smaller portion sizes, 7) Cut out sweetened beverages, 8) Eat reduced-carbohydrate food products, 9) Eat reduced-fat-products, 10) Count calories, 11) Reduce sedentary activities, 12) Consume over-the-counter diet products, 13) Reduce the amount of food prepared away from home, 14) Consume meal replacement products, 15) Incorporate physical activity into daily routines, 16) Go to formal weight loss program, 17) Keep a food diary, or 18) Use Internet web-site with individualized diet program. Respondents were also asked to report on their weekly weight control practices: "Which of the following, if any, do you do most days of the week?" and were asked to select all that applied from a list of 6 items. These items included: 1) Track how many calories you eat, 2) Track how many carbohydrates you eat, 3) Track how many grams of fat you eat, 4) Plan your meals and snacks throughout the day, 5) Think about the amount of food you put on your plate, and 6) Measure the amount of food you put on your plate. Respondents who did not select any of the listed activities were classified as "not specified". An additional question on the frequency of weighing oneself was asked in a separate question, "How frequently do you weigh yourself?" Respondents could select every day, every week, every month, every couple of months, about once a year or less, or never.
Physical activity/sports and leisure-time activity
Respondents were also asked to report all physical activities/sports they engage in from a list of 18 specific activities: "Which of the following physical activities/sports do you participate in regularly?" These items included baseball/softball, basketball, jogging/running, walking, biking, bowling, golf, exercise class, lifting weights, yoga/meditation, karate/martial arts, swimming, hiking, hunting/fishing, camping, skiing/snowboarding, tennis, and volleyball. In addition, respondents were asked to select leisure-time activities that they enjoyed doing regularly from a list of 29 possible activities. For descriptive purposes, we combined various items considered similar in energy expenditure (e.g., playing computer games and playing video games). Respondents who did not select any of the activities were classified as "not specified".
Barriers to losing weight or maintaining weight loss
Respondents were asked about 9 possible barriers to weight control: "The following is a list of possible reasons that keep people from losing weight or maintaining a healthy weight." For each item, respondents were asked to characterize its influence using a 7-point Likert scale (1 = no or little influence; 7 = influences a lot). The items were as follows: 1) I eat away from home too often, 2) I'm often too tired to exercise, 3) I like to eat junk food/have a sweet tooth, 4) I don't have time to exercise, 5) I don't really pay attention to what I'm eating, 6) I don't have anyone to exercise with me, 7) Diet/healthy foods are not as filling/still feel hungry, 8) It is too hard to stick with an exercise routine, and 9) Diet/healthy foods cost too much. For regression analysis, responses 1–3 were combined to create "no influence", 4 represented neutral and 5–7 were combined to represented "influence."
Statistical analysis
From the 4,345 respondents to HealthStyles, we chose as our analytic sample to the 2,124 participants who were classified as successful weight losers (n = 587, 14.4%) or unsuccessful weight losers (n = 1,537, 32.1%). We excluded respondents who had maintained weight with or without effort (n = 1,363, 32.9%), gained weight and had not tried to lose it (n = 355, 8.5%), paid no attention to their weight (n = 304, 7.6%) or were missing data on weight loss or maintenance (n = 199, 4.7%). Participants with missing height or weight (n = 77) or those who reported extreme height or weight values (outside the 1st–99th percentile in the 1999–2002 National Health and Nutrition Examination Survey) (n = 44) were also excluded. We also excluded female respondents who stated that they were currently pregnant or who did not respond to the question on pregnancy (n = 52). After exclusions the final sample numbered 1,958 (some participants met one or more exclusion criteria).
We compared successful and unsuccessful weight losers by their demographic characteristics, weight-loss strategies, self-monitoring behaviors, and activities also compared them by nine barriers described. Because of the multiple testing involved, we selected p = 0.01 as our level of significance for the chi-square test to reduce the type II error probability. We used multivariable logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for successful weight loss (versus unsuccessful) in a model that included sex, age, race, education, annual household income and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). We also used multivariable logistic regression models that adjusted for sex, age, race, education, annual household income, and BMI to assess the relation between being a successful weight loser and specific barriers to losing or maintaining weight. Missing data because of no response were excluded from the individual comparisons. All analyses were conducted using SAS-callable (version 9.1, Cary, NC) SUDAAN (version 9.0 Research Triangle Institute, Research Triangle Park, NC) to account for the complex sampling design and weighting procedure.
