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Diet and Physical Activity
Diet and Physical Activity Behaviors among
Americans Trying to Lose Weight: 2000
Behavioral Risk Factor Surveillance System
Connie L. Bish,* Heidi Michels Blanck,† Mary K. Serdula,† Michele Marcus,‡ Harold W. Kohl III,† and
Laura Kettel Khan†
Abstract
BISH, CONNIE L., HEIDI MICHELS BLANCK, MARY
K. SERDULA, MICHELE MARCUS, HAROLD W.
KOHL III, AND LAURA KETTEL KHAN. Diet and
physical activity behaviors among Americans trying to lose
weight: 2000 Behavioral Risk Factor Surveillance System.
Obes Res. 2005;13:596– 607.
Objective: To examine the prevalence and correlates of trying
to lose weight among U.S. adults, describe weight loss strate-
gies, 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 ⱖ18 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 medi-
cal 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 respon-
dents who were trying to lose weight, ⬃19% of women and
22% of men reported using fewer calories and ⱖ150
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.
Key words: BMI, overweight, physician advice, recom-
mendation, use
Introduction
Weight loss is a common concern for many Americans
(1); in 1998, about one-third of Americans reported that
they were trying to lose weight (2,3). Despite these efforts,
U.S. obesity rates increased from 23% (1988 to 1994) to
31% (1999 to 2000) (4). Because of this increase, physi-
cians and other medical professionals can expect to encoun-
ter overweight or obese persons in clinical settings (5).
Decreased calorie intake and increased physical activity
are the cornerstones of weight control (6 – 8). Overweight
and obese individuals are advised to reduce energy intake
levels by 500 to 1000 kcal/d to lose weight (6,9). Reduced
calorie intake is the most important dietary component for
weight loss; reducing dietary fat alone without reducing
calories is not shown to be effective (6,10,11).
The physical activity level recommended to lose weight
or prevent weight gain varies. In 1998, the National Heart,
Lung and Blood Institute (NHLBI)
1
advised 30 to 45 min-
utes of moderate physical activity 3 to 5 d/wk for weight
loss and maintenance, with a long-term goal of achieving
ⱖ30 minutes on most, preferably all, days of the week
Received for review April 22, 2004.
Accepted in final form December 20, 2004.
The costs of publication of this article were defrayed, in part, by the payment of page
charges. This article must, therefore, be hereby marked “advertisement” in accordance with
18 U.S.C. Section 1734 solely to indicate this fact.
*Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical
Sciences, Emory University, Atlanta, Georgia; †Division of Nutrition and Physical Activity,
Centers for Disease Control and Prevention, Atlanta, Georgia; and ‡Department of Epide-
miology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Address correspondence to Laura Kettel Khan, Division of Nutrition and Physical Activity,
Centers for Disease Control and Prevention, 4770 Buford Hwy., NE, Mailstop K26, Atlanta,
GA 30341.
E-mail: ldk7@cdc.gov
Copyright © 2005 NAASO
1
Nonstandard abbreviations: NHLBI, National Heart, Lung, and Blood Institute; ACSM,
American College of Sports Medicine; IOM, Institute of Medicine; BRFSS, Behavioral Risk
Factor Surveillance System.
596 OBESITY RESEARCH Vol. 13 No. 3 March 2005
(ⱖ150 min/wk) (6). In 2001, the American College of
Sports Medicine (ACSM) advised eventual progression to
200 to 300 min/wk of moderate exercise for long-term
weight loss and maintenance (9). In 2002, the Institute of
Medicine (IOM) recommended 60 minutes daily (420 min/
wk) of moderate-intensity physical activity to prevent
weight gain (12).
An analysis of Behavioral Risk Factor Surveillance Sys-
tem (BRFSS) data from 1996 found that only one-fifth of
Americans who were trying to lose weight used the recom-
mended minimal combination of reducing calories and par-
ticipating in ⱖ150 min/wk of leisure-time physical activity
(1), and only 42% of obese adults who had visited a phy-
sician in the previous 12 months for a routine checkup
reported being advised to lose weight by their health care
provider (13).
The objectives of this study, which used data from the
2000 BRFSS, were to examine the prevalence and correlates
of trying to lose weight, describe weight control strategies
among U.S. adults who reported trying to lose weight, and
assess attainment of combined dietary and physical activity
recommendations for weight loss and weight gain preven-
tion among U.S. adults who reported that they were trying
to lose weight.
Research Methods and Procedures
The BRFSS is a telephone survey conducted by state
health departments. Each state, the District of Columbia,
and Puerto Rico selected an independent probability sample
of non-institutionalized residents ⱖ18 years of age. In 2000,
184,450 persons responded to the BRFSS survey; descrip-
tions of BRFSS survey methods have been previously pub-
lished (14). The median 2000 Council of American Survey
Research Organizations response rate was 48.9% (range,
28.8% to 71.8%) (15).
Respondents were asked, “Are you now trying to lose
weight?” Those who answered yes were asked, “Are you
eating either fewer calories or less fat to lose weight?”
Response options were 1) “Yes, fewer calories”; 2) “Yes,
less fat”; 3) “Yes, fewer calories and less fat”; or 4) “No.”
We defined respondents who followed the minimal dietary
recommendation for weight loss as those who reported
consuming fewer calories (1 or 3 above). We did not con-
sider those who answered “Yes, less fat” as meeting the
weight loss dietary recommendation.
