Exploring Cause-Specific Mortality, Weight Management Goals, Motivations, and Approach Selection

Abstract

Obesity is a chronic and multifactorial disease that is associated with increased morbidity and mortality. Study 1 investigated differences in cause-specific mortality risks between obesity classes stratified by age and sex. Cox proportional hazard ratios were used to analyze data from NHANES Continuous (1999 to 2018) with mortality follow-up through Dec 31, 2019. Obesity class III is strongly associated with higher mortality risk than class I obesity in adults younger than 65 years of age and to a lesser degree in older men, while there were no significant associations in older women. Mortality risks were generally not different between obesity class I and II. Study 2 investigated differences in the weight loss by weight management goals, approaches employed, and the desired weight loss for adults attempting weight loss or preventing weight gain using NHANES Continuous (2007 to 2012). Generalized linear models with least squared adjusted means and Bonferroni post hoc tests were used. Both men and women tended to gain weight despite wanting to lose a significant amount of weight and employing several weight management approaches. This highlights that weight management approaches may have limited success in preventing weight gain or achieving the desired weight loss in the general population regardless of the approach used. Study 3 explored differences in weight loss and treatment time with health, mobility, and/or esthetics motivations for attempting weight loss among adults who participated in a publicly funded obesity management program at the Wharton Medical Clinic using least squared adjusted means. Despite small differences in treatment time and weight loss goals, differences in the motivations for attempting weight loss were not significantly associated with differences in the weight loss achieved. Overall, this thesis suggests that mortality rates for different specific causes are only elevated for severe obesity and disproportionately affects adults younger than 65 years of age. However, lifestyle interventions for obesity management may be limited in their effectiveness, and individual motivations, goals or approaches may not lead to a meaningful or sustained weight loss, highlighting the need for more effective obesity management approaches.