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1.  Black/White Differences in Perceived Weight and Attractiveness among Overweight Women 
Journal of Obesity  2013;2013:320326.
Numerous studies have reported that Black women are more satisfied with their bodies than White women. The buffering hypothesis suggests that aspects of Black culture protect Black women against media ideals that promote a slender female body type; therefore, Black women are expected to exhibit higher body esteem than White women. To test this hypothesis, the current study aimed to assess the influence of race on weight perception, perceived attractiveness, and the interrelations between body mass index (BMI) and perceived attractiveness among overweight and obese women. Participants were 1,694 respondents of Wave IV of the National Longitudinal Study on Adolescent Health (M = 28.89 years). Black (n = 531) or White (n = 1163) obese or overweight women were included in the current study. As expected, Black women reported lower perceived weight and higher attractiveness than White women, despite higher body mass for Black women. Furthermore, race moderated the relationship between BMI and perceived attractiveness; for White women, a negative relationship existed between BMI and attractiveness, whereas for Black women, BMI and attractiveness were not related. The study findings provide further support for the buffering hypothesis, indicating that despite higher body mass, overweight Black women are less susceptible to thin body ideals than White women.
PMCID: PMC3600308  PMID: 23533721
2.  Low lymphocyte count in underweight Japanese women 
Young women being underweight is a public health problem in Japan. The aim of this study was to investigate this problem by measuring lymphocyte count as an indicator of nutritional status.
The subjects were 114 women aged 20–39 who participated in an annual health checkup for residents in a city in Aichi, Japan. Data from a questionnaire, physical examination, and blood tests were analyzed in relation to women who were severely underweight [body mass index (BMI) ≤ 17.5 kg/m2], slightly underweight (17.5 < BMI < 18.5 kg/m2), of normal weight (18.5 ≤ BMI < 25 kg/m2), and obese (BMI ≥ 25 kg/m2).
Lymphocyte count tended to be lower with a decrease in BMI. The prevalence of low lymphocyte count of <1,500/mm3 increased in underweight women. In women who had restricted food intake for weight loss, leukocyte count, and total serum protein, and lymphocyte count were lower. A multivariate logistic regression analysis showed the association of low lymphocyte count to being severely underweight [odds ratio (OR): 1.95; 95% confidence interval (CI): 1.07–3.56] and to restricted food intake for weight loss (OR: 3.73; 95% CI: 0.91–15.30).
This study suggests that being severely underweight and on restricted food intake for weight loss in adult women can be risk factors for low lymphocyte count, an indicator of malnutrition. It is important for young women to maintain BMI >17.5 kg/m2 and not to restrict food intake when of normal weight or underweight in order to prevent malnutrition.
PMCID: PMC2698227  PMID: 19568895
Underweight; Diet; Lymphocyte; Malnutrition; Women
3.  Mental health impairment in underweight women: do body dissatisfaction and eating-disordered behavior play a role? 
BMC Public Health  2011;11:547.
We sought to evaluate the hypothesis that mental health impairment in underweight women, where this occurs, is due to an association between low body weight and elevated levels of body dissatisfaction and/or eating-disordered behaviour.
Subgroups of underweight and normal-weight women recruited from a large, general population sample were compared on measures of body dissatisfaction, eating-disordered behaviour and mental health.
Underweight women had significantly greater impairment in mental health than normal-weight women, even after controlling for between-group differences in demographic characteristics and physical health. However, there was no evidence that higher levels of body dissatisfaction or eating-disordered behaviour accounted for this difference. Rather, underweight women had significantly lower levels of body dissatisfaction and eating-disordered behaviour than normal-weight women.
The findings suggest that mental health impairment in underweight women, where this occurs, is unlikely to be due to higher levels of body dissatisfaction or eating-disordered behaviour. Rather, lower levels of body dissatisfaction and eating-disordered behaviour among underweight women may counterbalance, to some extent, impairment due to other factors.
PMCID: PMC3160375  PMID: 21740596
Body dissatisfaction; eating-disordered behaviour; mental health; underweight; women
4.  Weight Control Attempts in Underweight Korean Adults: Korea National Health and Nutrition Examination Survey, 2007-2010 
Korean Journal of Family Medicine  2013;34(6):393-402.
Underweight refers to the weight range in which health risk can increase, since the weight is lower than a healthy weight. Negative attitudes towards obesity and socio-cultural preference for thinness could induce even underweight persons to attempt weight control. This study was conducted to investigate factors related to weight control attempts in underweight Korean adults.