Respondents were asked, “Are you using physical activ-
ity or exercise to lose weight?” Those trying to lose weight
who answered yes were categorized as “using physical
activity or exercise” for weight loss. To determine weekly
minutes of leisure-time physical activity, participants were
asked if they had participated in physical activity or exer-
cises during the past month and were questioned further to
determine the type, duration, and frequency of the two
leisure-time physical activities they had participated in most
frequently during the preceding month. Based on four rec-
ommended physical activity levels from national organiza-
tions, leisure-time physical activity was categorized into
four levels (ⱖ150, ⱖ200, ⱖ300, and, ⱖ420 min/wk). These
categories are not mutually exclusive.
At the end of the interview, respondents were asked to
report their current height and weight without shoes. We
calculated BMI as weight (kilograms) divided by height
(meters squared) and grouped respondents in the following
three categories: normal weight (⬍25.0 kg/m
2
), overweight
(25.0 to 29.9 kg/m
2
), and obese (ⱖ30.0 kg/m
2
) (6).
Age in years, race/ethnicity, education level, and smok-
ing status were determined by survey question responses
(16). Medical advice regarding weight was determined by
asking, “About how long has it been since you last visited
a doctor for a routine checkup?” Respondents were later
asked, “In the past 12 months, has a doctor, nurse, or other
health professional given you advice about your weight?”
Responses were categorized as 1) Yes, lose weight; 2) Yes,
maintain weight; or 3) No advice. A fourth category, 4) No
doctor seen in past 12 months, was defined for respondents
who indicated that they had not seen a physician in the past
12 months when they answered the question about how long
it had been since they visited a doctor.
Individuals were excluded from analysis if they did not
report height and/or weight (n ⫽ 8268); did not report
weight control behaviors (n ⫽ 2348), age, race/ethnicity, or
education (n ⫽ 1692); were pregnant (n ⫽ 2218); were
outside sex-specific reference values from the Third Na-
tional Health and Nutrition Examination Survey 1989 to
1994 (17) for height, weight, or BMI (n ⫽ 141); did not
report components used to determine weekly leisure-time
physical activity minutes (n ⫽ 88); did not report smoking
status (n ⫽ 431); were missing information about their last
routine checkup (n ⫽ 1732); were missing information
about medical advice regarding weight in the past 12
months (n ⫽ 199); or reported advice to gain weight (n ⫽
3018). Failure to report height and weight occurred more
frequently than any other data omission and accounted for
loss of ⬃4% of the sample. The 99.9th percentile cut-point
for leisure-time physical activity represented respondents
who either reported or had data entered as ⱖ7.14 h/d (3000
min/wk). We determined this level of leisure-time physical
activity to be excessive and also excluded these observa-
tions from analysis (n ⫽ 128). The final analytic sample
consisted of 164,187 respondents.
Analysis of eating fewer calories and weekly minutes of
leisure-time physical activity as indicators of attainment of
weight loss recommendations was limited to respondents
who answered yes to the question “Are you now trying to
lose weight?” (n ⫽ 64,799).
We used SAS (version 8.02; SAS Institute, Cary, NC)
and SUDAAN (version 8.02; Research Triangle Institute,
Research Triangle Park, NC) for statistical analysis to ac-
Behaviors of Americans Trying to Lose Weight, Bish et al.
OBESITY RESEARCH Vol. 13 No. 3 March 2005 597
count for the complex sampling design. Because of poten-
tial differing effects by sex and weight, all analyses were
stratified by sex and BMI. Key independent variables of
interest were age, race/ethnicity, education, smoking status,
and medical advice regarding weight.
2
tests were used to
test between-group differences for proportions. We set sta-
tistical significance at p ⬍ 0.05 for all comparisons.
Variables associated with trying to lose weight were
determined using logistic regression to estimate prevalence
odds ratios for trying to lose weight (n ⫽ 64,799) vs. doing
nothing about weight (n ⫽ 40,919). Respondents who re-
ported trying to maintain weight (n ⫽ 58,469) were ex-
cluded from this analysis. Variables associated with weight
loss strategies among those trying to lose weight were
Table 1. Prevalence of trying to lose weight
Characteristics
Women
Total
(n ⴝ 94,536)
BMI > 30 kg/m
2
(n ⴝ 19,455)
BMI 25 to 29.9 kg/m
2
(n ⴝ 27,666)
BMI < 25 kg/m
2
(n ⴝ 47,415)
n* Percentage† n* Percentage† n* Percentage† n* Percentage†
Overall 42,776 46.3 13,425 70.0 16,117 59.9 13,234 28.9
Age (years)
18 to 29 7,025 45.6 1,668 78.5 2,295 71.5 3,062 31.0
30 to 39 9,436 51.4 2,769 76.2 3,350 67.9 3,317 34.0
40 to 49 9,884 51.3 3,144 71.1 3,603 66.5 3,137 32.4
50 to 59 7,783 51.4 2,778 70.8 3,062 61.0 1,943 31.7
60 to 69 4,770 43.4 1,781 64.1 2,011 51.5 978 23.2
ⱖ70 3,878 29.8 1,285 55.7 1,796 39.6 797 13.0
Race or ethnicity
Non-Hispanic white 32,959 45.6 9,555 69.4 12,408 60.9 10,996 29.5
Non-Hispanic black 3,733 46.2 1,904 68.4 1,332 47.9 497 20.0
Hispanic 4,168 50.9 1,458 73.4 1,663 62.8 1,047 29.5
Other 1,916 44.6 508 76.6 714 67.0 694 29.0
Education
Less than high school 4,459 42.7 2,091 62.5 1,571 49.4 797 19.7
High school graduate 13,535 45.5 4,700 69.8 5,233 56.7 3,602 26.5
Some college or
technical school 12,987 49.1 3,947 73.3 4,930 63.8 4,110 31.7
College graduate 11,795 46.0 2,687 73.6 4,383 66.5 4,725 31.2
Smoking status
Current 8,414 42.0 2,419 69.5 3,104 57.5 2,891 26.3
Former 10,331 51.7 3,328 70.9 3,982 62.8 3,021 33.6
Never 24,031 45.9 7,678 69.8 9,031 59.5 7,322 28.4
Medical advice regarding
weight
Yes, lose weight 8,939 80.8 5,279 81.0 2,928 83.3 732 70.8
Yes, maintain weight 663 34.2 144 40.5 242 39.6 277 29.2
No advice 24,767 40.6 5,634 63.5 9,773 55.2 9,360 27.4
No doctor seen in past
12 months 8,407 45.7 2,368 69.1 3,174 61.3 2,865 29.4
* Unweighted number.
