Patterns of weight loss attempts and clinically significant weight loss among US adolescents and adults: analysis of NHANES 2021–2023

Abstract

Objective

Obesity remains a major public health challenge in the United States. We estimated the prevalence of weight loss attempts and clinically significant weight loss (CWL) among US adolescents and adults, and to assess associations with age, sex, race/ethnicity, and BMI.

Methods

We analyzed National Health and Nutrition Examination Survey (NHANES) data collected from 2021 to 2023. The analytic sample included 6308 participants aged ≥16 years. We assessed past-year weight loss attempt (yes/no) and CWL (≥5 % and ≥10 %) using measured current weight and self-reported weight 1 year earlier. Weighted estimates accounted for NHANES complex sampling; multivariable logistic regression adjusted for age, sex, race/ethnicity, and BMI category.

Results

47.4 % reported attempting weight loss, with differences by age (P < 0.01), sex (P < 0.01), and BMI (P < 0.01), but not race/ethnicity (P = 0.22). Among those attempting weight loss, 28.2 % achieved ≥5 % while 12.9 % achieved ≥10 % weight loss. Adolescents showed the highest prevalence of achieving ≥10 % weight loss (15.8 %; P = 0.02). Overweight and obesity were strongly associated with attempts (adjusted odds ratios, aOR 3.20 and 6.60), and females had higher odds than males (aOR 1.96).

Conclusions

While weight loss attempts are prevalent, CWL is achieved by a minority, demonstrating the need for effective, equitable obesity treatment and prevention strategies.

1. Introduction

Obesity is a significant public health concern in the United States, with approximately 40 % of adults and 20 % of adolescents currently affected (Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023, 2024). It is strongly associated with cardiovascular disease, type 2 diabetes, nonalcoholic fatty liver disease, and certain cancers and reduced quality of life (Powell-Wiley et al., 2021). It is a major modifiable risk factor for preventable mortality, primarily through its association with cardiovascular disease, type 2 diabetes, and certain cancers (Danaei et al., 2009). The economic implications of obesity are profound, with annual obesity-related medical costs exceeding $170 billion (Ward et al., 2021). Despite considerable public health efforts, the prevalence of obesity continues to rise across all age groups, racial/ethnic populations, and socioeconomic strata (Emmerich et al., 2025).

Weight management is a key strategy to mitigate obesity-related risks. Even modest weight reductions of 5 % to 10 % can yield clinically meaningful improvements in cardiometabolic health, including reduced blood pressure, improved glycemic control, and favorable lipid changes (Ryan and Yockey, 2017). However, achieving and maintaining weight loss is notoriously difficult. Behavioral interventions can be effective in the short term, yet long-term adherence remains limited, and many individuals experience weight regain (Lemstra et al., 2016).

Previous research has described trends in weight loss attempts using earlier National Health and Nutrition Examination Survey (NHANES) cycles, yet nationally representative estimates after 2018 remain limited (Martin et al., 2018). The years following the COVID-19 pandemic brought substantial lifestyle disruptions, altered dietary habits, and increased use of anti-obesity medications, potentially shifting national patterns of weight control (Mazidi et al., 2021; Berning et al., 2025). Understanding who attempts to lose weight and who succeeds is essential for informing policy and designing interventions that are both effective and equitable.

This study used data from the 2021–2023 NHANES to assess the prevalence of weight loss attempts and clinically significant weight loss among US adolescents and adults. We also examined demographic factors associated with weight loss behaviors and outcomes, providing timely insights into contemporary patterns of weight control efforts across the population.

2. Methods

2.1. Data source and study population

We analyzed publicly available data from the 2021–2023 NHANES, conducted by the National Center for Health Statistics (NCHS). NHANES employs a complex, multistage probability sampling design to provide nationally representative estimates of the US civilian noninstitutionalized population. The cycle included in-person interviews and physical examinations. The unweighted response rates for interviews and examinations in the August 2021–August 2023 cycle were 34.6 % and 25.7 % respectively (Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS), 2025). A total of 8459 non-pregnant participants aged ≥16 years were eligible. A total of 2151 participants (25.4 %) had incomplete data for at least one key variable, leaving a final analytic sample of 6308 with complete data (74.6 % of the eligible sample). NHANES is a publicly available, de-identified dataset; therefore, this secondary analysis was exempt from institutional review board review.

2.2. Measures

Height and weight were obtained from the NHANES Mobile Examination Center (MEC) physical examination, where trained staff measured standing height (cm) and weight (kg) using standardized protocols and calibrated equipment. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared (kg/m²). Among adults (≥20 years), BMI was categorized using standard cut points: underweight (<18.5), normal weight (18.5–24.9), overweight (25.0–29.9), and obesity (≥30.0 kg/m²) (Flegal et al., 2014). Among adolescents (16–19 years), BMI category was based on age- and sex-specific CDC BMI-for-age percentiles: underweight (<5th percentile), healthy weight (5th- < 85th), overweight (85th–<95th), and obesity (≥95th percentile) (Flegal et al., 2014).

