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

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes

It is commonly assumed that a person identifying that they are 'overweight' is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight-related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight.

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

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.

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.