Abstracts

Introduction

Currently, obesity can be considered as one of the major health issues, since it is associated with several diseases¹1. Hauser C, Benetti M, Rebelo FP. Estratégias para o emagrecimento. Rev Bras Cineantropom Desempenho Humano 2004; 6: 72-81. ^{, 2}2. World Health Organization & Canada. Preventing chronic diseases: a vital investment World Health Organization. Public Health Agency of Canada: Geneva; 2005.. According to the World Health Organization, more than one billion adults are overweight, and at least 300 million are clinically obese²2. World Health Organization & Canada. Preventing chronic diseases: a vital investment World Health Organization. Public Health Agency of Canada: Geneva; 2005.. In Brazil, some studies have demonstrated the increased prevalence of obesity in several regions of the country³3. Monteiro CA, Conde WL, Popkin BM. Income-specific trends in obesity in Brazil: 1975-2003. Am J Public Health 2007; 97(10): 1808-12.

4. Instituo Brasileiro de Geografia e Pesquisa. Pesquisa de Orçamento Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Brasília: IBGE; 2010.

5. Lino MZ, Muniz PT, Siqueira KS. Prevalência e fatores associados ao excesso de peso em adultos: inquérito populacional em Rio Branco, Acre, Brasil, 2007-2008. Cad Saude Publica 2011; 27: 797-810. ^{- 6}6. Linhares Rda S, Horta BL, Gigante DP, Dias-da-Costa JS, Olinto MT. Distribuição de obesidade geral e abdominal em adultos de uma cidade no Sul do Brasil. Cad Saude Publica 2012; 28(3): 438-47.. Data available in the Family Expenditure Survey (Pesquisa de Orçamentos Familiares - POF), from 2008 to 2009, show that 12% of the Brazilian men and 17% of the Brazilian women aged 20 years old or more are with obesity⁴4. Instituo Brasileiro de Geografia e Pesquisa. Pesquisa de Orçamento Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Brasília: IBGE; 2010..

A study conducted with the objective of investigating the reasons why people wished to lose weight showed that the appearance was mentioned as the main motive for the desire to be thinner by 50% of the people, followed by health (35%) and mood (15%)⁷7. O'Brien K, Venn BJ, Perry T, Green TJ, Aitken W, Bradshaw A, et al. Reasons for wanting to lose weight: different strokes for different folks. Eat Behav 2007; 8(1): 132-5.. Whatever the reason, the fact is that studies conducted in countries like the United States or those in Europe point out that the prevalence of adults who wish to lose weight is high and similar⁸8. Williamson D, Serdula MK, Anda RF, Levy A, Byers T. Weight loss attempts in adults: goals, duration, and rate of weight loss. AM J Public Health 1992; 82(9): 1251-7.

9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6.

10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4.

11. McElhone S, M Kearney J, Giachetti I, Franz Zunft H-J, Martınez JA. Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union. Public Health Nutr 1999; 2(1A): 143-51.

12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.

13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39.

14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21.

15. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight specific practices among U.S. adults. Am J Prev Med 2004;26(5):402-6.

16. Mercado II. Healthy and unhealthy weight loss practices of Latino women at a college in USA. Ter Psicol 2008; 26: 199-205.

17. Rodríguez-Rodríguez E, Aparicio A, López-Sobaler AM, Ortega RM. Percepción del peso corporal y medidas adoptadas para su control en población española. Nutr Hosp 2009; 24(5): 580-7. ^{- 18}18. Field AE, Haines J, Rosner B, Willett WC. Weight-control behaviors and subsequent weight change among adolescents and young adult females. Am J Clin Nutr 2010; 91(1): 147-53.. Out of the studies carried out in the United States, by telephone inquiry, the proportion of people who wanted to lose weight ranged from 20% to 57%⁸8. Williamson D, Serdula MK, Anda RF, Levy A, Byers T. Weight loss attempts in adults: goals, duration, and rate of weight loss. AM J Public Health 1992; 82(9): 1251-7.

