Background: Weight misperception might preclude the adoption of healthful weight-related attitudes and behaviors among overweight and obese individuals, yet limited research exists in this area. We examined associations between weight misperception and several weight-related attitudes and behaviors among a nationally representative sample of overweight and obese US adults. Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were used. Analyses included non-pregnant, overweight and obese (measured body mass index ≥ 25) adults aged 20 and older. Weight misperception was identified among those who reported themselves as “underweight” or “about the right weight”. Outcome variables and sample sizes were: weight-loss attitudes/behaviors (wanting to weigh less and having tried to lose weight; n = 4,784); dietary intake (total energy intake; n = 4,894); and physical activity (meets 2008 US physical activity recommendations, insufficiently active, and sedentary; n = 5,401). Multivariable regression models were stratified by gender and race/ethnicity. Analyses were conducted in 2009-2010. Results: These overweight/obese men and women who misperceived their weight were 71% (RR 0.29, 95% CI 0.25-0.34) and 65% (RR 0.35, 95% CI 0.29-0.42) less likely to report that they want to lose weight and 60% (RR 0.40, 95% CI 0.30-0.52) and 56% (RR 0.44, 95% CI 0.32-0.59) less likely to have tried to lose weight within the past year, respectively, compared to those who accurately perceived themselves as overweight. Blacks were particularly less likely to have tried to lose weight. Weight misperception was not a significant predictor of total energy intake among most subgroups, but was associated with lower total energy intake among Hispanic women (change -252.72, 95% CI -433.25, -72.18). Men who misperceived their weight were less likely (RR 0.68, 95% CI 0.52-0.89) to be insufficiently active (the strongest results were among Black men) and women who misperceived their weight were less likely (RR 0.74, 95% CI 0.54, 1.00, p = 0.047) to meet activity recommendations compared to being sedentary. Conclusion: Overall, weight misperception among overweight and obese adults was associated with less likelihood of interest in or attempts at weight loss and less physical activity. These associations varied by gender and race/ethnicity. This study highlights the importance of focusing on inaccurate weight perceptions in targeted weight loss efforts.

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Does perception equal reality? Weight misperception in relation to weight-related attitudes and behaviors among overweight and obese US adults

BACKGROUND: Weight perception has been studied with a limited focus on “feeling overweight.” This study, using a more inclusive definition of overestimation and underestimation, examines adolescents' weight perception focusing on how accurate it is in relation to body mass index (BMI)-based weight status and how it varies across socio-demographic factors.

METHODS: Data are from the 2007 Minnesota Student Survey, a paper-and-pencil survey completed in the classroom by students in public schools. The final analyses were based on the data from 87,418 high school students who were asked about their height and weight.

RESULTS: Weight perception and the BMI-based weight status (based on self-reported weight and height) were strongly and positively correlated, but substantial discordance was observed with more than a quarter of the students (27.6%) having discordant weight perception. Males, minorities, and those from low-income households were more likely than their respective counterparts to have a discordant weight perception. Overall, underestimation was more prevalent than overestimation. Girls were more likely to overestimate, while boys were more likely to underestimate. Black and Hispanic females and those from low-income households were more likely to underestimate than overestimate their weight, while Asian/Pacific Islander males were more likely to overestimate than underestimate.

CONCLUSIONS: If underestimation is more prevalent among Black or Hispanic females and those from low-income households, the already higher prevalence of obesity among these groups is unlikely to decrease. Overestimation, on the other hand, can be a risk factor for unhealthy weight-control behaviors. Monitoring adolescents' perceived weight in addition to their BMI is critical to understanding the challenge we face with childhood obesity.

Overestimation and underestimation: adolescents' weight perception in comparison to BMI-based weight status and how it varies across socio-demographic factors.

Using the Health Belief Model to Develop Culturally Appropriate Weight-Management Materials for African-American Women

Self-perception of weight and its association with weight-related behaviors in young, reproductive-aged women.

Obesity is an increasingly common and serious problem in the United States [1]. Recent estimates suggest that 66.3% of adults are overweight or obese (BMI ≥ 25.0 kg/m2) [2]. In spite of public health efforts promoting increased awareness of overweight and obesity, a substantial proportion of adults may inaccurately identify their weight status [3, 4]. Among overweight and obese individuals, under-estimation of weight status may contribute to minimization or denial that current weight is a health risk [3], and may thus contribute to health problems associated with obesity due to a failure to respond [5, 6].

Earlier studies have explored demographic differences in weight status perception among overweight and obese as a unitary group. Accuracy in overweight perception has been associated with age, gender, race, BMI, physical activity level, smoking behavior, income, and educational background [3, 4, 7-11]. However few studies have examined psychological and behavioral correlates of weight status misclassification among obese individuals. Psychological and behavioral characteristics are particularly important to examine among more severely obese individuals (e.g., class II) who under-estimate their weight status. These individuals are also at higher risk of medical problems than overweight or less severely obese individuals due to greater adiposity. Given that research consistently demonstrates an association between obesity and depression, low self-esteem, and poorer quality of life [12, 13], it is important to understand the relationship between psychological factors and accuracy of weight status perception.

While several studies suggest that accuracy of self-reported weight appears to be unrelated to psychological features (e.g., [11, 14-16], the literature remains very limited. Notably, these studies did not ask participants to identify their weight status as under weight, normal weight, overweight, or obese but rather examined the discrepancy between self-reported and actual weight. It may be more relevant from a behavioral or clinical perspective to examine how obese individuals who identify as “obese” differ from those who misidentify their weight status as “overweight.” Additionally, previous research on weight misperception has classified individuals as accurate or inaccurate according to standard cut-offs for weight classifications. Therefore individuals who are just beyond a given cutoff are grouped alongside individuals with much greater disparity between actual and reported classifications. The current study seeks to examine weight status misperception among individuals classified as Class II obese (35≤BMI<40), and to determine whether, within this group, accuracy in weight status perception is associated with psychological and behavioral factors.

Psychological and Behavioral Correlates of Excess Weight: Misperception of Obese Status among Persons with Class II Obesity

BACKGROUND
Understanding the reasons for overweight and obesity is critical to addressing the obesity epidemic. Often the decision to lose weight is based as much on one’s self-perception of being overweight as on inherent health benefits.

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Angela M. Galka

Papers

Factors Associated with Misperception of Weight in the Stroke Belt