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Clinically significant weight loss wasn't very common in U.S. adults with overweight or obesity, a cohort study suggested.

In a sample of nearly 18.5 million ambulatory adults followed for anywhere from 3 to 14 years, the annual probability of achieving clinically meaningful weight loss -- defined as 5% or more -- among those with overweight and obesity was low, at just one in 10, reported Lyudmyla Kompaniyets, PhD, of the National Center for Chronic Disease Prevention and Health Promotion at the CDC in Atlanta, and colleagues.

This probability increased with initial body mass index (BMI) category, from one in 12 people with initial overweight (one in 14 men and one in 11 women) to one in six men and women with an initial BMI of 45 or higher, they noted in .

The adjusted annual probability of reducing BMI to the healthy weight category was achieved in one in 19 individuals with overweight and one in 1,667 people with a BMI of 45 or higher. This probability was higher among women than men (one in 1,201 vs one in 2,870).

During the study period, 33.4% of those with overweight and 41.8% of those with obesity achieved a clinically significant weight loss, while only 23.2% and 2.0% of these adults reduced BMI down to the healthy weight category, respectively, the authors said.

"Given the health benefits of clinically meaningful weight reduction at any level of excess weight, 5% or greater weight loss can be a reasonable target for obesity management efforts," they wrote. "Clinicians and public health efforts can focus on messaging and referrals to interventions that support adults with excess weight in achieving and sustaining clinically meaningful weight loss."

Kompaniyets and team noted that they weren't necessarily surprised to see that women had a higher incidence of weight loss at any starting weight versus men, as this is consistent with prior research. Not only do more women more often than men, but metabolic surgery is historically far more common in women. Likewise, weight loss medications, like GLP-1 receptor agonists, tend to induce greater weight loss in women.

Nonetheless, Kompaniyets and colleagues pointed out that the data in this particular study are reflective of a "healthcare-seeking population with overweight or obesity regardless of any individual's intention to lose weight," and therefore people who are actively trying to lose weight may experience greater weight reductions.

Data for this study came from the IQVIA ambulatory electronic medical records database and included 18,461,623 patients ages 17 to 70 (median age 54); 56.7% were women, 72.3% were white, and 7.7% were Black. All patients had a minimum of 3 years of BMI data and were followed from January 2009 through February 2022.

Annual probability of a 5% or greater weight loss was slightly lower among Black women versus white women, and slightly higher among Black men versus white men after initial overweight, but lower after initial severe obesity.

There were no available data on factors influencing weight loss, like engagement in intensive health behavior and lifestyle interventions, physical activity level, access to healthy or nutritious food, diet, or socioeconomic determinants of health, which was a limitation to the study, the authors noted. They also said they were unable to differentiate between intentional and unintentional weight loss.

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