Racial and Ethnic Differences in Weight Loss Strategies among US Adults, a Cross- sectional Study of NHANES 2007 – 2018

Background Weight loss strategies, like obesity disparities, are influenced by public health efforts, health care inequities, and marginalization. Understanding how weight loss behaviors vary by race and ethnicity is essential for population health monitoring and equity-focused obesity interventions. This study aimed to determine racial and ethnic differences in strategies used to attempt weight loss among U.S. adults. Methods Cross-sectional analyses of six pooled cycles of National Health and Nutrition Examination Survey (2007–2018) data from adults aged ≥ 20 years (n = 5,821 men; n = 8,523 women) with a past-year weight loss attempt. The weight history questionnaire assessed weight loss strategies. Using White subgroups as the referent, gender-stratified multivariable logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for strategy use by race and ethnicity. Results Mexican (OR: 1.54; 95% CI: 1.14,2.06), additional Hispanic women (OR: 1.49; 95% CI: 1.02,2.17) and Black men (OR: 1.64; 95% CI: 1.19,2.27) had higher odds of using non-prescription supplements. Black women had higher odds of using exercise (OR: 1.74; 95% CI: 1.53,1.97), drinking a lot of water (OR: 1.49;95% CI: 1.25–1.77), and eating less fat (OR: 1.27;95% CI: 1.09–1.49). Black men had higher odds of using exercise (OR: 1.65; 95% CI: 1.35,2.01) and drinking a lot of water (OR: 1.75; 95% CI: 1.46,2.09). Black women (OR: 1.54; 95% CI: 1.30,1.81) and men (OR: 1.29; 95% CI: 1.04,1.59) had higher odds of skipping meals. Conclusions Racial and ethnic differences in weight loss behaviors, particularly those linked to disordered eating, emphasize the importance of population health surveillance and policies that promote equitable, evidence-based approaches to obesity interventions.