Cross-cultural differences in weight loss maintenance: a comparison between North America and Europe.

Abstract

Background: The purpose of this study was to compare behavioral, psychosocial, and neighborhood environmental factors of long-term weight loss maintainers in North America and Europe.

Methods: Participants were weight loss maintainers in WeightWatchers in North America (n = 3656) and Europe (n = 624) who had maintained a ≥ 9.1 kg (21.7 kg on average) weight loss for ≥1 year (5.3 years on average) and had a current mean BMI of 29.9 kg/m². Validated surveys assessed behavioral (e.g., self-weighing, dietary strategies, restaurant eating, physical activity, sedentary time) psychological (e.g., habit strength, future focus, diet consistency, motivation, quality of life, body image, internalized weight bias), and neighborhood environment factors.

Results: Weight loss maintainers in North America vs. Europe had higher odds of weekly self-weighing (95% vs. 91%; OR = 1.7 [95% CI: 1.1, 2.5]), eating at fast food restaurants ≥weekly (11.6% vs. 2.6%; 7.7 [3.9, 14.3]; p < 0.001]), and other restaurants (29.7% vs 17.3%; OR = 1.47 [1.2, 2.1]; p < 0.001), more positive scores for body image (21.4 vs.20.7; η_p² = 0.253; p < 0.001) and body satisfaction (28.7 vs 22.8; η_p² = 0.248; p < 0.001), less weight bias internalization (3.0 vs 3.1; η_p² = 0.320; p < 0.001), shape concerns (2.3 vs 2.4; η_p² = 0.181; p < 0.001) and weight concerns (2.6 vs2.7; η_p² = 0.176; p < 0.001), and higher quality of life (75.0 vs. 73.4; η_p² = 0.154; p < 0.001), including general health perception (72.3 vs 68.1; η_p² = 0.187; p < 0.00), and physical functioning (81.3 vs 79.2; η_p² = 0.252; p < 0.001). In a multivariable regression, the variables that most strongly differentiated weight loss maintainers in North America and Europe were fast food consumption (OR = 10.8 [4.6, 25.5] p < 0.001) and self-weighing (OR = 1.9 [1.2,3.0]; p < 0.01).

Conclusions: Weight loss maintainers in North America and Europe differed in restaurant eating and self-weighing practices but otherwise reported similar behavioral, psychological, and environmental strategies.