Moderation of weight misperception on the associations between obesity indices and cardiovascular disease risk

PurposeTo evaluate whether weight misperception is associated with estimated cardiovascular disease (CVD) risk and whether gender moderates the association between obesity indices and CVD risk.MethodsIn 7836 men and 10299 women aged 40-79 years without CVD history from the 2014–2018 Korea National Health and Nutrition Examination Survey, the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using Pooled Cohort Equations. Weight misperception was defined as accurate estimation, overestimation, or underestimation by comparing perceived body shape to actual weight category. Obesity indices were BMI and waist circumference (WC).ResultsIn fully-adjusted models, odds of 10-year ASCVD risk of ≥ 7.5% were lower in men with overestimating weight (odd ratio [95% confidence interval], 0.85 [0.73, 0.99] after adjusting for BMI; 0.79 [0.68, 0.92] after adjusting for WC), but higher in women with underestimating weight (1.44 [1.27, 1.63] after adjusting for BMI; 1.42 [1.26, 1.61] after adjusting for WC) compared to those with accurate weight estimates. Compared to women with accurate weight estimates, the ASCVD risk associated with obesity indices was higher in those who underestimated weight (ß [95% CI], 0.33 [0.23, 0.43] for BMI; 0.16 [0.13, 0.20] for WC), whereas it was lower in those who overestimated weight (-0.15 [-0.28, -0.02] for BMI; -0.07 [-0.11, -0.03] for WC). In men, weight misperception did not moderate the association between obesity indices and the ASCVD risk.ConclusionWeight misperception was associated with CVD risk independently across gender and moderates the association between obesity indices and CVD risk in women.

Association between body weight misperception and dietary patterns in Brazilian adolescents: Cross-sectional study using ERICA data

The association between body image and eating behaviors or weight control strategies has been demonstrated in the scientific literature, but there is a lack of evidence on the association between weight misperception and food consumption indicators in adolescents. This study aimed to evaluate the association between weight misperception and dietary patterns (DPs) in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). It was a national school-based cross-sectional study conducted among students aged 12–17 years. Data were collected in the form of anthropometric measurements, responses in self-answered questionnaires, and 24-h dietary recall. The following variables were assessed: weight underestimation and overestimation (independent variables), which were defined as the presence of a disagreement between nutritional status and self-perceived weight; dietary patterns (dependent variables), defined by a posteriori method using principal component factor analysis; and individual and demographic variables (covariates). Data analysis was performed using the Poisson regression models method, stratified by sex. A total of 52,038 adolescents with normal weights were evaluated. The weight misperception prevalence was 34.0% (95% confidence interval [CI]: 33.0, 35.0). Three DPs were identified: “Traditional Brazilian,” “Processed meat sandwiches and coffee,” and “Ultra-processed and sweet foods.” In girls, weight underestimation was directly associated with the “Traditional Brazilian” (1.24; 95% CI: 1.08, 1.43) and “Ultra-processed and sweet foods” DPs (1.29; 95% CI: 1.09, 1.54), and overestimation was inversely associated with all the DPs. In boys, a direct association between underestimation and the “Ultra-processed and sweet foods” DP (1.29; 95% CI: 1.10, 1.51) was found. Overestimation was inversely associated with the “Traditional Brazilian” DP (0.79; 95% CI: 0.63, 0.99). The inverse association between overestimation and the “Traditional Brazilian” DP, and the direct association between underestimation and the “Ultra-processed and sweet foods” DP indicated that weight misperception was related to unhealthy eating habits in Brazilian adolescents.

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

<b><i>Introduction:</i></b> Obesity affects more than one-quarter of adults in Saudi Arabia and is on the rise. A significant proportion of overweight and obese individuals misperceive their weight, and this misperception can affect their likelihood to exercise, consume healthy foods, or change unhealthy dietary habits. This study examines the prevalence of weight misperceptions in a national sample of Saudi adults and explores weight misperception association with sociodemographic factors, behavioral factors, and health status. <b><i>Methods:</i></b> This study was a nationwide cross-sectional survey conducted via phone interviews. A proportional quota sampling technique was used to obtain equal distributions of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. Weight and height were self-reported, and obesity was determined as a BMI ≥30. Participants were asked to describe their current weight as ideal, underweight, overweight, or obese. Misclassification was then compared across groups according to a range of sociodemographic factors, behavioral risk factors, and health indicators. <b><i>Results:</i></b> Of the 6,239 participants contacted, 4,709 (75.5%) responded and completed the interview. Of them, 50.1% were female, and the mean age was 36.4 (SD ± 13.55) years. The majority (70.1%) of participants indicated having weighed themselves within the past 30 days. The prevalence of weight misperception in general was 42.0%, and in obese participants, it was 67.6%. In addition, a significant association was observed between weight misperception and obesity, age-group, educational level, diagnosed chronic condition, self-rated health, and sedentary lifestyle. There was no significant association between weight misperception and gender, physical activity, or a nutritional knowledge. <b><i>Conclusions:</i></b> Weight misperception could be used as an indicator of a poor health routine that may lead to negative health outcomes.

