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

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Lauren Butler, Alejandra Gutierrez, Tamara Marsh, Rachel W. Goode, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7973909/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Intentional Weight Loss Obesity Disparities Weight Loss Strategies Disordered Eating NHANES Exercise Skipping Meals Non-prescription Supplement Use Figures Figure 1 Figure 2 Figure 3 Introduction Racial and ethnic obesity disparities in the United States (U.S.) are well documented. Black and Hispanic communities experience higher obesity prevalences than White communities, which differ by gender [ 1 – 3 ]. Though many factors influence obesity disparities, one important factor may be adverse social determinants of health, including inequitable access to health care and marginalization [ 4 ]. Over the past two decades obesity prevention public health efforts have targeted Black and Hispanic communities in the U.S. [ 5 – 6 ]. Weight loss strategies, like obesity disparities, are influenced by public health efforts, health care inequities, and marginalization. Understanding how weight loss strategies differ by race and ethnicity is necessary to inform more equitable public health policy, research, and practice [ 7 , 8 ]. Examining weight-loss behaviors within a population health framework provides insight into how behavioral determinants contribute to obesity inequities and can inform national monitoring and prevention efforts. National Health and Nutrition Examination Survey (NHANES 2013–2016) estimates indicate that nearly 50% of U.S. adults tried to lose weight in the past 12 months, with differences in weight loss attempts by gender and race [ 9 ]. A higher percentage of women (56.4%) than men (41.7%) reported a weight loss attempt in NHANES 2013–2016 [ 9 ]. While nearly 50% of women in all race and ethnic groups attempted weight loss annually, estimates for men were lower and differed by race with 37.9% of Black, compared to 42% of White, men reporting a weight loss attempt in NHANES 2013–2016 [ 9 ]. Data (NHANES 2007–2012) has shown that Black and Hispanic adults were less likely than White adults to attempt weight loss, but that gap has closed for women and is changing for men [ 9 , 10 ]. Given increased weight loss attempts, deeper investigation of potential racial and ethnic differences in weight loss strategies is necessary. For example, previous studies have reported mixed findings on using exercise to attempt weight loss among Black, compared to White adults [ 9 – 14 ]. However, a recent NHANES 2017–2020 study, using Hispanic adults as the referent, suggests that Black adults may have higher odds of exercising to attempt weight loss than White adults [ 15 ]. Additionally, Hispanic and Black male college students and adolescents have been more likely to engage in unhealthy or restrictive weight control practices [ 16 , 17 ]. Restrictive weight control strategies, such as skipping meals, have been associated with disordered eating behaviors, weight cycling, and weight gain [ 18 – 21 ]. Cross-sectional studies have examined specific weight control strategies, including unhealthy practices, used by women, college students and adolescents from racial and ethnic minority communities [ 16 – 18 , 22 – 24 ]. One study of Latinas living in Rhode Island reported that respondents who lived in the U.S. longer were more likely to eat low fat foods or using herbal products than fasting or commercial weight loss programs to attempt weight loss [ 24 ]. Another study of African American women in Florida, showed that eating less fried foods or sweets and increasing physical activity were used more often than skipping meals or joining a weight loss program [ 23 ]. Yet nationally representative studies of racial and ethnic differences in the use of skipping meals and other specific weight loss strategies including women and men are limited [ 25 ]. While previous research has shown increases in the proportion of adults attempting weight loss among marginalized racial and ethnic groups in the U.S., less is known about differences in specific weight loss attempt strategies [ 25 , 26 ]. To build an evidence base that informs sound public health initiatives aimed at eliminating racial and ethnic obesity disparities, nationally representative studies are needed [ 13 , 25 ]. The primary aim of the current study is to determine the strategies most likely to be used to attempt weight loss by Black and Hispanic, compared to White, adults in the U.S. To understand racial and ethnic differences in weight loss strategies among those who actually lost weight, sensitivity analyses restricted to those who reported weight loss were conducted. Materials and Methods Study Design and Subjects The NHANES is a repeated, cross-sectional survey of the civilian, non-institutionalized U.S. population administered by the National Center for Health Statistics (NCHS) division of the Centers for Disease Control and Prevention and U.S. Department of Agriculture (USDA). The NHANES utilizes a multistage, stratified area probability sampling design to select participants representative of the U.S. population. All participants gave informed consent and ethics approval was obtained from the NCHS Ethics Review Board. The study was conducted in accordance with the principles of the Declaration of Helsinki. Texas State University’s Institutional Review Board (IRB) determined that this study is not regulated by the provisions in 45 CFR § 46.102 and does not require IRB approval. This study utilized publicly available data from six pooled cycles of the NHANES: 2007–2008; 2009–2010; 2011–2012; 2013–2014; 2015–2016; 2017–2018 (n = 59,842). Missing data was excluded using listwise deletion and imputation was not used to handle missing data. To be comparable to other studies of weight loss attempts in the U.S., data from participants younger than 20 years old was excluded (n = 25,011) [ 8 , 22 , 24 ]. We also excluded participants who did not attempt weight loss in the past 12 months (n = 19,600) and who were missing intentional weight loss or covariate data. Due to small sample sizes, participants with a BMI < 18.5 kg/m 2 were also excluded. Figure 1 is a STROBE flow diagram that depicts the number of participants included and excluded based on study criteria. The final analytic sample included 14,344 adults ≥ 20 years of age who attempted weight loss in the past 12 months (n = 5,821 men; n = 8,523 women). A secondary analytic dataset of adults who reported an intentional weight loss of ≥ 10 pounds in the last 12 months (n = 4,078) was created from the primary analytic sample (Fig. 1 ) . < The NHANES datasets, questionnaires and related documentation can be accessed via the National Center for Health Statistics website: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx . Weight Loss Attempts and Strategies The NHANES Weight History Questionnaire is interviewer-administered and asks interviewees questions related to attempted weight loss during the past 12 months. Similar to previously published studies, the final analytic sample included all participants who reported attempting weight loss in the past 12 months regardless of whether weight loss was achieved. 9,13,15,26 For sensitivity analyses, a subsample of adults who reported an intentional weight loss of ≥ 10 pounds in the last 12 months was created from the primary analytic sample (Fig. 1 ) . Strategies used to attempt weight loss that were consistently reported at each survey year were investigated in this study. Those 18 strategies are reported in Table 1 . Respondents could report multiple strategies. Due to small sample sizes and using an approach similar to Mokari-Yamchi & Rosenkranz, “Started to Smoke or Began to Smoke Again” and “Took Laxatives or Vomited” were combined into one category [ 15 ]. Table 1 Eighteen weight loss attempt strategies included in the current study a Weight Loss Attempt Strategy 1. Exercised 2. Switched to foods with lower calories 3. Drank a lot of water 4. Ate less fat 5. Ate less food (amount) 6. Ate more fruit, vegetables, salads 7. Ate fewer carbohydrates 8. Ate less sugar, candy sweets 9. Changed eating habits (Didn’t eat late at night, ate several small meals a day) 10. Skipped meals 11. Took other pills, medicines, herbs or supplements not needing a prescription 12. Used a liquid diet formula such as Slimfast or Optifast 13. Joined a weight loss program such as Weight Watchers, Jeny Craig, Tops, or Overeaters Anonymous 14. Ate “diet” foods or products 15. Followed a special diet such as Dr. Atkins, South Beach, or other high protein or low carbohydrate diet, cabbage soup diet, Ornish, Nutrisystem, Body-for-Life 16. Took diet pills prescribed by a doctor 17. Started to smoke or began to smoke again b 18. Took laxatives or vomited b a Weight loss attempt strategies reported at each survey year in the National Health and Nutrition Examination Survey from 2007–2018 were included in the current study. b Due to small sample sizes and using an approach similar to Mokari-Yamchi & Rosenkranz, “Started to smoke or began to smoke again” and “Took laxatives or vomited” were combined into one category for analyses. 15 Race and Ethnicity Race and ethnicity data were obtained from the Demographics Questionnaire, and derived NHANES category names were edited and categorized to be consistent with recommendations from the United States Office of Management and Budget as follows: “Mexican”; “All additional Hispanic”; “Black”; “White “; and “Asian and all additional groups incl. Multiracial or Multiethnic “ [ 27 ]. Covariates Sociodemographic data, smoking status and insurance coverage were obtained from trained interviewer-administered questionnaires. Body Mass Index (BMI) was calculated from measured weight in kilograms divided by height in meters squared (kg/m 2 ). Analyses included the following categorical covariates that have been associated with strategies used to attempt weight loss: age (20–39, 40–59, 60–80), education (less than high school, high school graduate, some college, college graduate or above), marital status (never married, currently married, previously married), being born in the U.S. (yes/no) and BMI (18.5–24.9 kg/m 2 , 25.0–29.9 kg/m 2 , 30.0–34.9 kg/m 2 , ≥ 35.0 kg/m 2 ). 