Association between weight perception and psychological distress

Background: Obesity is a well-known cause of cardiovascular disease burden and premature death, but effects on depressive symptoms remain equivocal. Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight, rather than those who perceive themselves as having an acceptable weight. Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress.

Methods: We conducted a cross-sectional study using data from the Australian National Health Survey 2004–2005 (N=17 253). All variables were collected by self-report. Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95% confidence intervals (95% CI) for medium (Kessler Psychological Distress Scale (K10) scores of 20–29) and high (K10 scores of 30–50) psychological distress (compared with K10 scores of 10–19 as the reference) associated with weight status (standard body mass index (BMI) cutoffs for underweight, overweight and obesity vs normal weight), weight perception (perceived underweight and overweight vs acceptable weight) and weight misperception (incorrect with BMI vs correct with BMI) adjusting for numerous important covariates.

Results: Overweight and underweight perception increased the odds of medium (40 and 50%) and high (50 and 120%) psychological distress, whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis. Gender, alcohol consumed per week and post-school education were not significant covariates (at P<0.10 level).

Conclusions: Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women. Well-designed prospective studies are still needed to determine whether weight perceptions cause psychological distress, and if so, whether symptoms are significantly reduced following effective intervention.

Weight perception in overweight adolescents: Associations with body change intentions, diet and physical activity

This study examined the association of weight perception and weight satisfaction with body change intentions and weight-related behaviours in 928 overweight adolescents (aged 11-18 years, 44% female). Accurate perception of weight was associated with trying to lose weight and inaccurate perception was associated with trying to gain muscle. Weight dissatisfaction was associated with trying to lose weight and gain muscle. Accurate weight perception and weight dissatisfaction were not associated with healthy weight-related behaviours. Awareness of overweight and body dissatisfaction may be detrimental to the adoption of healthy weight-control behaviours. Interventions with overweight adolescents should encourage body satisfaction, rather than promoting awareness of overweight.

Weight status and perception barriers to healthy physical activity and diet behavior

Background : Physical inactivity and insufficient fruit and vegetable consumption are key risk factors for obesity and noncommunicable diseases. Weight perceptions may affect physical activity and diet behaviors. We report current prevalence estimates of Australian adults meeting recommended levels of leisure-time physical activity (LTPA) (150 min/week or more of at least moderate-intensity physical activity (including walking) on 5 days/week) and fruit (2 servings/day) and vegetable (5 servings/day) consumption for health benefits, by weight status and perceptions.
Methods : We conducted a cross-sectional survey analysis of data for 16 314 adults from the Australian National Health Survey 2004–2005. All variables were collected by self-report. Weighted estimates were age- and gender-specific, and data were analyzed using logistic regression with acceptable weight referent categories, adjusting for covariates.
Results : Among acceptable, overweight and obese adults, the prevalence of LTPA was 26.8, 26.1 and 19.3% for men, and 27.7, 23.7 and 19.7% for women, respectively. Approximately 55 and 15% of adults consumed sufficient fruit servings/day and vegetable servings/day, respectively, and less than 5% of adults met combined LTPA and diet guidelines. Overweight decreased the odds ratio for LTPA among women but not men, and obesity decreased the odds ratio for LTPA among both men and women. Overweight perception conferred odds ratios of 0.83 (95% CI 0.70–0.97, P=0.021) for overweight men, and of 0.74 (95% CI 0.62–0.88, P=0.001) and 0.69 (95% CI 0.59–0.80, P<0.001) for obese men and women, respectively; for LTPA, whereas no significant associations were found for acceptable weight perception. No consistent associations between weight status or perceptions and diet behaviors were found.
Conclusions : Overweight perception may be another barrier to physical activity participation among men and women with excess body weight. Public health strategies might need to focus on overcoming weight perception as well as weight status barriers to adopting healthy physical activity behaviors.

Which measures of adiposity are related to Australian adolescent's perception of their weight?

Aim
To determine which measurement of adiposity – standardised body mass index (BMI-z), waist circumference or body fat percentage – is most closely correlated with adolescents' weight perception and whether this differs by gender.

Methods
Weight and height (used to calculate BMI-z), waist circumference and body fat percentage were measured in 2278 adolescents aged between 12 and 16 and compared with self-reported weight status.

Results
The distribution of subjects across the three weight categories (underweight, healthy weight and overweight) differed significantly between BMI-z, waist circumference and body fat percentage (p < 0.001). BMI-z was most closely aligned with perceived weight status in boys and girls, and waist circumference was also a good correlate of weight perception in boys. Boys were more likely than girls to underestimate their weight when it was defined by BMI-z; however, girls were equally likely to underestimate their weight when it was defined by waist circumference. The majority of adolescents underestimated their weight status when it was defined by BF%.

Conclusion
BMI-z is the closest correlate of self-perceived weight status. In the absence of internationally accepted reference values for waist circumference, BMI-z is the most appropriate measure to verify weight perception.

