Probability of 5% or Greater Weight Loss or BMI Reduction to Healthy Weight Among Adults With Overweight or Obesity

Abstract

ImportanceInformation on the probability of weight loss among US adults with overweight or obesity is limited.ObjectiveTo assess the probability of 5% or greater weight loss, 10% or greater weight loss, body mass index (BMI) reduction to a lower BMI category, and BMI reduction to the healthy weight category among US adults with initial overweight or obesity overall and by sex and race.Design, Setting, and ParticipantsThis cohort study obtained data from the IQVIA ambulatory electronic medical records database. The sample consists of US ambulatory patients 17 years or older with at least 3 years of BMI information from January 1, 2009, to February 28, 2022. Minimum age was set at 17 years to allow for the change in BMI or weight starting at 18 years. Maximum age was censored at 70 years.ExposuresInitial BMI (calculated as weight in kilograms divided by height in meters squared) category was the independent variable of interest, and the categories were as follows: lower than 18.5 (underweight), 18.5 to 24.9 (healthy weight), 25.0 to 29.9 (overweight), 30.0 to 34.9 (class 1 obesity), 35.0 to 39.9 (class 2 obesity), and 40.0 to 44.9 and 45.0 or higher (class 3 or severe obesity).Main Outcomes and MeasuresThe 2 main outcomes were 5% or greater weight loss (ie, a ≥5% reduction in initial weight) and BMI reduction to the healthy weight category (ie, BMI of 18.5-24.9).ResultsThe 18 461 623 individuals in the sample had a median (IQR) age of 54 (40-66) years and included 10 464 598 females (56.7%) as well as 7.7% Black and 72.3% White patients. Overall, 72.5% of patients had overweight or obesity at the initial visit. Among adults with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI (from 1 in 12 individuals with initial overweight to 1 in 6 individuals with initial BMI of 45 or higher). Annual probability of BMI reduction to the healthy weight category ranged from 1 in 19 individuals with initial overweight to 1 in 1667 individuals with initial BMI of 45 or higher. Both outcomes were generally more likely among females than males and were highest among White females. Over the 3 to 14 years of follow-up, 33.4% of persons with overweight and 41.8% of persons with obesity lost 5% or greater of their initial weight. At the same time, 23.2% of persons with overweight and 2.0% of persons with obesity reduced BMI to the healthy weight category.Conclusions and RelevanceResults of this cohort study indicate that the annual probability of 5% or greater weight loss was low (1 in 10) despite the known benefits of clinically meaningful weight loss, but 5% or greater weight loss was more likely than BMI reduction to the healthy weight category, especially for patients with the highest initial BMIs. Clinicians and public health efforts can focus on messaging and referrals to interventions that are aimed at clinically meaningful weight loss (ie, ≥5%) for adults at any level of excess weight.

Weight Loss Treatment and Longitudinal Weight Change Among Primary Care Patients With Obesity

“…Among 31 284 patients with obesity in 2017 and follow-up weight data in 2019, 25.9% achieved 5% or greater weight loss. Prior work has shown that between 10% and 27% of patients with obesity achieve 5% or greater weight loss over 6 months to 5 years, with a greater annual probability of achieving 5% or greater weight loss observed among individuals with a higher baseline BMI (≥35) …”

“Dare to feel full”—A group treatment method for sustainable weight reduction in overweight and obese adults: A randomized controlled trial with 5-years follow-up

“…It is therefore likely that lifestyle and behavioral modifications will be crucial in secondary prevention and management of overweight and obesity also in the future. However, the probability of reaching normal weight or maintaining substantial weight loss among adults with overweight or obesity was found to be very low when patients receiving bariatric surgery were excluded [ 41 , 42 ]. The methods available to enhance behavioral and lifestyle changes evidently needs innovation to improve in both clinical and public health contexts.…”

Exercise Combined with a Low-Calorie Diet Improves Body Composition, Attenuates Muscle Mass Loss, and Regulates Appetite in Adult Women with High Body Fat Percentage but Normal BMI

“…Our results showed that reducing daily energy intake by 500 kcal through dietary control was effective in reducing body weight by more than 5%, even if additional meals were offered to compensate for the energy expenditure caused by exercise ( Table 3 ), which is consistent with the findings of Tang et al [ 26 ]. A 5% weight loss is widely recognized as the threshold at which clinically meaningful health improvements, including a decrease in systolic and diastolic blood pressure, fasting blood glucose, and glycated hemoglobin, as well as increase in high-density lipoprotein cholesterol, can be obtained [ 27 , 28 ]. However, most of the individuals were unable to achieve desirable weight loss via lifestyle intervention.…”