Weight status misperceptions among UK adults: the use of self-reported vs. measured BMI

Mediterranean Diet Favors Vitamin K Intake: A Descriptive Study in a Mediterranean Population

The Mediterranean diet (MD) is associated with improved longevity and the prevention and management of chronic inflammatory diseases (CIDs). Vitamin K, which is present in MD core components such as leafy green vegetables, is also known as a protective factor for CIDs. Estimates of vitamin K intake in Mediterranean settings are still scarce, and the association between MD and vitamin K intake is yet to be established. This study analyzed vitamin K intake and MD adherence in the Algarve region, in Portugal. We conducted a cross-sectional study in a nonrandom sample of adults using an online questionnaire which included a validated food-frequency questionnaire and a screener for MD adherence. A total of 238 participants were recruited (68% women and 32% men). Adherence to the MD was low (11%). Only 10% of the participants had vitamin K intake below the adequate intake. Adherence to the MD was positively correlated with vitamin K intake (r = 0.463; p < 0.001) and age (r = 0.223; p < 0.001). Our findings underscore the importance of promoting adherence to the MD for optimal vitamin K intake, and future research should focus on developing effective interventions to promote this dietary pattern, particularly among younger individuals and men.

Quality of life and psychosocial outcomes among children with metabolically healthy and unhealthy obesity

BACKGROUND

Obesity and obesity-related morbidities are associated with poor psychosocial adjustment and health-related quality of life (HRQoL). This study aims to examine HRQoL and psychosocial outcomes in children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and the effects of familial health on these outcomes.

METHODS

Four hundred and six children with BMI for age ≥ 97th percentile were classified as having MHO and MUO based on the absence or presence of metabolic abnormalities. HRQoL and psychosocial outcomes were assessed using validated questionnaires such as PedsQL and DASS-21.

RESULTS

There were no significant differences in HRQoL and psychosocial outcomes between children with MHO and children with MUO. Children with MUO and prior knowledge of existing metabolic conditions reported significantly lower total HRQoL (71.18 ± 17.42 vs. 75.34 ± 15.33), and higher depression (12.16 ± 11.80 vs. 8.95 ± 8.52) and stress (12.11 ± 8.21 vs. 10.04 ± 7.92) compared to children with MHO. Children with MUO who had fathers with metabolically unhealthy phenotype reported significantly lower total HRQoL (72.41 ± 15.67 vs. 76.82 ± 14.91) compared to children with MUO who had fathers with metabolically healthy phenotype.

CONCLUSION

Prior knowledge of existing metabolic abnormalities was associated with poorer HRQoL and mental health in children with obesity. Paternal metabolic health status influenced HRQoL in children with MUO.

IMPACT

First study that compared health-related quality of life (HRQoL) and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). No significant differences in HRQoL and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). Children with MUO who had prior knowledge of existing metabolic conditions reported lower HRQoL, higher depression and stress compared to children with MHO. Paternal metabolic health status was found to influence HRQoL in children with MUO. Mental health support intervention with paternal involvement should be provided for children with MUO.

Neighborhood Social Environment and Body Mass Index: The Mediating Role of Mental Wellbeing

The association between neighborhood-built environment and body mass index (BMI) is well-characterized, whereas fewer studies have explored the mechanisms underlying the relationship between neighborhood social environment and obesogenic behaviors. Using data from a random sample of 16,820 residents ≥18 years from all 169 Connecticut towns and seven ZIP Codes in New York, this study examines the influence of neighborhood social environment on residents' mental wellbeing, physical activity, and BMI. Structural equation modeling was conducted to estimate direct and indirect effects of neighborhood social environment on BMI, using mental wellbeing and physical activity as intermediate variables. There were significant total [β(SE) = 0.741 (0.170), p < 0.0001], direct [β(SE) = 0.456 (0.1890), p = 0.016], and indirect [β(SE) = 0.285 (0.061), p < 0.0001] effects of neighborhood social environment on BMI. Low physical activity was a partial mediator of the effect of non-favorable neighborhood social environment on BMI [β(SE) = -0.071 (0.011), p < 0.0001]. The association between neighborhood social environment and BMI was also mediated by mental wellbeing [β(SE) = 0.214 (0.060), p < 0.0001], and by mental wellbeing through physical activity [β(SE) = 0.071 (0.011), p < 0.0001]. Study findings provide further support for building strong social environments to improve population health and suggest that strategies prioritizing mental wellbeing may benefit behavioral interventions aimed at reducing obesity risk and should be a focus of prevention efforts in and of itself.

