Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003–2008 Study

International Journal of Obesity volume 35, pages 1063–1070 (2011)Cite this article

Subjects

Abstract

Objectives:

To examine the association between perceived overweight status and weight control, discrepancies between perceived and measured weight status, and opportunities for health care professionals (HCPs) to correct weight perception among US adults.

Design:

Population-based cross-sectional study.

Subjects:

In all, 16 720 non-pregnant adults from the 2003 to 2008 National Health and Nutrition Examination Survey.

Results:

Overall, 64% (73% women, 55% men) reported a desire to weigh less and 48% (57% women, 40% men) reported pursuing weight control. Weight control was positively associated with overweight perception (odds ratio (OR) women 3.74; 95% confidence interval (CI) 2.96, 4.73; OR men 2.82; 95% CI 2.11, 3.76) and an HCP diagnosis of overweight/obesity (OR women 2.22; 95% CI 1.69, 2.91; OR men 2.14; 95% CI 1.58, 2.91), independent of measured weight status. A large proportion of overweight individuals (23% women, 48% men) perceived themselves as having the right weight. Also, 74% of overweight and 29% of obese individuals never had an HCP diagnosis of overweight/obesity. Although the majority of overweight/obese individuals (74% women, 60% men) pursued at least one weight management strategy, fewer (39% women, 32% men) pursued both dietary change and physical activity. Among overweight/obese adults, those with an HCP diagnosis of overweight/obesity were more likely to diet (74 versus 52%), exercise (44 versus 34%), or pursue both (41 versus 30%, all P<0.01) than those who remained undiagnosed.

Conclusion:

HCPs have unused opportunities to motivate their patients to control and possibly lose weight by correcting weight perceptions and offering counseling on healthy weight loss strategies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Flegal KM, Graubard BI, Williamson DF, Gail MH . Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861–1867.

    Article  CAS  PubMed  Google Scholar 

  2. Haslam DW, James WP . Obesity. Lancet 2005; 366: 1197–1209.

    Article  PubMed  Google Scholar 

  3. Daviglus ML, Liu K, Yan LL, Pirzada A, Manheim L, Manning W et al. Relation of body mass index in young adulthood and middle age to medicare expenditures in older age. JAMA 2004; 292: 2743–2749.

    Article  CAS  PubMed  Google Scholar 

  4. Willett WC, Dietz WH, Colditz GA . Guidelines for healthy weight. N Engl J Med 1999; 341: 427–434.

    Article  CAS  PubMed  Google Scholar 

  5. Curioni CC, Lourenco PM . Long-term weight loss after diet and exercise: a systematic review. Int J Obes (Lond) 2005; 29: 1168–1174.

    Article  CAS  Google Scholar 

  6. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 2007; 107: 1755–1767.

    Article  PubMed  Google Scholar 

  7. Tsai AG, Wadden TA . Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005; 142: 56–66.

    Article  PubMed  Google Scholar 

  8. Lemon SC, Rosal MC, Zapka J, Borg A, Andersen V . Contributions of weight perceptions to weight loss attempts: differences by body mass index and gender. Body Image 2009; 6: 90–96.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gregory CO, Blanck HM, Gillespie C, Maynard LM, Serdula MK . Perceived health risk of excess body weight among overweight and obese men and women: differences by sex. Prev Med 2008; 47: 46–52.

    Article  PubMed  Google Scholar 

  10. Wardle J, Haase AM, Steptoe A . Body image and weight control in young adults: international comparisons in university students from 22 countries. Int J Obes (Lond) 2006; 30: 644–651.

    Article  CAS  Google Scholar 

  11. Wardle J, Johnson F . Weight and dieting: examining levels of weight concern in British adults. Int J Obes Relat Metab Disord 2002; 26: 1144–1149.

    Article  CAS  PubMed  Google Scholar 

  12. Atlantis E, Barnes EH, Ball K . Weight status and perception barriers to healthy physical activity and diet behavior. Int J Obes (Lond) 2008; 32: 343–352.

    Article  CAS  Google Scholar 

  13. Lewis BS, Lynch WD . The effect of physician advice on exercise behavior. Prev Med 1993; 22: 110–121.

    Article  CAS  PubMed  Google Scholar 

  14. Bull FC, Jamrozik K . Advice on exercise from a family physician can help sedentary patients to become active. Am J Prev Med 1998; 15: 85–94.

    Article  CAS  PubMed  Google Scholar 

  15. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS) National Health and Nutrition Examination Survey 2003–2004 Public Data General Release File Documentation. Available at http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/general_data_release_doc_03-04.pdf. US Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD.

  16. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS) National Health and Nutrition Examination Survey 2005–2006 Public Data General Release File Documentation. Available at http://www.cdc.gov/nchs/data/nhanes/nhanes_05_06/general_data_release_doc_05_06.pdf. US Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD.

  17. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS) National Health and Nutrition Examination Survey 2007–2008 Public Data General Release File Documentation. Available at http://www.cdc.gov/nchs/nhanes/nhanes2007–2008/generaldoc_e.htm US Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD.

  18. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS) National Health and Nutrition Examination Survey Analytic and Reporting Guidelines. Available at http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/nhanes_analytic_guidelines_dec_2005.pdf. US Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD.

  19. National Institutes of Health, National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health, National Heart, Lung, and Blood Institute: Bethesda, MD, 1998.

  20. Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727.

    Article  PubMed  Google Scholar 

  21. Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW . Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282: 1353–1358.