† Percentage is weighted to be nationally representative.
Behaviors of Americans Trying to Lose Weight, Bish et al.
598 OBESITY RESEARCH Vol. 13 No. 3 March 2005
determined using logistic regression to estimate prevalence
odds ratios for those who were eating vs. not eating fewer
calories, using vs. not using exercise or physical activity,
and combining vs. not combining fewer calories and ⱖ150
min/wk of leisure-time physical activity.
Results
The majority of respondents were non-Hispanic whites
between 24 and 54 years of age who had completed high
school. Fifty-eight percent of respondents were women,
37% were overweight, and another 20% were obese.
Table 1. Continued
Men
Total
(n ⴝ 69,651)
BMI > 30 kg/m
2
(n ⴝ 14,593)
BMI 25 to 29.9 kg/m
2
(n ⴝ 32,069)
BMI < 25 kg/m
2
(n ⴝ 22,989)
n* Percentage† n* Percentage† n* Percentage† n* Percentage†
22,023 32.8 8,935 62.8 11,086 35.9 2,002 9.5
3,129 27.3 1,113 63.0 1,550 36.8 466 8.4
4,478 30.8 1,874 60.7 2,244 31.6 360 7.7
5,295 35.9 2,278 62.6 2,585 36.7 432 10.5
4,471 41.0 1,926 66.0 2,185 40.7 360 14.6
2,814 37.0 1,155 63.1 1,460 38.4 199 11.3
1,836 26.4 589 60.5 1,062 31.3 185 7.5
17,525 32.8 6,960 63.5 9,013 36.3 1,552 9.1
1,351 30.9 751 64.2 524 28.2 76 6.3
1,987 34.5 830 60.4 957 35.2 200 11.8
1,160 32.1 394 54.7 592 45.5 174 13.4
2,082 28.1 1,020 55.3 889 28.9 173 7.5
6,107 30.4 2,768 59.9 2,880 31.5 459 7.2
5,911 32.4 2,510 63.1 2,919 35.4 482 9.0
7,923 37.4 2,637 70.1 4,398 42.8 888 12.6
3,898 24.5 1,573 56.0 1,958 29.1 367 5.8
7,776 38.8 3,251 66.3 3,955 40.2 570 11.1
10,349 33.4 4,111 63.3 5,173 36.3 1,065 10.9
5,013 76.8 3,203 80.6 1,672 72.1 138 59.6
274 22.7 71 40.5 157 25.3 46 13.5
10,013 28.0 3,173 55.4 5,736 33.3 1,104 8.8
6,723 28.9 2,488 57.4 3,521 33.1 714 8.8
Behaviors of Americans Trying to Lose Weight, Bish et al.
OBESITY RESEARCH Vol. 13 No. 3 March 2005 599
The overall prevalence of trying to lose weight was
higher among women (46%) than among men (33%; Table
1). The prevalence of trying to lose weight increased from
a low of 6% for men with BMI ⬍25 kg/m
2
who were
current smokers to highs of 83% for overweight women and
81% for obese men who were advised to lose weight by a
medical professional. Women and men who reported med-
ical advice to lose weight had the highest prevalence of
trying to lose weight. This category was also the most
consistent across all BMI categories and ranged from 71%
to 83% among women and from 60% to 81% among men.
