Public Opinions and Weight Action about Diet Nutrition and Physical Activity - Do Americans Accurately Assess Their Weight?

Although public health officials have declared an epidemic of overweight and obesity in the United States, many Americans who are overweight apparently remain unconvinced that their body weights are excessive. Fred Kuchler and Jayachandran Variyam examined discrepancies between American adults' weight status and their perceptions by comparing self-reported height and weight data and individuals' assessments of their weight. Kuchler and Variyam published their findings in "Misperceptions in Self-Assessed Weight Status Vary along Demographic Lines," (FoodReview, vol. 25, no. 3, Winter 2002).

The investigators found that among persons who were overweight but not obese (those with body mass index greater than 25 but less than 30) more than 40 percent did not perceive themselves as overweight, instead considering TABLE 11.3
Public opinion poll on weight loss or gain over the last five years, as related to diet and health, July 2003
THINKING ABOUT HOW YOUR WEIGHT HAS CHANGED OVER THE PAST FIVE YEARS, WOULD YOU SAY YOU HAVE…

	Gained weight %	Stayed the same %	Lost weight %
Status of weight situation
Overweight	58	26	16
About right	36	47	17
Description of diet
Very healthy	33	40	27
Somewhat healthy	47	37	16
Not healthy	50	38	12
Description of health
Excellent	40	46	14
Good	47	34	19
Fair/poor	45	34	21
SOURCE: David W. Moore, "Gaining Weight and Health Situation: Thinking about How Your Weight Has Changed over the Past Five Years, Would You Say You Have…," in "More Americans Gaining Than Losing Weight," Poll Analyses, The Gallup Organization, Washington, DC, August 21, 2003. Copyright © 2003 by The Gallup Organization. Reproduced by permission of The Gallup Organization. [Online] http://www.gallup.com/content/default.asp?ci=9097 [accessed February 20, 2004]

themselves "about right" or underweight. Among persons who were obese based on BMI (BMI equal to or greater than 30) 13 percent felt they were normal weight or underweight. (See Table 11.4.) The investigators found that while women were more likely to accurately assess their weight status than men were, they also were more likely to consider themselves overweight when they were not overweight (BMI less than 25).

Kuchler and Variyam classified survey respondents in terms of the accuracy of their perceptions about their weight. Persons who were overweight or obese and described themselves as overweight were termed "realists," persons of healthy weight who said their weight was about right were "practical." "Doubters" were those who were overweight or obese but characterized themselves as healthy weight or underweight, and persons of healthy weight who considered themselves overweight as well as underweight individuals who described themselves as healthy or overweight were described as "anxious." The investigators found that the accuracy of weight assessment varied along demographic and socioeconomic lines, with increasing education associated with a decrease in the percentage of "doubters" and an overall improvement in accuracy attributable to increases in "realists," and "practicals," despite a higher percentage of respondents classified as "anxious." (See Table 11.5.)

Table 11.5 also displays variation in perception along racial and ethnic lines. The majority of Asians was found to be "practical," while non-Hispanic blacks included more "doubters" and fewer "anxious."

TABLE 11.4
Self-reported weight status, 1994–96

	Individuals who are obese1			Individuals who are overweight but not obese2			Individuals who are not overweight or obese3
Item	All	Men	Women	All	Men	Women	All	Men	Women
People who say they are overweight	87.0	83.2	90.2	59.4	47.8	77.1	17.4	8.5	23.9
People who say they are about right or underweight	13.0	16.8	9.8	40.6	52.2	22.9	82.6	91.5	76.1
1Body mass index greater than or equal to 30.
2Body mass index greater than or equal to 25 but less than 30.
3Body mass index less than 25.
SOURCE: Fred Kuchler and Jayachandran N. Variyam, "Table 1. Some Who Are Obese Say Their Weight Is about Right," in "Misperceptions in Self-Assessed Weight Status Vary along Demographic Lines," Food Review, vol. 25, no. 3, Winter 2002 [Online] http://www.ers.usda.gov/publications/FoodReview/dec2002/ [accessed January 10, 2004]

