In 2001, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity
was issued in response to the increasing population prevalence of overweight and obesity and the resulting public health threat [1
]. At the time of this report, the prevalence of overweight (BMI 25 kg/m2
– 29.9 kg/m2
) and obesity (BMI ≥ 30 kg/m2
) among adults was 34% and 30.5%, respectively, based on data from the National Health and Nutrition Examination Survey (NHANES) 1999–2000 [2
] which reflected an increase from the 32% who were overweight and 22.5% who were obese during the NHANES III survey period (1988–1994) [3
]. See Figure . The most recent overweight/obesity prevalence data from NHANES in 2003–2004 found that 34% of all adults ≥ 20 years of age were overweight and 32% were obese [2
]. Clearly we are moving in the wrong direction. Though a number of different factors have been attributed to this occurrence, including fewer opportunities to be physically active and increased accessibility of food [1
]; this study attempts to explore the potential contribution of alterations in self-perception of weight. For the purposes of this study, distorted weight perception occurs when one perceives his/her weight to be in a different category (underweight, overweight, just right) than would be determined when making a comparison to the NIH Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults – The Evidence Report [4
Comparisons of BMI categories between NHANES III (1988–1994) and NHANES 1999–2004, adults ages 20+. (light gray) – NHANES III (1988–1994). (black) – NHANES 1999–2004.
Distorted weight perception is not a new phenomenon and is actually very well documented [5
]. Studies in this area have consistently found that women (regardless of weight status category) are more likely to perceive themselves as overweight when compared to overweight men. Emslie et al found that among British bank and university workers, overweight women were more likely to perceive themselves as overweight than men [15
]. This is also clearly illustrated in a study by Inoue et colleagues where they compared the agreement between measured BMI and perceived weight status. They found that 55.3% of normal weight women perceived themselves as overweight [16
Caucasians are more likely to perceive themselves as overweight when compared to African Americans and Mexican Americans. Overweight people of higher socioeconomic status (SES) are more likely to perceive themselves overweight when compared to those of lower SES. Individuals with BMIs greater than 30 are more likely to perceive themselves overweight when compared to those with BMIs between 25.0–29.9 kg/m2
]. This observation appears to hold true across all races and genders.
The overweight public's failure to accurately recognize their own overweight status prior to becoming obese may prevent them from changing behaviors that might contribute to additional weight gain. Therefore, it is important to understand the magnitude of weight status distortion within persons with BMI scores within the overweight range.
The intent of the present study was to determine if there is a trend for more individuals observed in the "overweight" BMI range to perceive themselves to be of "normal" or healthy weight by comparing NHANES (1999–2004) to NHANES III (1988–1994). This study also assessed whether income, race and gender moderated this effect.