15 To account for trends in weight loss attempts and strategies over time, analyses adjusted for survey year (2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016, 2017–2018) [ 26 ]. Insurance coverage likely influences therapeutic choices, especially access to medications and healthcare resources, thus analyses adjusted for insurance coverage (yes/no). Because 9.30% of participants with eligible data had missing income data (n = 1,399), income was not included as a covariate in the current analysis. Statistical Analysis To account for the complex, multistage probability sampling design of NHANES, including unequal probabilities of selection, non-response, and post-stratification adjustments, the Mobile Examination Center weights provided by the NCHS were applied to all analyses. To align with an intersectional research framework and because weight loss behaviors have been shown to differ between men and women, all analyses were stratified by gender [ 8 , 25 , 26 ]. Descriptive analyses tested whether select characteristics for Mexican, all additional Hispanic, Black, or Asian and all additional groups incl. Multiracial or Multiethnic adults differed from White adults. To determine differences in categorical covariates Wald’s tests with Bonferroni correction for multiple comparisons were used. To assess racial and ethnic differences in weight loss strategies, separate logistic regression models, treating the use of each strategy as a binary outcome (yes/no) were used. Race and ethnicity, modeled as indicator variables for each race/ethnic group, was the independent variable. White subgroups were the referent groups in gender-stratified models and unadjusted and adjusted analyses were conducted. Adjusted models included Adjusted analyses included the following categorical covariates that have been associated with strategies used to attempt weight loss: age (20–39, 40–59, 60–80), education (less than high school, high school graduate, some college, college graduate or above), marital status (never married, currently married, previously married), being born in the U.S. (yes/no) and body mass index (BMI) (18.5–24.9 kg/m 2 , 25.0–29.9 kg/m 2 , 30.0–34.9 kg/m 2 , ≥ 35.0 kg/m 2 ) [ 15 ]. To account for trends in weight loss attempts and strategies over time, analyses adjusted for survey year (2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016, 2017–2018) [ 26 ]. Insurance coverage likely influences therapeutic choices, especially access to medications and healthcare resources, thus analyses adjusted for insurance coverage (yes/no). Because 9.30% of participants with eligible data had missing income data (n = 1,399), income was not included as a covariate in the current analysis. Sensitivity analyses were conducted by restricting the sample to participants who reported a weight loss of ≥ 10 pounds. age, education, marital status, being born in the US, BMI, survey year and insurance coverage. Sensitivity analyses were conducted by restricting the sample to participants who reported a weight loss of ≥ 10 pounds. All data analyses were performed with STATA (version 17, 2023, StataCorp, College Station, TX) using survey commands. Results Among adults ≥ 20 years of age who reported an intentional weight loss attempt (n = 15,140) those excluded from the study (n = 796) were more likely to belong to a historically marginalized racial group and less likely to consider themselves overweight, desire to weigh less or belong to a BMI category > 30 kg/m 2 ( Table S1 ). The survey weighted distributions of covariates for Mexican, all additional Hispanic, Black, or Asian and all additional groups incl. Multiracial or Multiethnic adults, compared to White adults, are presented for women in Table 2 and for men in Table 3 . Table 2 Characteristics of U.S. women ≥ 20 years of age who attempted weight loss, NHANES 2007–2018 a Characteristic Total (n = 8,523) Mexican (n = 1,345) All Additional Hispanic (n = 982) White (n = 3,301) Black (n = 1,957) Asian and All Additional b (n = 938) How do you consider your weight? Overweight 78.5 ± 0.6 79.5 ± 1.2 75.6 ± 1.6 78.7 ± 0.8 81.9 ± 0.8 72.3 ± 2.2 Underweight 0.8 ± 0.1 1.0 ± 0.3 2.1 ± 0.6 0.6 ± 0.2 1.1 ± 0.3 0.8 ± 0.3 About Right 20.7 ± 0.6 19.5 ± 1.3 22.3 ± 1.7 20.7 ± 0.8 17 ± 0.8 26.9 ± 2.1 0.31 0.001 0.004 0.01 Would you like to weigh more, less, or the same? More 0.3 ± 0.1 0.6 ± 0.2 0.9 ± 0.2 0.2 ± 0.1 0.7 ± 0.2 0.3 ± 0.2 Less 91.9 ± 0.4 91.5 ± 0.8 90.2 ± 1.0 92.7 ± 0.5 90.4 ± 0.7 88.8 ± 1.1 The Same 7.8 ± 0.4 8 ± 0.8 8.9 ± 1.0 7.1 ± 0.5 8.9 ± 0.7 10.9 ± 1.1 0.04 < 0.001 0.001 0.001 Age group (years) 20–39 37.3 ± 0.8 53.1 ± 1.7 48.1 ± 1.8 32.9 ± 1.1 40.1 ± 1.4 46.1 ± 2.1 40–59 39.3 ± 0.8 34.3 ± 1.4 37 ± 1.6 39.7 ± 1.0 42.2 ± 1.3 38.8 ± 2.0 60–80 23.4 ± 0.6 12.6 ± 1.0 14.9 ± 1.1 27.4 ± 0.8 17.7 ± 0.9 15.1 ± 1.3 < 0.001 < 0.001 < 0.001 < 0.001 Education level < High School 11.6 ± 0.5 37.1 ± 1.8 26.1 ± 1.8 7.2 ± 0.6 13.9 ± 0.8 6.4 ± 0.9 High School 21.4 ± 0.6 24.1 ± 1.4 19.9 ± 1.4 21.6 ± 0.9 22.8 ± 1.1 15.1 ± 2.1 Some College 35.4 ± 0.8 28.7 ± 1.7 33.5 ± 1.8 35.7 ± 1.1 39.9 ± 1.3 34.7 ± 2.3 College Graduate 31.6 ± 1.1 10.1 ± 1.1 20.5 ± 1.3 35.5 ± 1.4 23.4 ± 1.2 43.8 ± 2.5 < 0.001 < 0.001 < 0.001 0.003 Marital status Never Married 16.4 ± 0.7 15.3 ± 1.2 18.7 ± 1.5 12.7 ± 0.7 33.9 ± 1.1 19.5 ± 1.6 Married 62.2 ± 0.8 65.3 ± 1.4 59.1 ± 1.5 66 ± 1.1 38.6 ± 1.1 66.6 ± 1.9 Previously Married 21.4 ± 0.6 19.3 ± 1.3 22.2 ± 1.3 21.3 ± 0.8 27.5 ± 1.2 13.9 ± 1.4 0.09 < 0.001 < 0.001 < 0.001 Born in the United States No 15.9 ± 0.8 50.2 ± 2.0 62.8 ± 2.5 4.0 ± 0.5 9.5 ± 1.4 57.7 ± 2.6 Yes 84.1 ± 0.8 49.8 ± 2.0 37.2 ± 2.5 96 ± 0.5 90.5 ± 1.4 42.3 ± 2.6 < 0.001 < 0.001 < 0.001 < 0.001 Insurance Coverage No 14.1 ± 0.6 38.3 ± 1.6 25.3 ± 2.0 9.8 ± 0.6 16 ± 1.1 14.1 ± 1.5 Yes 85.9 ± 0.6 61.7 ± 1.6 74.7 ± 2.0 90.2 ± 0.6 84 ± 1.1 85.9 ± 1.5 < 0.001 < 0.001 < 0.001 0.002 Body Mass Index Category (kg/m 2 ) 18.5 to < 25 20.2 ± 0.7 10.5 ± 1.1 16.0 ± 1.2 22.8 ± 0.9 7.0 ± 0.7 33.7 ± 2.0 25 to < 30 30.3 ± 0.7 31.2 ± 1.2 33.9 ± 1.5 31.3 ± 1 21.6 ± 1.0 31.7 ± 1.9 30 to < 35 23.1 ± 0.6 26.4 ± 1.2 26.3 ± 1.5 21.9 ± 0.9 28.2 ± 1.0 18.5 ± 2.1 ≥ 35 26.4 ± 0.6 31.9 ± 1.4 23.8 ± 1.4 24 ± 0.9 43.1 ± 1.0 16.1 ± 1.8 < 0.001 < 0.001 < 0.001 < 0.001 a Data for women ≥ 20 years of age who attempted weight loss in the past 12 months from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 (n = 8,523). Values are proportions (% ± SE). All proportions take into account survey design and sample weights. Statistical significance set at p < 0.002 after Bonferroni correction for multiple comparisons (p < 0.05/32 = 0.002). b Includes Asian and all additional groups incl. Multiracial or Multiethnic. Table 3 Characteristics of U.S. men ≥ 20 years of age who attempted weight loss, NHANES 2007–2018 a Characteristic Total (n = 5,821) Mexican (n = 898) All Additional Hispanic (n = 561) White (n = 2,381) Black (n = 1,229) Asian and All Additional b (n = 752) How do you consider your weight? Overweight 72.9 ± 0.8 72.7 ± 1.6 70.2 ± 2.3 75.2 ± 1.1 67 ± 1.5 64.1 ± 2.8 Underweight 1.1 ± 0.2 1.3 ± 0.6 2.4 ± 0.8 0.8 ± 0.2 1.5 ± 0.4 1.1 ± 0.5 About Right 26 ± 0.8 26 ± 1.4 27.4 ± 2.2 24 ± 1.1 31.5 ± 1.3 34.8 ± 2.8 0.40 0.01 < 0.001 < 0.001 Would you like to weigh more, less, or the same? More 1.9 ± 0.2 1.7 ± 0.4 2.7 ± 0.8 1.7 ± 0.3 3 ± 0.6 2.4 ± 0.6 Less 85 ± 0.7 83.3 ± 1.3 80.0 ± 2.1 87.1 ± 0.8 78.9 ± 1.3 81.1 ± 2.0 The Same 13.1 ± 0.7 15.0 ± 1.4 17.3 ± 1.8 11.3 ± 0.8 18 ± 1.2 16.6 ± 1.9 0.03 0.001 < 0.001 0.003 Age group (years) 20–39 37.7 ± 0.9 55.0 ± 1.6 49.3 ± 2.9 32.5 ± 1.2 40.9 ± 1.5 48.2 ± 2.5 40–59 39.5 ± 0.9 34.1 ± 1.6 37.6 ± 2.9 40.3 ± 1.1 42.6 ± 1.5 36.9 ± 2.6 60–80 22.8 ± 0.9 10.8 ± 0.9 13.1 ± 1.2 27.2 ± 1.1 16.5 ± 0.9 14.8 ± 2.0 < 0.001 < 0.001 < 0.001 < 0.001 Education level < High School 11.9 ± 0.7 36.8 ± 2.2 22.4 ± 2.0 7.7 ± 0.8 13.7 ± 1.1 8.1 ± 1.4 High School 21.2 ± 0.9 24.7 ± 1.5 23.9 ± 2.1 20.2 ± 1.3 27.6 ± 1.3 15.2 ± 2.1 Some College 31.8 ± 0.8 26.3 ± 1.9 33.2 ± 2.5 32.2 ± 1.2 36 ± 1.4 28.5 ± 2.5 College Graduate 35.2 ± 1.4 12.2 ± 1.4 20.6 ± 2.0 39.9 ± 1.8 22.6 ± 1.3 48.2 ± 3.4 < 0.001 < 0.001 < 0.001 0.04 Marital status Never Married 19.3 ± 0.8 22.1 ± 1.6 20.6 ± 1.8 16.5 ± 1.0 30.3 ± 1.9 24.9 ± 2.3 Married 67.8 ± 1.0 66.0 ± 2.1 67.7 ± 2.3 70.4 ± 1.2 54.2 ± 1.7 65.3 ± 2.9 Previously Married 12.9 ± 0.7 11.9 ± 1.5 11.7 ± 1.3 13.1 ± 0.9 15.5 ± 1.2 9.8 ± 1.9 0.02 0.10 < 0.001 0.002 Born in the U.S. No 16.4 ± 0.8 51.4 ± 2.9 59.8 ± 2.9 4.0 ± 0.5 11.3 ± 1.2 52.5 ± 3.5 Yes 83.6 ± 0.8 48.6 ± 2.9 40.2 ± 2.9 96.1 ± 0.5 88.7 ± 1.2 47.5 ± 3.5 < 0.001 < 0.001 < 0.001 < 0.001 Insurance Coverage No 15.2 ± 0.6 38.8 ± 2.4 26.4 ± 2.3 9.3 ± 0.7 23.7 ± 1.5 17.6 ± 1.9 Yes 84.8 ± 0.6 61.2 ± 2.4 73.6 ± 2.3 90.7 ± 0.7 76.3 ± 1.5 82.4 ± 1.9 < 0.001 < 0.001 < 0.001 < 0.001 Body Mass Index Category (kg/m 2 ) 18.5 to < 25 8.3 ± 0.6 5.4 ± 0.9 6.3 ± 1.2 8.4 ± 0.8 5.5 ± 0.7 16.1 ± 1.7 25 to < 30 37.7 ± 0.9 34.1 ± 1.6 38.2 ± 2.3 38.6 ± 1.2 28.9 ± 1.5 43.8 ± 2.8 30 to < 35 31.3 ± 0.9 36.3 ± 2.1 34.5 ± 2.4 31.1 ± 1.3 31.5 ± 1.5 25.5 ± 2.2 ≥ 35 22.7 ± 0.7 24.1 ± 1.7 21.1 ± 2.4 22 ± 0.9 34.1 ± 1.4 14.7 ± 2.5 0.01 0.36 < 0.001 < 0.001 a Data for men ≥ 20 years of age who attempted weight loss in the past 12 month from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 (n = 5,821). Values are proportions (% ± SE). All proportions take into account survey design and sample weights. Statistical significance set at p < 0.002 after Bonferroni correction for multiple comparisons (p < 0.05/32 = 0.002). b Includes Asian and all additional groups incl. Multiracial or Multiethnic. Figure 2 shows adjusted odds ratios and 95% confidence intervals (OR: (95%CI)) of women using each strategy to attempt weight loss according to racial or ethnic subgroup. Compared to White women, the adjusted odds of exercise use were higher among Mexican (OR: 1.32; 95% CI: 1.09,1.60) and Black (OR: 1.74; 95% CI: 1.53,1.97) women. Mexican (OR: 1.34; 95% CI: 1.11,1.62), All Additional Hispanic (OR: 1.43; 95% CI: 1.17,1.74) and Black (OR: 1.49; 95% CI: 1.25,1.77) women had higher adjusted odds of drinking a lot of water to attempt weight loss, compared to White women. Compared to White women, Mexican (OR: 1.50; 95% CI: 1.21,1.87), All Additional Hispanic, (OR: 1.45; 95% CI: 1.19,1.77), Black (OR: 1.27; 95% CI: 1.09,1.49) and Asian and all additional groups incl. Multiracial or Multiethnic (OR: 1.27; 95% CI: 1.03,1.57) women had higher adjusted odds of eating less fat to attempt weight loss. Compared to White women, Black women had higher adjusted odds of skipping meals (OR: 1.54; 95% CI: 1.30,1.81) and starting to smoke, use laxatives or vomiting (OR: 1.96; 95% CI: 1.29,2.97) and lower adjusted odds of using a weight loss program to attempt weight loss (OR: 0.63; 95% CI: 0.49,0.82). Compared to White women Mexican (OR: 1.54; 95% CI: 1.14,2.06) and All Additional Hispanic (OR: 1.49; 95% CI: 1.02,2.17) women had higher adjusted odds of using non-prescription supplements to attempt weight loss. Unadjusted ORs and 95% CIs of women using each strategy to attempt weight loss according to racial or ethnic subgroup are available in Table S2 . Compared to