The impact of weight misperception on health-related quality of life in Korean adults (KNHANES 2007-2014): a community-based cross-sectional study

Health-related quality of life in long-term early-stage breast cancer survivors compared to general population in Korea

PURPOSE

This study assessed health-related quality of life (HRQoL) of long-term breast cancer (BC) survivors diagnosed at early stages and compare with cancer-free, age-matched women.

METHODS

The study population included BC survivors diagnosed with ductal carcinoma in situ (DCIS) or breast cancer stages I-II, who had undergone lumpectomy/mastectomy, with time since diagnosis ranging from 9 to 16 years. Survey was conducted at two tertiary hospitals in 2020. Data for cancer-free female controls was randomly drawn from a population-based survey and age-, education-matched with 1 case: 3 controls ratio. Self-reported HRQoL was assessed using EQ-5D with five dimentions. EQ-5D utility index score was calculated. Difference in EQ-5D score was evaluated using the Tobit regression model with adjustment for other covariates.

RESULTS

Of 273 survivors. 88% and 12% underwent mastectomy and lumpectomy, respectively. The mean (standard deviation, SD) age at survey was 57.3 (8.5) years old. BC survivors reported significantly more problems performing daily activities (11% vs. 5%, p < 0.001), pain/discomfort (46% vs. 23%, p < 0.001), and anxious/depressed feelings (44% vs. 8%, p < 0.001) relative to the controls. Difference in EQ-5D score between BC survivors and the general population was higher in older age groups. The overall EQ-5D score of BC survivors was statistically lower than that of the control subjects (adjusted [Formula: see text]=0.117, p < 0.001).

CONCLUSION

Long-term BC survivors who survived beyond ten years post-diagnosis experience more pain, anxiety, and distress, leading to an overall poorer HRQoL.

IMPLICATIONS FOR CANCER SURVIVORS

This study suggest the importance of follow-up care, particularly focusing on pain, anxiety, and distress management to enhance the HRQoL of long-term BC survivors.

Age and gender differences in misperceptions of body shape in a Taiwanese population

OBJECTIVES

Most studies of body size perception have been performed in adolescents, and most focus on gender differences in accurate perception of body size. This study investigated misperceptions of body sizes among males and females at different stages of adulthood in Taiwan.

DESIGNS

In-person home interviews were used to proportionally and randomly select 2095 adult men and women to answer the East Asian Social Survey. Participants were divided into 18-39, 40-64, and 65 + age groups. The main variables analyzed were self-perceived body size and standardized BMI.

RESULTS

Women, unlike men, were more likely to misperceive their body size as being overweight (OR = 2.92; p < .001). People with higher self-perceived social status were less likely to misperceive themselves as overweight (OR = 0.91; p = .01). People with college educations were 2.35 times more likely to overestimate their body size as being heavier than they were (p < .001) and less likely to underestimate it as being thinner than they were (OR = 0.45; p < .001). Women 18-35 and 36-64 years old were 6.96 and 4.31 times more likely (p < .001) to misperceive themselves as being overweight than women 65 or older, who were more likely to misperceive themselves as being too thin. There were no significant differences in body size misperceptions among the three age groups of adult men (p > .05). We found no different significant discrepancies between self-perceived body size and actual BMI between the older men and women (p = .16). However, younger and middle-aged men were 6.67 and 3.1 times more likely to misperceive themselves as being too thin than women in their same age groups (OR = 0.15 and OR = 0.32, respectively).

CONCLUSIONS

Age and gender affect self-perceptions of body size in Taiwan. Overall, women are more likely than men to misperceive themselves as being too big, and men are more likely than women to misperceive themselves as too thin. Older women, however, were more likely to misperceive themselves as being too thin. Clinicians and health educators should know that people's perceptions and concerns regarding their body size vary by age and gender.

Weight self-perception and weight loss attempts in Chinese cardiovascular patients and non-cardiovascular patients: evidence from a population-based study

BACKGROUND

Weight loss is a significant improvement for individuals with overweight or obesity, especially for cardiovascular patients. The driving effects of weight self-perception and attempts to lose weight are vital in weight management, yet weight misperception is a direct culprit for the undesirability of weight control and obesity prevention. This study aimed to investigate weight self-perception and misperception and weight loss attempts in Chinese adults, especially among cardiovascular and non-cardiovascular patients.