Perception of weight status in Australian adolescents

 This thesis examined Australian adolescents’ perception of their weight and the association of weight perception with weight related behaviours. Overall, this thesis indicated that many adolescents misperceive their weight status and that this is related to gender specific body ideals. Accurate perception of weight did not promote positive health behaviours.

Characteristics of energy under-reporting in children and adolescents

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3–17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006–7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3–10 and 11–17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3–10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet–disease associations in children.

Health implications of body size perception and weight tolerance in older adults

Obesity is a well-recognized risk factor for Type II diabetes and cardiovascular disease. In this study a high percentage of older adults were either overweight or obese. The aims were to assess older adults' tolerance for excess weight, and to compare self-perceptions of an acceptable weight with national guidelines. Participants were 76 males and females aged between 65 and 97 years. Results indicated that 60 per cent accurately identified their own body size. Further, participants were more tolerant of excess weight in males compared to females, regardless of age. It was concluded that this cohort remains vulnerable to weight-related illnesses.

Biopsychosocial correlates of weight status perception in Australian adolescents

This study examined the utility of the biopsychosocial model to predict accuracy of weight status perception among Australian adolescents. The factors included in this framework were: age, gender, and BMI-z (biological factors); satisfaction with body weight and shape (psychological factors); socioeconomic status, peer weight (social factors). Cross-sectional data, including measured height and weight, and self-reported weight status, was obtained from 2954 adolescents (mean age = 14.6, 56% male) who participated in the It's Your Move! study. Accuracy of weight status perception was associated with gender, BMI-z, SES, and weight and shape satisfaction. Gender differences in weight status perception were moderated by satisfaction with weight. In boys, weight satisfaction was associated with perceived healthy weight; in girls, it was associated with perceived healthy weight and underweight. Moderately overweight adolescents are most at risk of underestimating their weight status and could benefit from education about the boundaries of the healthy weight range.

Does maternal concern about children's weight affect children's body size perception at the age of 6.5? A community-based study

OBJECTIVE: Though overweight is often established by school entry, not all mothers of such children report weight concerns. Enhancing concern might assist lifestyle change, but could lead to child body dissatisfaction. We investigated (i) perceived/desired body size and body dissatisfaction in mothers and their 6.5-year-old children, and (ii) the impact of earlier maternal concern about overweight on children's body mass index (BMI) status and body dissatisfaction. DESIGN: Prospective community study. SETTING: Melbourne, Australia. SUBJECTS: 317 mother-child dyads. MAIN EXPOSURES: Child and maternal BMI (kg m(-2)) at 4.0 and 6.5 years; maternal concern about child overweight at 4.0 years. OUTCOME MEASURES: Paired perceived and desired body size on 7-point figural rating scales self-reported by mothers and children, and reported by mothers regarding children; dissatisfaction ('desired' minus 'perceived') score. RESULTS: For all three actual BMI perceived size pairings (mother self-report, mother's report on child and child self-report), BMI correlated with perceived body size (r=0.82 (mother self-report); r=0.65 (mother reporting on child); r=0.22 (child self-report); all P<0.001). Similarly, all three dissatisfaction scores were greater with increasing BMI status. Children's own dissatisfaction scores correlated with their actual BMI, but were not related to mothers' own body dissatisfaction scores or with mothers' dissatisfaction with children's body size. Maternal concern about overweight at the age of 4 years was not associated with BMI change, or child body dissatisfaction by the age of 6.5. Most mothers of overweight and obese children (88 and 90%, respectively) regarded their child as the middle figure (that is, 4) or thinner. CONCLUSIONS: Despite low rates of recognition of child overweight, maternal perceptions of the child's body correlated strongly with the child's actual BMI. Maternal concerns about child BMI did not appear to impact on child BMI change or child body dissatisfaction.

The relationship between quality of life and perceived body weight an dieting history in Dutch men and women

OBJECTIVES: (1) To study the relationship between quality of life (QoL) and measured and perceived weight and dieting history in Dutch men and women; (2) to assess the effect of weight loss over a 5 y period on QoL.

DESIGN: A cross-sectional study, in a sub-sample longitudinal over 5 y.

SUBJECTS: A total of 2155 men and 2446 women, aged 20-59 and recruited from the general population from three towns in The Netherlands.

MEASUREMENTS: Body weight, height, self-administered questionnaire including questions concerning demographic variables and weight loss practices as part of the Dutch Monitoring project on Risk Factors for Chronic Disease (MORGEN). The Rand-36 questionnaire was used as the QoL measure.