9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6. ^{- 10}10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4. ^{, 12}12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8. ^{, 14}14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21., while, in Europe, the prevalence of individuals who wished the same ranged from 19% to 66%¹¹11. McElhone S, M Kearney J, Giachetti I, Franz Zunft H-J, Martınez JA. Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union. Public Health Nutr 1999; 2(1A): 143-51. ^{, 17}17. Rodríguez-Rodríguez E, Aparicio A, López-Sobaler AM, Ortega RM. Percepción del peso corporal y medidas adoptadas para su control en población española. Nutr Hosp 2009; 24(5): 580-7. ^{, 19}19. Navia B, Ortega R, Requejo A, Mena M, Perea J, Sobaler L. Influence of the desire to lose weight on food habits, and knowledge of the characteristics of a balanced diet, in a group of Madrid university students. Eur J Clin Nutr 2003; 57 Suppl 1: S90-3.. In these studies, it was possible to observe that some aspects were associated with strategies to lose weight, especially with diet and physical exercise: female gender, being young, white, high schooling, not being smoker and being overweight⁸8. Williamson D, Serdula MK, Anda RF, Levy A, Byers T. Weight loss attempts in adults: goals, duration, and rate of weight loss. AM J Public Health 1992; 82(9): 1251-7.

9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6.

10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4. ^{- 11}11. McElhone S, M Kearney J, Giachetti I, Franz Zunft H-J, Martınez JA. Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union. Public Health Nutr 1999; 2(1A): 143-51. ^{, 13}13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39.

14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21. ^{- 15}15. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight specific practices among U.S. adults. Am J Prev Med 2004;26(5):402-6. ^{, 20}20. Méndez-Henández P, Dosamantes-Carrasco D, Lamure M, López-Loyo P, Hernández-Palafox C, Pineda-Pérez D, et al. Weight-loss practices among university students in Mexico. Int J Public Health 2010; 55(3): 221-5.. On the other hand, body mass index (BMI) indicated the inverse relationship with the practice of physical exercises as a strategy to lose weight²¹21. Kruger J, Galuska DA, Serdula MK, Kohl HW 3rd. Physical activity profiles of U.S. adults trying to lose weight: NHIS 1998. Med Sci Sports Exerc 2005; 37(3): 364-8..

A study conducted in Brazil, with college students from the State of Pernambuco, analyzed their self-evaluation toward weight. Women reported to have been trying to lose weight more frequently, while men tried to gain it²²22. Colares V, Franca Cd, Gonzalez E. Condutas de saúde entre universitários: diferenças entre gêneros. Cad Saude Publica 2009; 25(3): 521-8. Population-based studies carried out in the city of Pelotas, in the State of Rio Grande do Sul, showed that approximately one-quarter of the adults wanted to lose weight one year prior to the interview²³23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006. ^{, 24}24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49.. In one of the studies conducted in Pelotas²³23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006., with adults, being a woman, non-smoker and obese have been associated with the attempt to lose weight. However, little is known about the strategies to lose weight involving young adults in Brazil.

Out of the used strategies, some studies revealed that most people go on a diet or change their eating habits in order to lose weight, followed by physical exercises⁹9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6.

10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4.

11. McElhone S, M Kearney J, Giachetti I, Franz Zunft H-J, Martınez JA. Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union. Public Health Nutr 1999; 2(1A): 143-51.

12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.

13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39.

14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21.

15. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight specific practices among U.S. adults. Am J Prev Med 2004;26(5):402-6.

16. Mercado II. Healthy and unhealthy weight loss practices of Latino women at a college in USA. Ter Psicol 2008; 26: 199-205. ^{- 17}17. Rodríguez-Rodríguez E, Aparicio A, López-Sobaler AM, Ortega RM. Percepción del peso corporal y medidas adoptadas para su control en población española. Nutr Hosp 2009; 24(5): 580-7. ^{, 23}23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006.

