Journal of Human Nutrition and Dietetics
WEIGHT LOSS Weight-loss strategies used by baby boomer men: a mixed methods approach D. C. S. James,1 C. K. Wirth,2 C. Harville II1 & O. Efunbumi1 1
Department of Health Science Education, University of Florida, Gainesville, FL, USA Department of Health, Leisure and Exercise Sciences, University of West Florida, Pensacola, FL, USA
2
Keywords men’s health, weight-loss strategies. Correspondence Delores C. S. James, Department of Health Science Education, University of Florida, PO Box 118210, Room 5 Florida Gym, Gainesville, FL 32611-8210, USA. Tel.: +1 352 294 1806 Fax: +1 352 392 1909 E-mail: [email protected] How to cite this article James D.C.S., Wirth C.K., Harville II C. & Efunbumi O. (2016) Weight-loss strategies used by baby boomer men: a mixed methods approach. J Hum Nutr Diet. 29, 217–224 doi: 10.1111/jhn.12305
Abstract Background: Baby Boomer men (those born in 1946–1964) are becoming obese at an earlier age compared to previous generations. The present study aimed to identify weight-loss strategies used by Baby Boomer men, to determine whether those strategies varied by weight status and to explore their dieting experiences. Methods: The study used a cross-sectional survey of 211 men and 20 indepth interviews. Results: Men had a mean (SD) body mass index (BMI) of 29.35 (5.07) kg m–2, with 82% being overweight or obese. Fifty-six percent were currently trying to lose weight. Healthy weight-loss strategies included reducing portions, increasing physical activity, cutting back on fried foods, cutting back on sweets, cutting back on alcohol, using meal replacement drinks/bars and joining a weight-loss programme. Unhealthy strategies included skipping meals and using over-the-counter ‘diet pills’. Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss programme and used diet pills had significantly higher BMIs than men who said they did not (P < 0.05 for all). Interviews revealed that older men struggle to lose weight, ‘I’ve been struggling for the last 2–3 years’. ‘The last time I really tried to lose weight I stayed on the diet for just a day or two’. Wives were considered essential to their weight management success. Conclusions: Men used a do-it-yourself weight-loss approach using both healthy and unhealthy strategies. Obese men were more likely to use unhealthy practices than overweight men.
Introduction By 2015, individuals aged ≥50 years will represent 45% of the population in the USA. This growth is largely a result of ‘Baby Boomers’, those born in 1946–1964 (1). Baby Boomers are developing obesity, heart disease, diabetes and other chronic diseases earlier than previous generations (2–4). More than one-third of the US population is obese, and there has been a 29% increase in obesity among Baby Boomer men in every decade since 1950 (5,6) . From 1960 to 1962, the average American man weighed close to 77.11 kg (170 lbs) but that increased to just over 90.72 kg (200 lbs) from 2003 to 2006 (7). Currently, 44% of Baby Boomer men are overweight and ª 2015 The British Dietetic Association Ltd.
34% are obese (5). Baby Boomer men are also more likely than their female counterparts to develop metabolic syndrome, which can significantly add to the burden of health care costs (8). Even though men report less body dissatisfaction than women do, they still report a degree of body dissatisfaction and a desire to lose weight (9–14). Furthermore, as men get older, they place greater value on their health and are more willing to assume more responsibility for their health (15). Despite expressing a desire to lose weight, it has been extremely difficult to recruit men into weight-loss management. Men in general, and older men in particular, are considered a ‘hard-to-reach’ population for health promotion and disease prevention programmes (15,16). Studies show that men 217
D. C. S. James et al.
Weight-loss strategies
are less likely than women to be concerned about their weight, as well as less likely than women to perceive themselves as overweight or obese, participate in in group and individual weight-loss programmes, have annual checkups, or seek advice from a health professional (14,17,18). Few studies have focused on weight management issues among older men and, to our knowledge, only one recent study has identified key factors for developing programmes and interventions for this group (12). Moreover, in the past 10 years, participation in weight-loss research has predominately been focused on women, and only 22% of participants in US studies were men (19). The present study aimed to: (i) identify weight-loss strategies used by Baby Boomer men; (ii) determine whether these strategies varied by weight status; and (iii) explore the men’s dieting experiences. By gaining a better understanding of these strategies, health professionals can better design and implement tailored messages, programmes and interventions that can actively engage and retain older men actively attempting to lose weight.