Embedded Distress: Social Integration, Gender, and Adolescent Depression

In adolescence, teens manage close friendships while simultaneously evaluating their social position in the larger peer context. Conceptualizing distinct local and global network structures clarifies how social integration relates to mental wellbeing. Examining local cohesion and global embeddedness in the context of key factors related to mental health, such as gender and friends' depression, can further distinguish when the structure and content of social integration relate to higher and lower depressive levels. Analyses using survey data from PROSPER (n = 27,091, grades 9-12) indicate global embeddedness is generally protective, but for girls, greater global embeddedness when friends are more depressive is associated with increased depressive symptoms. For girls, greater local cohesion reduces associations between more depressive friends and increased depressive levels, while for boys, both local cohesion and friends' depression are largely irrelevant. Results indicate the importance of considering both local and global network integration in tandem with gender and friends' depression to understand how social integration relates to mental health.

Machine learning-based obesity classification considering 3D body scanner measurements

Obesity can cause various diseases and is a serious health concern. BMI, which is currently the popular measure for judging obesity, does not accurately classify obesity; it reflects the height and weight but ignores the characteristics of an individual's body type. In order to overcome the limitations of classifying obesity using BMI, we considered 3-dimensional (3D) measurements of the human body. The scope of our study was limited to Korean subjects. In order to expand 3D body scan data clinically, 3D body scans, Dual-energy X-ray absorptiometry, and Bioelectrical Impedance Analysis data was collected pairwise for 160 Korean subjects. A machine learning-based obesity classification framework using 3D body scan data was designed, validated through Accuracy, Recall, Precision, and F1 score, and compared with BMI and BIA. In a test dataset of 40 people, BMI had the following values: Accuracy: 0.529, Recall: 0.472, Precision: 0.458, and F1 score: 0.462, while BIA had the following values: Accuracy: 0.752, Recall: 0.742, Precision: 0.751, and F1 score: 0.739. Our proposed model had the following values: Accuracy: 0.800, Recall: 0.767, Precision: 0.842, and F1 score: 0.792. Thus, our accuracy was higher than BMI as well as BIA. Our model can be used for obesity management through 3D body scans.

Measurement accuracy and reliability of self-reported versus measured weight and height among adults in Malaysia: Findings from a nationwide blood pressure screening programme

Most studies reporting prevalence of obesity use actual weight and height measurements. Self-reported weight and height have been used in epidemiological studies as they have been shown to be reliable, convenient, and inexpensive alternatives to actual measurements. However, the accuracy of self-reported weight and height might vary in different regions because of the difference in health awareness and social influences. This study aims to determine the accuracy and reliability of self-reported weight and height compared to actual measured weight and height among adults in Malaysia. This was a cross-sectional study conducted at the community level during blood pressure screening campaigns. Participants self-reported their weight and height in a questionnaire survey. Their weight and height were validated using measurements by researchers on the same setting. Body mass index (BMI) was defined as underweight (<18.5kg/m2), normal (18.5-22.9 kg/m2), overweight (23-27.4 kg/m2) and obesity (≥27.5 kg/m2). Bland-Altman analysis, intraclass correlation coefficients and weighted Kappa statistics were used to assess the degree of agreement between self-reported and measured weight and height. A total of 2781 participants were recruited in this study. The difference between the mean self-reported and measured weight and height were 0.4 kg and 0.4 cm respectively. Weighted Kappa statistics analysis showed that there was a substantial agreement between the BMI classifications derived from self-reported and actual measurement (ҡ = 0.920, p<0.001). There was no marked difference in the sensitivity and specificity of self-reported BMI among Malaysian adults by gender. We observed substantial agreement between self-reported and measured body weight and height within a sample of Malaysian adults. While self-reported body weight showed weaker agreement with actual measurements particularly for obese and overweight individuals, BMI values derived from self-reported weight and height were accurate for 88.53% of the participants. We thus conclude that self-reported height and weight measures may be useful for tracking and estimating population trends amongst Malaysian adults.

Association between bodyweight perception, nutritional status, and weight control practices: A cross-sectional analysis from the Chilean Health Survey 2016–2017

This research aimed (1) to examine the agreement between body mass index (BMI)-based nutritional status and perceived nutritional status overall and by socio-demographic factors and (2) to state the association between the accuracy of weight perception and weight control practices in the Chilean adult population. A population-based cross-sectional study was carried out with 5,192 Chilean adult participants from the Chilean National Health Survey 2016–2017. Agreement between BMI-based weight status and body weight perception for the total sample and across subgroups was determined using the weighted kappa coefficient. The agreement between BMI-based and perceived nutritional status of the total sample was fair (kappa = 0.38). A higher rate of weight perception accuracy was identified in women, younger respondents, and participants with higher education, a higher income, and from urban areas than their counterparts. Respondents with overweight or obesity tended to underestimate their nutritional status. Actions to lose weight were higher in those who had the right perception of their overweight/obesity condition and those who overestimated their body weight, regardless of their nutritional status. In all groups, weight loss behaviors were more related to the perceived than the BMI-based nutritional status. The consequences of accurate perception of the nutritional status are discussed including its effects on body weight and mental health.

