Obesity is characterized by an excess of body fat, and its prevalence has risen due to modernization in diet and lifestyle. The World Health Organization has reported that 39.0% of adults worldwide are overweight, while 13.0% are obese [1]. In Korea, between 31.3% and 34.4% of adults are considered obese, using a Body Mass Index (BMI) threshold of 25 kg/m² and data from 2019~2020 [2, 3]. The prevalence of adult obesity in some cities within Korea's northern Gyeonggi Province was 37.0% in 2019 and 34.8% in 2020 [4]; this is slightly higher than the Korean average, indicating regional disparities. The increasing prevalence of obesity has become a serious societal issue. Obesity is associated with the exacerbation of diabetes, dyslipidemia, and cardiovascular and cerebrovascular diseases [5, 6], as well as adverse impacts on the immune system and chronic inflammation [7]. This underscores the importance of weight management as a crucial health-promoting behavior. A reduction of 1 kg in body weight can decrease blood pressure by 1 mmHg [8] and the abdominal fat area by 10 cm² [9]. Moreover, weight loss is associated with lowered blood pressure or blood glucose levels [10, 11], a reduced prevalence of cardiovascular disease [12], and, ultimately, a decrease in mortality [13].

As evidenced by these research findings, weight loss is a fundamental health-promoting behavior; however, regional health statistics data from the Korea Community Health Survey (KCHS), Korea's annual nationwide survey, reveal that the prevalence of obesity (BMI ≥25 kg/m²) in Seoul has risen from 22.5% in 2011 to 29.2% in 2021. This increase is even more pronounced in Gyeonggi Province, where obesity rates climbed from 23.4% to 31.6% over the same period. Furthermore, the prevalence of weight loss attempts, defined as the percentage of individuals who have tried to lose or maintain weight in the past year, was 67.1% in Gyeonggi Province compared to 72.0% in Seoul. This rate in Gyeonggi Province is higher than in provincial areas (e.g., Gyeongsangnam Province or Chungcheongbuk Province) but lower than in metropolitan cities (e.g., Busan or Daegu) [14]. Some regions of northern Gyeonggi Province have no tertiary hospitals and only a limited number of public health centers. Given the recent population influx into northern Gyeonggi Province, it is essential to examine the health behaviors, obesity, and weight loss efforts among residents.

A weight loss attempt can be influenced by a variety of factors, including personal characteristics such as age, gender, and education level. One study indicated that weight loss behavior among Koreans varies depending on gender, education level, perceived health status, and BMI [15]; however, this finding has not garnered much attention in subsequent research. Weight loss attempts have also been reported to potentially be associated with perceived sensitivities, such as awareness of blood pressure or blood sugar levels, perception of self-body image or weight, and awareness of unhealthy nutrition [16, 17, 18]. The results of previous studies on the relationship between subjective weight perception and weight control behaviors have been inconsistent. In one study, researchers found that unawareness of weight excess can hinder weight loss attempts, and experiences or perceptions of memories can counteract the desire to lose weight [19]. However, another study found no evidence to suggest that accurate recognition of overweight status leads to a lower BMI [20]. Research on weight loss has examined various aspects of weight loss efforts, such as the relationship between self-regulation ability and self-efficacy [21], the effects of intermittent fasting on weight loss [22], and unhealthy weight loss behaviors [23].

The Korea Disease Control and Prevention Agency (KDCA) carries out a nationwide annual health survey at the community level, in collaboration with public health centers, with the aim of laying the groundwork for regional health promotion projects based on scientific evidence. To this end, raw data are obtained for each municipality and province and made available in the form of comprehensive national health statistics; this allows for regional comparative analysis and generalization of research findings. In this context, the present study utilized data from the KCHS to investigate the potential relationship between weight loss attempts and awareness of personal blood pressure or blood sugar levels, as well as subjective body weight perception, among overweight or obese adults in northern Gyeonggi Province. The findings of this study are anticipated to provide valuable information for the planning and implementation of weight loss or obesity intervention programs. This study aims 1) to examine the awareness rates of blood pressure and blood sugar, subjective body weight perception, and weight loss attempt rates among the study participants, and 2) to investigate the relationship between awareness of blood pressure and blood sugar, subjective body weight perception, and weight loss attempts.