White men, Black men had higher adjusted odds of exercise use (OR: 1.65; 95% CI: 1.35,2.01) to attempt weight loss (Fig. 3). Compared to White men, Mexican (OR: 1.34; 95% CI: 1.06,1.69), All Additional Hispanic (OR: 1.47; 95% CI: 1.10,1.96), Black (OR: 1.75; 95% CI: 1.46,2.09) men had higher adjusted odds of drinking a lot of water to attempt weight loss. Compared to White men, Black men had higher adjusted odds of eating more fruits, vegetables and salads (OR: 1.26; 95% CI: 1.05,1.51) to attempt weight loss. All Additional Hispanic (OR: 1.38; 95% CI: 1.06,1.80) and Black (OR: 1.33; 95% CI: 1.11,1.58) men had higher adjusted odds of eating less fat to attempt weight loss. Compared to White men, Black men had higher adjusted odds of skipping meals (OR: 1.29; 95% CI: 1.04,1.59) to attempt weight loss. All Additional Hispanic men, compared to White men, had higher adjusted odds of using diet pills prescribed by a doctor (OR: 3.48; 95% CI: 1.57,7.71) to attempt weight loss. Compared to White men, Mexican (OR: 1.71; 95% CI: 1.09,2.67) and Black (OR: 1.64; 95% CI: 1.19,2.27) men had higher adjusted odds of using non-prescription supplements to attempt weight loss. Black (OR: 3.58; 95% CI: 1.88,6.80) and Asian and all additional groups incl. Multiracial or Multiethnic (OR: 2.68; 95% CI: 1.20,5.98) men, had higher adjusted odds of starting to smoke, taking laxatives or vomiting to attempt weight loss. Black men, compared to White men, had higher adjusted odds of following a liquid diet (OR: 1.70; 95% CI: 1.02,2.81). Unadjusted ORs and 95% CIs of men using each strategy to attempt weight loss according to racial or ethnic subgroup are available in Table S3 . Unadjusted and adjusted OR and 95% CI for women and men who reported an intentional weight loss of ≥ 10 pounds are shown in Table S4 and Table S5 , respectively. In general, estimates were robust and strengthened after excluding participants who did not report a weight loss of ≥ 10 pounds. Discussion This study contributes population-level evidence on racial and ethnic disparities in weight-loss behaviors, highlighting behavioral determinants (e.g., skipping meals, non-prescription supplement use) that may perpetuate health inequalities in the U.S. Black women, Mexican women and Black men were more likely to exercise, drink a lot of water and consume less fat as compared to White women and men, respectively. Mexican and Black men and Hispanic women were more likely to report non-prescription supplement use. We observed racial and ethnic disparities in weight loss behaviors linked to disordered eating, with Black women and men being more likely to report skipping meals, starting to smoke or using laxatives or vomiting compared to White adults. Our findings contribute to the limited understanding of racial and ethnic differences in weight loss behaviors, which may contribute to worsened obesity disparities. Our study makes an important contribution to the literature on racial and ethnic differences in exercising as a weight loss strategy in the U.S. Previous research has yielded mixed results with some older studies reporting that Black adults are less likely than White adults to exercise to attempt weight loss [ 10 , 12 , 14 ]. Using White adults as the referent, our findings indicate that Black men and women are more likely to exercise as a weight loss strategy. Nationally representative studies provide insight into what might contribute to higher rates of exercise use among Black men and women in the current study [ 12 , 28 , 29 ]. In recent years, physical activity interventions targeting Black communities in the U.S. have shifted towards more culturally tailored and community-based approaches that have been shown to be effective at supporting health behavior change [ 6 ]. Furthermore, there has been an increase in the prevalence of women and Black people in the U.S. meeting general physical activity recommendations [ 28 ]. Additionally, exercising as a weight loss strategy has increased among U.S. adults over time [ 26 ]. Our findings imply that increases among Black men and women may underlie this general population trend. Additional research is needed to understand trends in the use of exercise as a weight loss strategy among Black adults in the U.S. Our results call attention to exercise motivated by weight loss. While exercise itself is a strengths-based health behavior, exercise motivated solely by the desire to lose weight has been associated with decreased physical activity among adults living with obesity and women in midlife [ 29 – 31 ]. Scholars have called for clinicians to encourage persons living with obesity to exercise with a focus on long-term improvements in cardiometabolic health rather than short term changes in body weight [ 32 ]. Our findings highlight the need to prioritize social determinants of health focused on improving health care access and quality, especially so that Black adults and Mexican women receive evidence-based guidance on exercising to attempt weight loss [ 33 ]. Our findings that Black men and women were more likely than White men and women to report skipping meals, starting to smoke or taking laxatives or vomiting to attempt weight loss add to a growing body of literature on racial and ethnic disparities in the weight loss behaviors linked to disordered eating [ 13 – 16 ]. Skipping meals as a weight loss strategy of African American women has been reported in community-based studies conducted in North Central Florida [ 22 , 23 ]. Our findings advance previous research with nationally representative results highlighting the use of skipping meals to lose weight among Black women and men in the U.S. Food restriction, including skipping meals, may increase the risk of binge eating, loss of control eating episodes, and disordered eating patterns [ 30 , 31 ]. Additionally, starting to smoke, taking laxatives or vomiting to lose weight are indicators of a disordered eating pattern. Chronic disordered eating patterns can lead to the development of Diagnostic and Statistical Manual of Mental Disorders-5 diagnosed eating disorders that are historically underrecognized in Black persons [ 30 , 34 ]. We found that Mexican and Black men and Hispanic women were more likely to use non-prescription supplements to attempt weight loss. Predatory marketing by health supplement corporations, like Herbalife, offers a possible explanation for non-prescription supplement use within Hispanic communities. In 2016, Herbalife was sued for malpractice including targeting Hispanic individuals for the use and sale of their products. Ultimately, Herbalife was required to restructure their business approach and refund affected sales associates and customers [ 35 ]. Our research adds to limited evidence that Black men may also be more likely to use non-prescription supplements to attempt weight loss [ 12 ]. To date, no over-the-counter supplements have been proven to be safe and effective for long-term weight loss. Public health policies that prevent the predatory marketing of supplements to underserved and marginalized racial and ethnic minority communities may be warranted. In the rapidly evolving pharmacological landscape of obesity care, our findings contribute to the limited understanding of racial and ethnic differences in weight loss behaviors. The strategies identified in this study reflect common weight loss approaches used by U.S. adults prior to the widespread uptake of glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide and tirzepatide) in obesity care. As GLP-1s gain popularity, it is possible that individuals will combine anti-obesity medication use with the strategies identified in our study. Members of underserved and historically marginalized communities face healthcare barriers that may limit their access to GLP-1s, potentially exacerbating, rather than resolving, obesity disparities [ 36 – 37 ]. Our findings serve as an important historical surveillance reference for understanding weight loss behaviors in the broader investigation of racial and ethnic obesity disparities in the U.S. 4.1 Limitations This study has strengths and limitations to consider. A primary strength is our use of nationally representative NHANES data which is collected systematically over time. Additionally, while most studies of intentional weight loss include all people who report attempting weight loss regardless of whether weight loss was achieved [ 9 , 14 , 26 ] we conducted sensitivity analyses restricting our analyses to those who reported losing ≥ 10 pounds in the last year. Our main findings related to exercise, skipping meals and starting to smoke or taking laxatives or vomiting were robust in both primary and sensitivity analyses. There are important limitations with NHANES data, including reliance on self-reported intentional weight loss strategies which may be subject to social desirability bias, and data collection limitations which limited our ability to analyze the Asian or Hispanic ethnicity subgroups. We were also only able to examine the weight loss strategies captured by the NHANES survey which may not represent all weight loss strategies used, including GLP-1 medications used for weight loss, by the general population. Although more recent NHANES cycles (2019–2020 and 2021–2023) have been conducted, there are methodological challenges with combining these surveys with previous NHANES surveys [ 38 ]; therefore, analyses were restricted to data from the NHANES 2007–2018 cycles. Conclusions This study provides nationally representative, population-level evidence of racial and ethnic differences in weight loss behaviors among U.S. adults. Black and Mexican women, and Black men, were more likely to use exercise, drink a lot of water, and consume less fat compared to White women and men, respectively. Black adults were also more likely to engage in weight loss behaviors linked to disordered eating, such as skipping meals and starting to smoke or using laxatives or vomiting. These behavioral disparities reflect underlying social and structural determinants that shape access to resources, cultural norms, and exposure to weight-loss messaging. Monitoring weight loss behaviors through national surveillance systems is essential for understanding population health obesity related inequalities. Especially in the ever-evolving investigation of obesity trends and treatments. Public health programming and policy should prioritize equitable, evidence-based guidance that addresses both safe and effective weight-loss practices and the broader conditions that perpetuate obesity disparities. Abbreviations NHANES National Health and Nutrition Examination Survey OR Odds Ratio CI Confidence Intervals US United States NCHS National