To investigate motivators and strategies of adult weight loss or management, 1805 adults aged 18 - 65 were asked by computer assisted telephone interviews about their weight management behavior during the previous four weeks. High levels of importance to reduce risks associated with chronic diseases such as cancer, heart disease and diabetes were observed, although were indistinguishable between people attempting or not attempting to lose or maintain weight. Results showed that BMI was the strongest predictor of attempting to manage weight irrespective of age and, compared with males, females were more likely to attempt weight management at a lower BMI. Among the weight management group, the most popular weight management strategy was to choose healthier food options (77% and 70% for females and males respectively). With the weight management group also more likely to be monitoring the amount of food they consume, limiting portions sizes and tracking their physical activity participation compared with people not managing their weight. The current study showed that the likelihood of weight management within four weeks prior to the survey peaked for both sexes when BMI reached obese levels, (BMI = 30 - 39.9), suggesting that among people categorised as obese most were attempting to manage their weight. The results also suggest that at least some adults were not attempting to maintain their weight in the four weeks prior to the survey, irrespective of their BMI status. The implications of these findings suggest more effective approaches to weight loss and maintenance could focus on strategies that directly address the benefits and motivations of weight loss and weight maintenance, rather than focusing on conveying the risks of being overweight and the importance of avoiding chronic disease.
Obesity prevalence among adult Australians continues to increase and as a result the burden of disease attributeable solely to high body mass (7.5% of total burden) is now very close to, and likely to overtake, tobacco (7.8%) as the leading modifiable cause of disease burden [
The act of maintaining or losing weight is complex, involving many decisions, ultimately around when and how much energy to consume and expend [
Previous studies have found socio-demographic characteristics such as age, sex, socio-economic status, income and education level to be associated with intention to lose or maintain weight [
Gender as a moderating effect on weight perception and weight management practices has been documented with men found more likely than women to underestimate their weight [
A number of psycho and socio-graphic variables have also been associated with weight maintenance including a person’s perception of health risk, their perceived body size and doctor’s advice to lose weight [12,13]. Attitudinal factors associated with long-term weight loss maintenance include initial readiness and motivation to change, autonomous motivation, regulatory focus and less life satisfaction prior to weight loss [17-20]. While health may be the primary reason provided for managing weight, self-esteem and appearance have also been found to be motivators, especially for women. A medical event or advice from a general practitioner have been reported as motivators for change [
Once individuals decide to maintain or lose weight then modifying their diet and increasing physical activity are the most prevalent lifestyle modifications [
The aim of this study was to identify differences in characteristics, attitudes towards health and behavioural actions between adults who have recently attempted to maintain or lose weight and those adults who have not.
Data were collected from a survey developed to evaluate the impact of the Draw the Line mass media campaign aimed at preventing unhealthy weight gain among West Australian adults. Cross-sectional data were collected on three occasions during 2009 and 2010 using computer assisted telephone interviewing. Respondents were selected randomly from the electronic Western Australian White Pages. Strategies implemented to ensure quality data collection and response rate included up to 10 call backs to obtain a contact, selecting household members with the most recent birthday, comprehensive interviewer training and interview monitoring. The research protocol was approved by the University of Western Australia Human Research Ethics Committee. In total 1805 West Australians aged 16 - 65 were surveyed. There were no statistically significant demographic differences between the three collection groups, thus it was considered appropriate to pool the survey data.
Socio-demographic characteristics: Demographic data included sex, age group, postcode, income, education level, height and weight. Place of residence, metropolitan Perth or regional Western Australia (WA), was derived from the postcode. The measure of socio-economic status (SES) was derived from the Australian Bureau of Statistics Socio-Economic Index for Areas (SEIFA), an index of relative socio-economic advantage and disadvantage [
Body Mass Index: Self-reported height and weight were collected to calculate BMI for each respondent by dividing weight in kilograms by the square of height in metres.
Weight management behaviour: Respondents were asked if, during the last four weeks, they had attempted to lose weight, not gain weight or not been concerned about their weight. Weight management behaviour was then collapsed into those who were managing their weight (attempted to lose or not gain weight) (MW) and those not concerned about their weight, who were not actively managing their weight (Not-MW).