items: weight management strategies (nine items, a = 0.80), foods in their diet that they need to eat more of (nine items, a = 0.81) and foods in the diet that they need to eat less of (seven items, a = 0.78). Men self-reported their weight and height. Body mass index (BMI) was calculated based on participants’ reported weight and height (kg m–2). Qualitative procedures A sample of 20 men who completed the survey agreed to participate in one-on-one interviews. The interviews were audio-taped and lasted 45–60 min. Each man provided their written informed consent and received a $20 gift card. The interview questions with relevant probes are shown in Table 1. Major topics included sources of dieting information, weight-loss strategies and information needed to lose weight. The topics covered included perception of weight status, dieting and weight management strategies, and areas for dietary improvement. Statistical analysis
Materials and methods This mixed method study design concurrently included a cross-sectional survey of 211 Baby Boomer men and 20 one-on-one semi-structured interviews. This approach allowed for the comparison and corroboration of the quantitative findings with qualitative findings and for both datasets to be combined within a joint discussion to provide a more holistic picture (20,21). The study was approved by the Institutional Review Board at the researchers’ institution. Quantitative procedures Data were collected with a convenience sample. Surveys were collected primarily at sporting events and civic organisation meetings. Each participant provided their verbal informed consent. No incentives were provided and the survey took approximately 15 min to complete. The survey was developed based on a review of the literature, a previously validated instrument (used with males and females) and several focus groups. The development, use and validation of the original instrument are discussed elsewhere (22,23).The instrument was modified to target only men. It was pilot-tested with five men who came from the target group. These pilot surveys were not included in the present study. Minor revisions were made in the wording and ordering of the questions. Demographic items included age, marital status, race/ethnicity, employment status, income level, educational level and home ownership. Cronbach’s a measured internal consistency of three questions that asked participants to ‘choose all that apply’ from several 218
The surveys were entered into a computerised database and frequency tables were generated and checked for completeness, range and consistency. Data were analysed using JMP, version 11 Pro (SAS Institute, Cary, NC, USA). Conventional cross-tabulations and analyses were used to summarise the data. Differences in mean BMI and study variables were examined using one-way analysis of variance (ANOVA) and Student’s t-test. Post-hoc comparisons were carried out using Tukey’s honestly significant difference. Significance was established at the P < 0.05 level for all tests. Data are reported as the mean (SD). Interview data were analysed using directed content analysis to identify key words and examine themes, concepts and patterns in the data relating to weight-loss strategies. This method also helps to triangulate, extend and support quantitative findings (24). A primary coder and two secondary coders coded the interview transcripts. There were in-depth reviews and re-reviews of the transcripts based on established themes from the codebook (25,26) . Coders also made annotated comments on the transcripts for discussion in team meetings. Several team meetings were used to discuss areas of agreement and disagreement with the themes until consensus was reached (27) . Select verbatim quotes that captured the men’s experiences, views and opinions are included in the text. Results Demographics The men had a mean (SD) age of 54 (5.57) years. Most were heterosexual (90%), White/Caucasian (75%), ª 2015 The British Dietetic Association Ltd.
