Abstract
BackgroundSelf-perceptions of health and disease can be a major driver of health behaviors. Improving accuracy of self-ascertainment of obesity may prompt uptake of weight-control behaviors in those with obesity.MethodsWe assess performance of self-perceived body size (‘too small’, ‘about right’ or ‘too large’), self-estimated BMI in kg/m2, and sociodemographics in detecting measured BMI category (under-, normal-, overweight and obese; BMI cutpoints 18.5, 25 and 30) in first bivariate and then multivariable models.ResultsOf 37,281 adults in the US from NHANES, 2, 34, 33 and 32% were under-, normal-, overweight and obese. Respectively 56, 73, 60 and 91% self-perceived as ‘too small’, ‘about right’, ‘too large’ and ‘too large.’ Of those who self-perceived as ‘too small’, 22% were underweight and 10% were overweight or obese. 99.7% of obese participants self-estimated a BMI in the overweight/obese range, including many who did not self-perceive as ‘too large’.Among obese participants, self-perception as either ‘about right’ or ‘too small’ was more likely for those who were younger (OR for perception as ‘too large’ 1.01 per year, 95% confidence interval 1.00–1.01) male (OR 0.33, (0.28–0.39)) nonwhite (ORs 0.36–0.79 for different ethnicities), low-income (ORs 0.61 and 1.8 for the lowest and highest of six categories, vs. the third) or measured recently (OR 0.98 (0.96–1.0) per year since 1999). Misperception was less common, but still existed, for participants with moderate or severe obesity (ORs 2.9 (2.3–3.5) and 7.9 (5.4–12), vs. ‘mild.’) (all p < 0.01.)ConclusionsA tenth of adults in the US with obesity, especially those from overweight peer groups, self-perceive as normal or underweight and thus may not be motivated to control their weight. However, virtually all self-estimate an overweight or obese BMI. If measured BMI is not available, self-estimates are sufficiently accurate that interventions may rely on it to identify obesity.
Highlights
IntroductionImproving accuracy of self-ascertainment of obesity may prompt uptake of weight-control behaviors in those with obesity
Self-perceptions of health and disease can be a major driver of health behaviors
As variables associated with obesity and/or weight misperception we considered age; sex; year of followup; ethnicity; objectively measured body mass index (BMI) as percent of self-estimated; and household income
Summary
Improving accuracy of self-ascertainment of obesity may prompt uptake of weight-control behaviors in those with obesity. Caloric imbalance leading to excess body weight is one of the largest causes of death in the US and a major contributor to six of the top ten causes of death worldwide: [1] it is perhaps the only behavioral risk factor which can affect individuals without their knowledge. Identifying and correcting weight misperception may increase the uptake of weight-control behaviors [3, 4] and help to mitigate the obesity epidemic. Previous estimates of weight misperception suggest that up to half of overweight people self-perceive as healthy-weight: these studies tend to be based on small and/or strongly selected samples (e.g. university students, [5] physicians [6]) and their estimates are difficult to generalize outside these groups. Neither the prevalence nor the correlates of body-size misperception have been well established
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