Center for Health Statistics GLP-1 glucagon-like peptide-1 Declarations Ethics approval and consent to participate All participants gave informed consent and ethics approval was obtained from the NCHS Ethics Review Board. Texas State University’s Institutional Review Board (IRB) determined that this study was not regulated by the provisions in 45 CFR § 46.102 and does not require IRB approval. Consent for publication Not applicable Competing Interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution J. Lauren Butler: Conceptualization, Methodology, Formal Analysis, Investigation, Resources, Writing – Original Draft, Writing – Review & Editing, Visualization, Supervision; Alejandra Gutierrez: Conceptualization, Investigation, Writing – Original Draft, Writing – Review & Editing, Visualization, Project Administration; Tamara Marsh: Conceptualization, Writing – Review & Editing, Visualization; Rachel W. Goode: Conceptualization, Writing – Review & Editing; Meghan Slining: Conceptualization, Writing – Review & Editing, Supervision. All authors made substantial contributions to the conception and design of the study, drafting the article, or revising it critically for important intellectual content, and approved the final version of the manuscript for submission. Acknowledgement The authors would like to thank Dave Wilson at the University of North Florida’s Center for Instruction and Research Technology for his expertise in developing the visualizations used to present the study’s main findings. His support greatly enhanced the clarity and impact of the manuscript. Data Availability The datasets analyzed during the current study are publicly available from the NHANES website: https://wwwn.cdc.gov/nchs/nhanes/default.aspx References Min J, Goodale H, Xue H, Brey R, Wang Y. Racial-Ethnic Disparities in Obesity and Biological, Behavioral, and Sociocultural Influences in the United States: A Systematic Review. Adv Nutr. 2021;12(4):1137–48. 10.1093/advances/nmaa162 . Hales CM, Carroll MD, Fryar CD, Ogden CL. 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Epub 2022 Sep 29. Erratum in: J Am Heart Assoc. 2023;12(6):e027630. 10.1161/JAHA.121.027630 . PMID: 36172953; PMCID: PMC9673703. Capoccia D, Milani I, Colangeli L, Parrotta ME, Leonetti F, Guglielmi V. Social, cultural and ethnic determinants of obesity: From pathogenesis to treatment. Nutr Metab Cardiovasc Dis. 2025;35(6):103901. 10.1016/j.numecd.2025.103901 . Epub 2025 Feb 1. PMID: 40087047. National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES). 2021–2023 Data Documentation, Codebook, and Frequencies – Overview Brief [Internet]. Hyattsville (MD): Centers for Disease Control and Prevention; 2024 [cited 2025 Oct 10]. Available from: https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/OverviewBrief.aspx?Cycle=2021-2023 Additional Declarations No competing interests reported. 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07:28:34","extension":"jpeg","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":20412,"visible":true,"origin":"","legend":"","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/ae1e7032c26616901205d13a.jpeg"},{"id":96249690,"identity":"fdaf4da7-c756-4aa4-bf20-ded7a731e3d1","added_by":"auto","created_at":"2025-11-19 07:36:01","extension":"jpeg","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65270,"visible":true,"origin":"","legend":"","description":"","filename":"groupimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/f76400257711dc81bcc47164.jpeg"},{"id":96080823,"identity":"b37732fb-1ec8-4f85-a9eb-b7e435753098","added_by":"auto","created_at":"2025-11-17 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11:28:09","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12702,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinegroupimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/716ad4289271e1815e8e2c74.png"},{"id":96249345,"identity":"f97eb16e-9184-4737-b99a-8fba730ddc63","added_by":"auto","created_at":"2025-11-19 07:33:07","extension":"png","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39031,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinegroupimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/e801f987752cdadaca86d14d.png"},{"id":96080824,"identity":"5c0ff1c7-7e21-478b-9cee-a2f229a1f22f","added_by":"auto","created_at":"2025-11-17 11:28:09","extension":"png","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":369,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinegroupimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/9e3145a986292104a83d175d.png"},{"id":96080829,"identity":"e49bb778-a46e-468a-9865-747ac5de3e70","added_by":"auto","created_at":"2025-11-17 11:28:09","extension":"xml","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":180832,"visible":true,"origin":"","legend":"","description":"","filename":"e0e8cacbab514650a5df0a12e2abb5271structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/973203ef3cbe4eeb0797c8e5.xml"},{"id":96080828,"identity":"f6e160ce-7b22-4e7a-9dd0-46046182c750","added_by":"auto","created_at":"2025-11-17 11:28:09","extension":"html","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":206631,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/e7d579887a12398ca4e930fb.html"},{"id":96080797,"identity":"d32fdbe0-85ad-4c0a-a6b2-e45491be35cb","added_by":"auto","created_at":"2025-11-17 11:28:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56187,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSTROBE flow diagram of study participant inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea \u003c/sup\u003eParticipants (n)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/64ead660151db329393a12a2.png"},{"id":96080798,"identity":"eab89857-fb3c-4826-81d8-f01fa2426f50","added_by":"auto","created_at":"2025-11-17 11:28:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":101811,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdjusted odds of weight loss attempt strategy use among US women ≥20 years, NHANES 2007 – 2018 \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Data for women ≥ 20 years of age who attempted weight loss in the past 12 months from the National Health and Nutrition Examination Survey (NHANES) 2007 – 2018 (n= 8,523). All estimates are odds ratios (OR) and 95% confidence intervals (95% CI) obtained from separate multivariable logistic regression models that regressed use of each weight loss strategy (binary outcome) on race and ethnicity (indicator variables) adjusted for age, education, marital status, birth in the U.S., insurance coverage, body mass index and survey year in Stata version 17 (2017, StataCorp). All estimates take into account survey design and sample weights. The White race subgroup (n=3,301) was the referent group in all models.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Includes all additional Hispanic groups\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec \u003c/sup\u003eIncludes Asian and all additional groups incl. Multiracial or Multiethnic\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/ce42db332e67b495d4e93c23.png"},{"id":96248245,"identity":"d3c5244d-4367-45c0-8c64-731886510cd8","added_by":"auto","created_at":"2025-11-19 07:28:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":105818,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdjusted odds of weight loss attempt strategy use among U.S. men ≥20 years, 2007 – 2018 \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea \u003c/sup\u003eData for men ≥ 20 years of age who attempted weight loss in the past 12 months from the National Health and Nutrition Examination Survey (NHANES) 2007 – 2018 (n= 5,821). All estimates are odds ratios (OR) and 95% confidence intervals (95% CI) obtained from separate multivariable logistic regression models that regressed use of each weight loss strategy (binary outcome) on race and ethnicity (indicator variables) adjusted for age, education, marital status, birth in the U.S., insurance coverage, body mass index and survey year in Stata version 17 (2017, StataCorp). All estimates take into account survey design and sample weights. The White race subgroup (n= 2,381) was the referent group in all models.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Includes all additional Hispanic groups\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec \u003c/sup\u003eIncludes Asian and all additional groups incl. Multiracial or Multiethnic\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/65f4712876e446c1bcc6d4b4.png"},{"id":97671600,"identity":"5f8b2cea-0d56-43d7-87e8-6eb7f8ff7360","added_by":"auto","created_at":"2025-12-08 09:32:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1639785,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/3c232970-9b8b-440f-a616-68d4d274f358.pdf"},{"id":96080796,"identity":"fc0f9509-35a5-424a-a424-9f45c429208d","added_by":"auto","created_at":"2025-11-17 11:28:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":26727,"visible":true,"origin":"","legend":"","description":"","filename":"TableS3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/da15dd95f140db6b6e35dcff.docx"},{"id":96080801,"identity":"0e9a8084-ada8-4dfe-adc4-666a8b454c70","added_by":"auto","created_at":"2025-11-17 11:28:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29342,"visible":true,"origin":"","legend":"","description":"","filename":"TableS4.docx","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/a0d0b33687ee33945fb150fa.docx"},{"id":96080802,"identity":"11b1c6ce-9084-4271-9300-ed2bdbaeed34","added_by":"auto","created_at":"2025-11-17 11:28:08","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":31590,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/f165e6e154fbdfe6cd10c7c1.docx"},{"id":96248410,"identity":"80c60e92-439b-4e45-b092-9d029e7509dd","added_by":"auto","created_at":"2025-11-19 07:28:26","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":28244,"visible":true,"origin":"","legend":"","description":"","filename":"TableS5.docx","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/53e106248d1767c3750707de.docx"},{"id":96080810,"identity":"3d195329-8d56-4ddf-bbaa-6b564d709f9c","added_by":"auto","created_at":"2025-11-17 11:28:09","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":28513,"visible":true,"origin":"","legend":"","description":"","filename":"TableS2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7973909/v1/43d8266d4ad1f84957e42d67.