We found a notable difference in weight perception between blacks and whites, particularly among black women. Despite being more often obese, black women were less likely to describe themselves as obese compared with white women. When taking into account fat distribution by utilizing WC as a measure of visceral adiposity, the observed difference in obesity underestimation between black and white women decreased but remained significant. Differences in weight underestimation were not due to underestimating weight measurement, since there were no differences in weight underestimation when BMI calculated from self-reported height and weight was considered. Therefore, racial differences in weight underestimation appear to be due to differences in weight perception, presumably secondary to cultural differences or a knowledge gap in interpreting what constitutes excess body weight and body weight satisfaction, thereby making an individual's culture a potential risk factor for obesity.
Racial differences in body weight perception have been previously examined, but have limitations. In a large sample of individuals, Johnson et al.25
assessed ethnic differences in self-reported and measured obesity and found that self-reported height and weight foreshadow underestimation of obesity prevalence. They also found the overestimation of height and the underestimation of weight and BMI occurred more in black women than white women. This study, however, did not compare self-described weight; that is, how one perceives his or her weight. Our study found no significant differences between self-reported and measured height and weight in both blacks and whites, while there was a substantial difference in the perception of overweight and obesity. Paeratakul et al.12
conducted a study on self-perception of weight and found that misperception of weight was higher among blacks compared with whites of the same weight. They also found weight misperception to be higher among men than women. This study only utilized self-reported measurements of body weight and height though. In a study conducted by Dorsey et al.26
based on NHANES, minorities and persons with lower educational levels were more likely to have a weight misperception. This study, however, did not take into account the presence or absence of cardiovascular risk factors other than diabetes, which may differ by race and may affect weight perception. In addition, it did not take into account other measures of obesity such as WC, which may influence weight perception and is associated with cardiovascular risk independent of BMI.27,28
The continued increase in prevalence of overweight and obesity, largely preventable conditions, in the United States is detrimental to the population and the health-care system because it is associated with substantial morbidity and mortality and health-care costs. The prevalence of diabetes mellitus is 2% among normal weight, 5% among overweight, and 10%–12% among obese individuals; the prevalence of hypertension is also dramatically higher among overweight and obese people than among normal weight people.9
It is known that higher rates of overweight and obesity exist in blacks compared with whites. An inaccurate perception of weight may be a significant barrier in initiating a change in lifestyle. Our data suggest that cultural differences in the perception of body weight could play an important role in the larger prevalence of overweight and obesity among blacks, particularly among black women. That there are cultural differences in weight perception related to race and ethnicity is suggested by a study of differences in self-perceived versus ideal body size in whites and blacks. Although blacks had higher prevalence of obesity compared with whites, researchers found that blacks had a smaller discrepancy between perceived and ideal body size, suggesting that blacks were more comfortable with their weight. Black participants tended to select larger ideal figures than white participants.29
In addition, cultural values in the black community place more weight on self acceptance and character over physical appearance.30,31
The findings of this study should be considered within the context of potential limitations. Health literacy was not measured in this study, which may contribute to race-related differences in weight perception. The use of a single item for weight perception may fail to reliably capture this psychological construct. However, this single item has been utilized in similar studies to assess weight perception.26,32
The modification of the NHANES questionnaire item on weight perception to include obesity could potentially affect its validity. However, this modification allowed for a more comprehensive analysis of weight perception in comparison with actual weight. Another limitation is that the sample was drawn from one metropolitan area, Atlanta, where the prevalence of overweight and obesity is higher than other geographic locations. However, populations with a high burden of obesity are those that could potentially benefit most from intervention. In addition, due to the high representation of blacks and their distribution across all socioeconomic classes, Atlanta is an ideal setting for the study of racial differences in risk factors and behaviors.
A multi-faceted community-based approach focusing on social and environmental factors and their effect on obesity in predominantly black communities may help elucidate etiologies for weight misperception and provide potential avenues for intervention. One facet is determining the important factors that contribute to change in cultural concepts of ideal weight in blacks. Yet another facet is evaluating any disparities between commonly held beliefs and evidence-based observations on the effects of excess weight. Although multiple studies have shown that minority neighborhoods have decreased access to healthy food choices, there are few longitudinal studies evaluating the effects of healthy food availability on weight in minority communities. Furthermore, there are few intervention studies addressing access and availability of healthy food choices and their effects on weight in minority communities.33–35
Adequately funded and evidence-based changes in policy and social infrastructure that promotes health education and a healthy lifestyle will likely have a significant impact not only on weight misperception but the prevalence of excess weight in this population.
In conclusion, our data reveal a significant misperception of weight among blacks, particularly black women, who have the highest burden of obesity. A comprehensive approach with efficient identification of social, cultural, and environmental factors that give rise to obesity tolerance in blacks may provide potential targets for intervention to ameliorate weight misperception and the prevalence of excess weight in blacks. Future studies should test the effectiveness of such strategies toward curbing the obesity epidemic among blacks, especially women.