[Skip to Navigation]
Sign In
Figure.  Trend by Sex in the Percentages of Adolescents Trying to Lose Weight, 1988-2014
Trend by Sex in the Percentages of Adolescents Trying to Lose Weight, 1988-2014

The body weight category was based on sex- and age-specific body mass index (BMI) percentiles derived from directly measured body height and weight. Error bars indicate the 95% CIs of the percentages. Overweight was defined as BMI between the 85th and the 94th percentiles (B and D), and obesity was defined as BMI in the 95th percentile or higher (A and C). For boys with obesity, the P for linear trend was .94. For boys with overweight, the P for linear trend was .68. For girls with obesity, the P for linear trend was .62. For girls with overweight, the P for linear trend was .004.

Table.  Percentage Differences of Trying to Lose Weight Among US Adolescents With Overweighta
Percentage Differences of Trying to Lose Weight Among US Adolescents With Overweighta
1.
Snook  KR, Hansen  AR, Duke  CH, Finch  KC, Hackney  AA, Zhang  J.  Change in percentages of adults with overweight or obesity trying to lose weight, 1988-2014.  JAMA. 2017;317(9):971-973.PubMedGoogle ScholarCrossref
2.
Kuczmarski  RJ, Ogden  CL, Grummer-Strawn  LM,  et al.  CDC growth charts: United States.  Adv Data. 2000;314(314):1-27.PubMedGoogle Scholar
3.
Spiegelman  D, Hertzmark  E.  Easy SAS calculations for risk or prevalence ratios and differences.  Am J Epidemiol. 2005;162(3):199-200.PubMedGoogle ScholarCrossref
4.
Lu  H, Tarasenko  YN, Asgari-Majd  FC, Cottrell-Daniels  C, Yan  F, Zhang  J.  More overweight adolescents think they are just fine: generational shift in body weight perceptions among adolescents in the US.  Am J Prev Med. 2015;49(5):670-677.PubMedGoogle ScholarCrossref
5.
Yaemsiri  S, Slining  MM, Agarwal  SK.  Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study.  Int J Obes (Lond). 2011;35(8):1063-1070.PubMedGoogle ScholarCrossref
6.
Hansen  AR, Duncan  DT, Woo Baidal  JA, Hill  A, Turner  SC, Zhang  J.  An increasing trend in health-care professionals notifying children of unhealthy weight status: NHANES 1999-2014.  Int J Obes (Lond). 2016;40(10):1480-1485.PubMedGoogle ScholarCrossref
Research Letter
June 25, 2018

Trends in Weight Loss Efforts Among US Adolescents With Overweight and Obesity

Author Affiliations
  • 1Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
  • 2Department of Health Education, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
  • 3Department of Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
JAMA Pediatr. 2018;172(8):782-784. doi:10.1001/jamapediatrics.2018.1012

Snook and colleagues1 reported recently that, despite the significant increase in the prevalence of obesity over decades, fewer US adults have tried to lose weight. However, the trend among adolescents, the population most susceptible to changes in social norms, is unclear. We assessed the trend in weight loss efforts among adolescents with overweight and obesity aged 16 to 19 years.

Methods

We used data from the National Health and Nutrition Examination Survey for this study. The 1988-1994 survey years were designated as the early period (reference), 1999-2004 as the intermediate period, and 2009-2014 as the recent period. After excluding 554 adolescents who were underweight (body mass index, <fifth percentile) and 741 adolescents who did not respond to questions pertaining to weight loss efforts, race/ethnicity, or family income, 1298 participants aged 16 to 19 years were included for the 1988-1994 period, 2900 participants were included for 1999-2004 period, and 1620 participants were included for 2009-2014 period. The 2000 Centers for Disease Control and Prevention growth charts2 were used to translate directly measured weight and height into sex- and age-specific body mass index percentiles and categorized adolescents as obese (≥95th percentile), overweight (85th-94th percentile), or normal weight (5th-84th percentile). The main question of interest, “During the past 12 months, have you tried to lose weight?” was asked directly in the 1988-1994 surveys. However, a skip pattern was incorporated with this question starting in the 1999-2000 survey. Adolescents whose self-reported body weight for 1 year ago was 4.54 kg or more than their self-reported current weight and reported this change as intentional were presumed to “have tried to lose weight in the past 12 months” and the question about having tried to lose weight was skipped. The question of interest was asked of all others, including those with an unintentional weight loss of 4.54 kg or more. Because the percentage of adolescents trying to lose weight, on average, was substantially above 10%, logistic regression cannot be justifed.3 Therefore, predicted population margins (PPM) were used to estimate the differences in the percentages of individuals trying to lose weight over the survey period. Bonferroni multiple comparison test was performed to test the percentage difference of adolescents trying to lose weight between the levels of variables, including survey period, after correcting for body mass index percentile, race/ethnicity, and family income. With appropriate weighting and nesting variables, analyses were conducted using SAS, version 9.4 (SAS Institute). Two-sided P values below critical points (.05 for trend test) were considered statistically significant.