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Racial and Ethnic Differences in Weight Loss Strategies among US Adults, a Cross- sectional Study of NHANES 2007 – 2018","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRacial and ethnic obesity disparities in the United States (U.S.) are well documented. Black and Hispanic communities experience higher obesity prevalences than White communities, which differ by gender [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Though many factors influence obesity disparities, one important factor may be adverse social determinants of health, including inequitable access to health care and marginalization [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Over the past two decades obesity prevention public health efforts have targeted Black and Hispanic communities in the U.S. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Weight loss strategies, like obesity disparities, are influenced by public health efforts, health care inequities, and marginalization. Understanding how weight loss strategies differ by race and ethnicity is necessary to inform more equitable public health policy, research, and practice [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Examining weight-loss behaviors within a population health framework provides insight into how behavioral determinants contribute to obesity inequities and can inform national monitoring and prevention efforts.\u003c/p\u003e\u003cp\u003eNational Health and Nutrition Examination Survey (NHANES 2013\u0026ndash;2016) estimates indicate that nearly 50% of U.S. adults tried to lose weight in the past 12 months, with differences in weight loss attempts by gender and race [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A higher percentage of women (56.4%) than men (41.7%) reported a weight loss attempt in NHANES 2013\u0026ndash;2016 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While nearly 50% of women in all race and ethnic groups attempted weight loss annually, estimates for men were lower and differed by race with 37.9% of Black, compared to 42% of White, men reporting a weight loss attempt in NHANES 2013\u0026ndash;2016 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Data (NHANES 2007\u0026ndash;2012) has shown that Black and Hispanic adults were less likely than White adults to attempt weight loss, but that gap has closed for women and is changing for men [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven increased weight loss attempts, deeper investigation of potential racial and ethnic differences in weight loss strategies is necessary. For example, previous studies have reported mixed findings on using exercise to attempt weight loss among Black, compared to White adults [\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, a recent NHANES 2017\u0026ndash;2020 study, using Hispanic adults as the referent, suggests that Black adults may have higher odds of exercising to attempt weight loss than White adults [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, Hispanic and Black male college students and adolescents have been more likely to engage in unhealthy or restrictive weight control practices [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Restrictive weight control strategies, such as skipping meals, have been associated with disordered eating behaviors, weight cycling, and weight gain [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCross-sectional studies have examined specific weight control strategies, including unhealthy practices, used by women, college students and adolescents from racial and ethnic minority communities [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. One study of Latinas living in Rhode Island reported that respondents who lived in the U.S. longer were more likely to eat low fat foods or using herbal products than fasting or commercial weight loss programs to attempt weight loss [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another study of African American women in Florida, showed that eating less fried foods or sweets and increasing physical activity were used more often than skipping meals or joining a weight loss program [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Yet nationally representative studies of racial and ethnic differences in the use of skipping meals and other specific weight loss strategies including women and men are limited [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. While previous research has shown increases in the proportion of adults attempting weight loss among marginalized racial and ethnic groups in the U.S., less is known about differences in specific weight loss attempt strategies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. To build an evidence base that informs sound public health initiatives aimed at eliminating racial and ethnic obesity disparities, nationally representative studies are needed [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The primary aim of the current study is to determine the strategies most likely to be used to attempt weight loss by Black and Hispanic, compared to White, adults in the U.S. To understand racial and ethnic differences in weight loss strategies among those who actually lost weight, sensitivity analyses restricted to those who reported weight loss were conducted.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Subjects\u003c/h2\u003e\u003cp\u003eThe NHANES is a repeated, cross-sectional survey of the civilian, non-institutionalized U.S. population administered by the National Center for Health Statistics (NCHS) division of the Centers for Disease Control and Prevention and U.S. Department of Agriculture (USDA). The NHANES utilizes a multistage, stratified area probability sampling design to select participants representative of the U.S. population. All participants gave informed consent and ethics approval was obtained from the NCHS Ethics Review Board. The study was conducted in accordance with the principles of the Declaration of Helsinki. Texas State University\u0026rsquo;s Institutional Review Board (IRB) determined that this study is not regulated by the provisions in 45 CFR \u0026sect;\u0026nbsp;46.102 and does not require IRB approval. This study utilized publicly available data from six pooled cycles of the NHANES: 2007\u0026ndash;2008; 2009\u0026ndash;2010; 2011\u0026ndash;2012; 2013\u0026ndash;2014; 2015\u0026ndash;2016; 2017\u0026ndash;2018 (n\u0026thinsp;=\u0026thinsp;59,842).\u003c/p\u003e\u003cp\u003eMissing data was excluded using listwise deletion and imputation was not used to handle missing data. To be comparable to other studies of weight loss attempts in the U.S., data from participants younger than 20 years old was excluded (n\u0026thinsp;=\u0026thinsp;25,011) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. We also excluded participants who did not attempt weight loss in the past 12 months (n\u0026thinsp;=\u0026thinsp;19,600) and who were missing intentional weight loss or covariate data. Due to small sample sizes, participants with a BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e were also excluded. Figure\u0026nbsp;1 is a STROBE flow diagram that depicts the number of participants included and excluded based on study criteria. The final analytic sample included 14,344 adults\u0026thinsp;\u0026ge;\u0026thinsp;20 years of age who attempted weight loss in the past 12 months (n\u0026thinsp;=\u0026thinsp;5,821 men; n\u0026thinsp;=\u0026thinsp;8,523 women). A secondary analytic dataset of adults who reported an intentional weight loss of \u0026ge;\u0026thinsp;10 pounds in the last 12 months (n\u0026thinsp;=\u0026thinsp;4,078) was created from the primary analytic sample (Fig.\u0026nbsp;1\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003c\u003cp\u003eThe NHANES datasets, questionnaires and related documentation can be accessed via the National Center for Health Statistics website: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://wwwn.cdc.gov/nchs/nhanes/Default.aspx\u003c/span\u003e\u003cspan address=\"https://wwwn.cdc.gov/nchs/nhanes/Default.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eWeight Loss Attempts and Strategies\u003c/h3\u003e\n\u003cp\u003eThe NHANES Weight History Questionnaire is interviewer-administered and asks interviewees questions related to attempted weight loss during the past 12 months. Similar to previously published studies, the final analytic sample included all participants who reported attempting weight loss in the past 12 months regardless of whether weight loss was achieved.\u003csup\u003e9,13,15,26\u003c/sup\u003e For sensitivity analyses, a subsample of adults who reported an intentional weight loss of \u0026ge;\u0026thinsp;10 pounds in the last 12 months was created from the primary analytic sample (Fig.\u0026nbsp;1\u003cb\u003e)\u003c/b\u003e. Strategies used to attempt weight loss that were consistently reported at each survey year were investigated in this study. Those 18 strategies are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Respondents could report multiple strategies. Due to small sample sizes and using an approach similar to Mokari-Yamchi \u0026amp; Rosenkranz, \u0026ldquo;Started to Smoke or Began to Smoke Again\u0026rdquo; and \u0026ldquo;Took Laxatives or Vomited\u0026rdquo; were combined into one category [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEighteen weight loss attempt strategies included in the current study\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight Loss Attempt Strategy\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExercised\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSwitched to foods with lower calories\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDrank a lot of water\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAte less fat\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAte less food (amount)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAte more fruit, vegetables, salads\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAte fewer carbohydrates\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAte less sugar, candy sweets\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChanged eating habits (Didn\u0026rsquo;t eat late at night, ate several small meals a day)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSkipped meals\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTook other pills, medicines, herbs or supplements not needing a prescription\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsed a liquid diet formula such as Slimfast or Optifast\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJoined a weight loss program such as Weight Watchers, Jeny Craig, Tops, or Overeaters Anonymous\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAte \u0026ldquo;diet\u0026rdquo; foods or products\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFollowed a special diet such as Dr. Atkins, South Beach, or other high protein or low carbohydrate diet, cabbage soup diet, Ornish, Nutrisystem, Body-for-Life\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTook diet pills prescribed by a doctor\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStarted to smoke or began to smoke again\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTook laxatives or vomited\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Weight loss attempt strategies reported at each survey year in the National Health and Nutrition Examination Survey from 2007\u0026ndash;2018 were included in the current study.