Weight Misperception among African American Adolescents: The Jackson Heart KIDS Pilot Study

Background: Weight misperception is a common problem among adolescents; how­ever, few studies have examined contribut­ing factors among an exclusively African American population. The purpose of this study was to examine factors associated with weight misperception among 12- to 19-year-old participants in the Jackson Heart KIDS Pilot Study (JHS-KIDS).Methods: Data were drawn from JHS-KIDS, a prospective, observational examination of cardiovascular-related risk factors among African American adolescents who were children or grandchildren of participants in the Jackson Heart Study. Adolescent weight misperception – discordance between mea­sured weight status and perceived weight status – was the primary outcome of inter­est. Self-reported weight control behaviors, parent concerns about adolescents’ weight, parent-perceived responsibility for adoles­cent’s weight and daily hassles were the primary independent variables of interest.Results: The analytic sample was equally divided by females (n=107) and males (n=105) and one third of study partici­pants (33.5%) had discordance between their actual and perceived weight. Results from fully adjusted sex-stratified modified Poisson regression models indicated that weight behavior control was significant among females (PR = .66, 95%CI:1.20- 2.30). Parental concerns about child weight were significant for males. Each additional point increase in the parent’s concern about their weight score was associated with a 9% increase in the adjusted prevalence of weight misperception among males (95%CI: 1.03-1.16).Conclusions: The sex-specific patterns in this study highlight heterogeneity among African American adolescents and an urgent need to consider sex and gender when developing targeted interventions for youth who are at high risk for weight misper­ceptions and unhealthy weight control practices. Ethn Dis. 2021;31(3):461-468; doi:10.18865/ed.31.3.461

Ethnicity, migration, and weight misperception: a Born in Bradford study

Background: Weight perception may differ by ethnicity but is not well-understood, particularly among migrants to the United Kingdom (UK). It is also unknown whether a figure rating scale (FRS) or perceived weight question (PWQ) is more accurate for assessing body weight perception. Methods: At 24-months postpartum, women in the Born in Bradford cohort (Bradford, UK) completed the 9-item Stunkard FRS and a 7-category PWQ. Both scales were condensed to weight categories representing the World Health Organisation cut-offs. Weighted kappa statistics assessed agreement between measured and perceived weight categories. Chi-squared and Fisher's exact tests assessed categories of misperception by ethnicity and migration and logistic regression was used to examine odds of underestimation. Results: Thirty percent of white British and 23% of Pakistani-origin women had obesity. Agreement between measured and perceived weight categories were similar for white British women using either a visual scale or weight question (FRS: Kappa; [95%CI]: 0.61 [0.56, 0.65]; PWQ: 0.61 [0.55, 0.68)]. Overall agreement was lower for Pakistani-origin women with the visual scale performing better (FRS (0.58 [0.52, 0.63]) vs PWQ (0.47 [0.40, 0.54]). Pakistani-origin women, particularly those born outside the UK, were more likely to underestimate their body weight compared to white British women; this was greater with the PWQ (18% vs 10%; p<0.001) than FRS (14% vs 6%; p<0.001). Pakistani-origin women were 154% more likely to underestimate their body weight compared to white British women with the FRS and 111% more likely to underestimate when using the PWQ. Conclusion: We observed ethnic differences in weight misperception with Pakistani-origin women more likely to underestimate their weight compared to white British women. Our findings suggest visual scales, rather than perceived weight questions, are more appropriate for the self-assessment of body weight.

Weight self-perception in adolescents: evidence from a population-based study

ABSTRACT OBJECTIVE: Evaluate weight misperception among adolescents and determine associations between self-perceived weight and sociodemographic characteristics, BMI, screen time, self-rated food quantity and diet quality, weekly frequency of breakfast and the consumption of healthy and unhealthy foods. DESIGN: A cross-sectional, two-stage, probabilistic population-based study was conducted in Campinas, Brazil. Multinomial logistic regressions were run to estimate weight self-perception. SETTING: Data from the Campinas Health Survey (ISACamp) and Campinas Food Consumption Survey (ISACamp-Nutri). PARTICIPANTS: A total of 911 adolescents aged 10–19 years. RESULTS: Nearly half (47.7%) of the adolescents with overweight/obesity did not evaluate their weight properly. Weight self-perception as thin and excess weight were associated with the female gender, overweight/obesity, self-rated diet quality as poor/very poor, and eating snacks ≥3 times/week. Adolescents who did not consume breakfast daily were less likely to perceive themselves as thin. Adolescents who ate excessively were more likely and those who consumed cookies/crackers ≥3 times/week were less likely to perceive themselves as having excess weight. CONCLUSIONS: Greater weight misperception was found in overweight/obese adolescents. Gender, BMI, self-rated food quantity/diet quality, weekly frequency of breakfast and some unhealthy foods were associated with self-perceived weight. The present findings could contribute to health promotion strategies targeting adolescents.