This was a cross-sectional study on 690 underweight adults aged 25 to 69 years using data from the Korea National Health and Nutrition Examination Survey, 2007-2010. Body image perception, weight control attempts during the past one year, various health behaviors, history of chronic diseases, and socioeconomic status were surveyed.
Underweight women had a higher rate of weight control attempts than underweight men (25.4% vs. 8.1%, P < 0.001). Among underweight men, subjects with the highest physical activity level (odds ratio [OR], 7.75), subjects with physician-diagnosed history of chronic diseases (OR, 7.70), and subjects with non-manual jobs or other jobs (OR, 6.22; 12.39 with reference to manual workers) had a higher likelihood of weight control attempts. Among underweight women, subjects who did not perceive themselves as thin (OR, 4.71), subjects with the highest household income level (OR, 2.61), and unmarried subjects (OR, 2.08) had a higher likelihood of weight control attempts.
This study shows that numbers of underweight Korean adults have tried to control weight, especially women. Seeing that there are gender differences in factors related to weight control attempts in underweight adults, gender should be considered in helping underweight adults to maintain a healthy weight.
PMCID: PMC3856281  PMID: 24340161
Underweight; Body Image; Body Weight; Weight Reduction; Social Class
5.  Bodyweight, Gender, and Quality of Life: A Population-based Longitudinal Study 
Quality of Life Research  2011;21(5):813-825.
The objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III.
Data come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3864 males and 4745 females who were 40+ in 1998/99 and followed through 2006/07. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used.
HRQL declined with age. For males, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For females being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise for females, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III.
Given that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for males are surprising. The HRQL results for females may reflect both the importance of body image on mental health and the health effects of excess weight.
PMCID: PMC3258331  PMID: 21842378
Body Mass Index; Health-Related Quality of Life; Obesity; Health Utilities Index; Trajectories
6.  Perception of weight and psychological variables in a sample of Spanish adolescents 
This study explored the relationship between body mass index (BMI) and weight perception, self-esteem, positive body image, food beliefs, and mental health status, along with any gender differences in weight perception, in a sample of adolescents in Spain.
The sample comprised 85 students (53 females and 32 males, mean age 17.4 ± 5.5 years) with no psychiatric history who were recruited from a high school in Écija, Seville. Weight and height were recorded for all participants, who were then classified according to whether they perceived themselves as slightly overweight, very overweight, very underweight, slightly underweight, or about the right weight, using the question “How do you think of yourself in terms of weight?”. Finally, a series of questionnaires were administered, including the Irrational Food Beliefs Scale, Body Appreciation Scale, Self Esteem Scale, and General Health Questionnaire.
Overall, 23.5% of participants misperceived their weight. Taking into account only those with a normal BMI (percentile 5–85), there was a significant gender difference with respect to those who perceived themselves as overweight (slightly overweight and very overweight); 13.9% of females and 7.9% of males perceived themselves as overweight (χ2 = 3.957, P < 0.05). There was a significant difference for age, with participants who perceived their weight adequately being of mean age 16.34 ± 3.17 years and those who misperceived their weight being of mean age 18.50 ± 4.02 years (F = 3.112, P < 0.05).
Misperception of overweight seems to be more frequent in female adolescents, and mainly among older ones. Misperception of being overweight is associated with a less positive body image, and the perception of being very underweight is associated with higher scores for general psychopathology.
PMCID: PMC3139532  PMID: 21792323
weight misperception; self-esteem; positive body image; psychological distress; food beliefs
7.  Differences in Weight Perception Among Blacks and Whites 
Journal of Women's Health  2011;20(12):1805-1811.
The prevalence of obesity is higher in blacks than whites, especially in black women, and is known to be associated with major cardiovascular disease risk factors, which are also more prevalent in blacks than whites. Weight perception may contribute to these differences if blacks are more likely to underestimate their weight. We explored race and gender differences in underestimation of weight using body mass index (BMI) and waist circumference (WC), after adjusting for other cardiovascular risk factors.
Methods and Results
We studied 219 white and 240 black women and men as part of the META-Health Study. Perceived weight was assessed over the phone and categorized into three categories: underweight or normal weight, overweight, or obesity. Height, weight, and WC were measured at a subsequent visit, and BMI was calculated. Logistic regression was used to compare the likelihood of underestimating actual weight category by race, before and after adjusting for sociodemographic, lifestyle factors, and medical history. In multivariate analysis, the odds of underestimating BMI category was greater than threefold in blacks compared with whites (OR 3.1, 95% CI 1.9–4.8) and was larger for black women than for black men (p<0.01 for interaction). When abdominal adiposity was taken into account by utilizing WC as a measure of weight, the observed difference in weight underestimation remained.