D. C. S. James et al.
Weight-loss strategies
Table 1 Interview guide (n = 20). 1. Please describe how you feel about your current weight? (Probe: Is it a concern for you? Why or why not?) 2. How do you know when you’re at a healthy weight? (Probe: How is your definition similar or different to that of health professionals?) 3. What comes to mind when you hear the following words: ‘healthy weight’ ‘overweight’ ‘obesity?’ (Probe: What is the difference between being overweight and being obese?) 4. Please describe the last time that you tried to lose weight? (Probes: What was the reason why you tried to lose weight? What is the hardest thing about keeping your weight down?) 5. What types of strategies are you using or have used in the past to lose weight? (Probes: What works for you? What doesn’t work?) 6. Where do you get your health and dieting information? (Probe: Who do you talk to if you need information on losing weight?) 7. What type of information do you need to help you lose weight or maintain a healthy weight? (Probe: Do you need information on nutrition, exercise, serving sizes?)
married (77%), college graduates or had college credits (63%), homeowners (88%) or employed (84%) and had incomes of over $50 000 per year (63%) (Table 1). Weight and health status BMI was calculated based on self-reported weight and height. The mean BMI for participants was 29.35 (5.07) kg m–2. Based on BMI, 43% were overweight, 39% were obese, 18% were normal and no-one was underweight. There were no significant differences in BMI on any of the demographic factors. With regards to weight satisfaction, 10% were very satisfied, 18% were satisfied, 33% were somewhat satisfied, 32% were dissatisfied and 7% were very dissatisfied. A one-way ANOVA indicated significant differences between BMI means and weight satisfaction (F4,204 = 26.82, P < 0.0001). Post-hoc comparisons revealed significant differences between men who were very dissatisfied [BMI = 35.80 (7.02) kg m–2] and all other groups; significant differences between men who were dissatisfied [BMI = 31.77 (4.78) kg m–2] and all other groups; and significant differences between men who were somewhat satisfied [BMI = 28.91 (3.80) kg m–2] and all other groups. There were no significant differences between those who were satisfied [BMI = 26.20 (2.73) kg m–2] and those who were very satisfied [24.63 (2.36) kg m–2]. During the interviews, several obese men expressed dissatisfaction with their weight. On the other hand, most of the overweight men expressed a degree of satisfaction with their body weight, especially given their age. The overweight men indicated they were pretty close to where they wanted to be but could stand to lose some weight. A few men weighed themselves regularly. ‘I weigh myself every week to keep it in check’. Most did not believe the BMI charts were realistic and said they knew instinctively what weight was right for them. ‘I think that I look good so I was very surprised when the doctor told me I was obese. I am a little heavy, but no way would I consider myself obese. I was startled when they told me I was obese’. ‘The weight they say is right for me just would ª 2015 The British Dietetic Association Ltd.
not feel right on me. I think it’s too low’. Some had a target weigh in mind. ‘My target is 165. At 155 (pounds) I look too wrinkly and skinny, so 165 just seem to be about the right spot for me’. ‘I am 185 (pounds) right now and that is pretty heavy for me. I would like to be about 165, but I will take being at 170 (pounds)’. Others appeared to be more concerned about their waist and pant size rather than their weight. ‘Relying on the fit of my pants is easier than getting on a scale every day’. ‘I wear a size 36 now but feel I was at my best at a size 34’. ‘Right now I wear a size 36, but I really should be in a 38. My pants are kind of tight [laughs]’. Abdominal fat was another indicator for some men. ‘If I look in the mirror and I see some suggestions of abdominal muscles, then I know that I am probably OK’. ‘It’s all about the gut.’ Some pointed to their overall energy level. ‘When I am at a good weight I feel better and I have more energy’. ‘Right now, I get out of breath and move sluggishly when I jog and play tennis’. ‘When I joined the gym, I couldn’t do 10 push-ups. Now, I can do 100. I feel good now’. Forty-two percent reported that a physician had told them to lose weight in the past 12 months. Men with higher BMIs were more likely to be told to lose weight than those with lower BMIs [BMI = 32.72 (5.26) kg m–2 versus 26.94 (3.25) kg m–2, t1,206 = 94.99, P < 0.0001]. Several participants reported that they had been diagnosed with elevated cholesterol (30%), hypertension (28%), diabetes (14%) and heart disease (5%). Significantly higher BMIs were found in men who were diagnosed with elevated cholesterol [BMI = 30.79 (5.29) kg m–2 versus 28.77 (4.89) kg m–2, t1,206 = 7.07, P < 0.01], diabetes [BMI = 33.39 (6.01) kg m–2 versus 28.72 (4.59) kg m–2, t1,206 = 4.59, P < 0.0001] and hypertension [BMI = 31.41 (5.46) kg m–2 versus 28.58 (4.70) kg m–2, t1,206 = 13.83, P < 0.001]. There were no significant differences in BMIs with those who were diagnosed heart disease (P > 0.05). Those who were diagnosed with diabetes or hypertension expressed the most dissatisfaction with their weight. ‘I have diabetes because I’m too heavy. I think I can to 219