Among women and men, the adjusted odds of trying to
lose weight vs. doing nothing about weight was generally
lower at older ages, higher with higher education status,
lower for current smokers, generally higher for former
smokers, and higher for those advised by a medical profes-
sional to lose weight (Table 2). Overall, women had 6 times
the odds of trying to lose weight when advised to lose
Table 2. Odds of trying to lose weight vs. nothing
Characteristic
Women
Total
(n ⴝ 61,546)
BMI > 30 kg/m
2
(n ⴝ 15,841)
BMI 25 to 29.9 kg/m
2
(n ⴝ 19,991)
BMI < 25 kg/m
2
(n ⴝ 25,714)
OR* 95% CI OR* 95% CI OR* 95% CI OR* 95% CI
Age (years)
18 to 29 1.00 1.00 1.00 1.00
30 to 39 1.16 1.04 to 1.29 0.90 0.66 to 1.22 0.76 0.56 to 1.04 1.06 0.93 to 1.21
40 to 49 1.20 1.08 to 1.34 0.80 0.59 to 1.08 0.85 0.63 to 1.15 0.97 0.85 to 1.12
50 to 59 1.02 0.91 to 1.15 0.64 0.47 to 0.87 0.51 0.37 to 0.69 0.91 0.77 to 1.07
60 to 69 0.69 0.61 to 0.77 0.55 0.40 to 0.75 0.37 0.27 to 0.51 0.49 0.41 to 0.59
ⱖ70 0.32 0.28 to 0.36 0.40 0.29 to 0.55 0.19 0.14 to 0.26 0.19 0.16 to 0.22
Race or ethnicity
Non-Hispanic white 1.00 1.00 1.00 1.00
Non-Hispanic black 0.67 0.61 to 0.75 0.88 0.71 to 1.07 0.48 0.40 to 0.58 0.35 0.28 to 0.42
Hispanic 0.91 0.80 to 1.03 1.17 0.88 to 1.56 0.76 0.59 to 0.96 0.74 0.62 to 0.89
Other 0.75 0.63 to 0.89 1.10 0.72 to 1.69 1.18 0.76 to 1.82 0.66 0.52 to 0.83
Education
Less than high school 0.82 0.74 to 0.91 0.64 0.52 to 0.79 0.63 0.51 to 0.78 0.70 0.59 to 0.84
High school graduate 1.00 1.00 1.00 1.00
Some college or technical
school 1.18 1.09 to 1.28 1.06 0.88 to 1.29 1.32 1.12 to 1.54 1.31 1.17 to 1.46
College graduate 1.18 1.09 to 1.29 1.17 0.92 to 1.49 1.58 1.32 to 1.88 1.44 1.28 to 1.62
Smoking status
Current 0.59 0.54 to 0.63 0.82 0.67 to 1.01 0.65 0.54 to 0.76 0.58 0.52 to 0.65
Former 1.39 1.28 to 1.51 1.15 0.95 to 1.39 1.47 1.25 to 1.73 1.40 1.24 to 1.59
Never 1.00 1.00 1.00 1.00
Medical advice regarding
weight
Yes, lose weight 6.24 5.50 to 7.09 2.43 2.02 to 2.92 4.05 3.13 to 5.23 9.87 6.83 to 14.26
Yes, maintain weight 1.25 1.00 to 1.57 1.13 0.66 to 1.94 0.91 0.56 to 1.48 1.80 1.33 to 2.43
No advice 1.00 1.00 1.00 1.00
No doctor seen in past
12 months 0.97 0.90 to 1.05 0.92 0.75 to 1.12 0.99 0.84 to 1.17 0.88 0.79 to 0.98
* OR (95% CI) of those trying to lose weight vs. doing nothing about their weight. Model adjusted for age, race/ethnicity, education,
smoking status, and medical advice regarding weight.
Behaviors of Americans Trying to Lose Weight, Bish et al.
600 OBESITY RESEARCH Vol. 13 No. 3 March 2005
weight (vs. no advice) and men had 10 times the odds of
trying to lose weight when advised to lose weight. The
odds of trying to lose weight among women and men
advised vs. not advised to lose weight decreased as BMI
increased, and the odds ratios were highest for normal
weight respondents.
Next, we examined specific weight loss strategies among
individuals who were trying to lose weight. Approximately
56% of women and 53% of men reported eating fewer
calories (Table 3). Higher odds of eating fewer calories
were observed among non-Hispanic whites, women be-
tween 30 and 69 years of age, men between 50 and 69 years
of age, and, among both sexes, those with higher education
and those advised to lose weight. Lower odds of eating
fewer calories to lose weight were observed among women
with less than a high school education and women who were
current smokers. These associations generally remained
constant across BMI strata (data not shown).
Table 2. Continued
Men
Total
(n ⴝ 44,172)
BMI > 30 kg/m
2
(n ⴝ 11,332)
BMI 25 to 29.9 kg/m
2
(n ⴝ 19,404)
BMI < 25 kg/m
2
(n ⴝ 13,436)
OR* 95% CI OR* 95% CI OR* 95% CI OR* 95% CI
1.00 1.00 1.00 1.00
1.15 1.03 to 1.28 0.84 0.64 to 1.09 0.72 0.61 to 0.86 0.85 0.66 to 1.11
1.44 1.29 to 1.62 0.84 0.62 to 1.15 0.85 0.71 to 1.02 1.33 1.04 to 1.71
1.54 1.37 to 1.74 0.80 0.60 to 1.07 0.86 0.72 to 1.04 2.11 1.59 to 2.80
1.17 1.02 to 1.35 0.66 0.48 to 0.90 0.73 0.59 to 0.90 1.41 1.02 to 1.96
0.71 0.62 to 0.82 0.68 0.47 to 0.98 0.50 0.40 to 0.61 0.81 0.57 to 1.16
1.00 1.00 1.00 1.00
0.93 0.81 to 1.05 1.30 1.02 to 1.65 0.69 0.57 to 0.85 0.65 0.43 to 0.99
1.22 1.06 to 1.40 1.03 0.75 to 1.42 0.99 0.81 to 1.22 1.52 1.12 to 2.05
0.95 0.77 to 1.17 0.66 0.44 to 0.98 1.32 0.95 to 1.84 1.45 1.00 to 2.11
0.81 0.70 to 0.93 0.69 0.52 to 0.91 0.77 0.63 to 0.95 0.90 0.64 to 1.28
1.00 1.00 1.00 1.00
1.13 1.03 to 1.23 1.11 0.92 to 1.34 1.18 1.03 to 1.36 1.37 1.07 to 1.75
1.63 1.49 to 1.78 1.74 1.41 to 2.15 2.04 1.79 to 2.33 2.15 1.73 to 2.68
0.53 0.49 to 0.58 0.71 0.55 to 0.90 0.60 0.53 to 0.69 0.43 0.34 to 0.54
1.27 1.16 to 1.38 1.21 0.99 to 1.48 1.27 1.12 to 1.45 1.01 0.82 to 1.25
1.00 1.00 1.00 1.00
10.13 8.53 to 12.03 3.51 2.76 to 4.47 5.91 4.37 to 8.01 31.31 17.32 to 56.59
1.28 0.94 to 1.75 0.60 0.31 to 1.16 2.40 1.45 to 3.98 1.87 1.06 to 3.32
1.00 1.00 1.00 1.00
0.93 0.86 to 1.01 1.01 0.82 to 1.25 0.86 0.77 to 0.97 0.89 0.75 to 1.07
Behaviors of Americans Trying to Lose Weight, Bish et al.
