Weight Loss Intentionality and Strategies in Urinary Incontinence

INTRODUCTION: Urinary incontinence (UI)-including stress (SUI), urge (UUI), and mixed (MUI) subtypes-is associated with obesity, and weight loss is commonly recommended for intervention. However, the comparative effects of intentionality and weight loss strategies on UI severity remain poorly defined. MATERIAL AND METHODS: We analyzed 16,331 adults from the 2001-2020 NHANES cohorts who self-reported 1-year weight loss and completed the UI questionnaire. Our use of a large, diverse sample of U.S. men and women and self-reported intentionality and strategies (dietary changes, exercise, intermittent fasting, and diet pills) was unique. UI severity was defined by number of leakage episodes. Ordinal logistic regression, adjusted for age, sex, race/ethnicity, body mass index (BMI), and comorbidities, evaluated associations between weight loss intentionality and UI severity. RESULTS: Among 16,331 adults, 9581 (58.7%) reported intentional and 6750 (41.3%) unintentional weight loss. After adjustment, intentional weight loss was associated with lower odds of more frequent SUI (0.79 OR [95%CI 0.68-0.92]), UUI (0.85 OR [95%CI 0.73-0.99]), and MUI (0.79 OR [95%CI 0.64-0.98]) compared to unintentional weight loss. Commonly used strategies included dietary modification (n = 8818), exercise (n = 5714), intermittent fasting (n = 1584), and diet pills (n = 238). Exercise was associated with the lowest prevalence of frequent SUI, UUI, and MUI symptoms in both males and females. Stratified analysis demonstrated that exercise remained associated with lower UUI symptom frequency even among individuals achieving ≤ 5% weight loss. CONCLUSIONS: Intentional weight loss was associated with lower likelihood of frequent UI symptoms compared to unintentional weight loss. Exercise was the intervention associated with the lowest severity of SUI, UUI, and MUI in both males and females. Our findings are consistent with current recommendations for active behavioral modification for UI weight loss. Additional prospective comparative analysis of exercise and other weight loss strategies is warranted.