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

Abstract

BackgroundWeight 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.MethodsData 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.ResultsThese 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.ConclusionOverall, 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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“…109 The higher likelihood of decreases in BMI category and of 5% weight loss among the more severely obese participants in this study is consistent with results from clinical trials 110 and previous cohort studies 111 in which higher BMI predicted greater weight loss. The increased probability of weight reduction among patients with more severe obesity may reflect more accurate perceptions of personal weight status 112,113 and higher treatment rates among these patients. It is also possible that BMI decreases in severely obese patients reflect unintentional weight loss resulting from greater comorbidity.…”

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“…Such attitudes may also decrease engagement of obsess individuals in weight control behaviors such as physical activity and diet (12)(13)(14)(15). In the United States, according to the NHANES 2003 -2006 data, among women who are overweight or obese, Blacks less likely fulfil recommended criteria for physical activity compared to any other racial groups, a difference which is mediated by more liberal body weight perceptions (16). Despite high awareness of health risks associated with obesity 142, Black women's health concerns are jeopardized by their cultural beliefs that are more tolerant of large body size (5).…”