How Unawareness of Weight Excess Can Increase Cardiovascular Risk?

Background: Obesity is a chronic disease with high prevalence in all age groups. Many overweight and obese people seem to be unaware of excess body weight. Aim: Analysis of people affected by the misperception of excess body weight and their eating behaviors simultaneously with selected health parameters. Methods: The study was conducted in 2017–2019 among 658 participants aged 20–79 from the population study—Bialystok PLUS (Poland). Results were based on clinical examinations and questionnaires. Results: Unawareness of overweight and obesity is common among adults (21.7%). Participants unaware of their overweight and obesity presented much higher risk factors. A high cardiovascular risk profile was observed more often among people not aware of overweight and obesity than among normal weight people (23.0% vs. 10.0%) as well as more common asymptomatic carotid artery atherosclerosis (49.7% vs. 31.3%). The subjective perception of overweight and obesity based on BMI (body mass index) was equal to 26.4 kg/m2 in women and 27.9 kg/m2 in men. The assessment of their diet was less favorable than that of people with normal weight. Conclusions: Unawareness of one’s excessive weight and its health consequences may lead to hesitancy to apply a healthy lifestyle and hence increase the cardiovascular risk in a substantial part of society. Therefore, it should be considered a part of the cardiovascular disease risk spectrum. Measurement of BMI and discussion about its health implications should be a routine procedure during healthcare contacts.

Animal obesity: What insights can a one health approach offer when it comes to veterinarians 'making every contact count'?

There is an overweight/obesity crisis in both human and companion animal populations globally. Veterinarians have an ethical obligation to protect animal welfare and, therefore, have a duty to intervene by supporting their clients in changing care plans to mitigate and prevent pet overweight/obesity. Currently, there is limited evidence in veterinary contexts for when and how this can be done effectively. In contrast, a more comprehensive body of literature has been developed on how human healthcare practitioners 'make every contact count' (MECC). This review begins by briefly exploring the cross-species multifactorial causes of overweight/obesity, before considering the literature regarding whether veterinarians reliably address overweight/obesity and the obstacles they encounter. The review then explores the evidence from human healthcare contexts in terms of how person-centred and health 'coaching-style' MECC interventions have supported weight management in adult and child populations and the barriers practitioners face when implementing these interventions. The final section interprets this literature to provide a fresh 'lens' through which veterinarians' concerns can be understood. Recommendations are made for enhancing veterinarians' capacity to develop the knowledge and skills needed for successful outcomes when MECC. Opportunities for developing local multi-stakeholder/agency teams taking a 'one health' approach are considered.

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.

Barriers in Adopting Healthy Body Weight Among Malaysian Population: A Cross-Sectional Study of Body Weight Perception and Misperception Versus Actual Body Weight

Perception of body weight has been recognized as an important barrier in the adoption of healthy lifestyles. Several factors affect perception of body weight, but the outcomes have been varied. This study aimed to study the perception and misperception of body weight and its association with the measured body mass index. A clinic-based cross-sectional study was done in the clinic using systematic sampling. Data were collected by using a self-administered questionnaire consisting of the sociodemographic profile, body weight perception question adopted from Weight Management Questionnaire and Youth Risk Behavior Surveillance System (YRBSS) 1991-2017. The prevalence of body weight misperception in the sample population was 58.6%. Most of the respondents were overweight (33.9%) and obese (33.9%). Respondents aged 25 years and older were 2.98 times more likely to have misperception compared with other age groups (95% CI: 1.21-3.19, P = .006). Divorced respondents were 4.70 times more likely to have body misperception compared with married respondents (95% CI 1.44-15.32, P = 0.01). This study showed that misperception of body weight could be influenced by reversible factors and measured body mass index. Hence, the rectification of these misperceptions is important in the clinical setting especially in these vulnerable groups of respondents.

COVID- 19 outbreak: Does confinement have any impact on weight change perception?

Purpose

This study aimed to evaluate the relationship between factors related to COVID-19 confinement (i.e., fear of COVID-19, anxiety, anger, boredom, eating disorders, and duration of confinement) and weight perception in a sample of the Lebanese population.