OBESITY RESEARCH Vol. 13 No. 3 March 2005 601
Table 3. Prevalence of weight loss behaviors and odds of using vs. not using specific weight loss strategies
Characteristic
Women trying to lose weight
Total (n ⴝ 42,526) Total (n ⴝ 42,732) Total (n ⴝ 42,526)
Eating fewer calories
Using physical
activity or exercise
Eating fewer calories and >150 min/wk
leisure-time physical activity
n* Percentage† OR‡ 95% CI n* Percentage† OR‡ 95% CI n* Percentage† OR‡ 95% CI
Overall 24,748 56.4 28,203 66.0 8,317 19.4
Age (years)
18 to 29 3,792 51.3 1.00 5,539 79.6 1.00 1,387 19.1 1.00
30 to 39 5,446 56.5 1.19 1.07 to 1.32 6,753 70.5 0.57 0.50 to 0.64 1,848 19.7 0.99 0.87 to 1.14
40 to 49 5,987 59.5 1.29 1.16 to 1.44 6,756 67.9 0.47 0.42 to 0.54 2,045 20.4 1.01 0.88 to 1.15
50 to 59 4,644 58.9 1.22 1.08 to 1.37 4,789 60.2 0.32 0.28 to 0.36 1,501 19.0 0.90 0.78 to 1.04
60 to 69 2,779 57.0 1.15 1.01 to 1.31 2,660 56.3 0.28 0.24 to 0.32 949 20.4 1.02 0.87 to 1.20
ⱖ70 2,100 53.8 1.02 0.88 to 1.18 1,706 44.2 0.17 0.14 to 0.19 587 16.7 0.81 0.65 to 1.00
Race or ethnicity
Non-Hispanic white 19,546 59.0 1.00 22,207 67.8 1.00 6,695 20.4 1.00
Non-Hispanic black 1,986 53.7 0.80 0.72 to 0.90 2,372 63.2 0.73 0.65 to 0.82 555 16.6 0.80 0.68 to 0.95
Hispanic 2,234 46.2 0.65 0.58 to 0.74 2,381 57.4 0.59 0.52 to 0.68 720 16.6 0.89 0.75 to 1.07
Other 982 50.3 0.69 0.56 to 0.85 1,243 69.6 0.95 0.75 to 1.19 347 18.0 0.84 0.63 to 1.10
Education
Less than high school 2,279 45.4 0.75 0.67 to 0.85 2,128 48.5 0.67 0.59 to 0.76 540 12.2 0.68 0.56 to 0.82
High school graduate 7,553 55.4 1.00 8,361 62.7 1.00 2,321 17.5 1.00
Some college or technical school 7,515 57.0 1.07 0.98 to 1.16 8,919 69.0 1.21 1.11 to 1.33 2,593 20.6 1.21 1.08 to 1.35
College graduate 7,401 61.9 1.26 1.15 to 1.37 8,795 74.4 1.53 1.40 to 1.68 2,863 23.8 1.42 1.28 to 1.58
Smoking status
Current 4,607 52.7 0.85 0.78 to 0.93 5,201 61.7 0.65 0.59 to 0.72 1,422 16.6 0.86 0.77 to 0.96
Former 6,089 58.5 0.99 0.91 to 1.08 6,827 65.7 1.02 0.93 to 1.11 2,209 22.0 1.16 1.04 to 1.29
Never 14,052 56.7 1.00 16,175 67.5 1.00 4,686 19.3 1.00
Medical advice regarding weight
Yes, lose weight 5,492 60.3 1.25 1.15 to 1.37 5,624 62.7 0.94 0.86 to 1.04 1,685 19.9 1.04 0.93 to 1.17
Yes, maintain weight 376 57.0 1.11 0.87 to 1.43 462 72.0 1.37 1.04 to 1.80 140 18.9 0.97 0.72 to 1.32
No advice 14,080 55.6 1.00 16,636 67.4 1.00 4,917 19.8 1.00
No doctor seen in past 12 months 4,800 54.6 0.98 0.90 to 1.07 5,481 64.8 0.79 0.72 to 0.87 1,575 18.0 0.89 0.79 to 0.99
* Unweighted number.
† Percentage is weighted to be nationally representative.
‡ Model adjusted for age, race/ethnicity, education, smoking status, and medical advice regarding weight.
Behaviors of Americans Trying to Lose Weight, Bish et al.
