The Effect of Weight Misperception and Contextual Factors on Weight Control Among Young Adults

Abstract

Background: Overweight and obesity is a significant public health problem in the United States. Young adulthood is a particularly vulnerable period for excess weight gain and development of overweight/obesity. Although standard behavioral weight control programs can produce clinically significant weight losses, they routinely struggle to recruit young adults, particularly young men and African-Americans. This limits our understanding of the efficacy of these programs for these individuals. Weight misperception has been proposed as a potential barrier to attempting weight loss. Evidence also suggests education level, income status, family medical history, occupational demands, and depressive symptoms are individually associated with attempting weight loss. Against this backdrop, it is important to examine the relative influence of weight misperceptions and other contextual factors to better understand why young adults, particularly men and African-Americans, do not attempt weight loss. Objective: To determine if observed differences in weight control by race and sex are due to differences in weight status perception accuracy among black and white young adults with overweight/obesity. The associations between contextual factors and weight loss attempts are also explored. Methods: Data from 2756 young adults (20-39 years old) who participated in the 2007-2014 National Health and Nutritional Examination Survey (NHANES) were analyzed. Logistic regression models examined the effect of weight status perception accuracy and contextual factors on weight loss attempts among young adults and men specifically. Moderation by sex was assessed in the sample as a whole and moderation by race in analyses limited to young adult men. Sensitivity analyses using a higher BMI threshold (BMI ≥ 27 kg/m2) were conducted to ensure that participants with a minimal weight misperception did not unduly influence findings. Results: Overall, 31% of young adults had an inaccurate weight status perception, with a significantly higher number of men, particularly black men, reporting an inaccurate perception of their weight. Young adults, and men specifically, were significantly more likely to report a weight loss attempt if they accurately perceived their weight (OR=3.66, 95% CI 2.80-4.77, p<0.01; OR=3.73; 95% CI 2.76-5.03; p<0.01, respectively). However, there was no moderation by sex or race. Higher education level and income status were associated with weight loss attempts among young adults in models that included both sexes and in those that were limited to men. Although not significant in the larger model, greater self-reported depressive symptoms were associated with weight loss attempts in analyses limited to young adult men. Sensitivity analyses were largely consistent with these findings. Conclusion: Most young adults with overweight/obesity accurately perceive their weight status. Weight status perception accuracy and certain contextual factors are important predictors of weight loss attempts among black and white young adults. Neither sex nor race moderated the association between weight status perception accuracy and weight loss attempts. These findings have implications for future research to better understand weight status perception and improve enrollment of young adults in weight control programs.