D. C. S. James et al.
Weight-loss strategies
get off insulin if I lose some weight’. ‘When I’m at a good weight my blood pressure usually falls in line’. ‘I changed my diet because I have diabetes and hypertension’. ‘I knew I had problems but did nothing until the doctor told me I had to do something about my weight’. It appears that the health problem had to be ‘serious’ before action was taken. Weight-loss strategies Participants were asked what they were currently doing about their weight. Fifty-six percent were trying to lose weight [BMI = 31.21 (5.11) kg m–2], 23% were not doing anything [BMI = 28.25 (3.45) kg m–2], 17% were trying to stay at a healthy weight [BMI = 26.06 (2.52) kg m–2] and 3% were trying to gain weight [BMI = 23.35 (1.51) kg m–2]. A one-way ANOVA indicated significant differences between BMI and weight management status (F3,205 = 18.02, P < 0.0001). Post-hoc comparisons showed differences between those trying to lose weight and all other groups and significant differences between those who were not trying to do anything and all other groups. There were no significant difference in BMIs between those trying to stay at a healthy weight and those trying to gain weight. Most of the men interviewed were making some efforts to lose weight or maintain their current weight. ‘It’s an ongoing process. I’m not trying to lose weight anymore, but I’m just trying to not get any bigger’. ‘I’ve been struggling for the last 2–3 years’. ‘The last time I really tried to lose weight I stayed on the diet for just a day or two. Now, I basically eat what I want but try to walk with my wife most evenings when I get home’. Both healthy and unhealthy weight-loss practices were used. Healthy practices included reducing portions (58%), increasing physical activity (47%), cutting back on fried foods (40%), cutting back on sweets (38%), cutting back on alcohol (15%), using meal replacement drinks/ bars (8%) and joining a weight-loss programme (8%). Unhealthy practices included skipping meals (9%) and using over-the-counter ‘diet pills’ (5%). Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss program and used diet pills had significantly higher BMI than those men who said they did not (P < 0.05 for all) (Table 2). Reducing portions of food and not going back for more food was a prevalent theme in the interviews. ‘I try not to overeat and I watch my portions. I know when I’ve had enough. Eating smaller portions is probably the key for me’. ‘Low carb eating works best for me. I love eating meat [laughs] so low carb is the way to go’. Skipping meals, using diet pills and liquid meals were mentioned by two men during the interviews. ‘Nothing 220
Table 2 Weight-loss strategies based on the body mass index (BMI) of Baby Boomer men (n = 211) Weight-loss strategies Eat less food Yes No Skip meals Yes No Less alcohol Yes No Less fried foods Yes No Less sweets Yes No Join program Yes No Exercise Yes No Meal shake/bar Yes No Diet pills Yes No
n
%
BMI (SD)
t
P
123 88
58 42
30.28 (5.05) 28.06 (4.84)
10.18
0.001*
18 193
9 91
31.89 (5.34) 29.11 (4.99)
5.03
0.026*
32 179
15 85
29.76 (4.73) 29.28 (5.14)
0.24
0.623
84 127
40 60
30.16 (4.89) 28.81 (5.13)
3.58
0.060
80 131
38 62
30.84 (5.50) 28.43 (4.57)
11.65
0.0008*
17 194
8 92
36.05 (7.02) 28.76 (4.42)
38.03
WEIGHT LOSS Weight-loss strategies used by baby boomer men: a mixed methods approach D. C. S. James,1 C. K. Wirth,2 C. Harville II1 & O. Efunbumi1 1
Department of Health Science Education, University of Florida, Gainesville, FL, USA Department of Health, Leisure and Exercise Sciences, University of West Florida, Pensacola, FL, USA
2
Keywords men’s health, weight-loss strategies. Correspondence Delores C. S. James, Department of Health Science Education, University of Florida, PO Box 118210, Room 5 Florida Gym, Gainesville, FL 32611-8210, USA. Tel.: +1 352 294 1806 Fax: +1 352 392 1909 E-mail: [email protected] How to cite this article James D.C.S., Wirth C.K., Harville II C. & Efunbumi O. (2016) Weight-loss strategies used by baby boomer men: a mixed methods approach. J Hum Nutr Diet. 29, 217–224 doi: 10.1111/jhn.12305