METHODS

We collected data from China HeartRescue Global Evaluation Baseline Household Survey 2015. Questionnaires were used to assess self-reported weight and cardiovascular patients. We used kappa statistics to check the consistency between weight self-perception and BMI. Logistic regression models were fitted to identify risk factors associated with weight misperception.

RESULTS

A total of 2690 participants were enrolled in the household survey, while 157 respondents were cardiovascular patients. According to questionnaire results, 43.3% of cardiovascular patients thought they were overweight and obese, while the percentage is 35.3% among non-cardiovascular patients. Kappa statistics indicated higher consistency of self-reported weight and actual weight among cardiovascular patients. Multivariate analysis showed weight misperception was significantly associated with gender, education level, and actual BMI. Lastly, 34.5% of non-cardiovascular patients and 35.0% of cardiovascular patients were trying to lose weight or keep weight. The majority of these people adopted combined strategies of controlling diet and exercise to lose or maintain weight.

CONCLUSIONS

Weight misperception was highly prevalent among cardiovascular or non-cardiovascular patients. Obese respondents, women, and individuals with lower education levels were more vulnerable to make weight misperception. However, no difference in the purpose of weight loss attempts was indicated among cardiovascular and non-cardiovascular patients.

Comparison of body size perception of young women in Korea and the United States

Body size perception among young women in Asian and Western countries is believed to be quite different, however, there are no confirming studies. We analyzed the data from young women aged between 20 and 40 who participated in the National Health and Nutrition Examination Survey (2001-2018) of the United States (US) and Korea. US young women had higher rates of being overweight and obesity than Korean young women, and there was no significant change over 20 years. In both countries, the percentage of properly estimating one's own weight exceeded 70 percent and remained relatively steady. The percentage of overestimating one's own weight was only about 10 percent in Korea in 2001, but increased to 20 percent. In the case of the US, the percentage was about 15 percent in 2001-2002, but has since continued to decline. The percentage of underestimating one's own body weight was about 18 percent in Korea in 2001, but decreased to about 8 percent. In the case of the US, the percentage was very low at about 10 percent in 2001-2002, but gradually increased to about 18 percent in 2017-2018. In conclusion, young women in the US tend to underestimate their body size, and those in Korea tend to overestimate it.

Moderation of Weight Misperception on the Associations Between Obesity Indices and Estimated Cardiovascular Disease Risk

BACKGROUND

This study aimed to investigate the gender-specific association between weight misperception and estimated cardiovascular disease (CVD) risk and gender-specific moderation of weight misperception in the associations between obesity indices and CVD risk.

METHODS

In 7836 men and 10,299 women aged 40-79 years without CVD history from the 2014-2018 Korea National Health and Nutrition Examination Survey, the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using Pooled Cohort Equations. Weight misperception was defined as accurate estimation, overestimation, or underestimation by comparing perceived weight to actual weight category. Obesity indices were BMI and waist circumference (WC).

RESULTS

In fully adjusted models, odds of 10-year ASCVD risk of ≥ 7.5% were lower in men with overestimating weight (odd ratio [95% confidence interval], 0.85 [0.73, 0.99] after adjusting for BMI;0.79 [0.68, 0.92] after adjusting for WC), but higher in women with underestimating weight (1.44 [1.27, 1.63] after adjusting for BMI;1.42 [1.26, 1.61] after adjusting for WC) compared to those with accurate weight estimates. Compared to women with accurate weight estimates, the ASCVD risk associated with obesity indices was higher in those who underestimated weight (ß [95% CI], 0.33 [0.23, 0.43] for BMI;0.16 [0.13, 0.20] for WC), whereas it was lower in those who overestimated weight (-0.15 [-0.28, -0.02] for BMI; -0.07 [-0.11, -0.03] for WC). In men, weight misperception did not moderate the association between obesity indices and the ASCVD risk.

CONCLUSIONS

These findings suggest that weight misperception was associated with estimated CVD risk independently across gender and moderates the association between obesity indices and estimated CVD risk in women.

Self-perceived Weight and Mortality in Korean Adults Based on the Korea National Health and Nutrition Examination Survey Data Linked to Cause of Death Statistics

Background

This study aimed to determine the associations between self-perceived weight, weight perception, and mortality risk among Korean adults.

Methods

Data from the 2007 to 2015 Korea National Health and Nutrition Examination Survey and the 2007 to 2019 Cause of Death Statistics were linked for this cohort study. A complex samples Cox regression analysis involving 42,453 participants (17,056 male; 25,397 female) was performed after excluding those who died within 1 year of the follow-up period, those with a history of cancer, those with cardiovascular diseases, those without body mass index (BMI) data, and those without self-perceived weight data.