TABLE 11.5
Demographic characteristics and self-assessed weight status, 1994–96

	Population shares
Characteristic	Doubters	Realists	Practical	Anxious
	Percent
Education:
Less than high school	28.4	39.2	27.1	5.3
High school	21.5	41.5	28.0	9.0
Some college	18.1	37.6	33.6	10.7
4 or more years of college	17.6	33.9	38.9	9.7
Race/ethnicity:
Non-Hispanic white	18.6	38.8	32.3	10.3
Non-Hispanic black	30.4	44.8	22.9	1.9
Asian	22.6	6.4	62.4	8.6
Hispanic	26.0	33.2	33.2	7.6
Age (years):
Less than 30	23.2	23.9	42.9	10.0
30–49	19.5	40.7	30.7	9.2
50–69	18.3	48.1	24.8	8.8
70 and older	27.1	29.8	35.9	7.2
Percent of poverty level:
Less than 130%	23.2	37.6	31.5	7.8
131–350%	22.9	36.0	32.3	8.9
Over 350%	17.8	40.3	32.3	9.6
Note: Numbers may not add to 100 percent due to rounding. Realists are those who are overweight or obese and say they are overweight. Practical are those who are healthy weight and say their weight is about right. Practical also include those who are underweight and say they are underweight. Doubters are those who are obese or overweight and say their weight is about right, as well as those who are obese, overweight, or healthy weight and say they are underweight. Anxious include those who are healthy weight and say they are overweight, as well as those who are underweight and say they are healthy or overweight.
SOURCE: Fred Kuchler and Jayachandran N. Variyam, "Table 2. There Are Fewer Doubters but More Anxious at Higher Education Levels," in "Misperceptions in Self-Assessed Weight Status Vary along Demographic Lines," Food Review, vol. 25, no. 3, Winter 2002 [Online] http://www.ers.usda.gov/publications/FoodReview/dec2002/ [accessed January 10, 2004]

Attitudes and knowledge about diet, nutrition, and body weight also varied among the four groups. Interestingly, the largest proportion of women who believed the "gene theory"—that an individual's weight status is predetermined, and as such, not within an individual's ability to control—were "realists." However, "realists" also predominated among men and women who disagreed with this premise. FIGURE 11.1
Weight survey respondents who agree that a person's weight is predetermined, by respondent class, 1994–96 (See Figure 11.1.) "Realists" were also the largest proportions of men and women who believed that it was not important to maintain a healthy weight. Among men and women slightly more "realists" than "practicals" considered it important to maintain a healthy weight. (See Figure 11.2.)

Women who were aware of the health risks and problems associated with overweight assessed their weight FIGURE 11.2
Weight survey respondents' opinion on the importance of maintaining a healthy weight, by respondent class, 1994–96 more accurately (the largest proportions were "realists" and "practicals") than those who were unaware of weight-related health issues. Among men a much larger proportion of those aware of weight-related health issues were "realists," but the unaware group included more "practicals." (See Figure 11.3.) In terms of knowledge about the relationship between diet, weight, and health, the proportion of "realists" increased with increasing knowledge. (See Figure 11.4.) These findings suggest that those most likely to make use of information about the relationships between diet, weight, and health are already reasonably knowledgeable about these issues.

The investigators concluded that a variety of health education and intervention programs are needed to reach the various subgroups of persons who are overweight and obese. For example, until "doubters" are convinced that they are overweight, they are unlikely to respond to health education programs emphasizing the relationship between health risks and overweight. "Realists" may pose the greatest challenge to health educators, since many already know about the relationship between overweight and health problems but believe that change is unimportant or impossible.

FIGURE 11.3
Weight survey respondents' awareness of health problems from overweight, by respondent class, 1994–96

Americans' Changing Shapes and Sizes

The results of a national size survey confirmed that Americans are not only getting heavier but also have changed in proportions. The "Size USA" project is an anthropometric (the study of human body measurements, and comparisons of these measurements) research study that gathered measurements of more than 10,000 people across the United States. Using a three-dimensional body scanner, researchers compiled measurements and analyzed them by gender, age groups, and four ethnicities as well as geography, annual household income, marital status, education, and employment status.

The survey was performed to assist apparel manufacturers to produce clothing that will offer a better fit to more consumers. In "Sizing Up America: Signs of Expansion from Head to Toe" (New York Times, March 1, 2004), Kate Zernike reported that the last such national survey of Americans was performed in 1941 by the United States Department of Agriculture (USDA). The USDA survey described the average American woman as a size 8, with a 35-inch bust, 27-inch waist, and 37.5-inch hip circumference. The 2003 Size USA survey found that the average FIGURE 11.4
Weight survey respondents' diet knowledge, by respondent class, 1994–96 white woman's bust, waist, and hip measurements in inches were 38-32-41 for women aged eighteen to twenty-five, and 41-34-43 for women aged thirty-six to forty-five. On average black women measured 43-37-46, Hispanic women 42.5-36-44, and an "other" category, composed primarily of Asian women, measured 41-35-43. Based on the Size USA survey, the average American woman wears a size 12 or 14 rather than a size 8.

