Smith Maia Phillips
St. George's University School of Medicine, PO Box 7, True Blue, West Indies, Grenada.
BMC Public Health. 2021 Jan 30;21(1):253. doi: 10.1186/s12889-021-10316-8.
Self-perceptions of health and disease can be a major driver of health behaviors. Improving accuracy of self-ascertainment of obesity may prompt uptake of weight-control behaviors in those with obesity.
We assess performance of self-perceived body size ('too small', 'about right' or 'too large'), self-estimated BMI in kg/m, and sociodemographics in detecting measured BMI category (under-, normal-, overweight and obese; BMI cutpoints 18.5, 25 and 30) in first bivariate and then multivariable models.
Of 37,281 adults in the US from NHANES, 2, 34, 33 and 32% were under-, normal-, overweight and obese. Respectively 56, 73, 60 and 91% self-perceived as 'too small', 'about right', 'too large' and 'too large.' Of those who self-perceived as 'too small', 22% were underweight and 10% were overweight or obese. 99.7% of obese participants self-estimated a BMI in the overweight/obese range, including many who did not self-perceive as 'too large'. Among obese participants, self-perception as either 'about right' or 'too small' was more likely for those who were younger (OR for perception as 'too large' 1.01 per year, 95% confidence interval 1.00-1.01) male (OR 0.33, (0.28-0.39)) nonwhite (ORs 0.36-0.79 for different ethnicities), low-income (ORs 0.61 and 1.8 for the lowest and highest of six categories, vs. the third) or measured recently (OR 0.98 (0.96-1.0) per year since 1999). Misperception was less common, but still existed, for participants with moderate or severe obesity (ORs 2.9 (2.3-3.5) and 7.9 (5.4-12), vs. 'mild.') (all p < 0.01.) CONCLUSIONS: A tenth of adults in the US with obesity, especially those from overweight peer groups, self-perceive as normal or underweight and thus may not be motivated to control their weight. However, virtually all self-estimate an overweight or obese BMI. If measured BMI is not available, self-estimates are sufficiently accurate that interventions may rely on it to identify obesity.
对健康和疾病的自我认知可能是健康行为的主要驱动因素。提高肥胖自我判定的准确性可能会促使肥胖者采取体重控制行为。
我们首先在单变量模型中，然后在多变量模型中评估自我感知的体型（“太小”、“合适”或“太大”）、自我估计的体重指数（kg/m）以及社会人口统计学特征在检测测量的体重指数类别（体重过轻、正常、超重和肥胖；体重指数切点分别为18.5、25和30）方面的表现。
在美国国家健康与营养检查调查（NHANES）的37281名成年人中，体重过轻、正常、超重和肥胖的比例分别为2%、34%、33%和32%。分别有56%、73%、60%和91%的人自我感觉“太小”、“合适”、“太大”和“太大”。在那些自我感觉“太小”的人中，22%体重过轻，10%超重或肥胖。99.7%的肥胖参与者自我估计的体重指数处于超重/肥胖范围内，其中包括许多自我感觉并非“太大”的人。在肥胖参与者中，年龄较小者（自我感觉“太大”的比值比为每年1.01，95%置信区间为1.00 - 1.01）、男性（比值比为0.33，（0.28 - 0.39））、非白人（不同种族的比值比为0.36 - 0.79）、低收入者（六个类别中最低和最高类别与第三类相比，比值比分别为0.61和1.8）或最近测量过的人（自1999年以来每年的比值比为0.98（0.96 - 1.0））更有可能自我感觉为“合适”或“太小”。对于中度或重度肥胖参与者，错误认知较少见但仍然存在（与“轻度”相比，比值比分别为2.9（2.3 - 3.5）和7.9（5.4 - 12））（所有p < 0.01）。结论：美国十分之一的肥胖成年人，尤其是那些来自超重同龄人组的人，自我感觉正常或体重过轻，因此可能没有动力控制体重。然而，几乎所有人都自我估计超重或肥胖的体重指数。如果无法获得测量的体重指数，自我估计足够准确，干预措施可以依靠它来识别肥胖。