Methods

A cross-sectional web-based survey carried out at a one-time point between April 3 and 18, 2020, enrolled 407 participants. Due to the imposed lockdown, respondents self-reported their weight and height. One dichotomized question (positive/negative) assessed the perception of weight change (yes = change perception, and no = no change perception). The variation in BMI was calculated by subtracting the estimated weight during confinement from the estimated weight before.

Results

No significant variation in BMI was detected before and during the confinement (p = 0.40), while a perceived weight change was found in 212 (52.1%) participants. The regression analysis showed that higher fear of COVID-19 score (ORa = 0.96) and higher self-reported weight change (ORa = 0.47) were associated with lower weight change perception. However, longer confinement duration (ORa = 1.07), higher anxiety (ORa = 1.05), and high eating concerns (ORa = 1.81) were associated with higher weight change perception.

Conclusion

Our results revealed that both the fear of COVID-19 and self-reported weight change were negatively associated with weight change perception, while higher anxiety and a longer duration of confinement correlated with a higher weight change perception. Further studies are necessary to confirm our findings.

The association between BMI self-selection, self-reported BMI and objectively measured BMI

Background: It is challenging to measure BMI accurately in population studies because it is an expensive and time-consuming task. As a result, subjectively measured BMI, calculated from self-reported height and weight, which we know to be inaccurate, is often used. The purpose of this study is to determine whether using a different, subjective method of measuring BMI, BMI self-selection, would be more accurate. BMI self-selection is determined by asking participants to place themselves in one of the BMI categories, underweight, normal weight, overweight or obese. Methods: A quantitative survey conducted in the outpatient departments of two hospitals in the South West of Ireland. Participants >18 years were included. Pregnant women were excluded. The final sample included 70 participants. Survey completion, including self-reported height and weight and BMI self-selection, preceded the objectively measured weight and height. Demographic and lifestyle factors were also recorded. Results: 59% of the sample were overweight or obese –63% of females and 54% of males. The sensitivity for correct BMI self-selection for normal weight, overweight and obese categories was 90%, 36% and 33% respectively. The sensitivity for BMI categories calculated from self-reported height and weight was 83%, 57% and 59% respectively. In analysis, age, regular alcohol consumption, unhealthy diet and lower levels of physical activity were all associated with underestimation of BMI. Conclusion: BMI self-selection is an accurate tool when used with normal weight individuals but shows poorer ability to demonstrate accurate measurement in overweight and obese BMI categories. It is inferior to the traditional self-reported BMI method for measuring BMI levels in the general population. Presently, we recommend continuing with self-reported BMI for BMI measurement in large population studies. However, further testing of BMI classification in larger studies is suggested and investigation into alternative objective methods of measurement is warranted.

Trajectories of eating behavior during COVID-19 lockdown: Longitudinal analyses of 22,374 adults

BACKGROUND & AIMS

The COVID-19 pandemic has led to the implementation of stay-at-home and lockdown measures. It is currently unknown if the experience of lockdown leads to long term changes in individual's eating behaviors. The objectives of this study were: i) to derive longitudinal trajectories of change in eating during UK lockdown, and ii) to identify risk factors associated with eating behavior trajectories.

METHOD

Data from 22,374 UK adults from the UCL COVID-19 Social study (a panel study collecting weekly data during the pandemic) were analyzed from 28th March to 29th May 2020. Latent Class Growth Analysis was used to derive trajectories of change in eating. These were then associated with prior socio-economic, health-related and psychological factors using multinomial regression models.

RESULTS

Analyses suggested five trajectories, with the majority (64%) showing no change in eating. In contrast, one trajectory was marked by persistently eating more, whereas another by persistently eating less. Overall, participants with greater depressive symptoms were more likely to report any change in eating. Loneliness was linked to persistently eating more (OR = 1.07), whereas being single or divorced, as well as stressful life events, were associated with consistently eating less (OR = 1.69). Overall, higher education status was linked to lower odds of changing eating behavior (OR = 0.54-0.77). Secondary exploratory analyses suggest that participants self-reported to have overweight were more commonly categorised into the group consistently eating more, whereas participants with underweigh persistently ate less.

CONCLUSION

In this study, we found that one third of the sample report changes in quantities eaten throughout the first UK lockdown period. Findings highlight the importance of adjusting public health programs to support eating behaviors in future lockdowns both in this and potential future pandemics. This is particularly important as part of on-going preventive efforts to prevent nutrition-related chronic diseases.

Body satisfaction of female staff members working in primary schools in Mangaung, Bloemfontein

Background

The role of psychosocial determinants of overweight and obesity is receiving attention in South African literature. South Africans tend to exhibit an inaccurate perception of their body weight.

