Weight perceptions, weight control and income: an analysis using British data

Relationships examined: Parent and child readiness to change and sociodemographic characteristics in family based weight loss treatment

BACKGROUND

Family based treatment is an effective, multipronged approach to address obesity as it plagues families.

OBJECTIVE

To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study.

METHODS

Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline.

RESULTS

A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (-0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, -0.10, p < 0.05), and Other, non-Hispanic (-0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non-Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change.

CONCLUSIONS

Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.

Rate of obesity within a mixed-breed group of horses in Ireland and their owners' perceptions of body condition and useability of an equine body condition scoring scale

BACKGROUND

Equine obesity is a significant health and welfare concern. The proportion of domestic horse populations that are overweight are as high as 45%. As the primary decision-makers for their horses' care, owners are theoretically ideally placed to identify whether their horses are appropriately conditioned, however, research in other countries has shown that many owners are unable to accurately judge their horse's body condition. In this study, through the comparison of body condition scoring (BCS) performed by an expert and the horse owners and interviews with owners, we aimed to identify the proportion of horses that were overweight or obese, to assess the accuracy of horse owners' BCS assessment both prior to and after receiving information and instructions on body condition scoring, and to identify common themes amongst owners' views regarding BCS assessment and the Henneke BCS system.

RESULTS

Forty-five percent of the horses in this study were overweight or obese. The agreement between the owners and an equine veterinarian regarding the horses' BCS was fair to good both prior to (κ = .311, P < 0.001; ICC = .502, P < 0.001) and after (κ = .381, P < 0.001; ICC = .561, P < 0.001) receiving information and instructions on scoring. Three quarters of the owners who took part in the study did not use any method of monitoring their horse's body condition. Thematic analysis of owner responses was varied, with the most common theme being an awareness of the need to monitor or make changes to their horse's condition with responses in this theme split between owners who felt in control and those who did not. Owner feedback on the utility and useability of the scorning system was that it was useful however parts are too technical or need improvement.

CONCLUSIONS

Equine obesity is a significant problem in this population in Ireland. Horse owners' ability to accurately judge their horse's condition does not improve with provision of instructions on body condition scoring. These results combined with owners' feedback on the Henneke BCS system indicate that it is not a tool that can be reliably used by owners.

Association between bodyweight perception, nutritional status, and weight control practices: A cross-sectional analysis from the Chilean Health Survey 2016–2017

This research aimed (1) to examine the agreement between body mass index (BMI)-based nutritional status and perceived nutritional status overall and by socio-demographic factors and (2) to state the association between the accuracy of weight perception and weight control practices in the Chilean adult population. A population-based cross-sectional study was carried out with 5,192 Chilean adult participants from the Chilean National Health Survey 2016–2017. Agreement between BMI-based weight status and body weight perception for the total sample and across subgroups was determined using the weighted kappa coefficient. The agreement between BMI-based and perceived nutritional status of the total sample was fair (kappa = 0.38). A higher rate of weight perception accuracy was identified in women, younger respondents, and participants with higher education, a higher income, and from urban areas than their counterparts. Respondents with overweight or obesity tended to underestimate their nutritional status. Actions to lose weight were higher in those who had the right perception of their overweight/obesity condition and those who overestimated their body weight, regardless of their nutritional status. In all groups, weight loss behaviors were more related to the perceived than the BMI-based nutritional status. The consequences of accurate perception of the nutritional status are discussed including its effects on body weight and mental health.

The Accuracy of Self-Perception of Obesity in a Rural Australian Population: A Cross-Sectional Study

Introduction:

Obesity is a major public health concern. Accurate perception of body weight may be critical to the successful adoption of weight loss behavior. The aim of this study was to determine the accuracy of self-perception of BMI class.

Methods:

Patients admitted to the acute medical service in one regional hospital completed a questionnaire and classified their weight as: “underweight,” “normal,” “overweight,” or “obese.” Reponses were compared to clinically measured BMIs, based on the WHO Classification. Patients were also questioned about health-related behavior. Data were analyzed via Pearson’s Chi-squared test.

Results:

Almost 70% of the participating patient population (n = 90) incorrectly perceived their weight category, with 62% underestimating their weight. Only 34% of patients who were overweight and 14% of patients with obesity correctly identified their weight status. Two-thirds of patients who were overweight and one-fifth of patients with obesity considered themselves to be “normal” or “underweight.” Patients with obesity were 6.5-fold more likely to misperceive their weight status. Amongst patients with overweight/obesity, those who misperceived their weight were significantly less likely to have plans to lose weight. Almost 60% had not made any recent health behavior changes. This is one of the first regional Australian studies demonstrating that hospitalized patients significantly misperceive their weight.