Abstract Background: Baby Boomer men (those born in 1946–1964) are becoming obese at an earlier age compared to previous generations. The present study aimed to identify weight-loss strategies used by Baby Boomer men, to determine whether those strategies varied by weight status and to explore their dieting experiences. Methods: The study used a cross-sectional survey of 211 men and 20 indepth interviews. Results: Men had a mean (SD) body mass index (BMI) of 29.35 (5.07) kg m–2, with 82% being overweight or obese. Fifty-six percent were currently trying to lose weight. Healthy weight-loss strategies included reducing portions, increasing physical activity, cutting back on fried foods, cutting back on sweets, cutting back on alcohol, using meal replacement drinks/bars and joining a weight-loss programme. Unhealthy strategies included skipping meals and using over-the-counter ‘diet pills’. Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss programme and used diet pills had significantly higher BMIs than men who said they did not (P < 0.05 for all). Interviews revealed that older men struggle to lose weight, ‘I’ve been struggling for the last 2–3 years’. ‘The last time I really tried to lose weight I stayed on the diet for just a day or two’. Wives were considered essential to their weight management success. Conclusions: Men used a do-it-yourself weight-loss approach using both healthy and unhealthy strategies. Obese men were more likely to use unhealthy practices than overweight men.
Introduction By 2015, individuals aged ≥50 years will represent 45% of the population in the USA. This growth is largely a result of ‘Baby Boomers’, those born in 1946–1964 (1). Baby Boomers are developing obesity, heart disease, diabetes and other chronic diseases earlier than previous generations (2–4). More than one-third of the US population is obese, and there has been a 29% increase in obesity among Baby Boomer men in every decade since 1950 (5,6) . From 1960 to 1962, the average American man weighed close to 77.11 kg (170 lbs) but that increased to just over 90.72 kg (200 lbs) from 2003 to 2006 (7). Currently, 44% of Baby Boomer men are overweight and ª 2015 The British Dietetic Association Ltd.
34% are obese (5). Baby Boomer men are also more likely than their female counterparts to develop metabolic syndrome, which can significantly add to the burden of health care costs (8). Even though men report less body dissatisfaction than women do, they still report a degree of body dissatisfaction and a desire to lose weight (9–14). Furthermore, as men get older, they place greater value on their health and are more willing to assume more responsibility for their health (15). Despite expressing a desire to lose weight, it has been extremely difficult to recruit men into weight-loss management. Men in general, and older men in particular, are considered a ‘hard-to-reach’ population for health promotion and disease prevention programmes (15,16). Studies show that men 217
D. C. S. James et al.
Weight-loss strategies
are less likely than women to be concerned about their weight, as well as less likely than women to perceive themselves as overweight or obese, participate in in group and individual weight-loss programmes, have annual checkups, or seek advice from a health professional (14,17,18). Few studies have focused on weight management issues among older men and, to our knowledge, only one recent study has identified key factors for developing programmes and interventions for this group (12). Moreover, in the past 10 years, participation in weight-loss research has predominately been focused on women, and only 22% of participants in US studies were men (19). The present study aimed to: (i) identify weight-loss strategies used by Baby Boomer men; (ii) determine whether these strategies varied by weight status; and (iii) explore the men’s dieting experiences. By gaining a better understanding of these strategies, health professionals can better design and implement tailored messages, programmes and interventions that can actively engage and retain older men actively attempting to lose weight.