Results
In our final analytic sample of successful and unsuccessful weight losers, one-third (30.96%) were successful at losing weight and keeping their weight off. The chances of being in the successful group were lower for women (adjusted OR = 0.63, 95%CI = 0.48-0.81) than men (the referent) (Table
Prevalence of successful and unsuccessful weight loss and adjusted odds of being successful by demographic characteristics – Styles Survey 2004.
Sample size
Successful
Unsuccessful
Na
%
(se)b
%
(se)
aORc
(95% CI)
Sex
1,958
30.96
(1.35)
69.04
(1.35)
Male
745
35.78
(2.20)
64.22
(2.20)
1.00
Female
1,213
27.36
(1.67)
72.64
(1.67)
0.63
(0.48–0.81)
Age
18–29
132
39.72
(5.66)
60.28
(5.66)
1.00
30–44
713
25.62
(1.82)
74.38
(1.82)
0.51
(0.30–0.89)
45–64
811
25.83
(1.67)
74.17
(1.67)
0.58
(0.34–1.00)
65+
302
44.05
(3.04)
55.95
(3.04)
1.21
(0.69–2.12)
Race/ethnicity
White
1,404
29.65
(1.51)
70.35
(1.51)
1.00
Black
204
32.99
(4.06)
67.01
(4.06)
1.50
(0.96–2.32)
Hispanic
234
34.05
(4.35)
65.95
(4.35)
1.20
(0.81–1.79)
Otherd
116
37.03
(6.90)
62.97
(6.90)
1.88
(0.51–1.53)
Education
College grad
571
34.03
(2.47)
65.97
(2.47)
1.00
Some College
716
27.34
(2.07)
72.66
(2.07)
0.78
(0.55–1.09)
<=High school
599
29.35
(2.27)
70.65
(2.27)
0.84
(0.58–1.24)
missing
72
43.71
(7.88)
56.29
(7.88)
1.28
(0.63–2.61)
Annual household income
>60 K
744
29.00
(1.81)
71.00
(1.81)
1.00
25–60 K
647
30.89
(2.41)
69.11
(2.41)
1.23
(0.90–1.68)
<25 K
567
33.79
(2.89)
66.21
(2.89)
1.15
(0.79–1.67)
Body mass index
<25.0
383
58.55
(2.99)
41.45
(2.99)
1.00
25.0<=<30.0
655
32.27
(2.39)
67.73
(2.39)
0.31
(0.22–0.42)
30.0<=<35.0
502
20.18
(2.13)
79.82
(2.13)
0.16
(0.11–0.24)
>35.0
418
14.70
(2.63)
85.30
(2.63)
0.12
(0.07–0.19)
a Unweighted sample size.
b Standard error.
c Odds ratio adjusted for sex, age, race/ethnicity, education, income, and BMI. CI indicates confidence interval.
d Includes American Indian, Alaska Native, Asian, Native Hawaiian, and Other Pacific Islander.
The five most common weight-control behaviors did not differ significantly (p > 0.005) between successful and unsuccessful weight losers: reduced amount of food consumed (79.60%; 82.39%), more fruits and vegetables consumed (71.37%; 65.91%), smaller portions (64.57%; 64.98%), fewer fatty foods (60.13%; 57.66%), and no sweetened beverages (56.50%; 52.57%) (Table
Most common weight-loss strategies reported among successful losers and unsuccessful weight losers – Styles Survey, 2004
Successful
Unsuccessful
(n = 543)
(n = 1,415)
χ2
n
%
(se)a
%
(se)a
p-value
Strategy:
Reduced amount of food
1,602
79.60
(2.21)
82.39
(1.19)
0.268
More fruits & vegetables
1,325
71.37
(2.25)
65.91
(1.53)
0.049
Smaller portions
1,271
64.57
(2.69)
63.98
(1.51)
0.849
Fewer fatty foods
1,134
60.13
(2.68)
57.66
(1.55)
0.425
No sweetened beverages
1,001
56.50
(2.67)
52.57
(1.56)
0.207
Exercise ≥30 min/day
780
46.91
(2.73)
37.54
(1.52)
0.003*
Add physical activity to daily routine
735
46.70
(2.75)
34.88
(1.48)
<0.001*
Reduce high-carbohydrate foods
882
40.45
(2.58)
45.36
(1.55)
0.108
Eat reduced-fat products
696
39.61
(2.70)
35.10
(1.51)
0.147
Reduced-calorie products
767
38.50
(2.61)
40.35
(1.56)
0.542
Reduce food prepared away from home
702
36.36
(2.62)
37.84
(1.58)
0.628
Eat reduced-carbohydrate food products
521
26.00
(2.23)
26.67
(1.44)
0.800
Reduce sedentary activity
379
21.96
(2.12)
16.97
(1.17)
0.039
Count calories
348
19.74
(2.09)
18.34
(1.32)
0.572
Food diary
251
12.97
(1.71)
13.05
(1.13)
0.965
Meal-replacement products
284
10.82
(1.66)
15.48
(1.08)
0.019
Over-the-counter diet products
273
10.36
(1.81)
15.89
(1.13)
0.010*
Formal weight-loss program
158
7.37
(1.48)
8.47
(0.81)
0.514
Web-site with individualized diet plan
73
2.60
(0.64)
5.33
(0.92)
0.016
Not specified
25
4.1
(0.90)
2.4
(0.44)
0.086
a Standard error.