Conclusion:

Patients with overweight/obesity had significantly higher rates of weight misperception and the majority had no intention to lose weight or to undertake any health behavior modification. Given the association between weight perception and weight reduction behavior, it introduces barriers to addressing weight loss and reducing the increasing prevalence of obesity in rural Australia. It highlights that doctors have an important role in addressing weight misperception.

Weight Loss and Usage of an Online Commercial Weight Loss Program (the CSIRO Total Wellbeing Diet Online) Delivered in an Everyday Context: Five-Year Evaluation in a Community Cohort

BACKGROUND

Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss.

OBJECTIVE

This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years.

METHODS

Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: "stayers" were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while "starters" began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss.

RESULTS

Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (β=.263; P<.001), with higher usage associated with greater weight loss.

CONCLUSIONS

This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided. If the results demonstrated here can be achieved at an even greater scale, the potential social and economic benefits will be extremely significant.

Misclassification of Self-Reported Body Mass Index Categories

BACKGROUND

Overweight and obesity are an increasingly serious public health problem in Western societies, including Germany. The tendency of overweight and obese people not to classify themselves as such limits the efficacy of information on the health risks of these conditions and lessens the motivation to change behavior accordingly. In this article, we summarize the available study data on the selfperception of weight class. We present and discuss the differences between selfreported body-mass index (BMI) category and the actual category of the BMI when it is calculated from the individual's measured height and weight.

METHODS

We systematically searched the Medline, EMBASE, and Cochrane Library databases in August 2017 for pertinent publications. The study protocol was published in the PROSPERO register (CRD42017064230). Meta-analyses were calculable for a number of subgroup analyses.

RESULTS

A total of 50 studies from 25 countries were identified that contained findings on self-estimation of weight in a total of 173 971 study participants. The percentage of correct self-categorizations of BMI category varied from 16% to 83%, with marked heterogeneity of the population groups studied. In Europe, women overestimated their BMI category three times as often as men (RR: 3.22; 95% confidence interval: [2.87; 3.62], I2 = 0%). Most erroneous classifications were based on underestimates. Study participants of normal weight were more likely than others to categorize their BMI correctly. In European studies, 50.3-75.8% categorized their BMI correctly. Low socioeconomic status was associated with an incorrect perception of BMI.

CONCLUSION

The self-assignment of BMI categories is often erroneous, with underestimates being more common than overestimates. Physicians should take particular care to provide appropriate information to persons belonging to groups in which underestimating one's BMI is common, such as overweight people and men in general.

Prevalence and predictors of weight loss maintenance: a retrospective population-based survey of European adults with overweight and obesity

BACKGROUND

The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population-based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt.

METHODS

Participants (N = 2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self-weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n = 1272).

RESULTS

Mean (SD) self-reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty-three percent of the total sample had maintained weight loss of ≥5% for at least 1 month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r²  = 0.338, P < 0.001).

PRINCIPAL CONCLUSIONS

Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours.

The effect of personalised weight feedback on weight loss and health behaviours: Evidence from a regression discontinuity design

Using a regression-discontinuity approach on a U.K. longitudinal dataset, this research analyses whether personalised weight feedback resulted in individuals losing weight over a period of between 2 and 7 years. The analysis presented here finds that being told one was "overweight" had, on average, no effect on subsequent weight loss; however, being told one was "very overweight" resulted in individuals losing, on average, approximately 1% of their bodyweight. The effect of feedback was found to be strongly moderated by household income, with those in higher income households accounting for seemingly all of the estimated effect due, in part, to increased physical activity. These findings suggest that the provision of weight feedback may be a cost-effective way to reduce obesity in adults. They do however also highlight that the differential response to the provision of health information may be a driver of health inequalities and that the provision of feedback may bias longitudinal health studies.

Trends and correlates of unhealthy dieting behaviours among adolescents in the United States, 1999-2013

Background

The increase in adiposity problems among United States adolescents has been accompanied by persistently high prevalence of unhealthy dieting behaviours (UDBs) such as fasting, taking diet pills/powders/liquids, and vomiting/taking laxatives. This study aimed to examine the associations of self-perceptions of weight status, weight change intentions (WCIs) and UDBs with sex, age and race, as well as trends of UDBs in American adolescents across the weight spectrum.

