Comparison between measured and perceived weight status in a nationally representative sample of Australian adults

https://doi.org/10.1016/j.orcp.2016.12.009Get rights and content

Summary

Background

Many individuals may not accurately perceive whether their weight status poses a health risk. This paper aimed to determine how accurately Australians perceived their weight status compared to objective measurements, and to determine what factors were associated with underestimating weight status.

Methods

Participants were 7947 non-pregnant adults from the 2011 to 2012 Australian National Nutrition and Physical Activity Survey, with complete data for self-reported and measured weight status. Multivariate logistic regression was used to examine associations between individual characteristics and accuracy of perceived weight status.

Results

Overall, 25.5% of the sample underestimated and 3.8% overestimated their weight status. Men were almost twice as likely as women to underestimate (34.0% vs 17.7%, p < 0.001). In both sexes, underestimating weight status was strongly associated with higher waist circumference, satisfaction with weight and older age. In men, underestimation was associated with low education levels and being on a diet, and in women, underestimating weight status was associated with being born overseas and area-level disadvantage.

Conclusions

At least a quarter of the adult population misperceives their weight status as healthy when in fact they are at increased risk of morbidity and mortality due to overweight and obesity. This may present a major barrier to prevention efforts.

Introduction

High rates of obesity worldwide highlight the need for increased awareness of the health implications of carrying excess weight, as well as the necessity of effective preventative actions both in Australia and globally [1]. Obesity is a major risk factor for multiple chronic health conditions including cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers [2]. In 2011–12, a total of 62.8% of Australian adults were overweight or obese, a substantial increase since 1995, when 56.3% of the Australian adult population were overweight or obese [3]. The annual cost of overweight and obesity to the Australian economy was estimated to be $56.6 billion in 2005 [4], and this cost is expected to grow, as prevalence continues to increase.

In general, prevalence of obesity is higher among males, lower socio-economic status (SES) groups, culturally diverse populations and people living in regional areas, placing these populations at increased risk of adverse health outcomes [3]. An erroneous perception (underestimation) of personal weight status has been shown to be associated with weight gain and reduced motivation and actions to prevent weight gain [5], [6], [7], [8]. An Australian study found that people who perceived their weight status to be underweight or normal weight at baseline gained more weight over the five-year study period than those who perceived themselves as very overweight at baseline [5].

Across the whole population, evidence suggests that underestimating weight status is more common than overestimating weight status [9]. Among adults, the evidence suggests that males are more likely to underestimate their weight status and females are more likely to overestimate their weight status [8]. There is less consistent evidence of a pattern between accuracy of weight status perceptions and socio-economic characteristics [8], [9]. Among children, there is evidence that parents of children with overweight and obesity commonly misclassify their children as healthy weight [10].

Perceptions of weight status may be influenced by a number of societal and cultural factors, including ideas of both “ideal” and “normative” weight status [8], [11], [12], [13]. With substantial increases in the prevalence of overweight and obesity over time, the majority of Australian adults are now overweight or obese [14], potentially contributing to a perception that being overweight is ‘normal’. The inverse of this may also contribute to misperceptions, particularly among females who, due to media portrayals of a very thin idealised body size, may believe they are overweight when in fact they are not [8], [15].

Several prevention efforts have attempted to address weight perception as a key trigger for self-management of weight status. For example, in Australia, the Live Lighter campaign aims to encourage Australian adults to lead healthier lifestyles and advocates for healthier environments to promote physical activity and healthy eating [16]. Initiated in 2012 in Western Australia and extended to Victoria and the Australian Capital Territory in 2014, the program included a mass media campaign using graphic and confronting images of abdominal fat to encourage Australians to prioritise healthy weight. Federally the 2013 Shape Up Australia campaign by the Australian Government’s National Partnership Agreement on Preventative Health aimed to improve health and wellbeing and increase awareness of a healthy body shape and weight [17]. Previous interventions like the Measure Up campaign [18] also aimed to raise awareness about the relationship between chronic disease and the risks of obesity, by promoting healthy waist circumferences, physical activity and healthy eating.

Changes in health behaviours are more likely to be successful when the individual recognises there is a problem [19]. Some studies have argued that self-awareness of a person’s weight may provide motivation to maintain a healthy weight [8]. Therefore a false perception of one’s weight may reduce motivation to engage in weight maintenance or reduction practices [8]. Importantly these differences may also be patterned by gender, social status and other factors, meaning interventions promoting healthy weight need to understand the differences between population segments to ensure accurate targeting of messages. In Australia, there is little known about how accurately the population perceive their weight status. This study set out to answer the following research questions;

  • 1.