    Article  CAS  PubMed  Google Scholar 

  22. Villanueva EV . The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health 2001; 1: 11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Chang VW, Christakis NA . Self-perception of weight appropriateness in the United States. Am J Prev Med 2003; 24: 332–339.

    Article  PubMed  Google Scholar 

  24. Kuk JL, Ardern CI, Church TS, Hebert JR, Sui X, Blair SN . Ideal weight and weight satisfaction: association with health practices. Am J Epidemiol 2009; 170: 456–463.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maynard LM, Serdula MK, Galuska DA, Gillespie C, Mokdad AH . Secular trends in desired weight of adults. Int J Obes (Lond) 2006; 30: 1375–1381.

    Article  CAS  Google Scholar 

  26. Johnson-Taylor WL, Fisher RA, Hubbard VS, Starke-Reed P, Eggers PS . The change in weight perception of weight status among the overweight: comparison of III NHANES (1988–1994) and 1999–2004 NHANES. Int J Behav Nutr Phys Act 2008; 5: 9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Johnson F, Cooke L, Croker H, Wardle J . Changing perceptions of weight in Great Britain: comparison of two population surveys. BMJ 2008; 337: a494.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Merrill RM, Richardson JS . Validity of self-reported height, weight, and body mass index: findings from the National Health and Nutrition Examination Survey, 2001–2006. Prev Chronic Dis 2009; 6: A121.

    PubMed  PubMed Central  Google Scholar 

  29. Kuchler F, Variyam JN . Mistakes were made: misperception as a barrier to reducing overweight. Int J Obes Relat Metab Disord 2003; 27: 856–861.

    Article  CAS  PubMed  Google Scholar 

  30. Rothman KJ . BMI-related errors in the measurement of obesity. Int J Obes (Lond) 2008; 32 (Suppl 3): S56–S59.

    Article  Google Scholar 

  31. Wharton CM, Adams T, Hampl JS . Weight loss practices and body weight perceptions among US college students. J Am Coll Health 2008; 56: 579–584.

    Article  PubMed  Google Scholar 

  32. Anderson LA, Eyler AA, Galuska DA, Brown DR, Brownson RC . Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States. Prev Med 2002; 35: 390–396.

    Article  PubMed  Google Scholar 

  33. Wee CC, Davis RB, Phillips RS . Stage of readiness to control weight and adopt weight control behaviors in primary care. J Gen Intern Med 2005; 20: 410–415.

    Article  PubMed  PubMed Central  Google Scholar 

  34. National Cholesterol Education Program (NCEP) Expert Panel. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.

    Article  Google Scholar 

  35. Manson JE, Skerrett PJ, Greenland P, VanItallie TB . The escalating pandemics of obesity and sedentary lifestyle. A call to action for clinicians. Arch Intern Med 2004; 164: 249–258.

    Article  PubMed  Google Scholar 

  36. Jackson JE, Doescher MP, Saver BG, Hart LG . Trends in professional advice to lose weight among obese adults, 1994 to 2000. J Gen Intern Med 2005; 20: 814–818.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Potter MB, Vu JD, Croughan-Minihane M . Weight management: what patients want from their primary care physicians. J Fam Pract 2001; 50: 513–518.

    CAS  PubMed  Google Scholar 

  38. Grumbach K, Bodenheimer T . Can health care teams improve primary care practice? JAMA 2004; 291: 1246–1251.

    Article  CAS  PubMed  Google Scholar 

  39. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B et al. National standards for diabetes self-management education. Diabetes Care 2009; 32 Suppl 1: S87–S94.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Whitlock EP, Orleans CT, Pender N, Allan J . Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002; 22: 267–284.

    Article  PubMed  Google Scholar 

  41. Rippe JM, McInnis KJ, Melanson KJ . Physician involvement in the management of obesity as a primary medical condition. Obes Res 2001; 9 (Suppl 4): 302S–311S.

    Article  PubMed  Google Scholar 

  42. Bish CL, Blanck HM, Serdula MK, Marcus M, Kohl III HW, Khan LK . Diet and physical activity behaviors among Americans trying to lose weight: 2000 behavioral risk factor surveillance system. Obes Res 2005; 13: 596–607.

    Article  PubMed  Google Scholar 

  43. Allison M, Keller C . Physical activity in the elderly: benefits and intervention strategies. Nurse Pract 1997; 22: 53–54 56, 58 passim.

    CAS  PubMed  Google Scholar 

  44. Miller SL, Wolfe RR . The danger of weight loss in the elderly. J Nutr Health Aging 2008; 12: 487–491.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the contributions made by NHANES participants and NHANES staff and investigators for making this data publicly available. We also acknowledge Thomas C Keyserling for his help reviewing a draft of the manuscript and Ruchika Goel Children's Hospital, University of Pittsburgh Medical Center, for her help with framing the study question.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA

    S Yaemsiri & S K Agarwal

  2. Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, NC, USA

    M M Slining

  3. Department of Medicine, University of Pittsburgh Medical Center, PA, USA

    S K Agarwal

Authors
  1. S Yaemsiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M M Slining
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S K Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S K Agarwal.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yaemsiri, S., Slining, M. & Agarwal, S. Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003–2008 Study. Int J Obes 35, 1063–1070 (2011). https://doi.org/10.1038/ijo.2010.229

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2010.229

Keywords

This article is cited by

Search

Advanced search

Quick links