ORIGINAL RESEARCH
Yubing Wang, PhD
Corresponding Author: Yubing Wang, PhD; Department of Human Movement Studies & Special Education, Old Dominion University.
Email: y8wang@odu.edu
DOI: 10.3122/jabfm.2025.250466R1
Keywords: Body Mass Index, Counseling, Epidemiology, NHANES, Nutrition Surveys, Obesity, Public Health, Weight Loss
Dates: Submitted: 12-09-2025; Revised: 02-20-2026; Accepted: 03-23-2026
Status: In Press.
INTRODUCTION: Clinician counseling is recommended for weight management, but national evidence on absolute and population effects are limited. It is aimed to quantify the absolute and population effects of clinician advice on current weight-control behaviors, using risk difference (RD), risk ratio (RR), population attributable fraction (PAF), and number needed to advise (NNA), and to test heterogeneity by BMI, sex, age, and poverty-income ratio (PIR).
METHODS: NHANES data (2005–2020) from 28,994 adults was analyzed. Exposure was self-reported receipt of clinician advice to control/lose weight in the past 12 months (NHANES item); the outcome was self-reported current controlling/losing weight. Survey-weighted modified Poisson models with marginal standardization estimated adjusted risks, assessed prespecified interactions, and performed sensitivity analyses (augmented inverse probability weighting [AIPW], leave-one-cycle-out, ≥2 visits, complete case).
RESULTS: Advice was associated with RD 19.2 percentage points (95% CI, 19.1–19.3) and RR 1.34 (1.33–1.34); PAF 8.5% (7.1–9.9), ≈10.0 million adults; NNA 5.2 (5.2–5.3). Subgroup analyses showed heterogeneity by BMI, sex, and PIR; population impact was greatest among adults with obesity (PAF 10.1%, ≈5.3 million). The absolute impact of advice on weight-control behavior was larger in men than women. Lower-income adults had the largest absolute and population impacts (RD 25.6; PAF 12.2%, ≈2.6 million). Findings were robust across sensitivity checks.
CONCLUSIONS: Clinician advice is associated with meaningful absolute and population benefits. Absolute and population metrics provide actionable targets to strengthen universal counseling with proportionate support.