Our data reveal a significant misperception of weight among blacks, particularly black women, who have the highest burden of obesity. A multifaceted approach with efficient identification of social, cultural, and environmental factors that give rise to obesity tolerance in blacks will provide potential targets for intervention, which may ameliorate weight misperception and the prevalence of excess weight in the black population.
PMCID: PMC3236990  PMID: 21988528
8.  Misperceived pre-pregnancy body weight status predicts excessive gestational weight gain: findings from a US cohort study 
Excessive gestational weight gain promotes poor maternal and child health outcomes. Weight misperception is associated with weight gain in non-pregnant women, but no data exist during pregnancy. The purpose of this study was to examine the association of misperceived pre-pregnancy body weight status with excessive gestational weight gain.
At study enrollment, participants in Project Viva reported weight, height, and perceived body weight status by questionnaire. Our study sample comprised 1537 women who had either normal or overweight/obese pre-pregnancy BMI. We created 2 categories of pre-pregnancy body weight status misperception: normal weight women who identified themselves as overweight ('overassessors') and overweight/obese women who identified themselves as average or underweight ('underassessors'). Women who correctly perceived their body weight status were classified as either normal weight or overweight/obese accurate assessors. We performed multivariable logistic regression to determine the odds of excessive gestational weight gain according to 1990 Institute of Medicine guidelines.
Of the 1029 women with normal pre-pregnancy BMI, 898 (87%) accurately perceived and 131 (13%) overassessed their weight status. 508 women were overweight/obese, of whom 438 (86%) accurately perceived and 70 (14%) underassessed their pre-pregnancy weight status. By the end of pregnancy, 823 women (54%) gained excessively. Compared with normal weight accurate assessors, the adjusted odds of excessive gestational weight gain was 2.0 (95% confidence interval [CI]: 1.3, 3.0) in normal weight overassessors, 2.9 (95% CI: 2.2, 3.9) in overweight/obese accurate assessors, and 7.6 (95% CI: 3.4, 17.0) in overweight/obese underassessors.
Misperceived pre-pregnancy body weight status was associated with excessive gestational weight gain among both normal weight and overweight/obese women, with the greatest likelihood of excessive gain among overweight/obese underassessors. Future interventions should test the potential benefits of correcting misperception to reduce the likelihood of excessive gestational weight gain.
PMCID: PMC2639379  PMID: 19102729
9.  Sociodemographic Characteristics of Underweight Korean Adults: Korea National Health and Nutrition Examination Survey, 2007-2010 
Korean Journal of Family Medicine  2013;34(6):385-392.
Underweight is associated with increased risk of mortality and morbidity. It is reported that the prevalence of underweight is increasing among Korean young women. However, there have been few studies on sociodemographic factors related to being underweight. This study was conducted to elucidate the sociodemographic characteristics of Korean underweight adults.
This study is a cross-sectional study of 7,776 adults aged 25 to 69 years using data from the Korea National Health and Nutrition Examination Survey, 2007-2010. Study subjects were composed of underweight and normal-weight adults excluding overweight adults. Body mass index was calculated from measured height and weight. Health behaviors such as smoking, drinking, and physical activity were surveyed through self-administered questionnaires, and socioeconomic status, marital status, and history of morbidity were surveyed through face-to-face interviews.
Women had a higher frequency of underweight (10.4% vs. 7.0%, P < 0.001) than men. Among men, current smoking (odds ratio [OR], 1.62) and past history of cancer (OR, 2.55) were independently related to underweight. Among women, young age (OR, 2.06), former smoking (OR, 1.69), and being unmarried (OR, 1.56) were identified as independently related factors of underweight. In addition, among both men and women, alcohol drinking (men OR, 0.57; women OR, 0.77) and past history of chronic diseases (men OR, 0.55; women OR, 0.43) were independently related to a lower frequency of underweight.
We showed that various sociodemographic factors were associated with underweight. It was ascertained that there were differences in the sociodemographic factors related to underweight between Korean men and women.
PMCID: PMC3856280  PMID: 24340160
Underweight; Sex; Social Characteristics; Demographic Factors
10.  Nutritional evaluation follow-up of the 1982 birth cohort, Pelotas, Southern Brazil 
Revista de saude publica  2008;42(Suppl 2):60-69.
To estimate the prevalence of over/underweight and its association with demographic and socioeconomic factors.
