The association between weight misperception and weight-related behaviors among U.S. adults with overweight and obesity

Abstract

Background: Weight misperception arises when there is a difference between an individual’s actual weight and their perceived weight status. This study aimed to determine associations between weight misperception and weight-related behaviors in individuals with overweight and obesity. Methods: The study utilized 2017–2020 data from the National Health and Nutrition Examination Survey (NHANES). Adult participants who answered the “How do you consider your weight?” question were included in the analysis. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using weighted logistic regression models to estimate associations between weight-related behaviors and weight misperception. Results: The study included 4,608 participants, of whom 1,155 (25.1%) misperceived their weight status. Weight misperception was highest among males (65.7%), young adults (33.9%), and non-Hispanic white individuals (56.3%). Multivariable analysis revealed that females were less likely than males to misperceive their weight (aOR: 0.32 [95% CI: 0.27–0.38]). Participants with higher incomes (aOR: 0.73 [95% CI: 0.56–0.95]) and obesity (aOR: 0.11 [95% CI: 0.09–0.13]) had lower odds of misperception. Conversely, Hispanic (aOR: 1.47 [95% CI: 1.16–1.86]), non-Hispanic Black individuals (aOR: 2.4 [95% CI: 1.86–3.11]), and single participants (aOR: 1.37 [95% CI: 1.14–1.63]) had higher odds. Weight misperceivers were significantly less likely to have attempted weight loss (aOR: 0.28 [95% CI: 0.23–0.33]) and engaged in weight-related behaviors, as compared to those with accurate weight perception. Conclusions: Lower engagement in weight-related behaviors was associated with weight misperception, highlighting the importance of awareness of actual weight for effective obesity interventions.