*Significant difference between successful and unsuccessful (p < 0.01).
Analysis of self-monitoring behaviors (conducted most days of the week) showed numerous significant differences by weight loss status (Table
Self-monitoring behaviors (dietary and body weighing) done on most days of the week among successful and unsuccessful weight losers – Styles Survey, 2004
Successful
Unsuccessful
(n = 543)
(n = 1,415)
χ2
Behavior:
n
%
(se)a
%
(se)a
p-value
Monitor amount of food on plate
1,169
63.22
(2.70)
56.80
(1.57)
0.039
Plan meals
559
35.90
(2.61)
24.88
(1.35)
0.000*
Track carbohydrates
293
18.40
(1.94)
13.51
(1.05)
0.026
Track calories
226
17.73
(1.99)
8.84
(0.80)
<0.001*
Track fat
181
16.40
(1.97)
6.57
(0.73)
<0.001*
Measure food on plate
187
15.89
(1.89)
6.73
(0.76)
<0.001*
Not specified
399
14.06
(2.27)
24.61
(1.44)
0.001*
Weigh oneself (frequency)
Daily
270
20.30
(2.03)
11.00
(0.91)
Less often
1,674
79.70
(2.03)
89.00
(0.91)
<0.001
a Standard error.
*Significant difference between successful and unsuccessful (p < 0.01).
The item about the frequency of weighing oneself was asked in a separate question.
Among both successful and unsuccessful weight losers, walking was the most common physical activity/sports (61.51% versus 56.41% difference not significant) (Table
Physical activities/sports reported by successful losers and unsuccessful weight losers – Styles Survey, 2004
Successful
Unsuccessful
(n = 543)
(n = 1,415)
χ2
Activity:
n
%
(se)a
%
(se)a
p-value
Walking
1,152
61.51
(2.65)
56.41
(1.57)
0.100
Lifting weights
229
19.01
(2.31)
10.86
(1.11)
0.002*
Biking
219
15.95
(2.35)
10.51
(0.95)
0.035
Hunting/fishing
231
15.05
(2.17)
11.54
(1.10)
0.152
Exercise class
209
13.77
(2.07)
9.35
(0.82)
0.049
Camping (overnight)
262
13.17
(1.71)
14.09
(1.26)
0.665
Swimming
240
11.93
(1.77)
12.83
(1.07)
0.664
Jogging/running
136
9.86
(1.57)
6.71
(0.79)
0.073
Hiking
143
8.07
(1.45)
8.00
(0.99)
0.968
Basketball
81
7.68
(1.91)
3.81
(0.62)
0.057
Golf
122
7.52
(1.24)
6.83
(0.83)
0.647
Bowling
126
7.34
(1.73)
7.09
(0.81)
0.895
Not specified
95
15.0
(1.79)
22.7
(1.31)
0.001
Yoga/meditation
83
5.52
(1.13)
4.07
(0.66)
0.268
Baseball/softball
79
5.43
(1.20)
3.97
(0.62)
0.278
Tennis
42
3.61
(1.04)
2.17
(0.51)
0.214
Volleyball
51
2.83
(1.01)
3.23
(0.65)
0.742
Skiing/snowboarding
38
2.21
(0.61)
2.16
(0.52)
0.951
Karate/martial artsb
18
1.65
(0.59)
0.42
(0.15)
0.045
*Significant difference between successful and unsuccessful significant (p < 0.01).
a Standard error.
b Estimates are unstable by National Center for Health Statistics standards (se [standard error]/estimate>0.3).