Aims

The purpose of this study was to determine levels of body satisfaction in female staff members working in primary schools in Mangaung, Bloemfontein.

Setting

Mangaung is a peri-urban area in Bloemfontein in the Free State province of South Africa.

Methods

Female staff members over the age of 18 years were invited to participate in the study. Anthropometric measurements of weight and height were measured using standardised techniques to calculate body mass index (BMI). Waist circumference (WC) was measured as an indicator of risk for non-communicable diseases (NCDs). Weight satisfaction was measured using a structured, self-administered body satisfaction questionnaire.

Results

The majority of the staff members (71.3%) were classified as obese (BMI > 30 kg/m²); similarly a majority of them were at a high risk of NCDs according to WC. A little over a third (34.8%) of the women perceived themselves to have a normal weight. The majority of the women who had no concern with their body image were obese (59.1%) and only 8.7% of the women in this study were markedly concerned with their body image. Of the 60.9% of women who reported having attempted to lose weight, 38.6% reported using exercise and 30.0% used water as a weight loss method.

Conclusion

Women's awareness of a healthy weight should be promoted if efforts to achieve weight loss are to be effective.

Association between obesity and periodontitis in Australian adults: A single mediation analysis

BACKGROUND

Obesity and periodontitis are conditions with high burden and cost. This study aims to unfold the proposed pathways through which the effect of obesity in the presence of health behaviors (dental visiting behavior and diabetes) increases the risk of periodontitis?

METHODS

The effect decomposition analysis using potential outcome approach was used to determine obesity-related periodontitis risk using the Australian National Survey of Adult Oral Health 2004 to 2006. A single mediation analysis for exposure, "physical-inactivity induced obesity," mediator "dental visiting behavior (a de facto measure of healthy behaviors)," outcome "periodontitis," and confounders "age, sex, household income, level of education, self-reported diabetes, alcohol-intake and smoking," was constructed for subset of 3,715 participants, aged ≥30 years. Proposed pathways were set independently for each risk factor and in synergy. The STATA 15 Paramed library was used for analysis. Sensitivity analysis was conducted to detect unmeasured confounding using non-parametric approach.

RESULTS

The average treatment effect of physical inactivity induced obesity to periodontitis is 14%. Pathway effect analysis using potential outcomes illustrated that the effect of obesity on periodontitis that was not mediated through poor dental visiting behavior was 10%. Indirect effect of obesity-mediated through poor dental visiting behavior on periodontitis was 3%.

CONCLUSIONS

The direct effect of physical inactivity induced obesity on periodontitis was higher than the indirect effect of obesity on periodontitis through dental visiting behavior. Establishing a pathway of causal relationship for obesity and periodontitis could help in developing management strategies that focuses on mediators.

Mediating role of body-related shame and guilt in the relationship between weight perceptions and lifestyle behaviours

INTRODUCTION

A substantial proportion of individuals with overweight or obesity perceive themselves as 'too heavy' relative to 'about right'. Perceiving one's weight as 'too heavy' is associated with lower levels of physical activity and higher levels of sedentary behaviour. However, the mechanisms underpinning the associations between weight perception and lifestyle behaviours have not been identified. Based on theoretical tenets and empirical evidence, the self-conscious emotions of shame and guilt may mediate these associations.

METHODS

Participants were young adults (n = 618, Mage = 24.0 ± .6 years) who provided data on weight, weight perception, body-related shame and guilt, physical activity and screen time.

RESULTS

Mediation analyses using the PROCESS macro indicated that shame and guilt significantly mediated the relationships between weight perception and physical activity and shame significantly mediated the relationship between weight perception and screen time.

CONCLUSIONS

These findings provide preliminary evidence that self-conscious emotions may be mechanisms by which weight perception influences physical activity and sedentary behaviour in young adults. However, longitudinal investigations of this mechanism are needed.

Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study

OBJECTIVE

To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland.

SETTING

Seven National Health Service (NHS) Scotland primary care centres.

PARTICIPANTS

A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated.

DESIGN AND METHODOLOGY

A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives.

RESULTS

(1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors.