Results

During 7.85 years of follow-up, the overall mortality rate was 3.8% (4.5% for male and 3.1% for female). Self-perceived thin weight status was associated with a 43% to 68% higher risk of all-cause mortality and a 2.48-times higher risk of cardiovascular mortality compared to self-perceived just right weight status after controlling for sociodemographic characteristics, health-related behaviors, underlying health status, BMI, and metabolic syndrome. After adjusting for the confounding factors, those who underestimated their weight had a 27% reduced risk of all-cause mortality than those who correctly estimated their weight. The risks of all-cause mortality and cardiovascular mortality were 2.14-times higher and 2.32-times higher, respectively, in the underweight group with an accurate weight estimation than in the normal weight group with an accurate weight estimation. However, all-cause mortality was 47% lower among participants with obesity who overestimated their weight.

Conclusion

Self-perceived thinness and accurately perceived underweight status were associated with increased risks of all-cause mortality and cardiovascular mortality among Korean adults.

Weight over-reporting is associated with low muscle mass among community-dwelling Japanese adults aged 40 years and older: a cross sectional study

Background

Weight misperception adversely affects health-related quality of life (HRQol); however, few studies have evaluated the relationship between weight misperception and muscle mass. This study aimed to examine the relationship of weight misperception with low muscle mass using skeletal muscle index (SMI) estimated by multifrequency bioelectrical impedance analysis (MF-BIA) among community-dwelling Japanese.

Methods

Participants were 525 Japanese individuals aged 40–91 years old (male 89, female 436). Misperception was calculated by subtracting measured value from self-reported weight, presented as a percentage and categorized into tertiles based on sex (under-reporters, acceptable reporters, and over-reporters). Appendicular lean mass was estimated using MF-BIA, and low muscle mass was defined using SMI values of 7.0 and 5.7 kg/m2 for males and females, respectively, based on the Asian Working Group for Sarcopenia 2019 consensus. We evaluated the association between prevalence of low muscle mass and weight misperception (under-reporters and over-reporters) using multivariate logistic regression including covariate.

Results

In total, 9.3% (49/525) of participants had low muscle mass. After adjusting for covariates, prevalence of low muscle mass was higher among over-reporters than acceptable-reporters (odds ratio [OR]; 2.37, 95% confidence interval [CI]; 1.03–5.44). Additionally, sensitivity analysis was performed on females, which confirmed that the prevalence of low muscle mass was higher in over-reporters than in acceptable-reporters (OR, 3.27; 95% CI, 1.18–9.12).

Conclusion

Weight misperception was significantly correlated with low muscle mass, especially in over-reporters.

Self-perceived weight and self-rated health have distinct relationships according to body mass index in Korean teenagers

It was hypothesized that adolescents who perceived themselves as underweight or overweight would be positively associated with poor self-rated health (SRH), regardless of their actual weight status, and that the SRH would be varied depending on the combination of their actual weight and their perceived weight. The study aimed to evaluate associations of self-perceived weight and body mass index (BMI)-based weight status with SRH in Korean adolescents. A cross-sectional study was conducted in 1658 female and 1888 male adolescents aged 10 to 18 years based on the Korea National Health and Nutrition Examination Survey using complex-samples logistic regression. Weight estimation was determined by comparing BMI-based weight and self-perceived body shape. Age, family affluence, and health status were confounders. In sex-specific analysis, the odds for poor SRH were higher in males who accurately estimated underweight or overweight and those who were normal weight, but overestimated weight compared with those who accurately self-perceived as being normal weight. In females, the odds for poor SRH were higher in those with normal weight but underestimated or overestimated weight compared with a female comparison group. In the overall analysis, males who accurately perceived their weight as underweight, males and females who perceived their weight as overweight despite being normal weight or overweight, and females who perceived weight as underweight despite being normal weight had higher odds for poor SRH compared with a female comparison group. In conclusion, as the hypothesis of this study, self-perceived overweight and underweight in adolescents were associated with poor SRH regardless of BMI, and the association differed by BMI in Korean adolescents.

Weight perception and self-rated health: are there differences between cancer survivors and non-cancer survivors?

PURPOSE

To compare relationships between self-perceived weight and self-rated health (SRH) between cancer survivors and non-cancer survivors.