Longitudinal cohort study of youths born in 1982 in Pelotas, Southern Brazil. In 2004-5 we interviewed 4,198 of the 5,914 cohort subjects, obtaining weight and stature measurements that were used to calculate body mass index (BMI). Underweight was defined as BMI lower than 18,5 kg/m2; overweight as BMI between 25 and 30kg/m2; and obesity as BMI IMC ≥ 30kg/m2. The effects of socioeconomic (family income and schooling) and demographic (skin color) variables, birthweight, and breastfeeding on underweight, overweight, and obesity were analyzed separately for men and women using Poisson regression.
Prevalence of underweight, obesity, and overweight were 6.0%, 8.2%, and 28.9%, respectively. In adjusted analysis, only birthweight remained associated with underweight among men and women. Poor men showed higher risk of underweight, but were protected from obesity and overweight. By contrast, risk of obesity and overweight was higher among poor women.
The present results underscore the importance of socioeconomic determinants on nutritional status, with special emphasis on the distinct effects these factors have among men and women in different nutritional conditions.
PMCID: PMC2671135  PMID: 19142346
Adult; Nutrition Assessment; Obesity, epidemiology; Deficiency Diseases, epidemiology; Socioeconomic Factors; Cohort Studies; Brazil
11.  Physical Activity and Obesity in Canadian Women 
BMC Women's Health  2004;4(Suppl 1):S6.
Health Issue
Overweight and obesity have been recognized as major public health concern in Canada and throughout the world. Lack of physical activity, through its impact on energy balance, has been identified as an important modifiable risk factor for obesity. Physical activity and obesity are also important risk factors for a variety of chronic diseases. This chapter provides an overview of the current state of physical activity and overweight/obesity among Canadian women.
Key Findings
For all ages combined more women (57%) than men (50%) are physically inactive (energy expenditure <1.5 KKD). Physical activity increases as income adequacy and educational level decrease. Physical inactivity also varies by ethnicity. The prevalence of both overweight (BMI 25.0 – 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) Canadian women has increased 7% since 1985. Obesity increases with age and is highest among women reporting low and lower middle incomes and lower levels of education. The prevalence of obesity is highest among Aboriginal women and men (28% and 22% respectively).
Data Gaps and Recommendations
There is currently no surveillance system in Canada to monitor the level of physical activity among children, those performing activity at work, at school or in the home. There is a gap in the knowledge surrounding socio-cultural and ecological determinants of physical activity and obesity and the associations of these to chronic disease among women and minority populations. Multi-sectoral policy interventions that act to decrease the broad systemic barriers to physical activity and healthy weights among all women are needed.
PMCID: PMC2096675  PMID: 15345069
12.  Racial Differences in Perception of Healthy Body Weight in Mid-Life Women: Results from Do Stage Transitions Result in Detectable Effects (STRIDE) Study 
Menopause (New York, N.Y.)  2013;20(3):269-273.
Perception of a healthy body weight may influence health behaviors including physical activity level, nutritional habits, and health outcomes, and these perceptions may vary importantly by race. Midlife is a critical period for women, which typically includes weight gain. We assessed the associations between perception of healthy body weight and body mass index (BMI) and whether they vary by race.
In the Do Stage Transitions Result in Detectable Effects (STRIDE) study, body mass index (BMI) and perception of body weight (healthy, underweight, or overweight) were measured at the baseline examination. Multinomial logistic regression models examined the associations, with race (White vs. Black) as a moderator variable.
Of 729 women enrolled, 689 women (95%, N=145 Black, N=544 White) were included in these analyses. Even though the average BMI was higher for Black women compared to White women (33.1 vs. 29.2, respectively, p<.0001), Black women were less likely to report that they weighed too much (RRR (Relative Risk Ratio) [95% CI]: 0.4 [0.2, 0.9], p 0.022) and more likely to think that they did not weigh enough (RRR [95% CI]: 14.2 [1.8, 110], p 0.011).
Although Black women in general face a greater threat of morbidity from weight-related chronic diseases, they are more likely to be accepting of their weight at higher BMI’s, relative to Whites. Weight-loss interventions and counseling about healthy body size may influence healthy behavior and reduce chronic disease risk.
PMCID: PMC3593962  PMID: 23435023
Midlife; Body Image; Weight-Perception; Race; Health; Behavior
13.  Weight-modification trials in older adults: what should the outcome measure be? 
Overweight older adults are often counseled to lose weight, even though there is little evidence of excess mortality in that age group. Overweight and underweight may be more associated with health status than with mortality, but few clinical trials of any kind have been based on maximizing years of healthy life (YHL), as opposed to years of life (YOL).