CONCLUSIONS

Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

Adolescents' Reactions to Adverts for Fast-Food and Confectionery Brands That are High in Fat, Salt, and/or Sugar (HFSS), and Possible Implications for Future Research and Regulation: Findings from a Cross-Sectional Survey of 11-19 Year Olds in the United Kingdom

The influence that marketing for foods high in fat, salt, and/or sugar (HFSS) has on adolescents extends beyond a dose-response relationship between exposure and consumption. It is also important to explore how marketing shapes or reinforces product/brand attitudes, and whether this varies by demography and Body Mass Index (BMI). To examine this, a cross-sectional survey was conducted with 11-19 year olds in the United Kingdom (n = 3348). Participants watched 30 s video adverts for a fast-food and confectionery brand. For each advert, participants reported reactions on eight measures (e.g., 1 = Makes [product] seem unpopular choice-5 = Makes [product] seem popular choice), which were binary coded based on whether a positive reaction was reported (Yes/No). At least half of adolescents had positive reactions to both adverts for 5/8 measures. Positive reactions had associations with age, gender and, to a lesser extent, BMI. For example, 11-15 year olds were more likely than 16-19 year olds to report appeal to their age group for the fast-food (OR = 1.33, 95% CI: 1.13-1.58) and confectionery advert (OR= 1.79, 95% CI: 1.51-2.11). If these reactions are typical of other HFSS products, future research and regulatory change should examine whether additional controls on the content of HFSS marketing, for example mandated health or nutritional information and revised definitions of youth appeal, offer additional protection to young people.

The role of drive for thinness in the association between weight status misperception and disordered eating

Weight status misperception is related to disordered eating outcomes, but little research has explored the differential impacts of misperception directionality, nor factors that explain these relationships. Self-Discrepancy Theory applied to body image gives a framework to how weight status over-perception may prompt a drive for thinness, which in turn may be important in the development of disordered eating cognitions and behaviors.

AIMS

To that end, the current study tested whether drive for thinness may account for the association between direction of weight status misperception and disordered eating behaviors.

METHODS

Young adults (N = 522) completed measures identifying weight status perception (accurate, under-, and over-perception), drive for thinness, and disordered eating attitudes and behaviors (appearance satisfaction, restrained, uncontrolled, and emotional eating). Indirect effect models with drive for thinness entered as the intervening variable were estimated for each outcome.

RESULTS

Drive for thinness accounted for the associations between weight status misperception and all outcomes. In general, compared to either accurate or under-perception, over-perception of weight status was associated with more disordered eating attitudes and behaviors via higher drive for thinness.

CONCLUSIONS

Consistent with Self-Discrepancy Theory, drive for thinness emerged as a possible mechanism of the association between weight status misperception and disordered eating outcomes. Findings suggest potential utility in targeting drive for thinness, as opposed to accuracy of weight status perception, for prevention of disordered eating attitudes and behaviors, including those that may contribute to weight gain.

Short term effects of a weight loss and healthy lifestyle programme for overweight and obese men delivered by German football clubs

Numbers of obese and overweight people continue to grow in Germany as they do worldwide. Men are affected more often but do less about it and few weight loss services attract men in particular. To evaluate the effectiveness of a men-only weight loss programme, Football Fans in Training (FFIT), delivered by football clubs in the German Bundesliga, we did a non-randomized trial with a waiting list control group. Participants' data were collected between January 2017 and July 2018. FFIT is a 12-week, group-based, weight loss programme and was delivered in stadia and facilities of 15 professional German Bundesliga clubs. Inclusion criteria were age 35-65 years, BMI ≥ 28 and waist circumference ≥100 cm. Clubs recruited participants through Social Media, E-Mail and match day advertisement. 477 German male football fans were allocated to the intervention group by order of registration date at their respective clubs. 84 participants on the waiting list were allocated to the control group. Primary outcome was mean difference in weight loss with treatment condition over time as independent variable. We performed a multilevel mixed-effects linear regression analysis. Results were based on Intention-to-treat (ITT) analysis with Multiple Imputation. After 12 weeks, the mean weight loss of the intervention group adjusted for club, course and participants' age was 6.24 kg (95% CI 5.82-6.66) against 0.50 kg (-0.47-1.49) in the comparison group (p < 0.001). The results indicate that Football Fans in Training effectively helped German men to reduce their weight and waist circumference.

Does perceived overweight increase risk of depressive symptoms and suicidality beyond objective weight status? A systematic review and meta-analysis

Obesity is associated with a significant disease burden, but whether recognising as opposed to failing to recognise personal overweight is beneficial or detrimental to mental health is unclear. Here we examine the associations between perceived overweight and depressive symptoms and suicidality. A systematic search of three electronic databases yielded 10,398 unique records, from which 32 studies (110 observations) were eligible for inclusion. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome using random effects meta-analyses and potential publication bias was examined. Perceived overweight was associated with an increased risk of depressive symptoms (OR: 1.42, CI: 1.31, 1.54 p <.0001, N >128,585) and suicidality (OR: 1.41, CI: 1.28, 1.56, p <.0001, N = 133,576) in both cross-sectional and longitudinal studies. The association between perceived overweight and poorer mental health was observed irrespective of study origin, participant age (children vs. adults), gender, and whether or not a person was objectively overweight. The pooled statistical relationship between objective weight status and poorer mental health was attenuated to non-significance when perceived overweight was accounted for, suggesting that the detrimental effect of overweight on mental health is largely dependent on whether or not a person identifies as overweight.