Health values: The importance of health and maintaining a healthy weight was assessed by eleven items regarding attitudes towards risk of chronic disease and weight status as well as internal and external influences on health. A three point Likert scale was used for each statement to detect degree of importance. Statements included “How important is it to you to do things to lower your risk of heart disease, follow recommended health guidelines, maintain a healthy weight or set a good example for others?”.
Behaviour: Nine items with six point Likert response scales were used to assess the frequency that respondents engaged in weight monitoring behaviours. Respondents who reported “often”, “almost always” or “always” carrying out the behaviour were considered to be “frequent” adopters of the behaviour. The behaviour items were taken from the Nothwehr weight management scale [
Data were imported into Statistical Analysis System (SAS) version 9.2 (Cary, North Carolina) for analysis. Managing weight during the previous four weeks (MW) or not (Not-MW) was tested for significant association with other surveyed variables by fitting the data to a logistic regression model with data weighted to reflect the age, sex and geographic distribution (Perth metropolitan or regional WA) within WA [
A total of 2734 eligible telephone numbers were called resulting in the completion of 1805 questionnaires, a response rate of 66%. A larger proportion of respondents (56%) were aged 35 - 54 than are found in WA (49%) [
In all but one BMI group a greater proportion of females were attempting to maintain or lose weight compared with males. Apart from females with a BMI of less than 20 at least one half of females in each BMI category were attempting to maintain or lose weight. Amongst males with a BMI of between 30 - 39.9, at least 60% were attempting to maintain or lose weight. The proportion of each BMI group engaged in MW peaked for both sexes during the BMI range 30 - 39.9, defined as “Obese” [
The importance of preventing disease, internal and external factors associated with weight management was explored by weight management status. Participants were asked to rate each of 11 statements concerning how personally important each was for their health.
aSocio-economic status, bManaging weight by attempting to lose or not gain weight.
sents the odds ratio for considering each statement important, stratified by weight management status. Overall, the majority of respondents rated each statement as important irrespective of their current weight management status.
When fitting the data to multivariate logistic regression model males and females who were maintaining or losing weight were approximately four times more likely to consider losing weight important than people not maintaining or losing their weight. The importance of disease, internal control or external support was not significantly associated with managing or not managing weight in this study.
Participants were asked to indicate how often they monitored or carried out physical activity and food related behaviours (
Amongst both males and females monitoring physical activity and food consumption frequently was significantly associated with managing weight. Fitting these data to multivariate models with BMI and income included, first separately for each sex and then overall with sex included as a fixed effect, people MW during the previous four weeks were significantly more likely to be monitoring the amount of food they consume, limit portions sizes and track amount of physical activity compared with people Not-MW. Females managing their weight were twice as likely as Not-MW females to track their physical activity for the week and the amount of food eaten each day. Amongst males tracking the amount
MW = Managing weight during previous four weeks by attempting to lose weight or stay the same, NS odds ratio not significant, aP < 0.01, (important vs. not), adjusted for BMI and income, bP < 0.01, (important vs. not), adjusted for BMI, income and sex.
of food eaten was significantly associated with managing weight while tracking physical activity was not.
Limiting the size of food servings was three times more likely amongst people managing their weight compared with people not managing their weight. The odds of suggesting physical activity to family or friends was negatively associated with managing weight, especially among females. Females who reported difficulty refusing food even when they were not hungry were twice as likely to be MW as females who did not report difficulty refusing food.
Of the 1805 respondents 978 (54%) were MW within the last four weeks with 41% (n = 404) reporting they successfully maintained or lost weight (234 females and 170 males). Success or not in MW was not associated with importance placed on disease, internal or external weight control or weight status (
This paper set out to investigate the characteristics of adults maintaining or losing weight within four weeks prior to the survey and the relationship between their attitudes towards health and actions to maintain or lose weight. The results show that adults in this study who were managing their weight in the four weeks prior to the survey were, ceteris paribus, merely trying not to gain or lose weight because of their BMI or perceived weight status. Females were nearly three times more likely to be intentionally managing their weight compared with males, a finding similar to previous research [
The current study showed that the likelihood of MW within four weeks prior to the survey peaked for both sexes when BMI reached obese levels, (BMI = 30 - 39.9), suggesting that among people categorised as obese most were attempting to manage their weight. What is not clear from the current study is the length of time that people may have been attempting to manage their weight and whether their BMI has changed over that period. The results of this study also suggest that at least some males and females were not attempting to maintain their weight in the four weeks prior to the survey, irrespective of their BMI status.