\u003c/p\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Due to small sample sizes and using an approach similar to Mokari-Yamchi \u0026amp; Rosenkranz, \u0026ldquo;Started to smoke or began to smoke again\u0026rdquo; and \u0026ldquo;Took laxatives or vomited\u0026rdquo; were combined into one category for analyses.\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eRace and Ethnicity\u003c/h3\u003e\n\u003cp\u003eRace and ethnicity data were obtained from the Demographics Questionnaire, and derived NHANES category names were edited and categorized to be consistent with recommendations from the United States Office of Management and Budget as follows: \u0026ldquo;Mexican\u0026rdquo;; \u0026ldquo;All additional Hispanic\u0026rdquo;; \u0026ldquo;Black\u0026rdquo;; \u0026ldquo;White \u0026ldquo;; and \u0026ldquo;Asian and all additional groups incl. Multiracial or Multiethnic \u0026ldquo; [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eSociodemographic data, smoking status and insurance coverage were obtained from trained interviewer-administered questionnaires. Body Mass Index (BMI) was calculated from measured weight in kilograms divided by height in meters squared (kg/m\u003csup\u003e2\u003c/sup\u003e). Analyses included the following categorical covariates that have been associated with strategies used to attempt weight loss: age (20\u0026ndash;39, 40\u0026ndash;59, 60\u0026ndash;80), education (less than high school, high school graduate, some college, college graduate or above), marital status (never married, currently married, previously married), being born in the U.S. (yes/no) and BMI (18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e, 25.0\u0026ndash;29.9 kg/m\u003csup\u003e2\u003c/sup\u003e, 30.0\u0026ndash;34.9 kg/m\u003csup\u003e2\u003c/sup\u003e, \u0026ge; 35.0 kg/m\u003csup\u003e2\u003c/sup\u003e).\u003csup\u003e15\u003c/sup\u003e To account for trends in weight loss attempts and strategies over time, analyses adjusted for survey year (2007\u0026ndash;2008, 2009\u0026ndash;2010, 2011\u0026ndash;2012, 2013\u0026ndash;2014, 2015\u0026ndash;2016, 2017\u0026ndash;2018) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Insurance coverage likely influences therapeutic choices, especially access to medications and healthcare resources, thus analyses adjusted for insurance coverage (yes/no). Because 9.30% of participants with eligible data had missing income data (n\u0026thinsp;=\u0026thinsp;1,399), income was not included as a covariate in the current analysis.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eTo account for the complex, multistage probability sampling design of NHANES, including unequal probabilities of selection, non-response, and post-stratification adjustments, the Mobile Examination Center weights provided by the NCHS were applied to all analyses. To align with an intersectional research framework and because weight loss behaviors have been shown to differ between men and women, all analyses were stratified by gender [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDescriptive analyses tested whether select characteristics for Mexican, all additional Hispanic, Black, or Asian and all additional groups incl. Multiracial or Multiethnic adults differed from White adults. To determine differences in categorical covariates Wald\u0026rsquo;s tests with Bonferroni correction for multiple comparisons were used.\u003c/p\u003e\u003cp\u003eTo assess racial and ethnic differences in weight loss strategies, separate logistic regression models, treating the use of each strategy as a binary outcome (yes/no) were used. Race and ethnicity, modeled as indicator variables for each race/ethnic group, was the independent variable. White subgroups were the referent groups in gender-stratified models and unadjusted and adjusted analyses were conducted. Adjusted models included Adjusted analyses included the following categorical covariates that have been associated with strategies used to attempt weight loss: age (20\u0026ndash;39, 40\u0026ndash;59, 60\u0026ndash;80), education (less than high school, high school graduate, some college, college graduate or above), marital status (never married, currently married, previously married), being born in the U.S. (yes/no) and body mass index (BMI) (18.5\u0026ndash;24.9 kg/m\u003csup\u003e2\u003c/sup\u003e, 25.0\u0026ndash;29.9 kg/m\u003csup\u003e2\u003c/sup\u003e, 30.0\u0026ndash;34.9 kg/m\u003csup\u003e2\u003c/sup\u003e, \u0026ge; 35.0 kg/m\u003csup\u003e2\u003c/sup\u003e) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To account for trends in weight loss attempts and strategies over time, analyses adjusted for survey year (2007\u0026ndash;2008, 2009\u0026ndash;2010, 2011\u0026ndash;2012, 2013\u0026ndash;2014, 2015\u0026ndash;2016, 2017\u0026ndash;2018) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Insurance coverage likely influences therapeutic choices, especially access to medications and healthcare resources, thus analyses adjusted for insurance coverage (yes/no). Because 9.30% of participants with eligible data had missing income data (n\u0026thinsp;=\u0026thinsp;1,399), income was not included as a covariate in the current analysis. Sensitivity analyses were conducted by restricting the sample to participants who reported a weight loss of \u0026ge;\u0026thinsp;10 pounds. age, education, marital status, being born in the US, BMI, survey year and insurance coverage. Sensitivity analyses were conducted by restricting the sample to participants who reported a weight loss of \u0026ge;\u0026thinsp;10 pounds. All data analyses were performed with STATA (version 17, 2023, StataCorp, College Station, TX) using survey commands.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong adults\u0026thinsp;\u0026ge;\u0026thinsp;20 years of age who reported an intentional weight loss attempt (n\u0026thinsp;=\u0026thinsp;15,140) those excluded from the study (n\u0026thinsp;=\u0026thinsp;796) were more likely to belong to a historically marginalized racial group and less likely to consider themselves overweight, desire to weigh less or belong to a BMI category\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e (\u003cstrong\u003eTable \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe survey weighted distributions of covariates for Mexican, all additional Hispanic, Black, or Asian and all additional groups incl. Multiracial or Multiethnic adults, compared to White adults, are presented for women in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and for men in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of U.S. women\u0026thinsp;\u0026ge;\u0026thinsp;20 years of age who attempted weight loss, NHANES 2007\u0026ndash;2018\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;8,523)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMexican\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,345)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll Additional Hispanic (n\u0026thinsp;=\u0026thinsp;982)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3,301)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBlack\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,957)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAsian and All Additional\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;938)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHow do you consider your weight?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e78.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e78.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnderweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbout Right\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWould you like to weigh more, less, or the same?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e91.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e91.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e92.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe Same\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e37.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e32.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e39.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e39.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducation level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt; High School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSome College\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e35.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e35.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege Graduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e31.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e35.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNever Married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreviously Married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBorn in the United States\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e15.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e84.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInsurance Coverage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e85.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e90.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBody Mass Index Category (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5 to \u0026lt;\u0026thinsp;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 to \u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e31.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 to \u0026lt;\u0026thinsp;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Data for women\u0026thinsp;\u0026ge;\u0026thinsp;20 years of age who attempted weight loss in the past 12 months from the National Health and Nutrition Examination Survey (NHANES) 2007\u0026ndash;2018 (n\u0026thinsp;=\u0026thinsp;8,523). Values are proportions (% \u0026plusmn; SE). All proportions take into account survey design and sample weights. Statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.002 after Bonferroni correction for multiple comparisons (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05/32\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Includes Asian and all additional groups incl. Multiracial or Multiethnic.