METHODS

A cross-sectional study based on the 2014-2019 Korea National Health and Nutrition Examination Survey was conducted for the associations of self-perceived weight status, measured BMI categories, and combined categories by self-perceived weight and measured BMI with SRH in 1622 cancer survivors and 29,903 non-cancer survivors using complex samples ordinal regression analysis after adjusting for sociodemographic factors, health behaviors, and concurrent diseases.

RESULTS

Compared to the comparison group (those who were normal weight and self-perceived as average weight in non-cancer survivors), adjusted odds for poorer SRH were higher in cancer survivors and non-cancer survivors who were underweight and self-perceived as underweight (adjusted odds ratios[aORs], 2.69 for non-cancer survivors; 2.62 for cancer survivors), those who were normal weight but self-perceived as underweight or overweight (aORs, 1.69-2.38 for non-cancer survivors; 2.34-3.78 for cancer survivors), and those who were overweight and self-perceived as overweight (aORs, 1.52 for non-cancer survivors; 2.42 for cancer survivors). In cancer survivors, the odds for poorer SRH were greater for those who were normal weight and self-perceived as average weight (aOR = 1.84), whereas the odds were not significant for those who were underweight or overweight and self-perceived as average weight. In non-cancer survivors who self-perceived as average weight, the odds for poorer SRH were significant in those with underweight (aOR = 1.35) or overweight (aOR = 0.84).

CONCLUSION

According to actual weight status, the association between self-perceived weight and SRH may differ between cancer survivors and non-cancer survivors.

Association between accuracy of weight perception and life satisfaction among adults with and without anxiety and mood disorders: a cross-sectional study of the 2015-2018 Canadian Community Health Survey

BACKGROUND

Weight status and weight perception have a significant impact on life satisfaction. As overweight prevalence increases in Canada, it is important to understand how accuracy of weight perception (AWP) is associated with life satisfaction. This study explored the association between AWP and life satisfaction among Canadian adults with and without anxiety and/or mood disorders.

METHODS

Using data from the 2015-2018 cycles of the Canadian Community Health Survey, an indicator of AWP was created to capture concordance between perceived weight and actual weight status. Univariate and multivariate Gaussian generalized linear models were assessed while stratifying by sex and presence of anxiety and/or mood disorders.

RESULTS

Our sample included 88 814 males and 106 717 females. For both sexes, perceiving oneself as overweight or underweight, regardless of actual weight status, was associated with lower life satisfaction (β = -0.93 to -0.30), compared to those who accurately perceived their weight as 'just about right'. Perceiving oneself as overweight or underweight was associated with more pronounced differences in life satisfaction scores in those with anxiety and/or mood disorders (β = -1.49 to -0.26) than in those without these disorders (β = -0.76 to -0.25).

CONCLUSION

Weight perception is more indicative of life satisfaction than actual weight status, especially in those with anxiety and/or mood disorders.

Misperception of Healthy Weight: Associations Among Weight, Body Size Satisfaction and Body Appreciation in Older Adults

Misperceived body weight in older people can affect their health and quality of life. We analysed the body image of older adults in Primary Health Care services in central Portugal, by considering participants' weight, body size satisfaction and body appreciation. This epidemiological and cross-sectional study involved 150 participants (56% women) with an average age of 74.9 years who completed questionnaires on body size and body appreciation. Forty-nine percent of participants were affected by overweight and 29% by obesity. The majority was not satisfied with their body size (71.2%), but had very high scores related to body appreciation. Around 40% of the participants with normal weight or overweight were satisfied with their body size. Multiple regression analysis revealed that both body size satisfaction and appreciation were negatively associated with obesity, but not with overweight. Older Portuguese adults are not able to assess if their weight is a risk to their health, but regardless of their perceived physical appearance, the elderly respect their body and are receptive to improving their health.

Weight underestimation and weight nonregulation behavior may be related to weak grip strength