Participants were asked, “During the past 12 months, have you tried to lose weight?” (yes/no). Clinically significant weight loss (CWL) was defined as a ≥5 % or ≥10 % reduction in body weight, calculated by comparing measured current weight from the MEC exam to self-reported weight one year prior. Demographic covariates included age, sex, race/ethnicity (non-Hispanic White, non-Hispanic Black, Mexican American, and other races), and BMI category.

2.3. Statistical analysis

Descriptive statistics summarized demographics and estimated the prevalence of weight loss attempts and CWL. Continuous variables are reported as weighted means with standard errors, categorical variables as unweighted frequencies and weighted percentages. Weight loss attempts and CWL were stratified by age, sex, race/ethnicity, and BMI categories. Bonferroni multiple comparison tests assessed differences across stratified variables, adjusting for potential confounders.

To examine factors independently associated with weight loss attempts and successful weight loss, we fit survey-weighted multivariable logistic regression models including age group, sex, race/ethnicity, and BMI category. The underweight group was excluded from regression analyses due to insufficient sample size for reliable estimation (3 participants). All analyses accounted for NHANES's complex sampling design and were conducted using R, version 4.4.1. Statistical significance was assessed using two-sided tests with P < 0.05. Multivariable logistic regression results were reported as adjusted odds ratios (aORs) with 95 % confidence intervals (CIs).

3. Results

This study included 6308 adolescents and adults, with a mean age of 47.0 years, of whom 50.6 % were female and 59.9 % were non-Hispanic White (Table 1). Of these participants, 2962 (47.4 %) reported attempting to lose weight in the past year. Weight loss attempts varied significantly across age groups (P < 0.01), with adolescents having the lowest prevalence (37.7 %) and middle-aged adults (40–59 years) having the highest (51.6 %). Females reported significantly higher weight loss attempts than males (53.8 % vs. 44.0 %; P < 0.01). Weight loss attempts were more common among individuals with overweight or obesity (P < 0.01). There were no significant differences by race or ethnicity (P = 0.22).

Table 1.

Characteristics of US adolescents and adults, NHANES 2021–2023.

Characteristics	Total (n = 6308)
Age (years)	47.0 ± 0.6
Age Categories (%)
16–19 years	503 (6.2)
20–39 years	1460 (32.6)
40–59 years	1672 (31.8)
60 years and over	2673 (29.4)
Sex (%)
Male	2895 (49.4)
Female	3413 (50.6)
Race/Ethnicity (%)
Non-Hispanic White	3649 (59.9)
Non-Hispanic Black	763 (10.6)
Mexican American	460 (7.3)
Others	1436 (22.2)
BMI (kg/m2)	29.4 ± 0.2
BMI group
Underweight	117 (2.0)
Normal weight	1756 (27.8)
Overweight	1952 (31.3)
Obese	2483 (39.0)
Initial weight (kg)	83.1 ± 0.7
Current weight (kg)	82.5 ± 0.8
Weight change (kg)	0.5 ± 0.1

Continuous variables are expressed as the weighted mean ± standard error; categorical variables are expressed as unweighted sample size (weighted percentages).

Abbreviations: BMI, body mass index.

Among participants attempting weight loss, 873 individuals (28.2 %) achieved ≥5 % weight loss over the past year. No significant differences in achieving 5 % weight loss were observed across age (P = 0.09), sex (P = 0.34), race/ethnicity (P = 0.18), or BMI categories (P = 0.91). Additionally, 392 participants (12.9 %) achieved ≥10 % weight loss, with adolescents showing the highest prevalence (15.8 %) compared to other age groups (P = 0.02). No significant differences were observed in achieving ≥10 % weight loss across sex (P = 0.48), racial/ethnic groups (P = 0.10), or BMI categories (P = 0.30). The detailed results are presented in Table 2.

Table 2.

Prevalence of weight-loss attempts and clinically significant weight loss and adjusted odds ratios among US adolescents and adults, NHANES 2021–2023.