24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49. ^{- 25}25. Weiss EC, Galuska DA, Khan LK, Serdula MK. Weight-control practices among U.S. adults, 2001-2002. Am J Prev Med 2006; 31(1): 18-24.. A recent study carried out in Pelotas confirms these data. Besides, the use of substances (medicines, teas, dietary supplements) to lose weight was mentioned by 48% of the studied people, and the intake of medicine, by 18% of the interviewed adults who reported some strategy to lose weight²⁴24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49.. While women reported to have more control over the diet and the use of substances, men reported doing more physical exercises to lose weight, which had already been observed in a previous population-based study conducted in the same city²³23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006..

As suggested by WHO, the prevention and control of obesity should be carried out through an integrated and multisectoral system, including environmental support for healthy diets and regular physical activities. However, unhealthy strategies that present risks for health, such as the use of medicine²³23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006. ^{, 24}24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49. to become thinner, are still being used. It is worth to mention that, recently, amphetamine-based drugs were forbidden in Brazil. The use of drugs with sibutramine is restricted to some indications, and it should only be used as adjunct therapy as part of a weight management program for obese patients, which should be followed-up by a food education program, besides the practice of physical activities that are compatible with the conditions of the user²⁶26. Brasil. Agência Nacional de Vigilância Sanitária. Anvisa mantém registro de sibutramina e cancela anfetamínicos. Disponível em: http://portal.anvisa.gov.br/wps/content/ anvisa+portal/anvisa/sala+de+imprensa/menu+- +noticias+anos/2011+noticias/anvisa+mantem+registro+de+ sibutramina+e+cancela+anfetaminicos
Disponível em: http://... .

The objective of this article was to identify, among the members of the 1982 birth cohort in Pelotas, who were trying to lose weight when they were about 23 years old, as well as the main strategies they used.

Methods

This study was conducted with a population of young adults from the 1982 birth cohort in Pelotas, Rio Grande do Sul. In that year, all of the maternity hospitals in the city were daily visited, and the mothers were interviewed right after labor. All of the births were monitored. At first, the sample included 5,914 live born babies, whose families lived in the urban zone of the city. After the perinatal study conducted in 1982, there were several follow-ups, and the details of the methodology used in this birth cohort can be found in other publications²⁷27. Victora CG, Barros FC, Martines JC, Béria JU, Vaughan JP. Estudo longitudinal das crianças nascidas em 1982 em Pelotas, RS, Brasil: metodologia e resultados preliminares. Rev Saude Publica 1985; 19: 58-68.

28. Victora C, Barros F, Lima R, Behague D, Gonçalves H, Horta B, et al. The Pelotas birth cohort study, Rio Grande do Sul, Brazil, 1982-2001. Cad Saude Publica 2003; 19(5): 1241-56.

29. Victora C, Barros F. Cohort profile: the 1982 Pelotas (Brazil) birth cohort study. Int J Epidemiol 2006; 35(2): 237-42. ^{- 30}30. Barros FC, Victora CG, Horta BL, Gigante DP. Metodologia do estudo da coorte de nascimentos de 1982 a 2004-5, Pelotas, RS. Rev Saude Publica 2008; 42(2 Suppl): 7-15..