The hypothesis of this study is that weight-related behaviors such as weight perception and weight control efforts may be related to health indicators such as grip strength as an indicator of muscle strength. This cross-sectional study aimed to prove this hypothesis by assessment of the associations of perceived weight status, weight misperceptions, and weight control efforts with grip strength. A questionnaire and measurements were used to assess the perceived weight status, weight control efforts, weight control methods, weight misperceptions, grip strength (sarcopenic vs normal), and confounding factors (measured body mass index, sociodemographic characteristics, concurrent chronic diseases, high sensitivity C-reactive protein, depressive mood, health-related quality of life, health behaviors, and protein intake) among 12,727 adults (men, 43.1%; 51.0 ± 16.6 years old) using the 2015 to 2017 Korea National Health and Nutrition Examination Survey. In fully adjusted models, the odds of sarcopenic grip strength tended to increase with thinner weight perceptions (P for trend <.001). Sarcopenic grip strength was inversely associated with accurate estimation or overestimation of weight (adjusted odds ratio [aOR] 0.64-0.68) and weight loss/maintenance efforts (aOR 0.68-0.73) compared with underestimation of weight and nonweight control efforts. These findings were consistent across sex and weight status, and were found among participants aged 60 years or older but not less than 60 years. In conclusion, this study supports the research hypothesis that the perception of one's own weight, the accuracy of the perceived weight, and the weight control efforts may be related to weak handgrip strength.

Bodyweight Misperception by Chinese American Females Influenced by Cultural and Social Ideals: Implication for Home Health Care

Bodyweight misperception results from the desire to achieve an ideal body emphasized by cultural mores and societal norms. It is sustained by the desire to be cultural compliant, especially for ethnic minority women such as Chinese American females. Through cultural beliefs, these women’s self-perceived weight status is distorted, which strengthens the impact of bodyweight misperception in their daily life as poor physical health, distressed psychosocial health, risky and unsafe health practices and behaviors, and diminished quality of life. Evidently, bodyweight misperception promotes maladaptive health behaviors. However, bodyweight misperception is barely captured in the current science about women’s health, and is minimally explored in research about Chinese American females’ desire and efforts to achieve the ideal body type. Therefore, the purpose of this literature review was to explore (1) body weight perception, (2) the factors associated with it, and (3) the negative health consequences triggered by it, in Chinese American females. Studies confirm that Chinese American females shape their body weight perception by internalized cultural ideals, acculturative stress, mass media, and social pressures. They overestimate their body weight more than underestimate it as evident by frequent weight-loss attempts. This internalized bodyweight misperception affects their physical and psychological health, with undesirable consequences on their quality of life. Home health care professionals interact closely with patients from diverse cultural backgrounds; remaining culturally sensitive is crucial in their practice. Knowledge from this literature review emphasizes the need for culturally appropriate weight management strategies for the delivery of competent home health care to Chinese American females.

Weight underestimation linked to anxiety and depression in a cross-sectional study of overweight individuals in a Sami and non-Sami Norwegian population: the SAMINOR Study

OBJECTIVES

Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations.

DESIGN

Population-based cross-sectional study.

SETTING

The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014.

PARTICIPANTS

The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m²) whereof 1384 underestimated their weight (42%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status.

RESULTS

A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status.

CONCLUSIONS

Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women.

Accuracy of Body Weight Estimation Among Palestinian Refugee Adolescents Living in Jordan: A Cross-Sectional Study

PURPOSE

We aimed to examine the prevalence of obesity among adolescents living in a refugee camp in Jordan and analyze the factors influencing their weight perceptions.

DESIGN

Cross-sectional survey.

METHODS

We examined the body weight perception, and the influence of psychological, cultural, and social factors, among Palestinian refugee adolescents living in Jordan using a cross-sectional survey. Univariate, bivariate, and multiple logistic regression analyses were used to investigate the relationships between body weight status, weight perception, satisfaction with weight, screen time, and depression status of these adolescents.

RESULTS

A total of 620 adolescents participated in the study, of which 24% were either overweight or obese. Overweight or obese adolescents were more likely to underestimate their weight (p < .001), while those with depressive symptoms (Patient Health Questionnaire for Adolescents score > 14), were more likely to overestimate their body weight (p = .021). Having symptoms indicative of depression (adjusted odds ratio [AOR] = 1.70; 95% confidence interval [CI] = 1.16-2.50) and having a body mass index in the overweight/obese range (AOR = 4.16; 95% CI = 2.73-6.35) were predictors of discordant weight perception.

CONCLUSIONS

This study showed that excess body weight is a significant issue among Palestinian refugee adolescents living in a refugee camp in Jordan. Underlying depression is an important factor in excess weight and distorted weight perceptions especially among this vulnerable group.

CLINICAL RELEVANCE

The study highlights the importance of addressing discordant body weight perception and depression in weight management in nursing interventions for vulnerable adolescent groups.

Unintentional weight loss, its associated burden, and perceived weight status in people with cancer

Purpose

Unintentional weight loss (UWL) is a prevalent problem in people with cancer and is associated with poorer psychosocial outcomes. A gap exists in understanding whether and how perceived and/or weight status impacts experiences of UWL. Thus, we sought to examine subjective experiences of UWL in people with cancer, and whether perceived and/or actual weight status impacts these experiences.

