The association between misperceptions around weight status and quality of life in adults in Australia

Age and gender differences in misperceptions of body shape in a Taiwanese population

OBJECTIVES

Most studies of body size perception have been performed in adolescents, and most focus on gender differences in accurate perception of body size. This study investigated misperceptions of body sizes among males and females at different stages of adulthood in Taiwan.

DESIGNS

In-person home interviews were used to proportionally and randomly select 2095 adult men and women to answer the East Asian Social Survey. Participants were divided into 18-39, 40-64, and 65 + age groups. The main variables analyzed were self-perceived body size and standardized BMI.

RESULTS

Women, unlike men, were more likely to misperceive their body size as being overweight (OR = 2.92; p < .001). People with higher self-perceived social status were less likely to misperceive themselves as overweight (OR = 0.91; p = .01). People with college educations were 2.35 times more likely to overestimate their body size as being heavier than they were (p < .001) and less likely to underestimate it as being thinner than they were (OR = 0.45; p < .001). Women 18-35 and 36-64 years old were 6.96 and 4.31 times more likely (p < .001) to misperceive themselves as being overweight than women 65 or older, who were more likely to misperceive themselves as being too thin. There were no significant differences in body size misperceptions among the three age groups of adult men (p > .05). We found no different significant discrepancies between self-perceived body size and actual BMI between the older men and women (p = .16). However, younger and middle-aged men were 6.67 and 3.1 times more likely to misperceive themselves as being too thin than women in their same age groups (OR = 0.15 and OR = 0.32, respectively).

CONCLUSIONS

Age and gender affect self-perceptions of body size in Taiwan. Overall, women are more likely than men to misperceive themselves as being too big, and men are more likely than women to misperceive themselves as too thin. Older women, however, were more likely to misperceive themselves as being too thin. Clinicians and health educators should know that people's perceptions and concerns regarding their body size vary by age and gender.

Weight perception and self-rated health: are there differences between cancer survivors and non-cancer survivors?

PURPOSE

To compare relationships between self-perceived weight and self-rated health (SRH) between cancer survivors and non-cancer survivors.

METHODS

A cross-sectional study based on the 2014-2019 Korea National Health and Nutrition Examination Survey was conducted for the associations of self-perceived weight status, measured BMI categories, and combined categories by self-perceived weight and measured BMI with SRH in 1622 cancer survivors and 29,903 non-cancer survivors using complex samples ordinal regression analysis after adjusting for sociodemographic factors, health behaviors, and concurrent diseases.

RESULTS

Compared to the comparison group (those who were normal weight and self-perceived as average weight in non-cancer survivors), adjusted odds for poorer SRH were higher in cancer survivors and non-cancer survivors who were underweight and self-perceived as underweight (adjusted odds ratios[aORs], 2.69 for non-cancer survivors; 2.62 for cancer survivors), those who were normal weight but self-perceived as underweight or overweight (aORs, 1.69-2.38 for non-cancer survivors; 2.34-3.78 for cancer survivors), and those who were overweight and self-perceived as overweight (aORs, 1.52 for non-cancer survivors; 2.42 for cancer survivors). In cancer survivors, the odds for poorer SRH were greater for those who were normal weight and self-perceived as average weight (aOR = 1.84), whereas the odds were not significant for those who were underweight or overweight and self-perceived as average weight. In non-cancer survivors who self-perceived as average weight, the odds for poorer SRH were significant in those with underweight (aOR = 1.35) or overweight (aOR = 0.84).

CONCLUSION

According to actual weight status, the association between self-perceived weight and SRH may differ between cancer survivors and non-cancer survivors.

Association between accuracy of weight perception and life satisfaction among adults with and without anxiety and mood disorders: a cross-sectional study of the 2015-2018 Canadian Community Health Survey

BACKGROUND

Weight status and weight perception have a significant impact on life satisfaction. As overweight prevalence increases in Canada, it is important to understand how accuracy of weight perception (AWP) is associated with life satisfaction. This study explored the association between AWP and life satisfaction among Canadian adults with and without anxiety and/or mood disorders.

METHODS

Using data from the 2015-2018 cycles of the Canadian Community Health Survey, an indicator of AWP was created to capture concordance between perceived weight and actual weight status. Univariate and multivariate Gaussian generalized linear models were assessed while stratifying by sex and presence of anxiety and/or mood disorders.

RESULTS

Our sample included 88 814 males and 106 717 females. For both sexes, perceiving oneself as overweight or underweight, regardless of actual weight status, was associated with lower life satisfaction (β = -0.93 to -0.30), compared to those who accurately perceived their weight as 'just about right'. Perceiving oneself as overweight or underweight was associated with more pronounced differences in life satisfaction scores in those with anxiety and/or mood disorders (β = -1.49 to -0.26) than in those without these disorders (β = -0.76 to -0.25).