American men have also increased in size. The size 40 regular, which measures 40-inches at the chest with a 34-inch waist, 40-inch hip, and a 15.5-inch collar, once considered the average, would be too small for many American men. The 2003 Size USA survey found that white men aged eighteen to twenty-five had a 41-inch chest, 35-inch waist, 41-inch hips and a 16-inch collar, and older white men, aged thirty-six to forty-five measured 44-38-42. Black men measured an average of 43-37-42, Hispanic men 44-38-42, and an "other" category, composed primarily of Asian men, measured 42-37-41.

Interestingly, measurements did not vary significantly by geography, education, or even income. The most significant variations in body shape were attributed to race, ethnicity, FIGURE 11.5
Percentage of men and women in each weight category, November 3–5, 2003 and age. For example, 11 percent of white women were described as having protruding stomachs compared to 3 percent of Hispanic women and 4 percent of black women. More Hispanic women (20 percent) were described as having "full waists" than white (10 percent) or black (15 percent) women. Nearly one-quarter of black men were described as having a "prominent seat" compared to 9 percent of white men and 8 percent of Hispanic men.

The study concluded that along with expanding waists, American men over age forty-five were most likely to have increased abdominal girth—"pot bellies"—and women older than thirty-six were most likely to have big hips. Nearly 20 percent of men were described as "portly" and another 19 percent had "lower front waists," meaning their waists were below their overhanging bellies.

Many Americans Deny Being Overweight

When Size USA participants were asked how they perceived their weight, more than half of the men (51 percent) and 38 percent of women described themselves as at "about the right weight." Just 10 percent of men and 21 percent of women said they were "quite a bit overweight."

A Gallup Poll conducted November 3–5, 2003, found that while 55 percent of Americans surveyed were overweight or obese as measured by BMI, just 41 percent said they considered themselves as either "somewhat" (37 percent) or "very" (4 percent) overweight. Figure 11.5 shows TABLE 11.6
Public opinion poll measuring individuals' assessment of their own weight, selected months October 1990–November 2003
HOW WOULD YOU DESCRIBE YOUR OWN PERSONAL WEIGHT SITUATION RIGHT NOW—VERY OVERWEIGHT, SOMEWHAT OVERWEIGHT, ABOUT RIGHT, SOMEWHAT UNDERWEIGHT, OR VERY UNDERWEIGHT?

	Very overweight %	Somewhat overweight %	About right %	Somewhat underweight %	Very underweight %	No opinion %
2003 Nov 3–5	4	37	53	5	1	*
2003 Jul 7–9	4	39	50	5	1	1
2002 Nov 11–14	6	36	51	5	1	1
2002 Jul 9–11	6	34	55	5	*	*
2001 Nov 8–11	6	38	51	4	*	1
2001 Jul 19–22	5	41	49	5	*	*
1999 Jul 22–25	4	35	53	6	1	1
1990 Oct 18–21	7	41	46	5	1	*
SOURCE: David W. Moore, "How Would You Describe Your Own Personal Weight Situation Right Now—Very Overweight, Somewhat Overweight, about Right, Somewhat Underweight, or Very Underweight?" in "Many Americans Deluding Themselves about Weight," The Gallup Organization, Washington, DC, November 26, 2003. Copyright © 2003 by The Gallup Organization. Reproduced by permission of The Gallup Organization. [Online] http://www.gallup.com/content/default.asp?ci=9829&pg=1 [accessed February 18, 2004]

that according to BMI more men (68 percent) than women (43 percent) were classified as overweight or obese. An analysis of historical trend data found that more Americans reported that they were overweight in 1990 than 2003, even though the percentage of overweight and obese Americans increased between 1990 and the end of 2003. (See Table 11.6.)

Although more than half (53 percent) of the population group known as "baby boomers"—adults aged thirty-nine to fifty-seven—consider themselves either "somewhat" or "very" overweight, even this group underestimates the problem, since the Centers for Disease Control and Prevention (CDC) estimated that 67 percent of Americans were overweight or obese in 2003. According to Gallup data, "baby boomers" and adults aged fifty-eight to seventy-four reported the highest percentages of overweight, 53 and 57 percent respectively, while 30 percent of younger adults (aged eighteen to thirty-nine) reported that they were overweight and the 30 percent of persons aged seventy-five and over said they were overweight.

In "Majority of Boomers Say They're Overweight" (Gallup Organization, June 17, 2003), Rick Blizzard observed that Gallup survey data indicated a direct relationship between self-reported personal health status and weight among adults. Forty-two percent of respondents who described their weight as "about right" also termed their physical health as "excellent" compared to just 13 percent of people who admitted that they were "very overweight." Respondents who said they were "very overweight" TABLE 11.7
Public opinion polls on the desire to lose or gain weight, selected years 1951–2003
WOULD YOU LIKE TO [ ROTATED: LOSE WEIGHT, STAY AT YOUR PRESENT WEIGHT, OR PUT ON WEIGHT?]