Methods

Data come from the biennial cross-sectional, school-based surveys, the Youth Risk Behaviour Surveillance System (1999–2013, n = 113,542). The outcome measures were the self-reported UDBs: fasting for 24 h or more; taking diet pills/powders/liquids; and vomiting/taking laxatives. Sex-stratified logistic regressions assessed relationships between weight status misperceptions across all weight statuses, race and WCIs with UDBs. Differential trends between races were assessed using race*year interaction terms.

Results

In males, all non-White races had higher odds of fasting and vomiting/taking laxatives than Whites (except fasting in Hispanic/Latinos), with Adjusted Odds Ratios (AORs) between 1.44 and 2.07. In females, Black/African Americans and Hispanic/Latinos had lower odds of taking diet pills/powders/liquids compared to Whites (AORs 0.50 and 0.78 respectively). Racial disparities persisted throughout the study period. Prevalence of fasting and vomiting/taking laxatives did not change between 1999 and 2013 for all races, while taking diet pills/powders/liquids decreased. Compared to individuals of normal weight who were accurate weight status perceivers, individuals of almost all other combinations of weight status and weight status perception had significantly higher odds of displaying any UDB outcome. Overestimation of weight status was found to be the strongest determinant of UDBs. Compared to individuals endorsing "not wanting to do anything" about their weight, individuals endorsing all other WCIs (including wanting to gain weight) also showed significantly higher odds for every UDB outcome, with wanting to lose weight having AORs of the greatest magnitudes.

Conclusions

Prevalence of UDBs is persistently high, and highest among females across all racial groups. UDBs may elevate undesired weight gain and weight loss in individuals who are obese/overweight and underweight respectively. Further research into weight status perceptions among adolescents may inform efforts to reduce UDBs.

Support needs of patients with obesity in primary care: a practice-list survey

BACKGROUND

UK guidelines recommend that patients with obesity in primary care receive opportunistic weight loss advice from health care professionals, but there is a lack of research into the characteristics and existing weight management practices of these patients. The aim of this study was to characterise primary care patients with obesity in England, to inform the screening, support, and referral options appropriate to this group.

METHODS

We surveyed 1309 patients registered at 15 GP practices in North East England, aged ≥18 years and with objectively recorded obesity (BMI ≥ 30 kg/m2). Study participants reported their weight history, health status, past and current weight loss activities, motivating factors, weight loss strategies used, professional support received, and perceived barriers to weight loss.

RESULTS

62% of participants were actively trying to lose weight, and a further 15% had attempted and discontinued weight loss in the last 12 months. Only 20% of the sample had sought GP support for weight loss in the last 12 months; instead, most efforts to lose weight were self-guided and did not use evidence-based strategies. Those who sought GP weight loss support were likely to use it and find it motivating. Participants had attempted weight loss on multiple previous occasions and overall felt less confident and successful at maintaining weight loss than losing it. Participants at greatest clinical risk (higher BMI and more health conditions) reported particularly low confidence and multiple barriers to weight loss, but were nevertheless highly motivated to lose weight and keep it off.

CONCLUSIONS

We identified the need for informational, structural, and weight loss maintenance-specific support for GP patients with objectively-recorded obesity. Study participants were motivated to lose weight and keep it off, but lacked the confidence and understanding of effective strategies required to do this. GP weight loss support was acceptable and useful but underutilised, indicating that screening and brief referral interventions to structured programmes may augment patients' current weight management activities and meet key support needs whilst optimising limited primary care resources.

Assessment of Weight Management Practices among Adults in the United Arab Emirates

With a rise in global incidence of overweight and obesity, the number of patients seeking weight management (WM) advice is likely to increase. Our aim was to explore the prevalence of WM practices and investigate association of WM goals with sociodemographic variables and practices among United Arab Emirates (UAE) adults. An exploratory, cross-sectional research was conducted on 1275 adult males and females, residing in UAE. A structured questionnaire was administered. WM goals to lose/maintain/gain weight were reported in 88.3% participants. WM goals were significantly associated with age, sex, marital status, education, current body weight perception, and medical condition. Out of 21 selected WM practices, popular strategies included increasing physical activity (52.9%), eating less fat (51.1%), consuming fewer calories (43.3%), joining gym (27.5%), skipping meals (26.1%), and consuming natural herbs and teas (20.7%). Visiting dietitian (12.3%) ranked ninth in the order of preference. Males focused on physical activity, gyms, and wellness centers and females on calories counting, dietitian visits, meals replacement, skipping meals, and natural herbs/teas. Married adults reported eating less fat (54.3% versus 47.3%, p = 0.020); singles opted calories counting, gyms, and meals replacement. Frequent referral sources were friends (37.8%) and Internet (32.1%). Most UAE adults had WM goals that were associated with sociodemographic variables and WM practices. Awareness about the ill-effects of unhealthy WM practices and importance of dietitian's consultation are imperative.