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of U.S. men\u0026thinsp;\u0026ge;\u0026thinsp;20 years of age who attempted weight loss, NHANES 2007\u0026ndash;2018\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5,821)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMexican\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;898)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll Additional Hispanic\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;561)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2,381)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBlack (n\u0026thinsp;=\u0026thinsp;1,229)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAsian and All Additional\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;752)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHow do you consider your weight?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e72.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e75.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnderweight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAbout Right\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWould you like to weigh more, less, or the same?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e87.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe Same\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducation level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt; High School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSome College\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e31.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e32.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCollege Graduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e39.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNever Married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreviously Married\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBorn in the U.S.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e83.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e96.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInsurance Coverage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e84.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e73.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBody Mass Index Category (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.5 to \u0026lt;\u0026thinsp;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 to \u0026lt;\u0026thinsp;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e38.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 to \u0026lt;\u0026thinsp;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e31.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e31.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Data for men\u0026thinsp;\u0026ge;\u0026thinsp;20 years of age who attempted weight loss in the past 12 month from the National Health and Nutrition Examination Survey (NHANES) 2007\u0026ndash;2018 (n\u0026thinsp;=\u0026thinsp;5,821). Values are proportions (% \u0026plusmn; SE). All proportions take into account survey design and sample weights. Statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.002 after Bonferroni correction for multiple comparisons (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05/32\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Includes Asian and all additional groups incl. Multiracial or Multiethnic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2\u003c/strong\u003e shows adjusted odds ratios and 95% confidence intervals (OR: (95%CI)) of women using each strategy to attempt weight loss according to racial or ethnic subgroup. Compared to White women, the adjusted odds of exercise use were higher among Mexican (OR: 1.32; 95% CI: 1.09,1.60) and Black (OR: 1.74; 95% CI: 1.53,1.97) women. Mexican (OR: 1.34; 95% CI: 1.11,1.62), All Additional Hispanic (OR: 1.43; 95% CI: 1.17,1.74) and Black (OR: 1.49; 95% CI: 1.25,1.77) women had higher adjusted odds of drinking a lot of water to attempt weight loss, compared to White women. Compared to White women, Mexican (OR: 1.50; 95% CI: 1.21,1.87), All Additional Hispanic, (OR: 1.45; 95% CI: 1.19,1.77), Black (OR: 1.27; 95% CI: 1.09,1.49) and Asian and all additional groups incl. Multiracial or Multiethnic (OR: 1.27; 95% CI: 1.03,1.57) women had higher adjusted odds of eating less fat to attempt weight loss. Compared to White women, Black women had higher adjusted odds of skipping meals (OR: 1.54; 95% CI: 1.30,1.81) and starting to smoke, use laxatives or vomiting (OR: 1.96; 95% CI: 1.29,2.97) and lower adjusted odds of using a weight loss program to attempt weight loss (OR: 0.63; 95% CI: 0.49,0.82). Compared to White women Mexican (OR: 1.54; 95% CI: 1.14,2.06) and All Additional Hispanic (OR: 1.49; 95% CI: 1.02,2.17) women had higher adjusted odds of using non-prescription supplements to attempt weight loss.\u003c/p\u003e\n\u003cp\u003eUnadjusted ORs and 95% CIs of women using each strategy to attempt weight loss according to racial or ethnic subgroup are available in \u003cstrong\u003eTable \u003cspan class=\"InternalRef\"\u003eS2\u003c/span\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eCompared to White men, Black men had higher adjusted odds of exercise use (OR: 1.65; 95% CI: 1.35,2.01) to attempt weight loss (Fig.\u0026nbsp;3). Compared to White men, Mexican (OR: 1.34; 95% CI: 1.06,1.69), All Additional Hispanic (OR: 1.47; 95% CI: 1.10,1.96), Black (OR: 1.75; 95% CI: 1.46,2.09) men had higher adjusted odds of drinking a lot of water to attempt weight loss. Compared to White men, Black men had higher adjusted odds of eating more fruits, vegetables and salads (OR: 1.26; 95% CI: 1.05,1.51) to attempt weight loss. All Additional Hispanic (OR: 1.38; 95% CI: 1.06,1.80) and Black (OR: 1.33; 95% CI: 1.11,1.58) men had higher adjusted odds of eating less fat to attempt weight loss. Compared to White men, Black men had higher adjusted odds of skipping meals (OR: 1.29; 95% CI: 1.04,1.59) to attempt weight loss. All Additional Hispanic men, compared to White men, had higher adjusted odds of using diet pills prescribed by a doctor (OR: 3.48; 95% CI: 1.57,7.71) to attempt weight loss. Compared to White men, Mexican (OR: 1.71; 95% CI: 1.09,2.67) and Black (OR: 1.64; 95% CI: 1.19,2.27) men had higher adjusted odds of using non-prescription supplements to attempt weight loss. Black (OR: 3.58; 95% CI: 1.88,6.80) and Asian and all additional groups incl. Multiracial or Multiethnic (OR: 2.68; 95% CI: 1.20,5.98) men, had higher adjusted odds of starting to smoke, taking laxatives or vomiting to attempt weight loss. Black men, compared to White men, had higher adjusted odds of following a liquid diet (OR: 1.70; 95% CI: 1.02,2.81).\u003c/p\u003e\n\u003cp\u003eUnadjusted ORs and 95% CIs of men using each strategy to attempt weight loss according to racial or ethnic subgroup are available in \u003cstrong\u003eTable \u003cspan class=\"InternalRef\"\u003eS3\u003c/span\u003e\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eUnadjusted and adjusted OR and 95% CI for women and men who reported an intentional weight loss of \u0026ge;\u0026thinsp;10 pounds are shown in \u003cstrong\u003eTable \u003cspan class=\"InternalRef\"\u003eS4\u003c/span\u003e\u003c/strong\u003e and \u003cstrong\u003eTable \u003cspan class=\"InternalRef\"\u003eS5\u003c/span\u003e\u003c/strong\u003e, respectively. In general, estimates were robust and strengthened after excluding participants who did not report a weight loss of \u0026ge;\u0026thinsp;10 pounds.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study contributes population-level evidence on racial and ethnic disparities in weight-loss behaviors, highlighting behavioral determinants (e.g., skipping meals, non-prescription supplement use) that may perpetuate health inequalities in the U.S. Black women, Mexican women and Black men were more likely to exercise, drink a lot of water and consume less fat as compared to White women and men, respectively. Mexican and Black men and Hispanic women were more likely to report non-prescription supplement use. We observed racial and ethnic disparities in weight loss behaviors linked to disordered eating, with Black women and men being more likely to report skipping meals, starting to smoke or using laxatives or vomiting compared to White adults. Our findings contribute to the limited understanding of racial and ethnic differences in weight loss behaviors, which may contribute to worsened obesity disparities.\u003c/p\u003e\u003cp\u003eOur study makes an important contribution to the literature on racial and ethnic differences in exercising as a weight loss strategy in the U.S. Previous research has yielded mixed results with some older studies reporting that Black adults are less likely than White adults to exercise to attempt weight loss [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Using White adults as the referent, our findings indicate that Black men and women are more likely to exercise as a weight loss strategy. Nationally representative studies provide insight into what might contribute to higher rates of exercise use among Black men and women in the current study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In recent years, physical activity interventions targeting Black communities in the U.S. have shifted towards more culturally tailored and community-based approaches that have been shown to be effective at supporting health behavior change [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, there has been an increase in the prevalence of women and Black people in the U.S. meeting general physical activity recommendations [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Additionally, exercising as a weight loss strategy has increased among U.S. adults over time [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our findings imply that increases among Black men and women may underlie this general population trend. Additional research is needed to understand trends in the use of exercise as a weight loss strategy among Black adults in the U.S.