Between October 2004 and August 2005, a search was conducted in the city of Pelotas for all of the individuals who were born in 1982, in order to perform interviews and examinations. In this follow-up, the member of the cohort was interviewed, the mean age being 23 years old (SD ± 0.4). The proportion of located young adults was 77.4%, including the 4,297 ones whose interviews were successfully made and the 282 deaths identified until 2005. A standardized and pre-codified research questionnaire was applied with household interviews. The questionnaire included several questions, including the matter of using some strategy to lose weight in the year prior to the interview, and, afterward, if the person was on any diet, drugs, physical exercise and/or tea in order to reduce body weight. For this study, pregnancy was defined as an exclusion criterion, which excluded the 103 women who were pregnant at the time of the interview. Trained interviewers applied the questionnaire and, at the end of the interview, the anthropometric measurements were collected. The technique for this collection was based on the recommendation by Lohmann³¹31. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign, Illinois. Human Kinetics Books; 1988.. Weight measurements were obtained with portable electronic scales (Seca uniscale(r), Germany), with 100 g precision. Anthropometer made of aluminum were used to measure height³²32. Gigante DP, Minten GC, Horta BL, Barros FC, Victora CG. Avaliação nutricional de adultos da coorte de nascimentos de 1982, Pelotas, RS. Rev Saude Publica 2008; 42: 60-9..

The affirmative response to the following question was considered as a dependent variable: "to have used some strategy to lose weight in the past year. Independent variables included in this analyses were demographic: gender (male or female), skin color (self-reported by the youngsters and classified as white or nonwhite) and marital status (with a partner or without a partner); socioeconomic: family income (sum of the values received in reais (Brazilian currency) by all of the residents in the household in the month prior to the interview, presented in tertile) and schooling (years of study presented in four categories: zero to four years; five to eight years; nine to eleven years; twelve years or more); behavioral: BMI, obtained through body weight measured in kilograms and divided by the square height in meters, presented according to the WHO classification (low weight, BMI < 18.5 kg/m²; adequate weight, BMI 18.5-24.9 kg/m²; overweight, BMI 25.0-29.9 kg/m² and obesity, BMI ≥ 30 kg/m^{2) 2}2. World Health Organization & Canada. Preventing chronic diseases: a vital investment World Health Organization. Public Health Agency of Canada: Geneva; 2005., and smoking (current tobacco consumption).

Data were doubly typed and compared in the software Epi-Info 6.04 and analyzed in the statistical software Stata, version 11.2. The population was described by prevalence and respective 95% confidence intervals (95%CI). The chi-square and the linear trend tests were used to compare the proportions. The interaction test by Mantel-Haenszel was used between the use of strategies to lose weight, gender and independent variables. The effects of demographic, socioeconomic and behavioral variables on the prevalence of the strategies used to lose weight in the past year were analyzed by the Poisson regression. The adjusted analysis was in accordance with a hierarchic model to include the variables. Therefore, demographic (gender, skin color and marital status) and socioeconomic variables (schooling and family income) were included. BMI and smoking were included together in the second level of analysis. The variables of the first level of analysis are adjusted and maintained in the model if p < 0.20. The variables in the second level are also adjusted and, for those in the first level, kept in the model. Variables with p < 0.05 were considered to be statistically significant. The prevalence of all of the strategies used to lose weight was presented for the whole group and separately, for men and women, and also according to BMI.

The research project was approved by the Research Ethics Committee of Universidade Federal de Pelotas (OF.15/11). In the follow-up of the longitudinal study in 2004 - 2005, the Ethics Committee approved the project and included the questionnaire. All of the participants signed the informed consent form. The authors declared there is no conflict of interests concerning this study.

Results

Out of the 4,194 individuals included in this study, there was slight predominance of the male gender (52.8%). Seventy five percent of the young adults defined themselves as being white and 62% had no partners. Almost half of the sample (48%) had completed from nine to eleven school years. With regard to nutritional status, 29% of the adults had excess weight (overweight or obesity) and 6% had low weight. Most of them did not practice physical activities during leisure time (64%) and 26% were smokers.

Among the interviewees, 28.5% (95%CI 27.1 - 29.8) reported having used some strategy to lose weight in the twelve months prior to the interview. There were significant differences as to gender, since 40% (95%CI 37.7 - 42.0) of the women used some sort of strategy when compared to 18% (95%CI 16.6 - 19.9) of the men. Even though this difference between men and women was significant, interaction tests between outcome, gender and dependent variables were not significant; therefore, we chose to show the total results, including men and women.