An Analysis of Real, Self-Perceived, and Desired BMI: Is There a Need for Regular Screening to Correct Misperceptions and Motivate Weight Reduction?

We study the relationship among real, self-perceived, and desired body mass index (BMI) in 21,288 adults from the Mexican National Health and Nutrition Survey 2012, analyzing the effect of sex and diagnosis of obesity/overweight by a healthcare professional. Self-perceived and desired BMI are analyzed via a figure rating scale question and compared to real BMI. Only 8.8 and 6.1% of the diagnosed and non-diagnosed obese, respectively, correctly identify themselves as such. For the obese, 20.2% of non-diagnosed and 12.7% of diagnosed perceive themselves as normal or underweight, while 49.1 and 37% of these are satisfied with their perceived BMI. Only 7.8% of the obese, whose real and perceived BMI coincide, have a desired BMI equal to their perceived one. In contrast, 43.2% of the obese, whose perceived BMI is normal, have a desired BMI the same as their perceived one. Although the average desired body figure corresponds to the normal BMI range, misperceptions of BMI correlate strongly with the degree of satisfaction associated with perceived BMI, with larger misperceptions indicating a higher degree of satisfaction. Hypothesizing that the differences between real, perceived, and desired weight are a motivator for weight change, one potential intervention could be the periodic assessment of real, perceived, and desired BMI in order to correct misleading weight misperceptions that could potentially obstruct positive behavioral change.

Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis

The purpose of this systematic review and meta-analysis was to estimate the prevalence of personal weight control attempts (weight loss and/or maintenance) worldwide and to identify correlates, personal strategies used and the underlying motives. We included epidemiological/observational studies of adults (≥18 years) reporting prevalence of weight control attempts in the past-year. Seventy-two studies (n = 1,184,942) met eligibility criteria. Results from high quality studies showed that 42% of adults from general populations and 44% of adults from ethnic-minority populations reported trying to lose weight, and 23% of adults from general populations reported trying to maintain weight annually. In general population studies, higher prevalence of weight loss attempts was observed in the decade of 2000-2009 (48.2%), in Europe/Central Asia (61.3%) and in overweight/obese individuals and in women (p < 0.01). Of the 37 strategies (grouped in 10 domains of the Oxford Food and Activity Behaviours Taxonomy) and 12 motives reported for trying to control weight, exercising and dieting (within the energy compensation and restraint domains, respectively) and wellbeing and long-term health were the most prevalent. To our knowledge, this is the first systematic review to investigate weight control attempts worldwide. Key strategies and motives were identified which have implications for future public health initiatives on weight control.

The obesity penalty in the labor market using longitudinal Canadian data

A Canadian study of weight discrimination also known as the obesity wage-penalty. This paper adds to the limited Canadian literature while also introducing a causal model, which can be applied to future Canadian studies. A general working-class sample group is utilized with personal income, which removes many biases introduced in other studies. The evidence suggests that a 1-unit increase in lagged BMI is associated with a 0.7% decrease in personal for obese Canadian females. Similar to other studies, the male results are inconsistent. The evidence brought forward in this study can provide an effective financial incentive for health promotion among Canadians for law and policy makers. Beyond health reasons, these results can also be applied as empirical evidence of gender discrimination based on body image perception. The evidence suggests that male physique is not a contributing factor in income, but larger female physique is associated with lower personal income.

Do All Activities "Weigh" Equally? How Different Physical Activities Differ as Predictors of Weight

In Britain, it is recommended that, to stay healthy, adults should do 150 minutes of moderate-intensity physical activity every week. The recommendations provided by the U.K. government, however, remain silent in regard to the type of activity that should be done. Using the annual Health Survey for England we compare how different types of physical activities predict a person's weight. In particular, we consider clinically measured body mass index and waist circumference. We document mean slopes emanating from ordinary least squares regressions with these measures as the dependent variables. We show that individuals who walk at a brisk or fast pace are more likely to have a lower weight when compared to individuals doing other activities. Additionally, we highlight that the association between physical activity and weight is stronger for females and individuals over the age of 50. Our overall conclusions are robust to a number of specifications.

