Differences in Adherence to Cardiovascular Lifestyle Recommendations, Diet Quality, and Weight Loss Strategies in 2007-2016 NHANES by Weight Loss Status

Abstract

Describe lifestyle behavior differences and weight loss intention behaviors for those with clinically significant weight loss. The American Heart Association Life’s Simple 7 (LS7) assesses modifiable behaviors associated with cardiovascular disease (CVD) risk. A high LS7 score (range 0-14) reflects adherence to recommendations. Individuals often employ diet and weight loss strategies to improve weight status, though many engage in detrimental practices. There is a need to identify differences in LS7 adherence, diet quality, and weight loss strategies between those with and without clinically significant weight loss (CSWL). Data from 2007-2016 National Health and Nutrition Examination Survey (NHANES) questionnaires, clinical measures, and 24-hour dietary recalls were assessed to determine differences in LS7 adherence, diet quality (Healthy Eating Index), and weight loss strategies between adults with: (1) intentional CSWL ≥5%; and (2) non-CSWL <5%, weight maintenance, or weight gain. ANOVA and chi-square tests were used to assess differences. While greater LS7 adherence was observed among non-CSWL individuals (n=17,499; 7.5±0.0 vs 7.4±0.1, p=0.028), those with CSWL (n=2,844) demonstrated higher diet quality (total HEI 52.9±0.4 vs 52.0±0.2, p=0.019) and more physical activity minutes/week (75.9±3.1 vs 68.3±1.5, p=0.017). However, 74% of all individuals demonstrated low adherence to dietary recommendations. A greater proportion of CSWL individuals reported strategies of exercising (p=0.016); non-CSWL individuals reported greater use of skipping meals (p=0.002) or prescription diet pills (p<0.001) to lose weight. Greater adherence to diet and physical activity recommendations was observed among individuals with CSWL, though overall LS7 adherence was low. Future research should address the implementation of evidence-based strategies that improve diet quality and reduce CVD risk among those with intent to lose weight.