items: weight management strategies (nine items, a = 0.80), foods in their diet that they need to eat more of (nine items, a = 0.81) and foods in the diet that they need to eat less of (seven items, a = 0.78). Men self-reported their weight and height. Body mass index (BMI) was calculated based on participants’ reported weight and height (kg m–2). Qualitative procedures A sample of 20 men who completed the survey agreed to participate in one-on-one interviews. The interviews were audio-taped and lasted 45–60 min. Each man provided their written informed consent and received a $20 gift card. The interview questions with relevant probes are shown in Table 1. Major topics included sources of dieting information, weight-loss strategies and information needed to lose weight. The topics covered included perception of weight status, dieting and weight management strategies, and areas for dietary improvement. Statistical analysis
Materials and methods This mixed method study design concurrently included a cross-sectional survey of 211 Baby Boomer men and 20 one-on-one semi-structured interviews. This approach allowed for the comparison and corroboration of the quantitative findings with qualitative findings and for both datasets to be combined within a joint discussion to provide a more holistic picture (20,21). The study was approved by the Institutional Review Board at the researchers’ institution. Quantitative procedures Data were collected with a convenience sample. Surveys were collected primarily at sporting events and civic organisation meetings. Each participant provided their verbal informed consent. No incentives were provided and the survey took approximately 15 min to complete. The survey was developed based on a review of the literature, a previously validated instrument (used with males and females) and several focus groups. The development, use and validation of the original instrument are discussed elsewhere (22,23).The instrument was modified to target only men. It was pilot-tested with five men who came from the target group. These pilot surveys were not included in the present study. Minor revisions were made in the wording and ordering of the questions. Demographic items included age, marital status, race/ethnicity, employment status, income level, educational level and home ownership. Cronbach’s a measured internal consistency of three questions that asked participants to ‘choose all that apply’ from several 218
The surveys were entered into a computerised database and frequency tables were generated and checked for completeness, range and consistency. Data were analysed using JMP, version 11 Pro (SAS Institute, Cary, NC, USA). Conventional cross-tabulations and analyses were used to summarise the data. Differences in mean BMI and study variables were examined using one-way analysis of variance (ANOVA) and Student’s t-test. Post-hoc comparisons were carried out using Tukey’s honestly significant difference. Significance was established at the P < 0.05 level for all tests. Data are reported as the mean (SD). Interview data were analysed using directed content analysis to identify key words and examine themes, concepts and patterns in the data relating to weight-loss strategies. This method also helps to triangulate, extend and support quantitative findings (24). A primary coder and two secondary coders coded the interview transcripts. There were in-depth reviews and re-reviews of the transcripts based on established themes from the codebook (25,26) . Coders also made annotated comments on the transcripts for discussion in team meetings. Several team meetings were used to discuss areas of agreement and disagreement with the themes until consensus was reached (27) . Select verbatim quotes that captured the men’s experiences, views and opinions are included in the text. Results Demographics The men had a mean (SD) age of 54 (5.57) years. Most were heterosexual (90%), White/Caucasian (75%), ª 2015 The British Dietetic Association Ltd.
