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Original research
Long-term weight loss success and the health behaviours of adults in the USA: findings from a nationally representative cross-sectional study
  1. Kerem Shuval1,2,3,
  2. Elisa Morales Marroquin4,5,
  3. Qing Li6,
  4. Gregory Knell4,5,7,
  5. Kelley Pettee Gabriel8,
  6. Jeffrey Drope9,
  7. Amy L Yaroch10,
  8. Karen G Chartier11,
  9. Bob M Fennis12,
  10. Mahmoud Qadan1
  1. 1School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa, Israel
  2. 2School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
  3. 3The Cooper Institute, Dallas, Texas, USA
  4. 4Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
  5. 5The Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
  6. 6American Cancer Society, Atlanta, Georgia, USA
  7. 7Children’s Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
  8. 8Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  9. 9Department of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois, USA
  10. 10Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
  11. 11School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
  12. 12Department of Marketing, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Kerem Shuval; kerem.shuval{at}


Objective To describe the relationship between long-term weight loss (LTWL) success and lifestyle behaviours among US adults.

Design Serial cross-sectional data from National Health and Nutrition Examination Survey cycles 2007–2014.

Setting and participants Population-based nationally representative sample. The analytic sample included 3040 adults aged 20–64 years who tried to lose weight in the past year.

Measures Participants were grouped into five LTWL categories (<5%, 5%–9.9%, 10%–14.9%, 15%–19.9% and ≥20%). Lifestyle-related behaviours included the following: alcohol intake, physical activity, smoking, fast-food consumption, dietary quality (Healthy Eating Index (HEI)) and caloric intake. Multivariable regression was employed adjusting for age, sex, race/ethnicity, marital status, education, household income and size, current body mass index and self-reported health status.

Results Individuals in the 15%–19.9% LTWL group differed significantly from the reference group (<5% LTWL) in their physical activity and dietary quality (HEI) but not caloric intake. Specifically, they had a higher HEI score (β=3.19; 95% CI 0.39 to 5.99) and were more likely to meet physical activity guidelines (OR=1.99; 95% CI 1.11 to 3.55). In comparison, the ≥20% LTWL group was significantly more likely to smoke (OR=1.63; 95% CI 1.03 to 2.57) and to consume lower daily calories (β=−202.91; 95% CI –345.57 to –60.25) than the reference group; however, dietary quality and physical activity did not significantly differ.

Conclusion Among a national sample of adults, a higher level of LTWL success does not necessarily equate to healthy weight loss behaviours. Future research should attempt to design interventions aimed at facilitating weight loss success while encouraging healthy lifestyle behaviours.

  • public health
  • preventive medicine
  • epidemiology

Data availability statement

Data are available in a public, open access repository. The current study used data from NHANES. It is publicly available and can be downloaded from the Centers for Disease Control and Prevention website:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available in a public, open access repository. The current study used data from NHANES. It is publicly available and can be downloaded from the Centers for Disease Control and Prevention website:

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  • Contributors KS conceived and led all aspects of the study. EMM meaningfully contributed to the write-up. QL and KS contributed to methodology employed, analytic approach and/or analyses. EMM, QL, GK, KPG, JD, ALY, KC, BMF and MQ provided critical insight on the methodology and/or feedback pertaining to study design and participated in critical revisions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.