Weight-Loss Regimens Among Overweight Adults -- Behavioral Risk Factor Surveillance System, 1987

To reduce the prevalence of overweight and related chronic diseases in the United States, the 1990 national health objectives proposed that "by 1990, 50 percent of the overweight population should have adopted weight loss regimens, combining an appropriate balance of diet and physical activity" (1). Data from 33 health departments (32 states and the District of Columbia) that participated in the 1987 Behavioral Risk Factor Surveillance System (BRFSS) were used to evaluate state-specific progress toward achieving this objective. The BRFSS collects data on behavioral risk fac tors through random-digit-dialed telephone interviews of adults greater than or equal to 18 years old (2).

Prevalence estimates of weight-loss regimens among overweight persons were derived from self-reported data. Survey respondents were asked if they were trying to lose weight. Those responding affirmatively were also asked if they were eating fewer calories and if they were increasing physical activity to lose weight. Based on their answers, respondents were classified as eating fewer calories, increasing physical activity, or doing both. Overweight was defined as a body mass index (BMI=weight (kg)/height (m)2) greater than or equal to 27.8 for men and greater than or equal to 27.3 for women. These values represent the sex-specific 85th percentile of BMI for U.S. adults aged 20-29 years, as estimated from the Second National Health and Nutrition Examination Survey (3).

The median prevalence of using the recommended weight-loss regimen (eating fewer calories and increasing physical activity) was 20.2% for overweight men and 31.4% for overweight women. Among men, the prevalence ranged from 12.9% in Maine to 35.5% in Missouri (Table 1). For women, the prevalence ranged from 19.1% in the District of Columbia to 41.9% in Utah (Table 2).

The median prevalence of eating fewer calories to lose weight was 43.6% among overweight men and 63.9% among overweight women. For men, the prevalence ranged from 30.6% in Rhode Island to 57.7% in Missouri (Table 1). Among women, the prevalence ranged from 47.7% in New Mexico to 72.3% in South Dakota (Table 2).  The median prevalence of increasing physical activity to lose weight was 24.3% for overweight men and 34.7% for overweight women. Among men, the prevalence ranged from 16.8% in North Carolina to 38.6% in Missouri (Table 1). For women, the prevalence ranged from 23.4% in Ohio to 50.7% in Utah (Table 2). Reported by: The following BRFSS coordinators: R Strickland, Alabama; T Hughes, Arizona; L Parker, California; M Rivo, District of Columbia; S Hoecherl, Florida; JD Smith, Georgia; E Tash, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; K Bramblett, Kentucky; R Schwartz, Maine; A Weinstein, Maryland; L Koumijian Yandel, Massachusetts; N Salem, Minnesota; N Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso, New Hampshire; L Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; B Lee, North Dakota; E Capwell, Ohio; J Cataldo, Rhode Island; D Lackland, South Carolina; L Post, South Dakota; D Riding, Tennessee; J Fellows, Texas; C Chakley, Utah; K Tollestrup, Washington; R Anderson, West Virginia; and R Miller, Wisconsin. Div of Nutrition and Office of Surveillance and Analysis, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Previous studies have indicated that an effective weight-loss regimen incorporates both reduced caloric intake and increased physical activity (4,5). The BRFSS data suggest that no state will meet the 1990 objective to have 50% of the overweight population adopt this regimen. The use of physical activity appears to be the limiting factor. More than half of the overweight adults surveyed were eating fewer calories to lose weight, but less than one third were increasing physical activity. Moreover, only 25% of overweight adults were using both caloric restriction and increased physical activity to lose weight. Men were less likely than women to be using any weight-loss regimen. There is no apparent association between weight-loss regimens and state-specific prevalence of overweight (6).

The low prevalence of increasing physical activity to lose weight may reflect 1) the sedentary lifestyle of U.S. adults (7) and 2) the emphasis on diet as a means of weight loss without adequately addressing the benefits of physical activity. The benefits of combining physical activity with diet education are demonstrated by the Zuni Diabetes Project (8). Participants in an ongoing exercise-education program lost a mean of 9 pounds, compared with a mean loss of 2 pounds for nonparticipants (9). As in this project, public health agencies and health-care providers should incorporate conveniently scheduled exercise classes, on-site health education and health assessment, reward incentives, and community involvement into weight-control programs.

References

1. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

2. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87. Public Health Rep 1988;103:366-75.

3. NCHS, Najjar MF, Rowland M. Anthropometric reference data and prevalence of overweight--United States, 1976-80. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1987; DHHS publication no. (PHS)87-1688. (Vital and health statistics; series 11, no. 238).

4. National Institutes of Health Consensus Development Panel. Health implications of obesity: National Institutes of Health Consensus Development Conference statement. Ann Intern Med 1985;103(6 pt 2):1073-7.ref

5. Council on Scientific Affairs, American Medical Association. Treatment of obesity in adults. JAMA 1988;260:2547-51.

6. CDC. Prevalence of overweight--Behavioral Risk Factor Surveillance System, 1987. MMWR 1989;38:421-3.

7. CDC. Sex-, age-, and region-specific prevalence of sedentary lifestyle in selected states in 1985--the Behavioral Risk Factor Surveillance System. MMWR 1987;36:195-8,203-4.

8. Leonard B, Leonard C, Wilson R. Zuni Diabetes Project. Public Health Rep 1986;101:282-8.

9. CDC. Community-based exercise intervention--the Zuni Diabetes Project. MMWR 1987; 36:661-4.

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