This paper examines the relationship of body mass index (BMI) to both YHL and YOL. Results were used to determine whether clinical trials of weight-modification based on improving YHL would be more powerful than studies based on survival.
We used data from a cohort of 4,878 non-smoking men and women aged 65–100 at baseline (mean age 73) and followed 7 years. We estimated mean YHL and YOL in four categories of BMI: underweight, normal, overweight, and obese.
Subjects averaged 6.3 YOL and 4.6 YHL of a possible 7 years. Both measures were higher for women and whites. For men, none of the BMI groups was significantly different from the normal group on either YOL or YHL. For women, the obese had significantly lower YHL (but not YOL) than the normals, and the underweight had significantly lower YOL and YHL. The overweight group was not significantly different from the normal group on either measure.
Clinical trials of weight loss interventions for obese older women would require fewer participants if YHL rather than YOL was the outcome measure. Interventions for obese men or for the merely overweight are not likely to achieve differences in either YOL or YHL. Evaluations of interventions for the underweight (which would presumably address the causes of their low weight) may be conducted efficiently using either outcome measure.
PMCID: PMC134473  PMID: 11985775
Aged; Mortality; QALY; Self-rated health; Active life expectancy; Ideal weight; Body mass index; Elderly
14.  Body image, body satisfaction, and eating patterns in normal-weight and overweight/obese women current smokers and never-smokers 
Addictive behaviors  2007;32(10):2329-2334.
In order to explore differences between women smokers and never-smokers in body image and eating patterns, we analyzed data obtained from 587 women (18−55 years old) recruited to participate in laboratory investigations not focused on weight concerns. The sample consisted of 420 current smokers and 167 never-smokers; 44% of each group were overweight or obese (BMI ≥25). Questionnaires included measures of body image, body dissatisfaction, and restrained and disinhibited eating. Smokers did not differ from never-smokers on perceived body shape but endorsed a thinner preferred body shape and scored lower on body satisfaction than never-smokers. Smokers also scored higher on measures of disinhibited eating. Among smokers, those who were overweight/obese scored higher than normal-weight smokers on concerns about post-cessation weight gain and lower on self-efficacy to avoid relapse if weight increased. Our findings suggest that women smokers may require help in attaining a more realistic body image and attention to dysfunctional eating patterns if they are to achieve and maintain a healthful weight and/or to quit smoking successfully. They also indicate that overweight smokers may be at elevated risk of relapse in the face of post-cessation weight gain.
PMCID: PMC1994054  PMID: 17320305
body image; eating; obesity; overweight; smoking; women
Eating behaviors  2006;8(3):418-422.
We hypothesized that among overweight women smokers, those with childhood onset of weight problems may be more likely to engage in unhealthy eating and dieting behaviors, including smoking to control weight. Data were collapsed from 89 currently overweight (BMI≥25) women smokers who were recruited to participate in smoking research projects that focused on weight, body image, and food intake. We compared those who reported first becoming overweight before Junior High School (n=22) with those who recalled first experiencing weight problems during Junior High School or later (n=67). Women with Childhood Onset weight problems reported first trying cigarettes at a significantly younger age than those with Later Onset (13 vs. 15 years of age, respectively), and they reported more nicotine withdrawal symptoms during smoking abstinence, with a significantly greater likelihood of endorsing anger/irritability and trouble concentrating. No group differences were evident for cigarettes per day or other indicators of nicotine dependence (e.g., FTND). Although it is unclear whether having weight problems during childhood contributes directly to smoking initiation, our results provide evidence that childhood weight problems may serve as a marker for earlier smoking experimentation and may also complicate cessation efforts due to its association with elevated withdrawal symptomatology. Future longitudinal studies with prospective measures of weight, dieting, and smoking initiation may be helpful in establishing causal pathways in different subgroups of smokers.
PMCID: PMC1989728  PMID: 17606240
childhood; weight problems; smoking; nicotine withdrawal; weight concerns; dieting
16.  Weight Misperception, Self-Reported Physical Fitness, Dieting and Some Psychological Variables as Risk Factors for Eating Disorders 
Nutrients  2013;5(11):4486-4502.
