Comparing “Apples and pears”: how well do women perceive their body size and shape?

Abstract

Obesity is associated with reproductive disorders, such as PCOS, and chronic disease risk. Increasing evidence suggests body shape (i.e., regional fat distribution, abdominal adiposity) is independently associated with risk. However, it is unknown whether women accurately perceive their shape so that information can be reliably collected. This study assessed the validity of self-reported body size and shape when compared to anthropometric measures. Interview responses and anthropometry were compared among 131 adult women enrolled as population controls for the operative cohort within a larger study on endometriosis. Body size was ascertained by self-report using the Stunkard 9-level figure drawings and body shape using stylized pear, hourglass, rectangle, and apple figures. Anthropometry (height, weight, waist and hip circumferences) was taken by trained researchers. Body size and body mass index (BMI) were compared using Spearman's correlation coefficient. Fat distribution indicators were compared across body shapes for all and non-obese women using ANOVA and Fisher's exact test. Women were primarily Caucasian (81%), aged 32 years, with an average BMI of 27.1 kg/m2. No one reported being the smallest or largest figure size. The correlation between figure size and BMI was 0.85 (P<0.001). Among non-obese women, waist-hip ratios (WHR) were 0.75, 0.75, 0.80, and 0.82 for pear, hourglass, rectangle, and apple, respectively (P<0.001). Women who reported being pear- compared to apple-shaped were less likely to have a WHR>0.8 (13% vs. 70%, respectively, P=0.002). Self-reported figure size and shape were consistent with anthropometric measures commonly used to assess obesity and fat distribution, respectively. Body shape may be a useful proxy measure in addition to self-reported size in large-scale surveys to determine reproductive and chronic disease risk.