National adults	Lose weight %	Put on weight %	Stay at present %	No opinion %
2003 Nov 3–5	60	8	32	*
2002 Nov 11–14	58	8	34	*
2001 Jul 19–22	59	7	34	*
1999 Jul 22–25	52	9	39	*
1996 Feb 23–25	55	4	41	*
1990 Oct 18–21	52	7	40	1
1957 Aug 29–Sep 4	35	11	49	5
1955 Jun 24–29	37	13	48	2
1954 Jul 2–7	35	14	50	1
1953 Feb 1–5	37	13	49	1
1951	31	17	50	2
SOURCE: David W. Moore, "41. Would You Like to [ ROTATED: Lose Weight, Stay at Your Present Weight, or Put on Weight]?" in "Many Americans Deluding Themselves about Weight," The Gallup Organization, Washington, DC, November 26, 2003. Copyright © 2003 by the Gallup Organization. Reproduced by permission of the Gallup Organization. [Online] http://www.gallup.com/content/default.asp?ci=9829&pg=1 [accessed February 18, 2004]

were more likely to describe their health as "fair" or "poor" (44 percent) than those who defined themselves as "somewhat overweight" (24 percent), "about right" (15 percent), or "underweight"(27 percent).

In 2003 the desire to lose weight was at an all-time high—nearly twice as many adults (60 percent) said they wanted to lose weight in November 2003 compared to 31 percent in 1951. (See Table 11.7.) Still, the desire to lose weight does not necessarily translate into action. Table 11.8 shows that only 9 percent more adults were seriously attempting to lose weight at the end of 2003 than in 1951. Although most of the overweight and obese respondents to the November 2003 poll said they wanted to lose weight, less than half (36 percent of those who were overweight and 45 percent of persons who were obese) were making an effort to do so. (See Figure 11.6.)

Mothers May Not Accurately Gauge Children's Weight

Parents play a pivotal role in terms of preventing childhood obesity by shaping their children's early eating and physical activity habits. Investigators at the University of Cincinnati College of Medicine, Department of Pediatrics and Children's Hospital Medical Center, Cincinnati, Ohio, observed that frequently mothers of overweight preschoolers appeared unaware of, or unconcerned about, their children's weight. To explore mothers' perceptions about how they determine when a child is overweight, why children become overweight, and barriers that prevent effective treatment of childhood obesity, Anjali Jain and her colleagues conducted group interviews with low-income mothers of pre-school children (twenty-four to sixty months old) who were overweight TABLE 11.8
Public opinion polls on attempts to lose weight currently underway, selected years 1951–2003
AT THIS TIME ARE YOU SERIOUSLY TRYING TO LOSE WEIGHT?

National adults	Yes %	No %	No opinion %
2003 Nov 3–5	28	72	*
2002 Nov 11–14	24	75	1
2001 Jul 19–22	25	75	*
1999 Jul 22–25	20	80	*
1996 Feb 23–25	26	74	*
1990 Oct 18–21	18	82	*
1955	17	83	*
1953	25	75	*
1951	19	81	*
SOURCE: David W. Moore, "At This Time Are You Seriously Trying to Lose Weight?" in "Many Americans Deluding Themselves about Weight," The Gallup Organization, Washington, DC, November 26, 2003. Copyright © 2003 by The Gallup Organization. Reproduced by permission of The Gallup Organization. [Online] http://www.gallup.com/content/default.asp?ci=9829&pg=1 [accessed February 18, 2004]

and determined to be at-risk for obesity. They reported the results of these structured interviews in "Why Don't Low-Income Mothers Worry about Their Preschoolers Being Overweight?" (Pediatrics vol. 1,007, no. 5, May 2001).

The investigators found that unlike health professionals who assess children's weight status by plotting height and weight on standard growth charts, mothers were more likely to express concern about children's overweight when their children were teased by peers or unable to participate in physical activities. The mothers did not consider their children overweight if the children were active, had a good appetite, and ate a healthy diet. Instead of describing their children as overweight, mothers described them as "thick," "strong," "big-boned," or "solid". The mothers interviewed also believed that an inherited tendency to be overweight, in terms of inherited metabolism or body type, practically guaranteed that the child would become overweight regardless of environmental factors. Given this perception, it was not surprising that the mothers believed they were unable to affect a child's biological predisposition to be overweight.