D. C. S. James et al.
Weight-loss strategies
Table 1 Interview guide (n = 20). 1. Please describe how you feel about your current weight? (Probe: Is it a concern for you? Why or why not?) 2. How do you know when you’re at a healthy weight? (Probe: How is your definition similar or different to that of health professionals?) 3. What comes to mind when you hear the following words: ‘healthy weight’ ‘overweight’ ‘obesity?’ (Probe: What is the difference between being overweight and being obese?) 4. Please describe the last time that you tried to lose weight? (Probes: What was the reason why you tried to lose weight? What is the hardest thing about keeping your weight down?) 5. What types of strategies are you using or have used in the past to lose weight? (Probes: What works for you? What doesn’t work?) 6. Where do you get your health and dieting information? (Probe: Who do you talk to if you need information on losing weight?) 7. What type of information do you need to help you lose weight or maintain a healthy weight? (Probe: Do you need information on nutrition, exercise, serving sizes?)
married (77%), college graduates or had college credits (63%), homeowners (88%) or employed (84%) and had incomes of over $50 000 per year (63%) (Table 1). Weight and health status BMI was calculated based on self-reported weight and height. The mean BMI for participants was 29.35 (5.07) kg m–2. Based on BMI, 43% were overweight, 39% were obese, 18% were normal and no-one was underweight. There were no significant differences in BMI on any of the demographic factors. With regards to weight satisfaction, 10% were very satisfied, 18% were satisfied, 33% were somewhat satisfied, 32% were dissatisfied and 7% were very dissatisfied. A one-way ANOVA indicated significant differences between BMI means and weight satisfaction (F4,204 = 26.82, P < 0.0001). Post-hoc comparisons revealed significant differences between men who were very dissatisfied [BMI = 35.80 (7.02) kg m–2] and all other groups; significant differences between men who were dissatisfied [BMI = 31.77 (4.78) kg m–2] and all other groups; and significant differences between men who were somewhat satisfied [BMI = 28.91 (3.80) kg m–2] and all other groups. There were no significant differences between those who were satisfied [BMI = 26.20 (2.73) kg m–2] and those who were very satisfied [24.63 (2.36) kg m–2]. During the interviews, several obese men expressed dissatisfaction with their weight. On the other hand, most of the overweight men expressed a degree of satisfaction with their body weight, especially given their age. The overweight men indicated they were pretty close to where they wanted to be but could stand to lose some weight. A few men weighed themselves regularly. ‘I weigh myself every week to keep it in check’. Most did not believe the BMI charts were realistic and said they knew instinctively what weight was right for them. ‘I think that I look good so I was very surprised when the doctor told me I was obese. I am a little heavy, but no way would I consider myself obese. I was startled when they told me I was obese’. ‘The weight they say is right for me just would ª 2015 The British Dietetic Association Ltd.
not feel right on me. I think it’s too low’. Some had a target weigh in mind. ‘My target is 165. At 155 (pounds) I look too wrinkly and skinny, so 165 just seem to be about the right spot for me’. ‘I am 185 (pounds) right now and that is pretty heavy for me. I would like to be about 165, but I will take being at 170 (pounds)’. Others appeared to be more concerned about their waist and pant size rather than their weight. ‘Relying on the fit of my pants is easier than getting on a scale every day’. ‘I wear a size 36 now but feel I was at my best at a size 34’. ‘Right now I wear a size 36, but I really should be in a 38. My pants are kind of tight [laughs]’. Abdominal fat was another indicator for some men. ‘If I look in the mirror and I see some suggestions of abdominal muscles, then I know that I am probably OK’. ‘It’s all about the gut.’ Some pointed to their overall energy level. ‘When I am at a good weight I feel better and I have more energy’. ‘Right now, I get out of breath and move sluggishly when I jog and play tennis’. ‘When I joined the gym, I couldn’t do 10 push-ups. Now, I can do 100. I feel good now’. Forty-two percent reported that a physician had told them to lose weight in the past 12 months. Men with higher BMIs were more likely to be told to lose weight than those with lower BMIs [BMI = 32.72 (5.26) kg m–2 versus 26.94 (3.25) kg m–2, t1,206 = 94.99, P < 0.0001]. Several participants reported that they had been diagnosed with elevated cholesterol (30%), hypertension (28%), diabetes (14%) and heart disease (5%). Significantly higher BMIs were found in men who were diagnosed with elevated cholesterol [BMI = 30.79 (5.29) kg m–2 versus 28.77 (4.89) kg m–2, t1,206 = 7.07, P < 0.01], diabetes [BMI = 33.39 (6.01) kg m–2 versus 28.72 (4.59) kg m–2, t1,206 = 4.59, P < 0.0001] and hypertension [BMI = 31.41 (5.46) kg m–2 versus 28.58 (4.70) kg m–2, t1,206 = 13.83, P < 0.001]. There were no significant differences in BMIs with those who were diagnosed heart disease (P > 0.05). Those who were diagnosed with diabetes or hypertension expressed the most dissatisfaction with their weight. ‘I have diabetes because I’m too heavy. I think I can to 219