Obesity treatment in disadvantaged population groups: where do we stand and what can we do?

Obesity is now the second leading cause of death and disease in the United States leading to health care expenditures exceeding $147 billion dollars. The socioeconomically disadvantaged and racial/ethnic minority groups are at significantly increased risk for obesity. Despite this, low income and minority individuals are underrepresented in the current obesity treatment literature. Additionally, weight loss outcomes for these high risk groups are well below what is typically produced in standard, well-controlled behavioral interventions and reach and access to treatment is often limited. The use of telecommunications technology may provide a solution to this dilemma by expanding dissemination and allowing for dynamic tailoring. Further gains may be achieved with the use of material incentives to enhance uptake of new behaviors. Regardless of what novel strategies are deployed, the need for further research to improve the health disparities associated with obesity in disadvantaged groups is critical. The purpose of this manuscript is to review the weight loss intervention literature that has targeted socioeconomically disadvantaged and racial/ethnic minority populations with an eye toward understanding outcomes, current limitations, areas for improvement and need for further research.

Owner misperception of canine body condition persists despite use of a body condition score chart

Canine obesity is a prevalent disease, but many owners are unaware of it, partly due to misperception of their dog's body shape. Body condition scoring (BCS) is a simple method of assessing body composition, but whether it can reduce owner misperception is unclear. Our aim was to determine the effect of a BCS system on owners' ability to estimate the body condition of their dog. Information from 110 dog owners attending three UK veterinary practices was gathered, by interview, between March and April 2013. First, owners were asked to determine their dog's body condition without guidance, and then reassess it using a five-point BCS chart. Most owners (85/110, 77 %) believed the chart to have improved their ability to estimate the condition of their dog correctly. However, only a weak agreement existed between owner estimates and those of the primary investigator, both with (kappa (κ) = 0·28; P < 0·001) and without (κ = 0·32; P < 0·001) the BCS chart. Furthermore, most owners incorrectly estimated their dog's body condition, both with (71/110; 64 %) and without (72/110; 65 %) the chart (P = 1·00), with underestimation being most common (with = 63/71, 89 %; without = 66/72, 92 %; P = 0·57). Owners of overweight dogs more commonly misperceived their dog's body condition, both with (BCS 1-3: 5/35, 14 %; BCS 4-5: 64/75, 85 %; P < 0·001) and without (BCS 1-3: 10/35, 28 %; BCS 4-5: 61/75, 81 %; P < 0·001) the BCS chart. Thus, use of a five-point BCS chart does not improve accuracy of owners' perception of their dog's body shape, despite the accompanying perception that it does.

Psychological changes following weight loss in overweight and obese adults: a prospective cohort study

Background

Participation in weight loss programs is often associated with improved wellbeing alongside reduced cardio-metabolic risk. In contrast, population-based analyses have found no evidence of psychological benefits of weight loss, but this may be due to inclusion of healthy-weight individuals. We therefore examined cardio-metabolic and psychological changes following weight loss in a cohort of overweight/obese adults.

Methods

Data were from 1,979 overweight and obese adults (BMI ≥25 kg/m²; age ≥50 y), free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing. Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%. Logistic regression examined changes in depressed mood (eight-item Center for Epidemiologic Studies Depression score ≥4), low wellbeing (Satisfaction With Life Scale score <20), hypertension (systolic blood pressure ≥140 mmHg or anti-hypertensives), and high triglycerides (≥1.7 mmol/l), controlling for demographic variables, weight loss intention, and baseline characteristics.

Results

The proportion of participants with depressed mood increased more in the weight loss than weight stable or weight gain groups (+289%, +86%, +62% respectively; odds ratio [OR] for weight loss vs. weight stable = 1.78 [95% CI 1.29–2.47]). The proportion with low wellbeing also increased more in the weight loss group (+31%, +22%, −4%), but the difference was not statistically significant (OR = 1.16 [0.81–1.66]). Hypertension and high triglyceride prevalence decreased in weight losers and increased in weight gainers (−28%, 4%, +18%; OR = 0.61 [0.45–0.83]; −47%, −13%, +5%; OR = 0.41 [0.28–0.60]). All effects persisted in analyses adjusting for illness and life stress during the weight loss period.

Conclusions

Weight loss over four years in initially healthy overweight/obese older adults was associated with reduction in cardio-metabolic risk but no psychological benefit, even when changes in health and life stresses were accounted for. These results highlight the need to investigate the emotional consequences of weight loss.