Results

The prevalence of overweight and obesity increased from 22.09% (95% CI, 18.20%-25.98%) in 1988-1994 to 36.17% (95% CI, 32.74%-39.60%) in 2009-2014; during the same period, the overall percentage of adolescents who had tried to lose weight decreased from 33.68% (95% CI, 29.19%-38.17%) to 32.74% (95% CI, 29.60%-35.88%). For adolescents with overweight, the percentage trying to lose weight decreased from 36.36% (95% CI, 13.86%-58.85%) in 1988-1994 to 31.30% (95% CI, 22.65%-39.95%) in 2009-2014 among boys and from 80.24% (95% CI, 69.09%-91.39%) in 1988-1994 to 59.14% (95% CI, 50.41%-67.86%) in 2009-2014 among girls (Figure). After adjustment for race/ethnicity, family income, and body mass index percentile, the percentage of girls with overweight trying to lose weight decreased by 12.11 percentage units (PPM = −12.11%; 95% CI, −24.74% to 0.52%; P = .06) between 1988-1994 and 1999-2004 and further down by 21.94 percentage units (PPM = −21.94%; 95% CI, −35.14% to −8.74%; P < .001) by 2009-2014 (P for trend < .001; Table); no significant decrease was observed among boys with overweight (P for trend = .44) despite an 8.01–percentage unit decrease (PPM = −8.01; 95% CI, −28.70% to 12.69%) during the entire study period. For boys with obesity, the percentage trying to lose weight decreased from 67.51% (95% CI, 50.92%-84.10%) in 1988-1994 to 51.01% (95% CI, 42.24%-59.78%) in 1999-2004, then increased to 66.82% (95% CI, 58.65%-74.98%) by 2009-2014. The corresponding percentages among girls with obesity were 69.50% (95% CI, 52.40%-86.61%) in 1988-1994, 69.45% (95% CI, 62.12%-76.79%) in 1999-2004, and 64.31% (95% CI, 52.92%-75.69%) in 2009-2014; no statistical significance was detected after multivariable adjustment for either sex with obesity.

Discussion

Fewer US adolescents with overweight tried to lose weight in 2009-2014 compared with their counterparts interviewed in 1988-1994, potentially compromising opportunities to prevent overweight from becoming obesity. With more than one-third of adolescents having overweight or obesity, it is cognitively difficult to view overweight as abnormal.4 More adolescents with overweight or obesity seem satisfied with their weight and not ready or motivated to engage in weight loss efforts.5 Failure among pediatricians to discuss weight issues with adolescents may also contribute to the decreasing trend.6 With small sample sizes, the self-report nature of this study, and differences between the participants who were included and those who were excluded, the generalizability of the conclusion might be jeopardized. It is not clear whether the decreasing trend to lose weight led to an increased prevalence of overweight and obesity or vice versa. Sex differences in the trend warrant further investigations.

Back to top
Article Information

Accepted for Publication: March 22, 2018.

Corresponding Author: Jian Zhang, MD, DrPH, Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460 (jianzhang@georgiasouthern.edu).

Published Online: June 25, 2018. doi:10.1001/jamapediatrics.2018.1012

Retraction and Replacement: This article was retracted and replaced on March 18, 2019, to fix errors throughout the article, figure, and table (see Supplement 1 for the retracted article with errors highlighted and Supplement 2 for the replacement article with corrections highlighted).

Author Contributions: Dr Zhang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Hawkins, Kazmierski, Hansen, Reid, Opoku, Zhang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Hawkins, Kazmierski, Reid, Opoku, Zhang.

Administrative, technical, or material support: Kazmierski, Hansen, Reid, Opoku, Zhang.

Study supervision: Zhang.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Anunay Bhattacharya, MPH, and Abraham Deng, MPH, Jiann-Ping Hsu College of Public Health, Georgia Southern University, doctoral students from the same class group as the student authors of this article, provided assistance on SAS programming, statistics, writing, and language editing at various stages of manuscript development. No compensation was provided for this assistance.

References
1.
Snook  KR, Hansen  AR, Duke  CH, Finch  KC, Hackney  AA, Zhang  J.  Change in percentages of adults with overweight or obesity trying to lose weight, 1988-2014.  JAMA. 2017;317(9):971-973.PubMedGoogle ScholarCrossref
2.
Kuczmarski  RJ, Ogden  CL, Grummer-Strawn  LM,  et al.  CDC growth charts: United States.  Adv Data. 2000;314(314):1-27.PubMedGoogle Scholar
3.
Spiegelman  D, Hertzmark  E.  Easy SAS calculations for risk or prevalence ratios and differences.  Am J Epidemiol. 2005;162(3):199-200.PubMedGoogle ScholarCrossref
4.
Lu  H, Tarasenko  YN, Asgari-Majd  FC, Cottrell-Daniels  C, Yan  F, Zhang  J.  More overweight adolescents think they are just fine: generational shift in body weight perceptions among adolescents in the US.  Am J Prev Med. 2015;49(5):670-677.PubMedGoogle ScholarCrossref
5.
Yaemsiri  S, Slining  MM, Agarwal  SK.  Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study.  Int J Obes (Lond). 2011;35(8):1063-1070.PubMedGoogle ScholarCrossref
6.
Hansen  AR, Duncan  DT, Woo Baidal  JA, Hill  A, Turner  SC, Zhang  J.  An increasing trend in health-care professionals notifying children of unhealthy weight status: NHANES 1999-2014.  Int J Obes (Lond). 2016;40(10):1480-1485.PubMedGoogle ScholarCrossref
×