Long-term weight loss success and the health behaviours of adults in the USA: findings from a nationally representative cross-sectional study

Kerem Shuval, Elisa Morales Marroquin, Qing Li, Gregory Knell, Kelley Pettee Gabriel, Jeffrey Drope, Amy L Yaroch, Karen G Chartier, Bob M Fennis, Mahmoud Qadan

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To describe the relationship between long-term weight loss (LTWL) success and lifestyle behaviours among US adults.

DESIGN: Serial cross-sectional data from National Health and Nutrition Examination Survey cycles 2007-2014.

SETTING AND PARTICIPANTS: Population-based nationally representative sample. The analytic sample included 3040 adults aged 20-64 years who tried to lose weight in the past year.

MEASURES: Participants were grouped into five LTWL categories (<5%, 5%-9.9%, 10%-14.9%, 15%-19.9% and ≥20%). Lifestyle-related behaviours included the following: alcohol intake, physical activity, smoking, fast-food consumption, dietary quality (Healthy Eating Index (HEI)) and caloric intake. Multivariable regression was employed adjusting for age, sex, race/ethnicity, marital status, education, household income and size, current body mass index and self-reported health status.

RESULTS: Individuals in the 15%-19.9% LTWL group differed significantly from the reference group (<5% LTWL) in their physical activity and dietary quality (HEI) but not caloric intake. Specifically, they had a higher HEI score (β=3.19; 95% CI 0.39 to 5.99) and were more likely to meet physical activity guidelines (OR=1.99; 95% CI 1.11 to 3.55). In comparison, the ≥20% LTWL group was significantly more likely to smoke (OR=1.63; 95% CI 1.03 to 2.57) and to consume lower daily calories (β=-202.91; 95% CI -345.57 to -60.25) than the reference group; however, dietary quality and physical activity did not significantly differ.

CONCLUSION: Among a national sample of adults, a higher level of LTWL success does not necessarily equate to healthy weight loss behaviours. Future research should attempt to design interventions aimed at facilitating weight loss success while encouraging healthy lifestyle behaviours.

Original languageEnglish
Article numbere047743
Pages (from-to)e047743-e047743
JournalBMJ Open
Issue number7
StatePublished - 14 Jul 2021

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


  • *epidemiology
  • *preventive medicine
  • *public health
  • Adult
  • Cross-Sectional Studies
  • *Diet
  • Health Behavior
  • Humans
  • Nutrition Surveys
  • United States
  • *Weight Loss
  • Diet
  • Weight Loss


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