Table 1 describes the prevalence of the use of strategies to lose weight in the whole sample and its association with demographic, socioeconomic and behavioral variables. The use of strategies was more frequent among white-skinned individuals, with increased schooling, family income and BMI, and also among young adults who were not smokers. On the other hand, marital status was not associated with the prevalence of the use of strategies to lose weight (p = 0.17).

After analyzing the associations between the use of strategies with the independent variables for the whole population with the Poisson regression, it was observed that the crude effects were maintained in the adjusted analysis, except for skin color (Table 2). The 12% increase in the prevalence of the use of strategies among white-skinned people disappears after the adjustment for other socioeconomic variables. The prevalence of strategies to lose weight was twice as high among women in relation to men, and only 14% higher among non-smokers in comparison with smokers. The direct relation between the increased prevalence of the use of strategies and increased schooling and family income also remained in the adjusted analysis, and it is possible to observe the more present effect of schooling than of income, when these two variables are included in the adjusted analysis of the same level. Young adults with obesity presented about three times more risk for the use of strategies to lose weight in comparison with those on adequate weight.

The main strategies used to lose weight are presented in Table 3. Most young adults tried diet followed by physical exercises. The combination of diet and physical exercise was used by 20% of the people, while 13% were on diet pills. The least mentioned strategy was the weight-loss tea (8%). After analyzing these strategies according to gender, it is observed that the diet, the pills and the teas are mostly used by women in the attempt to lose weight, while physical exercises were mostly adopted by men.

In Figure 1, it is possible to observe the prevalent strategies used to lose weight according to BMI for men and women. Low weight was not included, because there were only few young adults with weight deficit using any strategy to lose weight. Physical exercise was mostly adopted by men, and diet was more used by women, and these results were also observed in all of the BMI classification categories. With regard to the diet among men, it is observed that it was mostly mentioned among those who were overweight and obese when compared to those with adequate weight, and this same result was observed for the combination of diet and physical exercises. Medicines were mostly used by obese men, while these proportions were also higher among women with adequate weight. It is worth to mention that, among women, the proportion of use of any of the strategies was similar in the three nutritional classification categories.

Discussion

The main advantage of this study is related to the fact that it refers to a young adult population representing all of the births of Pelotas in the year of 1982. This is the longest and oldest cohort study developed in medium- or low-income countries, with appropriate methods and high follow-up rates³³33. Victora CG, Barros FC. Cohort profile: the 1982 Pelotas (Brazil) birth cohort study. Int J Epidemiol 2006; 35(2): 237-42.. On the other hand, this study is restricted to the investigation of the used strategies, including the diet, without analyzing if such a diet is nutritionally balanced and efficient in order to lose weight. However, considering the high prevalence of excess weight in this population of young adults³⁴34. Gigante DP, Minten GC, Horta BL, Barros FC, Victora CG. Avaliação nutricional de adultos da coorte de nascimentos de 1982, Pelotas, RS. Rev Saude Publica 2008; 42(Suppl 2): 60-9., the description of the main weight-loss strategies should contribute and lead to proper interventions to control and treat the excess weight in young populations. Also, one of the possible limitations of this study is the fact that the participants might have used more than one strategy to lose weight, and at the time of the interview they only mentioned one of the options.

Some kind of strategy to lose weight was used in the past year by almost one-third of the young adults in the 1982 birth cohort. Most inquiries conducted in high-income countries show higher prevalence¹²12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.

13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39. ^{- 14}14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21. ^{, 16}16. Mercado II. Healthy and unhealthy weight loss practices of Latino women at a college in USA. Ter Psicol 2008; 26: 199-205.

17. Rodríguez-Rodríguez E, Aparicio A, López-Sobaler AM, Ortega RM. Percepción del peso corporal y medidas adoptadas para su control en población española. Nutr Hosp 2009; 24(5): 580-7.