602 OBESITY RESEARCH Vol. 13 No. 3 March 2005
Table 3. Continued
Characteristic
Men trying to lose weight
Total (n ⴝ 21,836) Total (n ⴝ 22,004) Total (n ⴝ 21,836)
Eating fewer calories
Using physical
activity or exercise
Eating fewer calories and >150 min/wk
leisure-time physical activity
n* Percentage† OR‡ 95% CI n* Percentage† OR‡ 95% CI n* Percentage† OR‡ 95% CI
Overall 12,066 53.4 15,002 69.0 4,860 22.0
Age (years)
18 to 29 1,522 48.5 1.00 2,570 83.2 1.00 707 22.5 1.00
30 to 39 2,315 50.7 1.01 0.87 to 1.18 3,305 73.3 0.50 0.41 to 0.60 939 20.7 0.83 0.69 to 1.00
40 to 49 2,963 53.2 1.09 0.93 to 1.28 3,641 67.5 0.36 0.30 to 0.44 1,140 20.3 0.78 0.65 to 0.94
50 to 59 2,646 58.0 1.26 1.06 to 1.49 2,853 64.0 0.29 0.23 to 0.35 1,011 23.2 0.87 0.71 to 1.05
60 to 69 1,608 57.1 1.25 1.04 to 1.51 1,651 59.7 0.26 0.21 to 0.32 654 23.7 0.94 0.76 to 1.16
ⱖ70 1,012 56.3 1.19 0.97 to 1.47 982 53.5 0.19 0.15 to 0.24 409 23.9 0.92 0.72 to 1.16
Race or ethnicity
Non-Hispanic white 9,820 55.7 1.00 12,009 69.3 1.00 4,006 23.7 1.00
Non-Hispanic black 676 49.0 0.80 0.67 to 0.94 944 70.8 1.09 0.91 to 1.32 242 17.8 0.77 0.62 to 0.96
Hispanic 1,009 45.9 0.77 0.65 to 0.92 1,240 65.7 0.85 0.70 to 1.02 359 17.5 0.85 0.68 to 1.07
Other 561 46.6 0.71 0.52 to 0.96 809 71.4 0.88 0.62 to 1.25 253 16.9 0.65 0.46 to 0.90
Education
Less than high school 1,074 46.3 0.84 0.70 to 1.02 1,040 53.5 0.67 0.55 to 0.81 269 11.2 0.52 0.40 to 0.67
High school graduate 3,204 51.5 1.00 3,887 65.1 1.00 1,175 20.0 1.00
Some college or technical school 3,138 52.6 1.04 0.91 to 1.17 4,112 69.9 1.19 1.04 to 1.37 1,315 23.5 1.22 1.05 to 1.42
College graduate 4,650 57.6 1.21 1.08 to 1.37 5,963 76.1 1.82 1.60 to 2.08 2,101 25.8 1.37 1.19 to 1.57
Smoking status
Current 2,008 50.2 0.93 0.81 to 1.06 2,447 65.6 0.78 0.68 to 0.90 727 18.5 0.91 0.78 to 1.08
Former 4,293 55.2 0.97 0.87 to 1.08 5,089 65.6 1.00 0.89 to 1.13 1,805 24.5 1.19 1.04 to 1.35
Never 5,765 53.4 1.00 7,466 72.6 1.00 2,328 21.6 1.00
Medical advice regarding weight
Yes, lose weight 2,973 58.7 1.25 1.11 to 1.41 3,195 65.3 0.92 0.81 to 1.04 1,088 21.9 0.95 0.83 to 1.09
Yes, maintain weight 149 53.1 1.07 0.70 to 1.64 190 72.5 1.39 0.92 to 2.11 65 21.9 0.96 0.55 to 1.69
No advice 5,428 52.6 1.00 6,950 70.0 1.00 2,316 22.9 1.00
No doctor seen in past 12 months 3,516 51.0 0.97 0.87 to 1.09 4,667 70.0 0.83 0.73 to 0.93 1,391 21.0 0.91 0.79 to 1.03
Behaviors of Americans Trying to Lose Weight, Bish et al.
OBESITY RESEARCH Vol. 13 No. 3 March 2005 603
About two-thirds of women and men trying to lose
weight reported using physical activity for weight loss (Ta-
ble 3). The odds of reporting the use of physical activity
decreased with age and increased with education. Among
women, non-Hispanic whites were more likely to report the
use of physical activity to lose weight than non-Hispanic
blacks and Hispanics. Among both sexes, those who had not
seen a doctor in the previous 12 months had significantly
lower odds of using physical activity, in contrast with indi-
viduals who received no advice about their weight but had
seen a doctor. These associations generally remained con-
stant across BMI strata (data not shown); however, non-
Hispanic black men who were obese had higher odds of
using physical activity for weight loss compared with non-
Hispanic white men (odds ratio, 1.36; 95% confidence
interval, 1.08 to 1.71).
We then examined those who met the weight loss strategy
of reduced calorie consumption and ⱖ150 min/wk of lei-
sure-time physical activity. Among those trying to lose
weight, 46% of women and 44% of men said they were
eating fewer calories and answered yes to the question
“Are you using physical activity or exercise to lose
weight?” (Table 4). However, only one-fifth met minimal
recommendations of eating fewer calories and engaging in
ⱖ150 min/wk of leisure-time physical activity (Table 3).
In general, meeting minimal recommendations did not dif-
fer by age. Non-Hispanic black women and men had lower
odds of reduced calories and ⱖ150 min/wk of leisure-time
physical activity than non-Hispanic whites. Odds for meet-
ing recommendations were higher with higher education
status and higher for former smokers vs. never smokers.
Women who had not seen a doctor in the previous 12
months had lower odds of reduced calories and minimal
physical activity. Otherwise, among both sexes, medical
advice to lose weight was not associated with use of the
recommended combination of fewer calories and ⱖ150
min/wk of leisure-time physical activity (Table 3). These
associations generally remained constant across BMI strata
(data not shown).
