Trends in Weight Loss Attempts and Strategies Among US Adolescents With Overweight or Obesity

OBJECTIVE: This study assessed national trends in weight loss attempts, clinically meaningful weight loss, and associated strategies among US adolescents with overweight or obesity. METHODS: We analyzed National Health and Nutrition Examination Survey (NHANES) 1999-2023 data for 2708 adolescents aged 16-19 years with overweight or obesity. Weight loss attempts and strategies were self-reported. Clinically meaningful weight loss was defined as ≥ 5% and ≥ 10% body weight reductions or a ≥ 0.2 reduction in body mass index (BMI) z-score over the prior year. Survey-weighted logistic regression assessed temporal trends and associations between strategies and weight loss success. RESULTS: The prevalence of weight loss attempts increased from 53.9% in 1999-2000 to 65.7% in 2021-2023 (p for trend < 0.001). Overall, 26.96% achieved a ≥ 5% weight loss and 12.58% achieved a ≥ 10% weight loss; 34.34% achieved a ≥ 0.2 BMI z-score reduction. Exercise and dietary changes were the most reported strategies. Reducing sugar intake (OR, 2.16) and prescription medication use (OR, 2.55) were associated with achieving a ≥ 5% weight loss, and prescription medication use (OR, 3.59) was also associated with achieving a ≥ 10% weight loss. Sugar intake reduction (OR, 1.89) and prescription medication use (OR, 2.73) were associated with achieving a ≥ 0.2 reduction in BMI z-score. CONCLUSIONS: Weight loss attempts increased over time, but clinically meaningful weight loss remained uncommon. Improved access to evidence-based, developmentally appropriate interventions is needed.