CONCLUSION

Weight perception is more indicative of life satisfaction than actual weight status, especially in those with anxiety and/or mood disorders.

The Accuracy of Self-Perception of Obesity in a Rural Australian Population: A Cross-Sectional Study

Introduction:

Obesity is a major public health concern. Accurate perception of body weight may be critical to the successful adoption of weight loss behavior. The aim of this study was to determine the accuracy of self-perception of BMI class.

Methods:

Patients admitted to the acute medical service in one regional hospital completed a questionnaire and classified their weight as: “underweight,” “normal,” “overweight,” or “obese.” Reponses were compared to clinically measured BMIs, based on the WHO Classification. Patients were also questioned about health-related behavior. Data were analyzed via Pearson’s Chi-squared test.

Results:

Almost 70% of the participating patient population (n = 90) incorrectly perceived their weight category, with 62% underestimating their weight. Only 34% of patients who were overweight and 14% of patients with obesity correctly identified their weight status. Two-thirds of patients who were overweight and one-fifth of patients with obesity considered themselves to be “normal” or “underweight.” Patients with obesity were 6.5-fold more likely to misperceive their weight status. Amongst patients with overweight/obesity, those who misperceived their weight were significantly less likely to have plans to lose weight. Almost 60% had not made any recent health behavior changes. This is one of the first regional Australian studies demonstrating that hospitalized patients significantly misperceive their weight.

Conclusion:

Patients with overweight/obesity had significantly higher rates of weight misperception and the majority had no intention to lose weight or to undertake any health behavior modification. Given the association between weight perception and weight reduction behavior, it introduces barriers to addressing weight loss and reducing the increasing prevalence of obesity in rural Australia. It highlights that doctors have an important role in addressing weight misperception.

Underestimation of Overweight and Health Beneficial Outcomes in Two Adolescent Cohorts in Norway - The HUNT Study

PURPOSE

Underestimating overweight may prevent efforts toward reducing weight, but simultaneously benefit mental health and well-being. The magnitude of underestimation of overweight and obesity in adolescents is largely unknown, and so is to what extent this underestimation is associated with dieting behaviors, mental distress, and life satisfaction. As overweight has become more common during the past decades, associations between body size underestimation and mental health may have changed.

METHODS

Overweight (iso-body mass index, iso-BMI ≥25) adolescents (aged 13-19 years) who participated in The Young-HUNT1 (1995-97, n = 1,338) or The Young-HUNT3 (2006-08, n = 1,833) surveys were included. Being overweight, but perceiving oneself as average-weighted or underweighted was defined as underestimation. Results were based on clinical examinations and self-report questionnaires. Multivariable logistic regression models were used to examine associations between body size underestimation, dieting behaviors, and symptoms of anxiety, depression, and life satisfaction.

RESULTS

Among adolescents with overweight and obesity (iso-BMI ≥25), the prevalence of obesity (iso-BMI ≥30), body size underestimation, and having symptoms of anxiety and depression had increased from the first survey to the next. At both time points, body size underestimation was more common among boys than girls. In 2006-08, body size underestimation was negatively associated with symptoms of anxiety and depression in both sexes, and overall associated with higher life satisfaction equally over time. Dieting behavior was negatively associated with underestimation of body size.

CONCLUSIONS

Body size underestimation in adolescents with overweight/obesity has become more prevalent and a phenomenon associated with less dieting, better life satisfaction and mental health in both boys and girls.

Utility Decrements Associated with Adult Overweight and Obesity in Australia: A Systematic Review and Meta-Analysis

OBJECTIVE

The aim was to conduct a systematic review and meta-analysis of health state utility decrements associated with overweight and obesity in adults 18 years and over, for use in modelled economic evaluations in Australia.

METHODS

A systematic review was conducted in nine databases to identify studies that reported health state utility values by weight status. Random-effects meta-analysis was used to synthesise average utility decrements (from healthy weight) associated with overweight, all obesity and obesity classes 1, 2 and 3. Heterogeneity surrounding utility decrements was assessed via sub-group analysis, random-effects meta-regression and sensitivity analyses.

RESULTS

Twelve studies were found for which data were used to synthesise utility decrements, estimated as overweight = 0.020 (95% confidence interval 0.010-0.030), all obesity = 0.055 (0.034-0.076), obesity class 1 = 0.047 (0.017-0.077), class 2 = 0.072 (0.028-0.116) and class 3 = 0.084 (0.039-0.130). There was considerable heterogeneity in our results, which could be accounted for by the different ages and utility instruments used in the contributing studies.

