Misclassification of Self-Reported Body Mass Index Categories

Abstract

verweight and obesity are a growing global public health problem (1). Epidemiological analyses have projected that overweight will be one of the top 4 global causes of preventable years of life lost in the future, besides hypertension, diabetes, and smoking (2). Already in 2007, the social costs of overweight amounted to 16 billion Pound Sterling in the United Kingdom (corresponding to 1% of their gross national product), with a strong upward trend. According to guideline recommendations on the prevention of myocardial infarction, stroke, and diabetes, physicians should offer lifestyle interventions to their overweight patients (3, 4). The 13 th nutrition report of the German Nutrition Society (DGE, Deutsche Gesellschaft für Ernährung e. V.) highlights the need to stop this obesity epidemic in Germany and calls for urgent action (5).According to the World Health Organization (WHO), in 2016 worldwide 39% of adults were overweight with a body mass index (BMI) of ≥ 25 kg/m 2 , while 11% of men and 15% of women were obese with a BMI of ≥ 30 kg/m 2 (6). The prevalence of obesity is high in Germany. Of the adult population, 54% have a BMI of ≥ 25 kg/m 2 and 18% of >30 kg/m 2 (7). In the United States, prevalence rates are even higher, with 36% of the population being obese (8).For weight-loss interventions to be successful, people need to be aware of the fact that they are overweight; without this awareness, a behavioral change is unlikely to happen (9-11). The agreement between self-perception and measured weight status has already been evaluated in numerous studies on a variety of populations; however, an aggregation of these data for the general adult population is missing.The aim of this review is to organize the available data from studies on weight perception in adults, to identify areas that need to be addressed in future research, and to provide summarized answers to the following questions:• How often is the self-perceived BMI categorization accurate?• Is misclassification based on overestimation or underestimation?• What groups of persons show good weight selfperception and what groups do not? SummaryBackground: Overweight and obesity are an increasingly serious public health problem in Western societies, including Germany. The tendency of overweight and obese people not to classify themselves as such limits the efficacy of information on the health risks of these conditions and lessens the motivation to change behavior accordingly. In this article, we summarize the available study data on the selfperception of weight class. We present and discuss the differences between selfreported body-mass index (BMI) category and the actual category of the BMI when it is calculated from the individual's measured height and weight.Methods: We systematically searched the Medline, EMBASE, and Cochrane Library databases in August 2017 for pertinent publications. The study protocol was published in the PROSPERO register (CRD42017064230). Meta-analyses were calculable for a number of subgroup analyses.Results: A total of 50 st...

Levels and Associations of Weight Misperception with Healthy Lifestyle among Adults in Saudi Arabia

“…This misperception was most pronounced in obese participants: 67.6% of obese participants misclassified their weight compared to 36.2% of overweight participants, 33.9% of normal weight participants, and 34.3% of underweight participants. About 8.4% of the obese participants in this study perceive themselves to be underweight or normal weight, which is similar to previous studies where the most common misclassification among obese participants was underestimation [25]. In line with Saudi Arabian [21] and international studies (25), our findings indicate that obese individuals are particularly vulnerable to weight misperception.…”

“…Similar to previous studies, we observed a significant association between age and weight perception, with older adults more likely to misperceive their weight than their younger peers [25]. Older adults were also more likely to be overweight and obese, which may contribute in part to the observed relationship between age and weight misperception.…”

Does Self-Perception Equal the Truth When Judging Own Body Weight and Height?

“…The prevalence of measured overweight or obesity (BMI ≥ 25) was nearly 60% in men and 30% in women, but more than half of those underreported their weight group when asked about this, especially the men (60% versus 40%, respectively). This is consistent with the results from a recent systematic review of more than 50 studies from 25 countries (n = 174,000), concluding that self-perceived BMI group is often incorrect, with underreporting being more prevalent than overreporting [27]. Comparable to our findings, others have also reported that men and those with a high BMI (≥25) were more likely to underreport than women and normal weight participants [27,31,45], a result that may to some degree be explained by the higher proportion of men (58%) than women (33%) in the high BMI category (≥25).…”

“…This is consistent with the results from a recent systematic review of more than 50 studies from 25 countries (n = 174,000), concluding that self-perceived BMI group is often incorrect, with underreporting being more prevalent than overreporting [27]. Comparable to our findings, others have also reported that men and those with a high BMI (≥25) were more likely to underreport than women and normal weight participants [27,31,45], a result that may to some degree be explained by the higher proportion of men (58%) than women (33%) in the high BMI category (≥25). Nevertheless, maintaining or reaching a healthy body weight is important for disease prevention and overall health [3].…”

“…Especially, a large proportion of men did not recognize their own overweight, and among both sexes, only one in three properly classified themselves as obese. Others have also reported that study participants misclassified perceived weight group compared to measured BMI [27][28][29][30].…”