The aims of the current study were to explore possible gender differences in weight misperception, self-reported physical fitness, and dieting, and to analyze the relationship between these variables and others, such as self-esteem, body appreciation, general mental health, and eating- and body image-related variables among adolescents. In addition, the specific risk for eating disorders was examined, as well as the possible clusters with respect to the risk status. The sample comprised 655 students, 313 females and 342 males, aged 16.22 ± 4.58. Different scales of perceived overweight, self-reported physical fitness and dieting together with the Body Mass Index (BMI) were considered along with instruments such as the International Physical Activity Questionnaire (IPAQ), General Health Questionnaire (GHQ-28), Self-Esteem Scale (SES), Body Appreciation Scale (BAS) and Eating Disorders Inventory-2 (EDI-2). Since some gender differences were found with respect to these adolescent groups, it is necessary to design prevention programs that not only focus on traditional factors such as BMI or body image, but also on elements like weight perception, self-reported fitness and nutritional education.
PMCID: PMC3847744  PMID: 24232917
weight misperception; self-reported physical fitness; diet; eating disorders; eating disordered behaviors; overweight; obesity
17.  Body Esteem and Self–examination in British Men and Women 
Breast and testicular cancers affect a substantial and increasing proportion of the global population. Self-examination encourages early detection and treatment of these cancers, which positively impacts on patient quality of life and survival.
The present study investigated the role of body esteem in breast and testicular self-examination. Men (N = 60) and women (N = 90) recruited from a British University completed the body esteem scale and either the testicular self-examination or breast self-examination questionnaire.
Logistic regression models revealed that body esteem predicted women's intention to engage in breast self-examination. Women with higher levels of sexual attractiveness and those with lower levels of weight concern were more likely to report that they would regularly self-examine in the future. Body esteem did not however, distinguish between those women that did or did not currently self-examine or predict men's current or intended testicular self-examination.
The findings have implications for the promotion of self-examination and highlight an emerging area of preventive health research.
PMCID: PMC3733036  PMID: 23930186
Body image; breast cancer; health behavior; self-examination; testicular cancer
18.  The effects of pre-pregnancy body mass index and gestational weight gain on perinatal outcomes in Korean women: a retrospective cohort study 
The purpose of the study was to evaluate the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain on perinatal outcomes in a population of Korean women.
We retrospectively reviewed the medical records of 2,454 women who had received antenatal care at Seoul St. Mary's Hospital from January 2007 to December 2009. We used World Health Organization definitions for Asian populations of underweight (BMI < 18.5), normal (BMI equal or higher 18.5 and < 23), overweight (BMI equal or higher 23 and < 25), and obese (BMI equal or higher 25). We analyzed perinatal outcomes according to the pre-pregnancy BMI and weight gain during pregnancy, and calculated the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from multiple logistic regression models by considering maternal age, parity, number of fetuses, length of gestation, and medical history.
Among obese women, the adjusted ORs for gestational diabetes, hypertensive disorder, and incompetent internal os of cervix were 4.46, 2.53, and 3.70 (95% CI = 2.63-7.59, 1.26-5.07, and 1.50-9.12), respectively, and the adjusted ORs for neonatal complications such as macrosomia and low Apgar score were 2.08 and 1.98 (95% CI = 1.34-3.22 and 1.19-3.29), respectively, compared with normal weight women. However, there was no positive linear association between gestational weight gain and obstetric outcomes. In normal weight women, maternal and neonatal complications were significantly increased with inadequate weight gain during pregnancy (p < 0.0001 and = 0.0180, respectively), and we observed similar results in underweight women (p = 0.0136 and 0.0004, respectively).
This study shows that pre-pregnancy overweight and obesity are more closely related to the adverse obstetric outcomes than excess weight gain during pregnancy. In addition, inadequate weight gain during pregnancy can result in significant complications.
PMCID: PMC3033321  PMID: 21241516
19.  The Psychological Consequences of Weight Change Trajectories: Evidence from Quantitative and Qualitative Data† 
Economics and human biology  2012;10(4):419-430.
We use quantitative and qualitative data to explore the psychological impact of weight change among American adults. Using data from the Midlife Development in the United States (MIDUS) study, a survey of more than 3,000 adults ages 25 to 74 in 1995, we contrast underweight, normal weight, overweight, obese I, and obese II/III persons along five psychosocial outcomes: positive mood, negative mood, perceived interpersonal discrimination, self-acceptance, and self-satisfaction. We further assess whether these relationships are contingent upon one's body mass index (BMI) at age 21. We find a strong inverse association between adult BMI and each of the five outcomes, reflecting the stigma associated with high body weight. However, overweight adults who were also overweight at age 21 are more likely than persons who were previously slender to say they were “very satisfied” with themselves. Results from 40 in-depth semi-structured interviews reveal similarly that persons who were persistently overweight or obese accept their weight as part of their identity, whereas those who experienced substantial weight increases (or decreases) struggle between two identities: the weight they actually are, and the weight that they believe exemplifies who they are. We discuss implications for stigma theory, and the ways that stigma exits and entries affect psychological well-being.