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.

Visual body size norms and the under-detection of overweight and obesity

Objectives

The weight status of men with overweight and obesity tends to be visually underestimated, but visual recognition of female overweight and obesity has not been formally examined. The aims of the present studies were to test whether people can accurately recognize both male and female overweight and obesity and to examine a visual norm-based explanation for why weight status is underestimated.

Methods

The present studies examine whether both male and female overweight and obesity are visually underestimated (Study 1), whether body size norms predict when underestimation of weight status occurs (Study 2) and whether visual exposure to heavier body weights adjusts visual body size norms and results in underestimation of weight status (Study 3).

Results

The weight status of men and women with overweight and obesity was consistently visually underestimated (Study 1). Body size norms predicted underestimation of weight status (Study 2) and in part explained why visual exposure to heavier body weights caused underestimation of overweight (Study 3).

Conclusions

The under-detection of overweight and obesity may have been in part caused by exposure to larger body sizes resulting in an upwards shift in the range of body sizes that are perceived as being visually 'normal'.

Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England

OBJECTIVE

To estimate obesity prevalence among healthcare professionals in England and compare prevalence with those working outside of the health services.

DESIGN

Cross-sectional study based on data from 5 years (2008-2012) of the nationally representative Health Survey for England.

SETTING

England.

PARTICIPANTS

20 103 adults aged 17-65 years indicating they were economically active at the time of survey classified into four occupational groups: nurses (n=422), other healthcare professionals (n=412), unregistered care workers (n=736) and individuals employed in non-health-related occupations (n=18 533).

OUTCOME MEASURE

Prevalence of obesity defined as body mass index ≥30.0 with 95% CIs and weighted to reflect the population.

RESULTS

Obesity prevalence was high across all occupational groups including: among nurses (25.1%, 95% CI 20.9% to 29.4%); other healthcare professionals (14.4%, 95% CI 11.0% to 17.8%); non-health-related occupations (23.5%, 95% CI 22.9% to 24.1%); and unregistered care workers who had the highest prevalence of obesity (31.9%, 95% CI 28.4% to 35.3%). A logistic regression model adjusted for sociodemographic composition and survey year indicated that, compared with nurses, the odds of being obese were significantly lower for other healthcare professionals (adjusted OR (aOR) 0.52, 95% CI 0.37 to 0.75) and higher for unregistered care workers (aOR 1.46, 95% CI 1.11 to 1.93). There was no significant difference in obesity prevalence between nurses and people working in non-health-related occupations (aOR 0.94, 95% CI 0.74 to 1.18).

CONCLUSIONS

High obesity prevalence among nurses and unregistered care workers is concerning as it increases the risks of musculoskeletal conditions and mental health conditions that are the main causes of sickness absence in health services. Further research is required to better understand the reasons for high obesity prevalence among healthcare professionals in England to inform interventions to support individuals to achieve and maintain a healthy weight.

Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory

Although overweight and obesity are widespread across most of the developed world, a considerable body of research has now accumulated, which suggests that adiposity often goes undetected. A substantial proportion of individuals with overweight or obesity do not identify they are overweight, and large numbers of parents of children with overweight or obesity fail to identify their child as being overweight. Lay people and medical practitioners are also now poor at identifying overweight and obesity in others. A visual normalization theory of the under-detection of overweight and obesity is proposed. This theory is based on the notion that weight status is judged relative to visual body size norms. Because larger body sizes are now common, this has caused a recalibration to the range of body sizes that are perceived as being 'normal' and increased the visual threshold for what constitutes 'overweight'. Evidence is reviewed that indicates this process has played a significant role in the under-detection of overweight and obesity. The public health relevance of the under-detection of overweight and obesity is also discussed.

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

BACKGROUND/OBJECTIVES

Weight perception, especially misperception, might affect health-related quality of life (HRQoL); however, related research is scarce and results remain equivocal. We examined the association between HRQoL and weight misperception by comparing obesity level as measured by body mass index (BMI) and weight perception in Korean adults.