RESULTS: In men, measured overweight (body mass index, BMI>25 kg=m2) was not associated with any dimension of QoL after adjustment for age, educational level and perceived overweight. Perceived overweight was related to reduced scores for general health and vitality. This relationship was independent of measured obesity. A history of repeated weight loss was associated with reduced scores for role functioning due to both physical and emotional problems. In women, measured overweight was significantly associated with lower scores for five out of eight QoL dimensions and perceived overweight with three: general health, vitality and physical functioning. A history of frequent weight loss was related to significantly reduced scores in six dimensions. However, only with history of frequent weight loss, and uniquely in women, was there a significant reduction in
scores on mental health and limited emotional role functioning. Measured and perceived overweight and frequent weight loss were all related to reduced scores for physical functioning. Longitudinal data indicate that in older women weight gain of 10% body weight or more was associated with a significant deterioration in QoL.

CONCLUSIONS: When looking at measures of QoL in relation to overweight it is important to separate the effects of perception of weight status and history of weight loss. We observed that the latter two factors were associated with reduced scores on several dimensions of QoL, particularly in women. These associations were observed to be independent of body weight. International Journal of Obesity (2001) 25, 1386 – 1392

The development of young adolescent boys' weight and shape concerns

This thesis' longitudinal study found that young adolescent boys' reported significant concerns with their weight and shape, particularly with respect to having a more muscular but lean physique. The strongest predictors of high body dissatisfaction, among boys, were poor perceptions of their sporting ability and low self-esteem. The portfolio examines the use of Single Session Therapy (SST) suggesting that SST can effectively reduce waiting lists and provide a single and complete intervention that is effective in approximately 50% of cases.

Body weight and weight loss : are health messages reaching their target?

Objective: To investigate lay peoples’ knowledge of health risks of overweight, accuracy of self-perception of body weight and perceived benefits of weight loss. Method: A nine item questionnaire was administered to a cross sectional survey of adults in metropolitan shopping centres, height and weight were measured. Results: Two hundred and nine (57% female) adults completed the survey. Thirty eight percent had a healthy BMI (18.5-24.9), 38% were overweight (BMI 25-29.9) and a further 22% were obese (BMI>30). However only 46% perceived themselves ‘overweight’, 50% considered themselves ‘just about right’ and 4% considered themselves ‘underweight’. Of those with a BMI of 25 or greater 28% considered their weight ‘just about right’. Over 80% thought ‘being overweight’ was ‘likely’ or ‘very likely’ to be a risk factor for cardiovascular disease, hypertension, diabetes and stroke; however 20% of overweight or obese individuals did not think their health would improve if they lost weight. Conclusion: A significant proportion of overweight or obese individuals do not accurately perceive their body weight and do not recognise the health advantages of weight loss despite recognising excess body weight as a risk factor for chronic diseases. Implications: Increasing the awareness of an individual’s BMI and promoting the benefits of modest weight loss maybe two underutilized strategies for population level weight control.

Weight status associations with physical activity intensity and physical self-perceptions in 10-to 11-year-old children

The study examined associations between children’s weight status, physical activity intensity, and physical self-perceptions. Data were obtained from 409 children (224 girls) aged 10–11 years categorized as normal-weight or overweight/obese. Physical activity was assessed using accelerometry, and children completed the Physical Self-Perception Profile. After controlling for the effects of age, maturation, and socioeconomic status vigorous physical activity was significantly associated with normal-weight status among boys (OR = 1.13, p = .01) and girls (OR = 1.13, p = .03). Normal-weight status was significantly associated with perceived Physical Condition (Boys: OR = 5.05, p = .008; Girls: OR = 2.50, p = .08), and Body Attractiveness (Boys: OR = 4.44, p = .007; Girls: OR = 2.56, p = .02). Weight status of 10–11 year old children was significantly associated with time spent in vigorous physical activity and self-perceptions of Body Attractiveness and Physical Condition.

Engaging patients, clinicians and health funders in weight management: the Counterweight Programme

Background. The Counterweight Programme provides an evidence based and effective approach for weight management in routine primary care. Uptake of the programme has been variable for practices and patients.

Aim. To explore key barriers and facilitators of practice and patient engagement in the Counterweight Programme and to describe key strategies used to address barriers in the wider implementation of this weight management programme in UK primary care.

Methods. All seven weight management advisers participated in a focus group. In-depth interviews were conducted with purposeful samples of GPs (n = 7) and practice nurses (n = 15) from 11 practices out of the 65 participating in the programme. A total of 37 patients participated through a mixture of in-depth interviews (n = 18) and three focus groups. Interviews and focus groups were analysed for key themes that emerged.

Results. Engagement of practice staff was influenced by clinicians’ beliefs and attitudes, factors relating to the way the programme was initiated and implemented, the programme content and organizational/contextual factors. Patient engagement was influenced by practice endorsement of the programme, clear understanding of programme goals, structured proactive follow-up and perception of positive outcomes.

Conclusions. Having a clear understanding of programme goals and expectations, enhancing self-efficacy in weight management and providing proactive follow-up is important for engaging both practices and patients. The widespread integration of weight management programmes into routine primary care is likely to require supportive public policy.