\u003c/p\u003e\u003cp\u003eOur results call attention to exercise motivated by weight loss. While exercise itself is a strengths-based health behavior, exercise motivated solely by the desire to lose weight has been associated with decreased physical activity among adults living with obesity and women in midlife [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e–\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Scholars have called for clinicians to encourage persons living with obesity to exercise with a focus on long-term improvements in cardiometabolic health rather than short term changes in body weight [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Our findings highlight the need to prioritize social determinants of health focused on improving health care access and quality, especially so that Black adults and Mexican women receive evidence-based guidance on exercising to attempt weight loss [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur findings that Black men and women were more likely than White men and women to report skipping meals, starting to smoke or taking laxatives or vomiting to attempt weight loss add to a growing body of literature on racial and ethnic disparities in the weight loss behaviors linked to disordered eating [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Skipping meals as a weight loss strategy of African American women has been reported in community-based studies conducted in North Central Florida [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our findings advance previous research with nationally representative results highlighting the use of skipping meals to lose weight among Black women and men in the U.S. Food restriction, including skipping meals, may increase the risk of binge eating, loss of control eating episodes, and disordered eating patterns [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Additionally, starting to smoke, taking laxatives or vomiting to lose weight are indicators of a disordered eating pattern. Chronic disordered eating patterns can lead to the development of \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders-5\u003c/em\u003e diagnosed eating disorders that are historically underrecognized in Black persons [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWe found that Mexican and Black men and Hispanic women were more likely to use non-prescription supplements to attempt weight loss. Predatory marketing by health supplement corporations, like Herbalife, offers a possible explanation for non-prescription supplement use within Hispanic communities. In 2016, Herbalife was sued for malpractice including targeting Hispanic individuals for the use and sale of their products. Ultimately, Herbalife was required to restructure their business approach and refund affected sales associates and customers [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Our research adds to limited evidence that Black men may also be more likely to use non-prescription supplements to attempt weight loss [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. To date, no over-the-counter supplements have been proven to be safe and effective for long-term weight loss. Public health policies that prevent the predatory marketing of supplements to underserved and marginalized racial and ethnic minority communities may be warranted.\u003c/p\u003e\u003cp\u003eIn the rapidly evolving pharmacological landscape of obesity care, our findings contribute to the limited understanding of racial and ethnic differences in weight loss behaviors. The strategies identified in this study reflect common weight loss approaches used by U.S. adults prior to the widespread uptake of glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide and tirzepatide) in obesity care. As GLP-1s gain popularity, it is possible that individuals will combine anti-obesity medication use with the strategies identified in our study. Members of underserved and historically marginalized communities face healthcare barriers that may limit their access to GLP-1s, potentially exacerbating, rather than resolving, obesity disparities [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e–\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Our findings serve as an important historical surveillance reference for understanding weight loss behaviors in the broader investigation of racial and ethnic obesity disparities in the U.S.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.1 Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has strengths and limitations to consider. A primary strength is our use of nationally representative NHANES data which is collected systematically over time. Additionally, while most studies of intentional weight loss include all people who report attempting weight loss regardless of whether weight loss was achieved [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] we conducted sensitivity analyses restricting our analyses to those who reported losing ≥ 10 pounds in the last year. Our main findings related to exercise, skipping meals and starting to smoke or taking laxatives or vomiting were robust in both primary and sensitivity analyses. There are important limitations with NHANES data, including reliance on self-reported intentional weight loss strategies which may be subject to social desirability bias, and data collection limitations which limited our ability to analyze the Asian or Hispanic ethnicity subgroups. We were also only able to examine the weight loss strategies captured by the NHANES survey which may not represent all weight loss strategies used, including GLP-1 medications used for weight loss, by the general population. Although more recent NHANES cycles (2019–2020 and 2021–2023) have been conducted, there are methodological challenges with combining these surveys with previous NHANES surveys [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]; therefore, analyses were restricted to data from the NHANES 2007–2018 cycles.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides nationally representative, population-level evidence of racial and ethnic differences in weight loss behaviors among U.S. adults. Black and Mexican women, and Black men, were more likely to use exercise, drink a lot of water, and consume less fat compared to White women and men, respectively. Black adults were also more likely to engage in weight loss behaviors linked to disordered eating, such as skipping meals and starting to smoke or using laxatives or vomiting. These behavioral disparities reflect underlying social and structural determinants that shape access to resources, cultural norms, and exposure to weight-loss messaging. Monitoring weight loss behaviors through national surveillance systems is essential for understanding population health obesity related inequalities. Especially in the ever-evolving investigation of obesity trends and treatments. Public health programming and policy should prioritize equitable, evidence-based guidance that addresses both safe and effective weight-loss practices and the broader conditions that perpetuate obesity disparities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNHANES\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Health and Nutrition Examination Survey\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Intervals\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNCHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Center for Health Statistics\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGLP-1\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eglucagon-like peptide-1\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eAll participants gave informed consent and ethics approval was obtained from the NCHS Ethics Review Board. Texas State University\u0026rsquo;s Institutional Review Board (IRB) determined that this study was not regulated by the provisions in 45 CFR \u0026sect;\u0026nbsp;46.102 and does not require IRB approval.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ. Lauren Butler: Conceptualization, Methodology, Formal Analysis, Investigation, Resources, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing, Visualization, Supervision; Alejandra Gutierrez: Conceptualization, Investigation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing, Visualization, Project Administration; Tamara Marsh: Conceptualization, Writing \u0026ndash; Review \u0026amp; Editing, Visualization; Rachel W. Goode: Conceptualization, Writing \u0026ndash; Review \u0026amp; Editing; Meghan Slining: Conceptualization, Writing \u0026ndash; Review \u0026amp; Editing, Supervision. All authors made substantial contributions to the conception and design of the study, drafting the article, or revising it critically for important intellectual content, and approved the final version of the manuscript for submission.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank Dave Wilson at the University of North Florida\u0026rsquo;s Center for Instruction and Research Technology for his expertise in developing the visualizations used to present the study\u0026rsquo;s main findings. His support greatly enhanced the clarity and impact of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets analyzed during the current study are publicly available from the NHANES website: https://wwwn.cdc.gov/nchs/nhanes/default.aspx\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMin J, Goodale H, Xue H, Brey R, Wang Y. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/OverviewBrief.aspx?Cycle=2021-2023\u003c/span\u003e\u003cspan address=\"https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/OverviewBrief.aspx?Cycle=2021-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intentional Weight Loss, Obesity Disparities, Weight Loss Strategies, Disordered Eating, NHANES, Exercise, Skipping Meals, Non-prescription Supplement Use","lastPublishedDoi":"10.21203/rs.3.rs-7973909/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7973909/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWeight 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eCross-sectional analyses of six pooled cycles of National Health and Nutrition Examination Survey (2007\u0026ndash;2018) data from adults aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years (n\u0026thinsp;=\u0026thinsp;5,821 men; n\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMexican (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\u0026ndash;1.77), and eating less fat (OR: 1.27;95% CI: 1.09\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eRacial 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.\u003c/p\u003e","manuscriptTitle":"Racial and Ethnic Differences in Weight Loss Strategies among US Adults, a Cross- sectional Study of NHANES 2007 – 2018","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-17 11:28:04","doi":"10.21203/rs.3.rs-7973909/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4565d265-2a89-4675-94e8-cfefe18ff761","owner":[],"postedDate":"November 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-05T12:09:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-17 11:28:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7973909","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7973909","identity":"rs-7973909","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}