Leisure-time activities reported by successful losers and unsuccessful weight losers – Styles Survey, 2004
Successful
Unsuccessful
(n = 543)
(n = 1,415)
χ2
Activity:
n
%
(se)a
%
(se)a
p-value
Listening to music
1,609
85.43
(1.60)
82.79
(1.09)
0.178
Reading
1,162
60.67
(2.72)
57.17
(1.57)
0.264
Arts/crafts/collecting
1,041
50.67
(2.74)
53.08
(1.56)
0.446
Going out to or renting movies
946
46.66
(2.79)
51.05
(1.57)
0.165
Playing cards/board games
926
45.70
(2.74)
47.09
(1.57)
0.659
Cooking/baking for fun
772
45.59
(2.74)
36.48
(1.49)
0.004*
Playing computer/video games
851
45.56
(2.81)
45.19
(1.58)
0.907
Shopping for fun
829
44.04
(2.72)
40.55
(1.51)
0.264
DIY home projects/parties
815
43.39
(2.72)
41.10
(1.56)
0.466
Gardening
840
42.78
(2.61)
38.65
(1.50)
0.167
Picnics/parks
615
32.75
(2.53)
30.66
(1.52)
0.478
Going to beach/lake
604
32.29
(2.61)
32.05
(1.51)
0.937
Gambling/casino/lottery tickets
663
31.67
(2.48)
37.67
(1.58)
0.043
Zoo/theme/water parks
584
30.35
(2.60)
31.02
(1.52)
0.826
Religious activities
585
28.92
(2.47)
28.12
(1.36)
0.777
Going to theater/symphony
380
22.56
(2.31)
19.22
(1.18)
0.199
Attending sports events
437
22.38
(2.28)
23.55
(1.37)
0.659
Going to nightclubs/bars
201
15.42
(2.53)
11.70
(1.16)
0.188
Book club
216
10.92
(1.55)
11.12
(1.04)
0.915
Adult education classes
148
8.28
(1.30)
6.49
(0.68)
0.222
Not specified
4
0.7
(0.36)
0.8
(0.29)
0.822
a Standard error.
*Significant difference between successful and unsuccessful significant (p < 0.01).
The following groups on the questionnaire were collapsed: playing cards and playing board games; playing computer games and playing video games; arts & crafts, collecting (dolls, cards), sewing/needlework, photography, and woodworking; gambling/casino and lottery tickets/scratch off; zoo and theme parks.
After adjustment for covariates, the odds of being a successful weight loser were 48%–76% lower for those reporting that exercise aspects were influencing factors (i.e., no time to exercise, too tired to exercise, no one to exercise with, too hard to maintain exercise routine) compared to those who reported little or no influence of exercise as a weight control barrier (Table
Prevalence of successful and unsuccessful weight loss by the influence of various barriers and odds of successful weight loss by barrier-Styles Survey, 2004
Successful
Unsuccessful
(n = 543)
(n = 1,415)
n
%
(se)a
%
(se)a
ORb
95% CI
Barrierc:
Too tired to exercise
No influence
551
48.45
(2.97)
20.95
(1.21)
1.00
Neutral
285
16.68
(2.49)
14.33
(1.05)
0.49
(0.33, 0.72)
Influence
1078
34.87
(2.60)
64.72
(1.46)
0.24
(0.19, 0.32)
No time to exercise
No influence
773
55.56
(2.79)
35.17
(1.50)
1.00
Neutral
374
16.66
(2.33)
20.35
(1.31)
0.46
(0.33, 0.65)
Influence
765
27.78
(2.46)
44.48
(1.58)
0.41
(0.31, 0.56)
Too hard to maintain exercise routine
No influence
636
51.71
(2.80)
24.99
(1.30)
1.00
Neutral
353
18.72
(2.39)
18.62
(1.21)
0.42
(0.31, 0.59)
Influence
929
29.58
(2.58)
56.40
(1.55)
0.26
(0.20, 0.35)
No one to exercise with
No influence
985
62.24
(2.76)
46.46
(1.57)
1.00
Neutral
292
12.21
(1.51)
15.29
(1.17)
0.67
(0.48, 0.95)
Influence
627
25.55
(2.67)
38.25
(1.60)
0.52
(0.39, 0.70)
Eat away from home too often
No influence
973
61.50
(2.89)
42.42
(1.54)
1.00
Neutral
292
12.71
(2.18)
17.18
(1.20)
0.56
(0.37, 0.84)
Influence
656
25.80
(2.69)
40.40
(1.59)
0.36
(0.27, 0.49)
Diet/health foods not satisfying
No influence
873
59.54
(2.83)
41.10
(1.55)
1.00
Neutral
398
22.09
(2.14)
22.09
(1.33)
0.58
(0.40, 0.83)
Influence
637
23.87
(2.61)
36.82
(1.54)
0.44
(0.33, 0.59)
Don't pay attention to diet
No influence
853
61.17
(2.60)
40.18
(1.54)
1.00