Methods

Participants were recruited through Cancer Support Community’s Cancer Experience Registry® and related networks. Participants completed an online survey that included the FAACT Anorexia-Cachexia subscale, and 19 items that captured six themes related to “beliefs and concerns” (positive beliefs, psychosocial impact, physical impact, cancer outcomes, self-esteem, relationships with others). Perceived weight status (PWS) was assessed using a single item. Body mass index (BMI) was calculated using self-reported weight and height measurements.

Results

Of 326 respondents, 114 reported experiencing UWL. Over one-third misperceived their weight, with 29% perceiving weight status as below their BMI status. UWL in those with perceived weight status of overweight/obese was associated with positive beliefs. However, being underweight by BMI or perceiving oneself as underweight were both associated with greater concerns about weight loss. Perceived weight status of underweight compared to normal or overweight/obese weight status was associated with poorer psychosocial well-being, personal control, self-esteem, and relationships with others.

Conclusion

In people with cancer, perceived weight status, rather than BMI, had greater impact on negative “beliefs and concerns” about UWL. Findings suggest assessment of both perceived and actual BMI to address the impact of UWL on psychosocial wellbeing.

Body weight perception, disordered weight control behaviors, and depressive symptoms among Korean adults: The Korea National Health and Nutrition Examination Survey 2014

BACKGROUND/ PURPOSE

Despite emerging evidence suggesting harmful influences of accurate weight perception on psychological health among individuals with obesity, little is known about the association in Asian populations. The aim of this study was investigate the association between body weight perception and depressive symptoms among Korean adults, and potential differential associations across gender.

METHODS

We used data from the sixth Korea National Health and Nutrition Examination Survey in 2014, comprising 3,318 female (n = 1,876) and male (n = 1,442) participants, aged 19-65 years, with no history of depression and a body-mass index (BMI)> = 18.5kg/m2. Depressive symptoms were measured by the Patient Health Questionnaire-9 Korean version. Weight perception patterns were categorized by comparing self-perceived and objectively measured weight status. Gender-stratified four-level multilevel linear models adjusted for age, BMI, menopause, education, income, marital status, urbanicity, chronic conditions, exercise, smoking, and alcohol use. Subgroup analyses were performed across BMI category.

RESULTS

Among women with obesity, those who underperceived their weight status reported fewer depressive symptoms compared to those who accurately perceived their weight status (β = -1.25, p<0.05). Among women with normal weight, those who overperceived their weight status reported more depressive symptoms compared to those who accurately perceived their weight status (β = 1.00, p<0.05). The same associations were not found in men.

CONCLUSION

Awareness-oriented strategies for obesity prevention and weight management focused on providing information on weight status may need to consider unintended consequences of accurate weight perception on mental health among individuals with obesity, particularly among women.

The Cardiometabolic Burden of Self-Perceived Obesity: A Multilevel Analysis of a Nationally Representative Sample of Korean Adults

Emerging evidence has shown that self-perception of overweight/obese status is associated with unfavorable cardiometabolic outcomes, above and beyond actual body weight. Given the lack of research among Asian populations, we examined the association between weight perception and metabolic syndrome (MetS) and cardiometabolic risks among Koreans. Data from the 2010–2015 Korea National Health and Nutrition Examination Survey, including women (N = 12,181) and men (N = 9,448) aged 19–65 years, were analyzed. Weight status perception was measured by participants’ self-evaluation of their body size (“very/slightly obese,” “normal,” and “very/slightly thin”). Overall, 23.2% of women and 28.7% of men had MetS. Our cross-sectional multilevel logistic analyses showed a significant positive association between self-perceived obesity (vs. perceived normal weight) and MetS, independent of BMI and sociodemographic/behavioral/medical conditions, with a stronger association detected among men (OR = 1.38, p < 0.05) than women (OR = 1.22, p < 0.05), confirmed by a statistically significant interaction. Additionally, perceived obesity was associated with high blood pressure (OR = 1.27, p < 0.05) and high triglycerides (OR = 1.38, p < 0.05) among men and low high-density lipoprotein cholesterol (OR = 1.15, p < 0.05) among women. While further prospective research is needed, our findings suggest that perception of being obese may be an unfavorable indicator of cardiometabolic health among Koreans regardless of actual body weight.