Underreporting of Dietary Intake: Key Issues for Weight Management Clinicians

Abstract

Underreporting of dietary intake is common in obesity treatment programs. Accurate reporting through daily food diaries is essential for organizing and personalizing treatment. This review explores key concerns for clinicians, summarizes the state of research on causes of underreporting and ways to promote consistency and accuracy, and identifies areas of need for future research. Dietary underreporting is a cross-cultural phenomenon, and obesity is the most consistent correlate. The association with BMI may be mediated by factors like socioeconomic status, gender, and body image. People with obesity—particularly women—tend to underreport high energy foods and those considered socially undesirable. Underreporting may be due to conscious or unconscious processes and is also influenced by literacy issues and the features of reporting tools. Perceived social pressure plays a role in underreporting, as does inconvenience of reporting. Web- and smartphone-based reporting options offer alternatives to paper-based reporting, but are prone to the same underreporting issues and may not accurately capture energy and micronutrient content. Some evidence indicates frequency and consistency of reporting are more important for weight loss than accuracy. Dietary underreporting remains a major issue in weight management for obesity. The majority of studies are descriptive, identifying associations but not incorporating psychometric tests or qualitative methods like interviews or focus groups to explore underlying issues. Multidisciplinary research is needed to better understand why people underreport and inform strategies to improve quality and consistency of reporting and aid patients with obesity in adhering to dietary goals.