PMCID: PMC3414673  PMID: 22580044
body mass index (BMI); psychological well-being; self-concept; stigma; temporal comparison theory; weight change
20.  Attitude of the individual to his own body weight 
A random height and weight survey in a London Borough showed that overweight people were most accurate in the assessment of their weight and underweight people were the least accurate. Overweight women were more aware of their size than overweight men.
Overweight women had made more attempts to lose weight than overweight men. There were no significant differences between overweight women of different age or class groups. Men in social classes A and B were more likely than men in other groups to have tried to lose weight.
These results show that the high prevalence of overweight associated with older and lower social class women cannot be explained by the fact that they are unaware of their size and only partly explained by the fact that they have not made attempts to lose weight.
The results of a second survey conducted among Consumers' Association members showed that the weights considered as ideal by these people corresponded very well with the ideal weights given by life insurance tables.
PMCID: PMC478850  PMID: 4850692
21.  The Implications of Maternal Overweight and Obesity on the Course of Pregnancy and Birth Outcomes 
Maternal and Child Health Journal  2006;10(Suppl 1):153-156.
The increasing prevalence of overweight and obesity among women of childbearing age is a growing public health concern in the United States. The average body mass index (BMI) is increasing among all age categories and women enter pregnancy at higher weights. Women are also more likely to retain gestational weight with each pregnancy. Women who are overweight (BMI 25–30) and obese (BMI ≥30) are at greater risk of adverse reproductive health outcomes compared to women of normal weight status (BMI 19.8–25). This article provides an overview of the complications associated with maternal overweight and obesity including diabetes, pre-eclampsia, c-sections, and birth defects. We present updated information on the weight trends among women. Finally, we present an overview of the prevention studies aimed at adolescents and women prior to pregnancy.
PMCID: PMC1592146  PMID: 16927160
Obesity; Nutrition; Women; Pregnancy; Postpartum
22.  Inaccurate Weight Perception is Associated With Extreme Weight Management Practices in US High-School Students 
To examine whether adolescents’ weight perception accuracy (WPA) was associated with extreme weight-management practices (EWPs) in differing body mass index (BMI) categories.
WPA, overassessment, and underassessment were determined by comparing self-reported BMI and weight perception among US high-school students in the 2009 National Youth Risk Behavior Survey. BMI was classified as: underweight (<5th percentile), healthy weight (5th–<85th), overweight (≥85th–<95th), and obese (≥95th). WPA was considered inaccurate if BMI and weight perception were discordant. Overassessors thought they were heavier than they were (among underweight/healthy groups); underassessors thought they were lighter than they were (among healthy/overweight/obese groups). EWPs included one or more of fasting, use of diet pills, or purging/laxative use. Logit models were fitted for different BMI sex strata.
In the final sample of 14,722 US high-school students with complete data, 20.2%, 85.7%, 5.8%, and 80.9% of those who were underweight, healthy weight, overweight, and obese, inaccurately assessed their weight, respectively. In turn, 11.4% and 17.6% of accurate and inaccurate assessors engaged in EWPs, respectively. After adjustment, underweight females who overassessed their weight had 12.6 times higher odds of EWPs (95% CI: 3.4–46.6). Also, there were elevated odds of EWPs among healthy weight students who overassessed their weight.
Overassessing healthy weight students and underweight girls had higher odds of 3 EWPs, likely related to an unhealthy desire to lose weight. This study demonstrates a need to further educate clinicians on WPA and its relationship to EWPs even among those of healthy weight who may be seen as non-risk.
PMCID: PMC3982798  PMID: 24172585
weight perception; eating disorder; obesity; YRBSS; Adolescent; dieting
23.  Health-related physical fitness and weight status in Hong Kong adolescents 
BMC Public Health  2010;10:88.
This study was designed to investigate the relation between health-related physical fitness and weight status in Hong Kong adolescents.
3,204 students aged 12-18 years participated in the Hong Kong Student Obesity Surveillance (HKSOS) project in 2006-2007. Anthropometric measures (height, weight) and health-related fitness (push-up, sit-up, sit-and-reach, 9-minute run) were assessed. Body mass index (BMI) was computed to classify participants into normal weight, underweight (Grade I, II/III), overweight, and obese groups. The associations of health-related physical fitness with BMI and weight status were examined by partial correlation coefficients and analysis of covariance, respectively.
