Twenty-Year Trends in the Prevalence and Predictors of Healthcare Provider Advice to Lose Weight: U.S. NHANES, 1999-2018

Abstract

Healthcare providers (HCP) play a critical role in screening for obesity and supports for obesity management. We examined 1999–2018 trends in the prevalence and predictors of U.S. adults being told to lose weight using ten nationally representative NHANES cycles (n=16,424). Survey-weighted descriptive statistics and multivariable logistic regression identified sociodemographic, anthropometric (BMI, WC), clinical (MetS, EOSS), and behavioral predictors stratified by age, sex, and ethnicity. Overall, 34.4% reported ever receiving weight-loss advice; the prevalence rose from 11.1% to 19.2% among overweight and from 20.9% to 33.4% among obese individuals. Adjusted models showed older age, female sex, higher BMI (OR overweight = 6.15; obese = 41.86), elevated WC (OR = 8.37), and EOSS stages 2 (OR = 3.90) and 3 (OR = 5.07) were strong independent predictors, while socioeconomic and behavioral factors were modest. HCP weight-loss advice increased over two decades but remains predominantly driven by simple anthropometric measures; integrating comprehensive clinical risk tools like EOSS may improve equitable obesity care.