An essential factor in preventing chronic diseases and maintaining health in adults is preventing obesity. In this regard, overweight or obese adults must become aware of the importance of losing weight and striving to control their weight. In this study, we analyzed data from residents in northern Gyeonggi Province because this region has a lower penetration of healthcare facilities and services than other cities, counties, and districts across Korea. In the results, the prevalence rates of obesity and overweight among participants were 43.6% (n=2,897) and 56.4% (n=3,674), respectively, with about half of the individuals needing to lose weight. However, 26.8% of them reported not attempting to lose or maintain their weight in the past year. Consequently, it is crucial to adequately convey the severe health risks of obesity and the urgent need to lose weight. Additionally, it is essential to comprehend the reasons that people do not attempt weight loss and the factors influencing those attempts. Public health centers across the country, including in Gyeonggi Province, offer ongoing programs for managing chronic diseases associated with obesity. These programs include early detection, patient registration and follow-up management, prevention education, and publicity campaigns, as well as practical obesity prevention programs such as physical examinations, exercise education, dietary regimes and nutrition counseling, walking adherence, and self-help group formation [25]. Despite the availability of these programs through public health centers, it is necessary to acknowledge the high prevalence of overweight and explore measures to effectively implement such programs. Although several weight control programs have been implemented in the past, the prevalence of overweight and obesity continues to increase. Some suggestions for addressing this ongoing issue include identifying the at-risk group, designing programs that focus on influencing factors, and implementing them continuously.

Weight loss attempts among participants varied according to their general and health-related characteristics, such as gender, age, education level, occupation, residential area, blood pressure, blood sugar level, and subjective body weight perception. Although women surpassed men in weight loss attempts, weight loss is more crucial for men due to their higher prevalence of smoking and drinking [26], lower prevalence of health-promoting behaviors [3], and higher prevalence of obesity-related hypertension or cardiovascular disease [27]. Additionally, older age was associated with fewer weight loss attempts. This finding warrants special attention, considering that the incidence of chronic diseases such as cardiovascular disease, hypertension, and diabetes increases due to overweight and obesity among middle-aged and older adults [28, 29]. Moreover, a higher education level was associated with a greater prevalence of weight loss attempts. Education is the most critical factor in determining health literacy [30], which can empower individuals and lead to health-promoting behaviors [31]. More specifically, health behaviors such as weight loss attempts are associated with health literacy-the ability to obtain, understand, and apply health-related information-or socioeconomic level, which is in turn linked to health inequality [32]. Thus, it is essential to recognize that individuals with lower education levels are at risk for health inequality and tend to attempt weight loss less frequently.

The prevalence of weight loss attempts was found to be related to individuals' awareness of their blood pressure or blood sugar levels. Specifically, nearly one-third (30.4%) of the respondents reported that they did not know their blood pressure or blood sugar levels, and these participants made fewer weight loss attempts than those who were aware of these levels. Consequently, increasing awareness of personal blood pressure and blood sugar levels may encourage individuals to make weight loss attempts. Currently, public health centers across Korea conduct annual programs to raise awareness of blood pressure and blood sugar levels in the general population, under the slogan "Blood pressure-Know your score!" Such programs must be actively promoted to continue this effort. Furthermore, since obesity is a risk factor for hypertension and diabetes, overweight or obese individuals should be provided with opportunities to engage more actively in weight loss attempts. This can be achieved by emphasizing that reducing body weight can lower blood pressure [33] and that the effect of blood pressure control becomes particularly evident with a weight loss of more than 10% [34].

The analysis concerning participants' subjective body weight perception revealed that only 63.8% of those classified as overweight or obese (≥23 kg/m²) perceived themselves as obese, while the remainder viewed themselves as thin or normal. Regarding the prevalence of weight loss attempts based on body weight perception, a greater proportion of individuals who perceived themselves as normal or obese made weight loss attempts than those who perceived themselves as thin. This indicates that although the perception of obesity leads to weight loss attempts, these efforts may not be made due to a distorted self-body image among obese individuals. This discrepancy between objective and subjective weight or distorted self-image has also been reported previously [11]. In effect, subjective body weight perception and shape influence weight loss attempts. For instance, normal-weight individuals who perceive themselves as obese tend to reduce carbohydrate intake, increase weight loss attempts [12], and engage more actively in exercises that are efficient for weight loss, such as walking rather than stretching [11]. Similarly, those with an obese self-image attempt weight loss [13] and tend to engage in health behaviors more actively than those without such a self-image [14]. These findings highlight the importance of an accurate perception of body weight and shape among obese or overweight individuals in attempted weight loss. Analyzing distorted self-image perceptions by age and gender and their relation to weight loss attempts could be an intriguing topic for future research. Based on the results of this study, we recommend prioritizing men, individuals over 50 years of age, and those with a low education level when planning weight control intervention programs. Furthermore, when designing an intervention program, we advise focusing on accurately recognizing one's own blood pressure, blood sugar level, and degree of obesity.

A limitation of this study is that the model did not include some relevant covariates, as this was a secondary analysis using data from the KCHS. The analysis was restricted to the variables present in the original survey data collection.

In conclusion, older individuals, men, and those with lower education levels are less likely to attempt weight loss, placing these population groups at higher risk for obesity-related health consequences. It is essential to provide education to these individuals to foster accurate awareness and perceptions of their blood pressure, blood sugar levels, and subjective body weight perception. By increasing their sensitivity to weight gain, they may be more naturally inclined to attempt weight loss.