    What proportion of Australians accurately perceived their weight status compared to objective measures and what proportion under- or overestimated their weight status?

  • 2.

    What individual characteristics are associated with underestimation of weight status?

Section snippets

Dataset

This study used data from the National Nutrition and Physical Activity Survey (NNPAS) 2011–12 for adults (18 years and over) who were not pregnant at the time of the survey. The NNPAS was a component of the Australian Health Survey (AHS) conducted by the Australian Bureau of Statistics (ABS), which surveyed a nationally representative sample of Australians, between May 2011 and June 2012. The AHS had three components: the National Health Survey (NHS), the National Health Measures Survey (NHMS)

Results

Table 1 shows the demographic and weight status profile of participants in the sample. The NNPAS included a total of 9318 Australian adults over the age of 18 who were not pregnant at the time of the survey. Over half of the sample was female (53.5%) and the average age was 49 years (SD 17.6). Almost two-thirds of the participants sampled lived in major cities (64.2%), significantly more females (20.2%) lived in inner regional areas compared to males (18.4%) (p < 0.05). Most participants were

Discussion

This study found that the majority of the Australian population accurately perceived their weight status. However, almost a third of the population have a misperception of their true weight status, whether they under- or overestimated their weight status. There were fewer Australians who overestimated their weight than those who underestimated their weight. Approximately 25% of the population underestimated their weight status; most of these were individuals with overweight or obesity who

Conclusion

Almost three-quarters of Australian adults had an accurate perception of their weight status. However, there are some individuals with overweight and obesity, particularly men, who considered their weight status to be within a normal, acceptable range. At least one in five Australian adults misperceive their weight status as healthy, when in fact many of these individuals are at serious risk of the increased morbidity and mortality associated with elevated weight status. Despite substantial

Funding

JH, KP, LA and MN were supported by funding from the National Heart Foundation of Australia and Deakin University for HeartStats: The Australian Heart Disease Statistics Project. MN is supported by an Alfred Deakin Postdoctoral Research Fellowship. SA is supported by funding from an Australian National Health and Medical Research Council/National Heart Foundation of Australia Career Development Fellowship (APP1045836). He is also a researcher on the US National Institutes of Health grant

Disclosure

All authors declare that they have no competing financial interests in relation to the work described.

Acknowledgements

The Authors wish to thank the National Heart Foundation of Australia and Deakin University for funding this work and the Australian Bureau of Statistics who provided the data.

References (26)

  • J. Siu et al.

    Perceived weight status may contribute to education inequalities in five-year weight change among mid-aged women

    Aust N Z J Public Health

    (2011)
  • K. Giskes et al.

    Do Australians perceive their weight status differentially and accurately? Implications for health promotion

    Aust N Z J Public Health

    (2008)
  • World Health Organization

    Obesity: preventing and managing the global epidemic

    WHO technical report series 894

    (2000)
  • World Health Organization

    Obesity and overweight

    (2015)
  • Australian Bureau of Statistics

    4338.0—Profiles of Health, Australia, 2011–13

    (2013)
  • S. Colagiuri et al.

    The cost of overweight and obesity in Australia

    Med J Aust

    (2010)
  • S.S. Mehta-Lee et al.

    Perception of weight status and its impact on gestational weight gain in an urban population

    Matern Child Health J

    (2013)
  • S.J. Herring et al.

    Misperceived pre-pregnancy body weight status predicts excessive gestational weight gain: findings from a US cohort study

    BMC Pregnancy Childbirth

    (2008)
  • J. Brug et al.

    Underestimation and overestimation of personal weight status: associations with socio-demographic characteristics and weight maintenance intentions

    J Hum Nutr Diet

    (2006)
  • S.E. Jackson et al.

    Weight perceptions in a population sample of English adolescents: cause for celebration or concern?

    Int J Obes

    (2015)
  • R.A. Abbott et al.

    Accuracy of weight status perception in contemporary Australian children and adolescents

    J Paediatr Child Health

    (2010)
  • S. Grabe et al.

    The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies

    Psychol Bull

    (2008)
  • H.-T. Chuang et al.

    Analysis of factors found to affect self-perceived weight status in Australia

    J Nurs Res

    (2010)
  • Cited by (0)

    View full text