Stratification	Weight loss attempt, n (weighted %)	Adjusted OR (95 % CI)	Weight loss ≥5%, n (weighted %)	Adjusted OR (95 % CI)	Weight loss ≥10 %, n (weighted %)	Adjusted OR (95 % CI)
Total	2962 (47.4)	–	873 (28.2)	–	392 (12.9)	–
Age categories (overall P)		<0.01		0.09		0.02
16–19 years	199 (37.7)	Reference	70 (35.2)	Reference	33 (15.8)	Reference
20–39 years	721 (48.6)	1.03 (0.78, 1.37)	212 (26.5)	0.65 (0.44, 0.97)	109 (14.1)	0.85 (0.41, 1.78)
40–59 years	868 (51.6)	0.94 (0.73, 1.21)	271 (29.8)	0.77 (0.47, 1.27)	120 (13.0)	0.75 (0.37, 1.54)
≥60 years	1174 (43.6)	0.70 (0.52, 0.95)	320 (27.0)	0.67 (0.45, 1.00)	130 (10.7)	0.61 (0.28, 1.35)
Sex (overall P)		<0.01		0.34		0.48
Male	1153 (41.0)	Reference	353 (29.6)	Reference	139 (12.2)	Reference
Female	1809 (53.8)	1.96 (1.72, 2.22)	520 (27.2)	0.88 (0.64, 1.23)	253 (13.4)	1.12 (0.79, 1.59)
Race/ethnicity (overall P)		0.22		0.18		0.1
Non-Hispanic White	1683 (46.1)	Reference	478 (27.7)	Reference	215 (12.9)	Reference
Non-Hispanic Black	364 (52.4)	1.02 (0.77, 1.35)	126 (33.7)	1.31 (0.94, 1.83)	64 (16.9)	1.27 (0.82, 1.97)
Mexican American	239 (52.7)	1.15 (0.68, 1.94)	70 (29.2)	1.03 (0.68, 1.55)	34 (14.5)	1.05 (0.62, 1.78)
Other races	676 (47.1)	1.13 (0.95, 1.34)	199 (26.1)	0.91 (0.63, 1.32)	79 (10.2)	0.74 (0.44, 1.25)
BMI group (overall P)		<0.01		0.91		0.3
Underweight	3 (1.0)	†	1 (29.0)	†	1 (29.0)	†
Normal weight	401 (24.5)	Reference	105 (27.3)	Reference	46 (12.5)	Reference
Overweight	921 (47.8)	3.20 (2.62, 3.90)	275 (27.7)	1.02 (0.59, 1.77)	112 (11.2)	0.93 (0.50, 1.74)
Obesity	1637 (65.9)	6.60 (5.42, 8.03)	492 (28.7)	1.04 (0.62, 1.76)	233 (14.0)	1.16 (0.68, 1.96)

Abbreviations: BMI, body mass index; OR, odds ratio; CI, confidence interval.

^†Underweight ORs are not shown due to very small cell counts.

In multivariable logistic regression adjusting for age, sex, race/ethnicity, and BMI (Table 2), BMI category showed the strongest association with weight loss attempts (overweight vs normal weight: aOR: 3.20, 95 % CI: 2.62, 3.90; obesity vs normal weight: aOR: 6.60, 95 % CI: 5.42, 8.03). Females had higher odds of attempting weight loss than males (aOR: 1.96, 95 % CI: 1.72, 2.22). Adults aged ≥60 years had lower odds of attempting weight loss compared to adolescents (aOR: 0.70, 95 % CI: 0.52, 0.95), while the 20–39 and 40–59 age groups did not differ significantly from adolescents. Adults aged 20–39 years had lower odds of achieving ≥5 % weight loss than adolescents (aOR: 0.65, 95 % CI: 0.44, 0.97); no other factors were independently associated with achieving ≥5 % weight loss. No independent associations were identified for achieving ≥10 % weight loss.

4. Discussion

This study provides an updated national portrait of weight loss behaviors and outcomes using the August 2021–August 2023 NHANES cycle, offering a post-pandemic snapshot of obesity-related efforts in the US. Nearly half of the participants reported attempting to lose weight in the past year. However, among those attempting weight loss, fewer than one-third achieved clinically meaningful weight loss (28.2 % achieved ≥5 % weight loss while 12.9 % achieved ≥10 %), which demonstrated persistent challenges in achieving sustained reductions despite high levels of motivation and awareness.

The prevalence of attempting to lose weight (47.4 %) appears broadly comparable to estimates from 2013 to 2016 (49.1 %) (Martin et al., 2018). Weight loss attempts were more frequent among women and middle-aged adults, consistent with longstanding patterns observed in behavioral and epidemiologic research (Martin et al., 2018). Women reported substantially higher prevalence than men (53.8 % vs 41.0 %). In adjusted analyses, female sex remained independently associated with attempting weight loss (aOR 1.96), consistent with prior literature suggesting that sociocultural pressures, body image norms, and health-related concerns may contribute to higher engagement in weight management among women (Elran-Barak, 2019). Middle-aged adults may engage in weight loss efforts more actively than other age groups due to health-oriented motivations, heightened awareness of chronic disease risks, the desire to improve physical appearance, increase energy levels, alleviate physical discomfort, and enhance psychological well-being and self-image (Lanoye et al., 2019).