18. Field AE, Haines J, Rosner B, Willett WC. Weight-control behaviors and subsequent weight change among adolescents and young adult females. Am J Clin Nutr 2010; 91(1): 147-53. ^{- 19}19. Navia B, Ortega R, Requejo A, Mena M, Perea J, Sobaler L. Influence of the desire to lose weight on food habits, and knowledge of the characteristics of a balanced diet, in a group of Madrid university students. Eur J Clin Nutr 2003; 57 Suppl 1: S90-3. ^{, 25}25. Weiss EC, Galuska DA, Khan LK, Serdula MK. Weight-control practices among U.S. adults, 2001-2002. Am J Prev Med 2006; 31(1): 18-24.. It is worth to mention that, in these studies, such prevalence refers to adults of all age groups¹²12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.

13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39. ^{- 14}14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21. ^{, 16}16. Mercado II. Healthy and unhealthy weight loss practices of Latino women at a college in USA. Ter Psicol 2008; 26: 199-205. ^{, 25}25. Weiss EC, Galuska DA, Khan LK, Serdula MK. Weight-control practices among U.S. adults, 2001-2002. Am J Prev Med 2006; 31(1): 18-24., including college students¹⁹19. Navia B, Ortega R, Requejo A, Mena M, Perea J, Sobaler L. Influence of the desire to lose weight on food habits, and knowledge of the characteristics of a balanced diet, in a group of Madrid university students. Eur J Clin Nutr 2003; 57 Suppl 1: S90-3.. The sample of one study in Spain included three times more women than men¹⁷17. Rodríguez-Rodríguez E, Aparicio A, López-Sobaler AM, Ortega RM. Percepción del peso corporal y medidas adoptadas para su control en población española. Nutr Hosp 2009; 24(5): 580-7.. In relation to population-based studies conducted in Pelotas, the prevalence factor was very similar to the one found in this study²³23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006. ^{, 24}24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49., as well as in the study carried out in Pernambuco, which included college students with the same mean age as the participants in this study²²22. Colares V, Franca Cd, Gonzalez E. Condutas de saúde entre universitários: diferenças entre gêneros. Cad Saude Publica 2009; 25(3): 521-8.

The associations between weight-loss strategies and socioeconomic variables show that the effects of the highest socioeconomic level are still associated, even when all of the variables are included in the model; however, the effect of schooling seems to have more impact than the effect of family income. The association between the use of weight-loss strategies and schooling was similar to the results of two studies conducted with North-Americans who were interviewed by telephone inquiries⁹9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6. ^{, 12}12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8..

Regarding the associations of weight-loss strategies and nutritional status, this study shows that the strategies were used by those who actually needed them, since the prevalence of some kind of weight-loss strategy increased with the increased BMI. These results are similar to those of two studies conducted in the United States⁸8. Williamson D, Serdula MK, Anda RF, Levy A, Byers T. Weight loss attempts in adults: goals, duration, and rate of weight loss. AM J Public Health 1992; 82(9): 1251-7. ^{, 12}12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.. On the other hand, an inquiry with the population of the United States⁹9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6. showed higher prevalence of the wish to lose weight among those individuals presenting with BMI < 26 kg/m².

The higher prevalence of the attempt to lose weight among the non-smoker interviewees in this study had already been reported in the study of Pelotas²³23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006.. Likewise, in the adult population of the United States, counting on physical activities as a weight-loss strategy was more frequently reported among non-smokers¹⁰10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4..

Therefore, as reported in other studies⁸8. Williamson D, Serdula MK, Anda RF, Levy A, Byers T. Weight loss attempts in adults: goals, duration, and rate of weight loss. AM J Public Health 1992; 82(9): 1251-7. ^{, 10}10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4. ^{, 12}12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.

13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39.

