Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England

Abstract

ObjectiveThis study aimed to investigate trends and sociodemographic factors underlying weight misperception in adults with overweight and obesity in England.MethodsThis study used descriptive and logistic regression analyses based on a pooled nationally representative cross‐sectional survey, Health Survey for England, for the years 1997, 1998, 2002, 2014, and 2015 of individuals with BMI ≥ 25 (n = 23,459). The main outcomes were (1) weight misperception and (2) weight‐loss attempts as well as the associations with demographic and socioeconomic characteristics and health status.ResultsThe proportion of individuals with overweight and obesity misperceiving their weight status increased over time between 1997 and 2015 (37% to 40% in men; 17% to 19% in women). There were socioeconomic disparities in the misperception of weight status, with lower‐educated individuals from poorer‐income households and members of minority ethnic groups being more likely to underestimate their weight. Those underestimating their overweight and obesity status were 85% less likely to try to lose weight compared with people who accurately identified their weight status.ConclusionsThe upward trend in underassessment of overweight and obesity status in England is possibly a result of the normalization of overweight and obesity. Obesity prevention programs need to consider differential sociodemographic characteristics associated with underassessment of weight status.

Response to Alleva and Tylka and Flint et al.

“…TO THE EDITOR: Alleva and Tylka comment that my study (1) does not show evidence of a causal relation between the body-positive movement and obesity. Rightly so, as the study never claimed any causal relationship, and there are no sentences that explicitly confirm a statistical relationship toward this direction.…”

Muttarak's Study Design Cannot Support the Link Between the Body‐Positive Movement and Overweight or Obesity

“…Unfortunately, Muttarak (1) erroneously made this causal claim. For example, she states that the availability of "plus-size" clothing likely "contributed to the normalization of stigma associated with overweight and obesity" (page 1125) and that the body-positive movement "can potentially undermine the recognition of being overweight and its health consequences" (page 1125) (1). Yet these statements extend beyond the conclusions allowable by her study design.…”

“…Jessica M. Alleva 1 and Tracy L. Tylka 2 TO THE EDITOR: We raise a substantial concern with a recent publication in Obesity (1). Here, we focus on the implied causal link between the body-positive movement and overweight and/or obesity.…”

In Response to “Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England”

“…In Response to "Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England" Stuart W. Flint 1 , Sarah Le Brocq 2 , and James Nobles 1,3 TO THE EDITOR: In the July edition of Obesity, Muttarak wrote that the normalization of overweight and obesity leads to the underestimation of overweight and obesity (1). These data are based on self-perceptions of weight across an 18-year period.…”

“…Stigmatizing and inaccurate media portrayals of obesity are suggested to influence public attitudes toward people with obesity (3). Although media reports of this article are indeed stigmatizing, Matturak's article (1) and subsequent press release (2) also disseminate unevidenced claims to the public about plus-size clothes brands. Many media reports of this article focused on the blame that the author attached to plus-size clothing brands, rather than the study findings… "Normalisation of 'plus size' may undermine the efforts to tackle obesity" -Business Standard (4) "Body-positive movement causes people to think they aren't obese, study says" -Newsweek (5) Within a month, this article achieved an Altmetric score of 541 (top 5%), with more than 60 media outlets publishing a story based on it.…”