Interestingly the raw proportion of MW among those with BMI > 40 was not as high as among those with a BMI of 30 - 39 (55% vs. 76%) although numbers in this morbidly obese category were small (n = 31). The health risks of being overweight have been publicly promoted for several years through mass media campaigns, particularly the risk of heart disease, cancer and diabetes. This was reflected in the majority of adults in this study who considered it important to lower their risk of developing these diseases, although in this study we observed no influence of perceived importance to lower risk of developing these diseases upon attempting to manage weight. Brink et al. had suggested that it was the diagnosis of disease that was the motivator for weight loss or risk of developing disease and the advice of a physician [
Other mediators of weight management explored in this study were the importance of having more energy and feeling more in control, neither of which were significant in predicting weight management. Being healthy for family and friends, following recommended guidelines and setting a good example for others were also found to be important to all respondents, though not significantly more so among adults managing their weight. These findings suggest weight management behaviour may be autonomous as described by Williams et al. when exploring predictors of weight loss and maintenance among 128 patients [
While we identified few mediation effects in this study people managing their weight were more likely to track their physical activity for the week and amount of food eaten that day, if not the kind of food they were eating. The use of dietary strategies such as consuming fewer calories and exercising more were common weight loss strategies reported in the literature [9,29]. Monitoring these behaviours may be an important action in weight management. Working physical activity into the day, which has been heavily promoted through social marketing campaigns in Western Australia, was not a frequent activity of people in the MW group. This suggests the possibility that physical activity remains a recreational pursuit, possibly even that physical activity may be viewed by some as a pursuit to be avoided regardless of their BMI. Adults in this study who were managing their weight in the four weeks prior to the survey limited the size of their food servings, a popular strategy among males who were MW and in line with weight loss strategies found elsewhere. Among females who reported finding it difficult to refuse food even when not hungry a significantly higher proportion were MW during the previous four weeks than among females who did not report this difficulty.
Success at MW was significantly associated with tracking food intake and being active with family and friends, the latter strategy seven times more likely to result in successful weight management among males. A limitation of the design of this study lies in the self-reported nature of the data. Objective measures such as the use of accelerometers to record physical activity and weighed food servings might serve to strengthen these findings, however among people attempting to lose weight the perceived value of healthy behaviour may be more important than the value of any physiological weight benefit.
The results of this study suggest that a person’s BMI is the strongest predictor of attempts to manage their weight and that females are more likely to manage their weight at a lower BMI compared with males. Few other mediators of weight management were observed in this study, suggesting that further investigation into underlying motivations and attitudes towards weight management should be explored. The study also found that people who were managing their weight were monitoring daily food intake and physical activity to ultimately reduce calories and increase their level of exercise. These were important for adults who were successful in managing their weight and the association between these behaviours and successful weight management supports continued promotion of these healthy messages.
1) Though suggesting physical activity to family and friends was the least popular strategy health care professsionals should consider advising patients commencing a weight-management program that, at least in the current study, this behaviour was the most closely associated with success.
2) Among females, refusing foods when not hungry resulted in a 5.5 times greater likelihood of successful weight management. This suggests a supportive environment may potentially improve the likelihood of success among women tempted by opportunity though it remains unknown if reducing opportunities to eat will have the same impact as the ability to refuse food when offered.
Data were collected as part of the Draw the Line Healthy Weight campaign funded by the Western Australian Department of Health and supported by Diabetes WA, Cancer Council WA and Heart Foundation WA. The authors were commissioned to conduct an evaluation of that campaign and the results reported in this study were drawn from that evaluation.