In light of varying physical activity recommendations
related to weight control and general health, we assessed
combinations of eating fewer calories with increasing phys-
ical activity levels. These leisure-time physical activity rec-
ommendations ranged from ⱖ150 to ⱖ420 min/wk. The
prevalence of women who reported eating fewer calories
and reported using physical activity to lose weight was signif-
icantly higher than men, but attainment of recommended levels
of leisure-time physical activity was significantly higher for
men than for women (Table 4). Among women, the prevalence
of eating fewer calories and engaging in ⱖ150 min/wk of
leisure-time physical activity was 19%, but decreased to 4%
when leisure-time physical activity recommendations were
increased to ⱖ420 min/wk. Among men, these prevalences
were 22% and 7%, respectively. Attainment of both diet and
leisure-time physical activity recommendations was signifi-
cantly different by BMI among women; however, this was not
observed among men.
Discussion
We found that, in 2000, 46% of U.S. women and 33% of
U.S. men reported trying to lose weight. The prevalence of
trying to lose weight was slightly higher than that previ-
ously reported using the 1996 BRFSS, which indicated that
44% of women and 29% of men reported trying to lose
weight (1). Although women were more likely to be trying
to lose weight, their strategies were not very different from
those of men. Women reported trying to lose weight at
lower BMI levels than did men. Whereas 60% of over-
weight women were trying to lose weight, men did not reach
this level until they were obese.
About one-half of respondents reported using fewer cal-
ories, and two-thirds reported using physical activity as
weight loss strategies. We found, however, that only one-
fifth of individuals trying to lose weight used a combina-
tion of reduced calories and the minimal recommended
physical activity level of ⱖ150 min/wk. The percentage
fell to 13% for women and 16% for men who combined
reduced calories with the lower bound of the ACSM
physical activity recommendation of 200 min/wk for
weight loss and maintenance, and 7% of women and 10% of
men combined reduced calories with the upper bound of
the ACSM recommendation of 300 min/wk of physical
activity. Thus, only a small fraction of those trying to lose
weight attained recommended leisure-time physical ac-
tivity levels combined with reduced calories for weight
loss. Weight loss maintenance is critical for long-term suc-
cess. Few individuals (4% of women and 7% of men)
reduced calories and met the 420 min/wk or more of phys-
ical activity recommended by the IOM for preventing
weight gain.
Education was the most consistently associated charac-
teristic with trying to lose weight and with attainment of
recommended strategies for weight loss. These associations
were noted in a dose–response fashion, with increased prev-
alence and odds found as educational level increased. These
associations have been previously reported (3). Education is
frequently used as a covariate when assessing associations
among health behaviors but rarely as the independent char-
acteristic of interest. Our results indicate that respondents
with less than a high school education consistently reported
the lowest level of trying to lose weight and the lowest odds
of using recommended strategies for weight loss. It may be
helpful to tailor weight loss messages for this population.
Consistent with an earlier study (13), medical advice to
lose weight was highly associated with reportedly trying to
lose weight, even in those with BMI ⬍25 kg/m
2
. In contrast
with those who had not received advice, women who had
received advice were ⬃6 times more likely to report trying
Behaviors of Americans Trying to Lose Weight, Bish et al.
604 OBESITY RESEARCH Vol. 13 No. 3 March 2005
Table 4. Prevalence of attainment of dietary and physical activity recommendations among adults trying to lose weight
Eating fewer
calories and
using exercise*
Eating fewer
calories and
>150 min/wk
leisure-time
physical activity
Eating fewer
calories and
>200 min/wk
leisure-time
physical activity
Eating fewer
calories and
>300 min/wk
leisure-time
physical activity
Eating fewer
calories and
>420 min/wk
leisure-time
physical activity
n† Percentage‡ n† Percentage‡ n† Percentage‡ n† Percentage‡ n† Percentage‡
Women trying to lose weight
Total 16,904 46.1§ 8,308 19.4§ 5,434 12.9§ 3,029 7.2§ 1,588 3.8§
BMI ⱖ 30 kg/m
2
4,828 43.7¶ 2,088 15.9¶ 1,336 9.9¶ 799 6.1¶ 417 3.0¶
BMI 25 to 29.9 kg/m
2
6,507 47.4 3,228 19.8 2,111 13.1 1,152 7.2 610 4.1
BMI ⬍ 25 kg/m
2
5,569 46.8 2,992 22.5 1,987 15.5 1,078 8.3 561 4.2
Men trying to lose weight
Total 8,336 44.2 4,852 22.0 3,511 16.2 2,191 10.4 1,335 6.7
BMI ⱖ 30 kg/m
2
3,304 44.9 1,853 21.3 1,352 16.0 847 10.2 520 6.4
BMI 25 to 29.9 kg/m
2
4,264 44.2 2,536 22.8 1,816 16.2 1,116 10.4 685 6.9
BMI ⬍ 25 kg/m
2
768 42.1 463 21.6 343 16.6 228 10.8 130 6.9
* Met dietary recommendation for weight loss and answered yes when asked “Are you using physical activity or exercise to lose weight?”
† Unweighted number.
‡ Percentage is weighted to be nationally representative.
§ Significant difference between women and men totals (
2
test p ⬍ 0.05).
¶ Significant difference among BMI strata within sex (
2
test p ⬍ 0.05).
Behaviors of Americans Trying to Lose Weight, Bish et al.
OBESITY RESEARCH Vol. 13 No. 3 March 2005 605
to lose weight and men were ⬃10 times more likely. Be-
cause medical advice is strongly associated with trying to
lose weight, clinicians should assess their patients’ risk of
obesity-related conditions through anthropometric measure-
ments (i.e., BMI, waist circumference) and identification of
obesity-related comorbidities, and advise those who are
overweight or obese to lose weight. From NHLBI clinical
guidelines for the treatment of overweight and obesity (6),
Serdula et al. (5) summarized a weight-loss counseling tool
that uses the five As: 1) assess obesity risk, 2) ask about
readiness to lose weight, 3) advise in designing a weight-
control program, 4) assist in establishing appropriate inter-
vention, and 5) arrange for follow-up. Counseling to help
set realistic lifestyle change goals for calorie reduction (i.e.,
deficit of 500 to 1000 kcal/d from baseline), physical ac-
tivity, and weight loss was encouraged and was based on the
NHLBI guidelines (6).