METHODS

Study subjects were 43 883 adults aged 19 years or older from cycles IV (2007-2009), V (2010-2012) and VI (2013-2014) of the Korean National Health and Nutrition Examination Survey. Multiple regression analyses comprising both logit and tobit models were conducted to evaluate the independent effect of obesity level as measured by BMI, weight perception and weight misperception on HRQoL after adjusting for demographics, socioeconomic status and number of chronic diseases. We also performed multiple regressions to explore the association between weight misperception and HRQoL stratified by BMI status.

RESULTS

Obesity level as measured by BMI and weight perception were independently associated with low HRQoL in both separate and combined analyses. Weight misperception, including underestimation and overestimation, had a significantly negative impact on HRQoL. In subgroup analysis, subjects with BMI ranges from normal to overweight who misperceived their weight also had a high risk of low HRQoL. Overestimation of weight among obese subjects associated with low HRQoL, whereas underestimation of weight showed no significant association.

CONCLUSIONS

Both obesity level as measured by BMI and perceiving weight as fat were significant risk factors for low HRQoL. Subjects who incorrectly perceived their weight relative to their BMI status were more likely to report impaired HRQoL, particularly subjects with BMI in the normal to overweight range. Based on these findings, we recommend political and clinical efforts to better inform individuals about healthy weight status and promote accurate weight perception.

Does Knowing Hurt? Perceiving Oneself as Overweight Predicts Future Physical Health and Well-Being

Identifying oneself as being overweight may be associated with adverse health outcomes, yet prospective tests of this possibility are lacking. Over 7 years, we examined associations between perceptions of being overweight and subsequent health in a sample of 3,582 U.S. adults. Perceiving oneself as being overweight predicted longitudinal declines in subjective health ( d = -0.22, p < .001), increases in depressive symptoms ( d = 0.09, p < .05), and raised levels of physiological dysregulation ( d = 0.24, p < .001), as gauged by clinical indicators of cardiovascular, inflammatory, and metabolic functioning. These associations remained after controlling for a range of potential confounders and were observed irrespective of whether perceptions of being overweight were accurate or inaccurate. This research highlights the possibility that identifying oneself as overweight may act independently of body mass index to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight-feedback interventions may have unforeseen adverse consequences.

Lack of Reality: Positive Self-Perceptions of Health in the Presence of Disease

The aim of this study was to determine if adults in Central Queensland have accurate self-perceptions of health. Data were collected as part of the 2010 Central Queensland Social Survey (N = 1289). Overweight/obesity is considered a health disorder and was determined using body mass index. Disease states were determined by asking respondents if they have: heart disease, high/low blood pressure, high cholesterol, high triglycerides, thyroid disorder, diabetes, and osteopenia/osteoporosis. Self-perceptions of health were assessed by asking, “Would you say that in general your health is” poor, fair, good, very good, excellent, don’t know, and no response. An accurate health perception occurred if: (1) A respondent with a disease/health disorder reported that their health was poor/fair or (2) A respondent without a disease/health disorder reported that their health was good/very good/excellent. The proportions of people with an accurate health perception by disease/health disorder were compared using a χ² test. A proportion ratio (PR) with a 95% confidence interval (CI) was calculated for each disease/health disorder. A logistic regression analysis was performed to examine the association between each disease/health disorder and health perception using gender, age, education, physical activity level, and smoking status as covariates. More than 50% of residents with each disease/health disorder reported their health to be good/very good/excellent. Residents with each disease/health disorder were less likely to have an accurate health perception than those without the corresponding disease/health disorder prior to (p < 0.001) and following adjustment of the covariates (p < 0.001). Our results suggest that overweight/obesity and prevalence of disease are not being recognized as unhealthy, which contradicts established definitions of health.

Overweight or about right? A norm comparison explanation of perceived weight status

Objectives

Body‐weight norms may explain why personal evaluations of weight status are often inaccurate. Here, we tested a ‘norm comparison’ explanation of weight status perceptions, whereby personal evaluations of weight status are biased by perceived body‐weight norms.

Methods

Study 1 examined whether perceptions of how one's own body weight compares to an average person predict personal evaluations of weight status. Study 2 examined whether manipulating perceptions of how one's own body weight compares to an average person influences whether or not a person identifies their own weight status as being overweight.

Results

In Study 1, if participants rated their body weight as being similar to the body weight of an average person, they were less likely to identify their weight status as being overweight. In Study 2, participants that were led to believe that their body weight was heavier than the average person were more likely to perceive their own weight status as being overweight.

Conclusions

Personal perceptions of weight status are likely to be shaped by a ‘norm comparison’ process. As overweight becomes more normal, underestimation of weight status amongst individuals with overweight and obesity will be more common.