Relationship of Weight Perceptions on Dietary Intake Behaviors in Healthy Weight and Overweight/Obese Adults: National Health and Nutrition Survey (2011-2014)

Abstract

Compare energy balance and diet quality differences of healthy weight and overweight/obese adults who perceive their weight status accurately versus inaccurately. Weight status can affect health outcomes, but weight misperceptions can cause altered health behaviors. This study assessed relationships between weight misperceptions, energy balance, and overall dietary quality in healthy weight and overweight/obese adults. Participants (n=7,599) included adults participating in the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Weight status and weight perception, based on the question “How do you consider your weight?”, were recoded into four categories: healthy weight accurate perceptions (HWaccurate), healthy weight inaccurate perceptions (HWinaccurate), overweight/obese accurate perceptions (OWaccurate), and overweight/obese inaccurate perceptions (OWinaccurate). Percent energy balance was calculated using actual energy intake divided by estimated energy requirements. The Healthy Eating Index (HEI-2015) was computed using two, 24-hour recalls. Multiple linear regression assessed differences in percent energy balance and HEI-2015 by weight perception category while adjusting for demographic factors. After adjusting for covariates, percent energy balance of HWinaccurate (72.82% SE 2.51, ß=-6.67, p=0.014), OWaccurate (69.59% SE 0.78, ß=-10.31, p<0.001), and OWinaccurate (70.95% SE 1.13, ß=-5.84, p<0.001) groups were significantly lower than HWaccurate group (79.66%, SE 0.81). HEI-2015 scores for OWaccurate participants were significantly lower than HWaccurate (HEI 53.61 SE 0.35 vs. HEI 56.72 SE 0.70, ß=-1.79, p<0.001), but were not significantly different from either inaccurate group. Healthy weight adults who perceive their weight accurately consume diets more closely matching their energy needs and dietary recommendations than do overweight/obese adults or those who perceive their weight inaccurately. This suggests that weight perceptions, not just weight status, should be considered during nutrition counseling for adults.