Age patterns differed for weight loss success. Although adolescents had the lowest prevalence of weight loss attempts, they showed the highest prevalence of achieving ≥10 % weight loss (15.8 %). This finding aligns with prior evidence that younger individuals have higher metabolic flexibility and shorter obesity duration, potentially facilitating greater responsiveness to behavior change (Gebara et al., 2022). Nonetheless, low engagement among youth is concerning given the rising prevalence of adolescent obesity and the tracking of weight status into adulthood. Strengthening early, developmentally appropriate interventions may be important both to increase healthy engagement and to support safe, sustained weight management.

The BMI category was most strongly associated with attempts to lose weight. After adjustment, participants with overweight and obesity had significantly higher odds of attempting weight loss than those with normal weight (aOR 3.20 and 6.60, respectively). However, weight-loss attempts were also reported among individuals who were classified as underweight or normal weight. Prior data showed that about one-quarter of underweight/normal-weight adults reported trying to lose weight (26.5 % in 2013–2016) (Martin et al., 2018). This pattern may reflect weight misperception, body dissatisfaction, and sociocultural pressures that shape “ideal” body size, particularly among women and adolescents (Voelker et al., 2015). Importantly, perceived overweight status has been linked to maladaptive weight-control behaviors and may increase vulnerability to disordered eating or overeating via internalized weight stigma (Romano et al., 2018). Given these concerns, public health and clinical messaging should continue to promote healthy behaviors and obesity prevention while avoiding unintended harms, including reinforcing inappropriate weight loss efforts among normal-weight individuals.

Despite broad awareness of obesity risks, achieving CWL remains difficult for most individuals. Multiple barriers contribute to this gap between intention and outcome, including environmental constraints (limited access to healthy foods, urban design discouraging physical activity), behavioral challenges (low adherence, unrealistic expectations), and biological adaptation to weight loss (reductions in resting energy expenditure) (de Jong et al., 2023). Psychological factors such as stress, depression, and weight stigma may also impair self-regulation and engagement with healthy behaviors (Steptoe and Frank, 2023). These forces illustrate why weight management is rarely a matter of willpower alone and why interventions focused exclusively on individual choice often yield modest, short-lived effects. Addressing these barriers requires a comprehensive, multi-level approach. At the individual level, structured behavioral interventions that incorporate self-monitoring, goal-setting, and problem-solving continue to serve as foundational strategies for effective weight management (Butryn et al., 2011). Policies that promote healthy food environments, regulate marketing of calorie-dense foods, and create safe spaces for physical activity can foster sustained behavioral change.

This study has several limitations. First, weight change and attempts were self-reported, introducing potential recall and social desirability bias. Second, the cross-sectional design prevents causal inference between demographic factors and outcomes. Third, NHANES does not capture detailed information on diet, physical activity, or use of anti-obesity medications, which are likely to influence both weight loss efforts and success. Additionally, the response rate for NHANES 2021–2023 was lower than pre-pandemic levels, though survey weighting mitigates potential nonresponse bias. Finally, a substantial proportion of participants (25.4 %) were excluded due to missing data for at least one key variable. Although NHANES survey weights address nonresponse at the sampling level, complete-case analysis may still introduce selection bias. Despite these limitations, this study provides the most current, nationally representative data on weight loss attempts and clinically significant weight loss among US adolescents and adults. These findings offer valuable insight into ongoing public health challenges and opportunities for targeted intervention.

5. Conclusion

In this nationally representative analysis of NHANES 2021–2023, nearly half of US adolescents and adults reported attempting to lose weight in the prior year, yet fewer than one-third of those attempting achieved clinically significant weight loss. Weight-loss attempts were more common among women, middle-aged adults, and individuals with higher BMI categories, while clinically meaningful weight loss showed limited variation across demographic subgroups. These findings point to a persistent gap between intention and achieved weight reduction in the general population. Future research should identify which weight loss strategies and support are most strongly associated with sustained, clinically meaningful weight loss in contemporary US settings.

CRediT authorship contribution statement

Yuping Zou: Writing – original draft, Investigation, Data curation. Guang Xiong: Writing – review & editing, Writing – original draft, Software, Formal analysis, Conceptualization. Ligang Liu: Writing – review & editing, Supervision, Project administration, Methodology, Investigation, Conceptualization.

Informed consent statement

The National Health and Nutrition Examination Survey (NHANES) protocol was approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board, and all participants provided written informed consent.

Ethics statement

NHANES was reviewed and approved by the NCHS Research Ethics Review Board, and written informed consent was obtained from all participants. This study is a secondary analysis of publicly available, de-identified NHANES data and was exempt from additional institutional review board review.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability

Data used in this study are publicly available from the National Health and Nutrition Examination Survey (NHANES) program of the Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/nhanes/