14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21. ^{- 15}15. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight specific practices among U.S. adults. Am J Prev Med 2004;26(5):402-6. ^{, 20}20. Méndez-Henández P, Dosamantes-Carrasco D, Lamure M, López-Loyo P, Hernández-Palafox C, Pineda-Pérez D, et al. Weight-loss practices among university students in Mexico. Int J Public Health 2010; 55(3): 221-5. ^{, 22}22. Colares V, Franca Cd, Gonzalez E. Condutas de saúde entre universitários: diferenças entre gêneros. Cad Saude Publica 2009; 25(3): 521-8

23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006.

24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49. ^{- 25}25. Weiss EC, Galuska DA, Khan LK, Serdula MK. Weight-control practices among U.S. adults, 2001-2002. Am J Prev Med 2006; 31(1): 18-24., the prevalence of weight-loss strategies is always higher among women in comparison with men. Among the women in the birth cohort, the prevalence of weight-loss strategies (40%) was similar to that observed in the Behavioral Risk Factor Surveillance System (BRFSS-1989)⁸8. Williamson D, Serdula MK, Anda RF, Levy A, Byers T. Weight loss attempts in adults: goals, duration, and rate of weight loss. AM J Public Health 1992; 82(9): 1251-7. and also to that of young college students of Pernambuco²²22. Colares V, Franca Cd, Gonzalez E. Condutas de saúde entre universitários: diferenças entre gêneros. Cad Saude Publica 2009; 25(3): 521-8.

On the other hand, among men, the prevalence of weight-loss strategies was around 20%, similar to that found in individuals aged fifteen years old or more in the European Union11. The highest prevalence of men willing to lose weight (42%) was observed in the state of Minnesota, in the United States¹⁴14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21..

However, it is important to consider that, in general, women are less satisfied with their weight. Two studies carried out in the United States assessing the difference between genders with regard to the perception and satisfaction with body weight and weight-loss strategies showed that women were more dissatisfied with their weight. Likewise, the prevalence of weight-loss strategies was higher among them³⁵35. Connor-Greene PA. Gender differences in body weight perception and weight-loss strategies of college students. Women Health 1988; 14(2): 27-42. ^{, 36}36. James DC. Gender differences in body mass index and weight loss strategies among African Americans. J Am Diet Assoc. 2003; 103(10): 1360-2.. In a study conducted in Florida³⁶36. James DC. Gender differences in body mass index and weight loss strategies among African Americans. J Am Diet Assoc. 2003; 103(10): 1360-2., men were significantly more satisfied than women in relation to weight, while women used more weight-loss strategies when compared to men.

Diet and physical exercises have been the most used weight-loss strategies in this study and others⁹9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6.

10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4.

11. McElhone S, M Kearney J, Giachetti I, Franz Zunft H-J, Martınez JA. Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union. Public Health Nutr 1999; 2(1A): 143-51.

12. Serdula M, Mokdad A, Williamson D, Galuska D, Mendlein J, Heath G. Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282(14): 1353-8.

13. Kabeer N, Simoes E, Murayi T, Brownson R. Correlates of overweight and weight-loss practices in Missouri. Am J Health Behav 2001; 25(2): 125-39.

14. Kottke TE, Clark M, Aase L, Brandel CL, Brekke MJ, Brekke LN, et al. Self-reported weight, weight goals, and weight control strategies of a midwestern population. Mayo Clin Proc 2002; 77: 114-21. ^{- 15}15. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight specific practices among U.S. adults. Am J Prev Med 2004;26(5):402-6. ^{, 21}21. Kruger J, Galuska DA, Serdula MK, Kohl HW 3rd. Physical activity profiles of U.S. adults trying to lose weight: NHIS 1998. Med Sci Sports Exerc 2005; 37(3): 364-8.. However, in the study conducted in Spain¹⁷17. Rodríguez-Rodríguez E, Aparicio A, López-Sobaler AM, Ortega RM. Percepción del peso corporal y medidas adoptadas para su control en población española. Nutr Hosp 2009; 24(5): 580-7., most participants increased the frequency of physical exercises in order to lose weight. Among the women in the 1982 birth cohort, however, most of them reported using all of the strategies to lose weight, except for physical activity, which was more prevalent among men. These results had already been presented for the adult population of Pelotas²⁴24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49.. The concern about body weight was more frequently reported by the female college students of Pernambuco, and the practice of physical activities as a way to lose weight, likewise, was mostly mentioned by men²²22. Colares V, Franca Cd, Gonzalez E. Condutas de saúde entre universitários: diferenças entre gêneros. Cad Saude Publica 2009; 25(3): 521-8.