D. C. S. James et al.
Weight-loss strategies
get off insulin if I lose some weight’. ‘When I’m at a good weight my blood pressure usually falls in line’. ‘I changed my diet because I have diabetes and hypertension’. ‘I knew I had problems but did nothing until the doctor told me I had to do something about my weight’. It appears that the health problem had to be ‘serious’ before action was taken. Weight-loss strategies Participants were asked what they were currently doing about their weight. Fifty-six percent were trying to lose weight [BMI = 31.21 (5.11) kg m–2], 23% were not doing anything [BMI = 28.25 (3.45) kg m–2], 17% were trying to stay at a healthy weight [BMI = 26.06 (2.52) kg m–2] and 3% were trying to gain weight [BMI = 23.35 (1.51) kg m–2]. A one-way ANOVA indicated significant differences between BMI and weight management status (F3,205 = 18.02, P < 0.0001). Post-hoc comparisons showed differences between those trying to lose weight and all other groups and significant differences between those who were not trying to do anything and all other groups. There were no significant difference in BMIs between those trying to stay at a healthy weight and those trying to gain weight. Most of the men interviewed were making some efforts to lose weight or maintain their current weight. ‘It’s an ongoing process. I’m not trying to lose weight anymore, but I’m just trying to not get any bigger’. ‘I’ve been struggling for the last 2–3 years’. ‘The last time I really tried to lose weight I stayed on the diet for just a day or two. Now, I basically eat what I want but try to walk with my wife most evenings when I get home’. Both healthy and unhealthy weight-loss practices were used. Healthy practices included reducing portions (58%), increasing physical activity (47%), cutting back on fried foods (40%), cutting back on sweets (38%), cutting back on alcohol (15%), using meal replacement drinks/ bars (8%) and joining a weight-loss programme (8%). Unhealthy practices included skipping meals (9%) and using over-the-counter ‘diet pills’ (5%). Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss program and used diet pills had significantly higher BMI than those men who said they did not (P < 0.05 for all) (Table 2). Reducing portions of food and not going back for more food was a prevalent theme in the interviews. ‘I try not to overeat and I watch my portions. I know when I’ve had enough. Eating smaller portions is probably the key for me’. ‘Low carb eating works best for me. I love eating meat [laughs] so low carb is the way to go’. Skipping meals, using diet pills and liquid meals were mentioned by two men during the interviews. ‘Nothing 220
Table 2 Weight-loss strategies based on the body mass index (BMI) of Baby Boomer men (n = 211) Weight-loss strategies Eat less food Yes No Skip meals Yes No Less alcohol Yes No Less fried foods Yes No Less sweets Yes No Join program Yes No Exercise Yes No Meal shake/bar Yes No Diet pills Yes No
n
%
BMI (SD)
t
P
123 88
58 42
30.28 (5.05) 28.06 (4.84)
10.18
0.001*
18 193
9 91
31.89 (5.34) 29.11 (4.99)
5.03
0.026*
32 179
15 85
29.76 (4.73) 29.28 (5.14)
0.24
0.623
84 127
40 60
30.16 (4.89) 28.81 (5.13)
3.58
0.060
80 131
38 62
30.84 (5.50) 28.43 (4.57)
11.65
0.0008*
17 194
8 92
36.05 (7.02) 28.76 (4.42)
38.03