More boys than girls were overweight or obese (18.0% vs 8.7%), but more girls than boys were underweight (22.3% vs 16.7%). Boys performed significantly (P < 0.001) better in sit-up (38.8 vs 31.6 times/min) and 9-minute run (1632.1 vs 1353.2 m), but poorer in sit-and-reach (27.4 vs 32.2 cm) than girls. All four physical fitness tests were significantly positively correlated with each other in both sexes, and BMI was only weakly correlated with sit up and sit-and-reach tests in boys. Decreasing performance (P for trend < 0.05) was observed from normal weight to overweight and obese for push-up, sit-up, and 9-minute run in both sexes. From normal weight to Grade I and Grade II/III underweight, decreasing performance (P for trend < 0.05) for sit-up and sit-and-reach in both sexes and for push-up in boys was observed.
The relations between BMI and health-related physical fitness in adolescents were non-linear. Overweight/obese and underweight adolescents had poorer performance in push-up and sit-up tests than normal weight adolescents. Different aspects of health-related physical fitness may serve as immediate indicators of potential health risks for underweight and overweight adolescents.
PMCID: PMC2836297  PMID: 20178615
24.  Relations of Meeting National Public Health Recommendations for Muscular Strengthening Activities With Strength, Body Composition, and Obesity: The Women’s Injury Study 
American journal of public health  2011;101(10):1930-1935.
We examined the relations of meeting or not meeting the 2008 Physical Activity Guidelines for Americans recommendations for muscular strengthening activities with percentage of body fat, body mass index (BMI; defined as weight in kilograms divided by height in meters, squared), muscular strength, and obesity classification in women.
We analyzed data on 918 women aged 20 to 83 years in the Women’s Injury Study from 2007 to 2009. A baseline orthopedic examination included measurement of height, body weight, skinfolds, and muscle strength.
Women who met muscle strengthening activity recommendations had significantly lower BMI and percentage of body fat and higher muscle strength. Women not meeting those recommendations were more likely to be obese (BMI≥30) compared with women who met the recommendations after we adjusted for age, race, and aerobic physical activity (odds ratio = 2.28; 95% confidence interval = 1.61, 3.23).
There was a small but significant positive association between meeting muscle strengthening activity recommendations and muscular strength, a moderate inverse association with body fat percentage, and a strong inverse association with obesity classification, providing preliminary support for the muscle strengthening activity recommendation for women.
PMCID: PMC3174351  PMID: 21852647
25.  The prevalence of physical, sexual and mental abuse among adolescents and the association with BMI status 
BMC Public Health  2012;12:840.
Studies among adults show an association between abuse and Body Mass Index (BMI) status. When an aberrant BMI status as a consequence of abuse is already prevalent in adolescence, early detection and treatment of abuse might prevent these adolescents from developing serious weight problems and other long-term social, emotional and physical problems in adulthood. Therefore, this study investigated the prevalence of physical, sexual and mental abuse among adolescents and examined the association of these abuse subtypes with BMI status.
In total, data of 51,856 secondary school students aged 13–16 who had completed a questionnaire on health, well-being and lifestyle were used. BMI was classified into four categories, underweight, normal weight, overweight and obesity. Adolescents reported if they had ever been physically, sexually or mentally abused. Crude and adjusted General Estimation Equation (GEE) analyses were performed to investigate the association between abuse subtypes and BMI status. Analyses were adjusted for ethnicity and parental communication, and stratified for gender and educational level.
Eighteen percent of the adolescents reported mental abuse, 7% reported sexual abuse, and 6% reported physical abuse. For underweight, overweight and obese adolescents these percentages were 17%, 25%, and 44%; 7%, 8%, and 16%; and 6%, 8%, 18% respectively. For the entire population, all these subtypes of abuse were associated with being overweight and obese (OR=3.67, 1.79 and 1.50) and all but sexual abuse were associated with underweight (OR=1.21 and 1.12). Stratified analyses showed that physical and sexual abuse were significantly associated with obesity among boys (OR=1.77 and 2.49) and among vocational school students (OR=1.60 and 1.69), and with underweight among girls (OR=1.26 and 0.83).
Mental abuse was reported by almost half of the obese adolescents and associated with underweight, overweight and obesity. Longitudinal analyses are recommended to explore the causality of and the mechanisms explaining this association between abuse and overweight.
PMCID: PMC3507854  PMID: 23033819
Abuse; Weight; Overweight; Obesity; Adolescents

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