By assessing the use of medicines or teas, such strategies were also mostly used by women in the cohort and in the more recent population-based study conducted in Pelotas²⁴24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49., which reinforces the fact that women wish to lose weight in a negligent manner, which can expose them to non-recommended practices, such as the use of anorexigenic agents¹⁰10. Serdula M, Williamson D, Anda R, Levy A, Heaton A, Byers T. Weight Control Practices in Adults: Results of a Multistate Telephone Survey. Am J Public Health 1994; 84(11): 1821-4. ^{, 23}23. Silveira EA. Estratégias para perder peso: prevalência e fatores associados em estudo de base populacional no sul do Brasil. [Dissertação de Mestrado]: Universidade Federal de Minas Gerais; 2006. ^{, 26}26. Brasil. Agência Nacional de Vigilância Sanitária. Anvisa mantém registro de sibutramina e cancela anfetamínicos. Disponível em: http://portal.anvisa.gov.br/wps/content/ anvisa+portal/anvisa/sala+de+imprensa/menu+- +noticias+anos/2011+noticias/anvisa+mantem+registro+de+ sibutramina+e+cancela+anfetaminicos
Disponível em: http://... .

It is also important to remember that the data in this study indicate that the attempt to lose weight by combining health practices, such as diet and physical exercise, was less frequent in comparison with the separate analysis of diet and exercises, which was similar to the results found in the United States⁹9. Levy A, Heaton AW. Weight control practices of US adults trying to lose weight. Ann Intern Med. 1993; 119(7 Pt 2): 661-6. ^{, 15}15. Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight specific practices among U.S. adults. Am J Prev Med 2004;26(5):402-6. and in the adult population of Pelotas²⁴24. Machado EC, Silveira MF, Silveira VM. Weight-loss strategies and use of weight-loss substances among adults: a population study. Cad Saude Publica 2012; 28(8): 1439-49..

In this study, it is important to mention that obese men presented four times more chances of using a weight-loss strategy when compared to those with adequate weight. As to obese women, they presented two times more chances than those with adequate weight. Also, after analyzing the prevalence of all weight-loss strategies according to BMI, it was observed that even with adequate weight, women use weight-loss strategies. The results suggest that the wish to lose weight among women is being less influenced by the obesity condition. This reinforces the idea that the woman, even with adequate weight, wants to lose weight, which was also demonstrated in a study with college students from Madrid19, in which 92% of the women who wanted to lose weight had adequate BMI.

Therefore, the idea that one out of three people with mean age of 23 years old used some weight-loss strategy in the past year indicates that adequate measures are necessary and urgent. So, it is important to avoid the practices considered to be improper to lose weight by means of public policies addressed to the young population and to the population with lower socioeconomic level, since these are the ones who do not use so many weight-loss strategies. This way, it can be possible to incorporate healthy techniques and habits, such as physical activity and food education. Once this is the most adequate proposal, which presents the best results³⁷37. Souto S, Ferro-Bucher JSN. Práticas indiscriminadas de dietas de emagrecimento e o desenvolvimento de transtornos alimentares. Rev Nutr 2006; 19(6): 693-704., it should be encouraged as the main tool of prevention and control of body weight, thus preventing the progress of obesity and its complications throughout life.

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