Although advice was important in both sexes, women
who had been advised to lose weight had lower odds of
trying to lose weight than men for all BMI strata. Because
women report trying to lose weight more frequently than
men, it is likely that they have attempted weight loss during
their lives, and medical advice to lose weight may not
motivate women to the same degree as men.
It is noteworthy that both normal weight women and men
who reported medical advice to lose weight had the highest
odds of trying to lose weight. Perhaps normal weight re-
spondents had less experience with weight loss than over-
weight and obese respondents; therefore, a higher propor-
tion of normal weight respondents heeded the advice to try
to lose weight. However, for a number of reasons, we
caution readers when considering these high odds ratios.
First, BMI strata were based on current self-reported weight
at the time of survey administration, but the medical advice
to lose weight may have been anytime during the prior year.
Therefore, an individual could have been overweight at the
time of the advice, lost or be losing weight, and had a BMI
⬍25 kg/m
2
when surveyed. Second, people tend to under
-
report their weight; therefore, their reported weight would
place them in the normal weight strata, but their response of
trying to lose weight would reflect their true weight. Finally,
those who reported advice to lose weight may have solicited
the advice from a medical professional based on their own
feelings about their weight, regardless of what their BMI
was.
Among those trying to lose weight, respondents advised
to lose weight were more likely to report eating fewer
calories to lose weight than those who received no such
advice. Medical advice to lose weight was not associated
with the use of physical activity to lose weight or with the
combination of reduced calories and ⱖ150 min/wk leisure-
time physical activity among women and men who were
trying to lose weight. Thus, medical advice to lose weight
was highly associated with trying to lose weight but gener-
ally not associated with meeting the minimal recommended
strategies for weight loss. These results support the recom-
mendation that weight loss counseling include advice re-
garding appropriate weight loss strategies (5–9).
Several study limitations must be considered. The cross-
sectional BRFSS study design limits conclusions regarding
causal relationships between characteristics such as physi-
cian counseling and weight control behaviors. A method-
ological limitation considered was the reliance on tele-
phones to gather data. Persons without telephones differ
from those with telephones in a number of chronic disease
risk factors and are likely to be of lower socioeconomic
status, more likely to report health problems that limit
activities, more likely to be current smokers, and less likely
to be physically active (18). Although these differences may
exist, telephone-based research is unlikely to be seriously
affected by coverage bias as long as telephone coverage is
high (18). Poststratification weights in all analyses were
used to minimize any potential coverage bias. Another
limitation of this telephone-based survey is that all infor-
mation is self-reported. The validity of self-reported weight
and height has been studied; individuals tend to overreport
their height and underreport their weight (19 –22). Thus,
overweight and obesity prevalence may be underestimated.
Physical activity levels may be underestimated because only
leisure-time activities were ascertained (no occupational or
transportation activity), and in a study of the relationship
between physical activity and mortality in a sample of
women, the contribution of non-leisure (household chores)
energy expenditure was 82% of women’s total activity (23).
Another limitation is that no information was collected on
actual caloric consumption— eating fewer calories was not
quantified, and it is not clear how many individuals who
said they were eating fewer calories would actually meet the
guidelines for a 500- to 1000-kcal/d reduction.
Although trying to lose weight is common among Amer-
icans, our findings suggest that few individuals who report
trying to lose weight comply with even minimal dietary and
physical activity recommendations for weight loss/control.
A further concern is that minimal (NHLBI) dietary and
physical activity recommendations are lower than recently
published results of successful strategies for weight loss and
maintenance (24,25). A study that illustrated successful
strategies for weight loss and maintenance included random
assignment to a treatment of high physical activity (⬇75
min/d) or standard behavioral therapy for obesity (⬇30
min/d). The high physical activity group had increased
physical activity levels and greater weight loss compared
with the standard behavioral therapy group (24). In a study
of long-term weight loss maintenance, individuals who lost
weight and kept it off used ongoing behavioral strategies of
low-calorie diets (1450 kcal/d) and high levels of physical
activity (⬎70 min/d) (25). Our study of 2000 BRFSS data
found that 4% of female and 7% of male respondents who
Behaviors of Americans Trying to Lose Weight, Bish et al.
606 OBESITY RESEARCH Vol. 13 No. 3 March 2005
were trying to lose weight combined eating fewer calories
with ⱖ60 min/d of leisure-time physical activity. Thus, few
2000 BRFSS survey respondents reported behaviors at the
increased levels recommended by the IOM and shown to be
useful for increased weight loss and prevention of weight
gain.
The increasing prevalence of overweight and obesity in
U.S. adults may be paralleled by increasing weight loss
efforts. Findings from the study of 2000 BRFSS data indi-
cate a slight increase from 1996 data in the prevalence of
adults trying to lose weight; however, less than one-fifth
met minimal recommendations for weight loss of eating
fewer calories and participating in ⱖ150 min/wk of physical
activity. Continued efforts are indicated to educate, moti-
vate, and support overweight and obese adults to engage in
the recommended weight loss behaviors of reduced calories
and ⱖ150 min/wk of physical activity.
Acknowledgments
There was no funding/outside support for this study.
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