Trends in Weight Loss Attempts and Strategies Among US Adolescents With Overweight or Obesity

This study assessed national trends in weight loss attempts, clinically meaningful weight loss, and associated strategies among US adolescents with overweight or obesity.

We analyzed National Health and Nutrition Examination Survey (NHANES) 1999-2023 data for 2708 adolescents aged 16-19 years with overweight or obesity. Weight loss attempts and strategies were self-reported. Clinically meaningful weight loss was defined as ≥ 5% and ≥ 10% body weight reductions or a ≥ 0.2 reduction in body mass index (BMI) z-score over the prior year. Survey-weighted logistic regression assessed temporal trends and associations between strategies and weight loss success.

The prevalence of weight loss attempts increased from 53.9% in 1999-2000 to 65.7% in 2021-2023 (p for trend < 0.001). Overall, 26.96% achieved a ≥ 5% weight loss and 12.58% achieved a ≥ 10% weight loss; 34.34% achieved a ≥ 0.2 BMI z-score reduction. Exercise and dietary changes were the most reported strategies. Reducing sugar intake (OR, 2.16) and prescription medication use (OR, 2.55) were associated with achieving a ≥ 5% weight loss, and prescription medication use (OR, 3.59) was also associated with achieving a ≥ 10% weight loss. Sugar intake reduction (OR, 1.89) and prescription medication use (OR, 2.73) were associated with achieving a ≥ 0.2 reduction in BMI z-score.

Weight loss attempts increased over time, but clinically meaningful weight loss remained uncommon. Improved access to evidence-based, developmentally appropriate interventions is needed.