Cross-cultural differences in weight loss maintenance: a comparison between North America and Europe

The purpose of this study was to compare behavioral, psychosocial, and neighborhood environmental factors of long-term weight loss maintainers in North America and Europe.

Participants were weight loss maintainers in WeightWatchers in North America (n = 3656) and Europe (n = 624) who had maintained a ≥ 9.1 kg (21.7 kg on average) weight loss for ≥1 year (5.3 years on average) and had a current mean BMI of 29.9 kg/m². Validated surveys assessed behavioral (e.g., self-weighing, dietary strategies, restaurant eating, physical activity, sedentary time) psychological (e.g., habit strength, future focus, diet consistency, motivation, quality of life, body image, internalized weight bias), and neighborhood environment factors.

Weight loss maintainers in North America vs. Europe had higher odds of weekly self-weighing (95% vs. 91%; OR = 1.7 [95% CI: 1.1, 2.5]), eating at fast food restaurants ≥weekly (11.6% vs. 2.6%; 7.7 [3.9, 14.3]; p < 0.001]), and other restaurants (29.7% vs 17.3%; OR = 1.47 [1.2, 2.1]; p < 0.001), more positive scores for body image (21.4 vs.20.7; η_p² = 0.253; p < 0.001) and body satisfaction (28.7 vs 22.8; η_p² = 0.248; p < 0.001), less weight bias internalization (3.0 vs 3.1; η_p² = 0.320; p < 0.001), shape concerns (2.3 vs 2.4; η_p² = 0.181; p < 0.001) and weight concerns (2.6 vs2.7; η_p² = 0.176; p < 0.001), and higher quality of life (75.0 vs. 73.4; η_p² = 0.154; p < 0.001), including general health perception (72.3 vs 68.1; η_p² = 0.187; p < 0.00), and physical functioning (81.3 vs 79.2; η_p² = 0.252; p < 0.001). In a multivariable regression, the variables that most strongly differentiated weight loss maintainers in North America and Europe were fast food consumption (OR = 10.8 [4.6, 25.5] p < 0.001) and self-weighing (OR = 1.9 [1.2,3.0]; p < 0.01).

Weight loss maintainers in North America and Europe differed in restaurant eating and self-weighing practices but otherwise reported similar behavioral, psychological, and environmental strategies.