Body Critique or Body Acceptance: Overweight Diagnosis and Weight Cycling Among Adults with a History of Overweight/Obesity in the United States 2017-2020 Public
Kleine, Kjersti (Spring 2022)
Abstract
Background: Weight cycling, or repeated episodes of intentional weight loss, is related to negative cardiovascular health outcomes. Clinical diagnosis of overweight by healthcare providers is an important component of weight loss counseling, but such diagnoses may inadvertently promote weight cycling. We assessed the association between clinical diagnosis of overweight and history of weight cycling among adults in the United States with a history of being overweight.
Methods: Data from 5,512 adults aged 20 and older assessed in the nationally representative 2017-2020 National Health and Nutrition Examination Survey who reported ever having BMI≥25.0 kg/m2 were analyzed. Participants who reported ever being told by a doctor or healthcare provider that they were overweight were considered to have a clinical diagnosis of overweight. Weight cycling was defined as an episode of intentional weight loss of 10 pounds or more. Participant weight cycling history was categorized as having no episodes (reference), low weight cycling (1-5 weight loss episodes), or high weight cycling (6 or more episodes). We conducted multinomial logistic regression analysis of the association between a clinical diagnosis of overweight and level of weight cycling (none, low, or high). Covariates included gender, age, race/ethnicity, family income to poverty ratio, and education.
Results: Among US adults who had ever been overweight, 50.7% reported clinical diagnosis of overweight, 49.7% reported low weight cycling and 16.8% reported high weight cycling. Adults with a clinical diagnosis of overweight had higher relative odds of both low and high weight cycling (OR=3.45; 95%CI: 2,83, 4.20 and OR=8.78; 95%CI: 5.73, 13.48, respectively), compared with no weight cycling. Non-Hispanic white adults and men had the highest odds ratios for high weight cycling history.
Conclusions: Clinical diagnosis of overweight was associated with substantially higher odds of weight cycling among adults who have ever been overweight. Approaches to tailor weight loss counseling by healthcare providers that prevent weight cycling should be explored to minimize the physiological and psychosocial implications of frequent episodic weight loss among overweight adults.
Table of Contents
Introduction 1
Extended Literature Review 3
Methods 9
Results 12
Figure 1. Participant diagram 14
Figure 2. Distribution of weight loss episodes by clinical diagnosis of overweight/obesity 15
Table 1. Characteristics of US adults with history of overweight, 2017-2020 16
Table 2. Association between clinical diagnosis of overweight/obesity and weight cycling 17
Table 3. Association between clinical diagnosis of overweight/obesity and weight cycling stratified by current weight perception and current weight status 18
Discussion 19
References 23
Appendices 26
Appendix A. Association between clinical diagnosis of overweight/obesity and Weight Cycling (unadjusted) 26
Appendix B. Association between clinical diagnosis of overweight/obesity and weight cycling stratified by current weight perception and current weight status (unadjusted) 26
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