CONCLUSIONS

Our results demonstrate that elevated weight status is associated with small but statistically significant reductions in utility compared with healthy weight, which will result in reduced quality-adjusted life years when extrapolated across time and used in economic evaluations.

Orthopaedic patients underestimate their body weight too: a cross-sectional study

INTRODUCTION

The relation between a large body mass and comorbidity, certain types of cancers and musculoskeletal disorders has been extensively documented. However, a high proportion of overweight patients appears unaware of the medical risks of their condition and frequently underestimates their body weight. This observation is prevalent across numerous medical specialties and settings.

METHODS

This study analysed the misperception of obesity status in a cohort of 1137 patients attending an orthopaedic clinic by means of self-completed questionnaires and objective biometrics.

RESULTS

Patients displayed a poor estimation of the self-body mass index (34.6%), especially among larger individuals, with 45.15% of pre-obese and 21.17% of obese patients previously attempting weight-loss. A direct association between low educational achievement and obesity rates was observed in orthopaedic patients.

DISCUSSION

Obesity is a well-known contributor to many conditions, including musculoskeletal diseases. Despite this association, many obese patients consider their body mass as normal. Misperception of self-body weight has been documented in many medical specialities, and this study confirms the same scenario in orthopaedic patients.

CONCLUSION

The association between self-image distortion and obesity observed in this study may assist in the evaluation and management of obesity cases in orthopaedic clinics.

Bodyweight Misperception by Chinese American Females Influenced by Cultural and Social Ideals: Implication for Home Health Care

Bodyweight misperception results from the desire to achieve an ideal body emphasized by cultural mores and societal norms. It is sustained by the desire to be cultural compliant, especially for ethnic minority women such as Chinese American females. Through cultural beliefs, these women’s self-perceived weight status is distorted, which strengthens the impact of bodyweight misperception in their daily life as poor physical health, distressed psychosocial health, risky and unsafe health practices and behaviors, and diminished quality of life. Evidently, bodyweight misperception promotes maladaptive health behaviors. However, bodyweight misperception is barely captured in the current science about women’s health, and is minimally explored in research about Chinese American females’ desire and efforts to achieve the ideal body type. Therefore, the purpose of this literature review was to explore (1) body weight perception, (2) the factors associated with it, and (3) the negative health consequences triggered by it, in Chinese American females. Studies confirm that Chinese American females shape their body weight perception by internalized cultural ideals, acculturative stress, mass media, and social pressures. They overestimate their body weight more than underestimate it as evident by frequent weight-loss attempts. This internalized bodyweight misperception affects their physical and psychological health, with undesirable consequences on their quality of life. Home health care professionals interact closely with patients from diverse cultural backgrounds; remaining culturally sensitive is crucial in their practice. Knowledge from this literature review emphasizes the need for culturally appropriate weight management strategies for the delivery of competent home health care to Chinese American females.

Weight underestimation linked to anxiety and depression in a cross-sectional study of overweight individuals in a Sami and non-Sami Norwegian population: the SAMINOR Study

OBJECTIVES

Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations.

DESIGN

Population-based cross-sectional study.

SETTING

The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014.

PARTICIPANTS

The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m²) whereof 1384 underestimated their weight (42%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status.

RESULTS

A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status.

CONCLUSIONS

Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women.

Unintentional weight loss, its associated burden, and perceived weight status in people with cancer

Purpose

Unintentional weight loss (UWL) is a prevalent problem in people with cancer and is associated with poorer psychosocial outcomes. A gap exists in understanding whether and how perceived and/or weight status impacts experiences of UWL. Thus, we sought to examine subjective experiences of UWL in people with cancer, and whether perceived and/or actual weight status impacts these experiences.

Methods

Participants were recruited through Cancer Support Community’s Cancer Experience Registry® and related networks. Participants completed an online survey that included the FAACT Anorexia-Cachexia subscale, and 19 items that captured six themes related to “beliefs and concerns” (positive beliefs, psychosocial impact, physical impact, cancer outcomes, self-esteem, relationships with others). Perceived weight status (PWS) was assessed using a single item. Body mass index (BMI) was calculated using self-reported weight and height measurements.

Results

Of 326 respondents, 114 reported experiencing UWL. Over one-third misperceived their weight, with 29% perceiving weight status as below their BMI status. UWL in those with perceived weight status of overweight/obese was associated with positive beliefs. However, being underweight by BMI or perceiving oneself as underweight were both associated with greater concerns about weight loss. Perceived weight status of underweight compared to normal or overweight/obese weight status was associated with poorer psychosocial well-being, personal control, self-esteem, and relationships with others.

Conclusion

In people with cancer, perceived weight status, rather than BMI, had greater impact on negative “beliefs and concerns” about UWL. Findings suggest assessment of both perceived and actual BMI to address the impact of UWL on psychosocial wellbeing.