Longitudinal impact of weight misperception and intent to change weight on body mass index of adolescents and young adults with overweight or obesity
Introduction
The percentage of adolescents who accurately perceive their weight status appears to be declining, particularly among youth with overweight (Lu et al., 2015). Currently, only 21% of boys and 36% of girls with overweight, and 58% of boys and 73% of girls with obesity, accurately perceive their weight status (Lu et al., 2015). Contrary to commonly held beliefs, weight status misperception may confer protection against weight gain and poor mental health outcomes. Two longitudinal studies found that individuals with overweight or obesity who perceived their weight status as “just about right” gained less weight over time than those who accurately reported themselves to be overweight (Robinson et al., 2015, Sonneville et al., 2015). In similar studies, youth with overweight or obesity who were accurate weight status perceivers reported more depressive symptoms (Al Mamun et al., 2007, Schiefelbein et al., 2012, Thurston et al., 2017) and lower health-related quality of life (Hayward, Millar, Petersen, Swinburn, & Lewis, 2014) than those who misperceived their weight status to be in a healthy range. These data reflect patterns observed in other nationally representative samples (Edwards et al., 2010, Lu et al., 2015, Sarafrazi et al., 2014) highlighting the frequency of the phenomenon of weight status misperception and underscoring its complex association with health benefits in adolescents with overweight/obesity.
Perception of weight status is associated with both unhealthy (e.g., fasting, purging) and healthy weight-related behaviors (e.g., portion size awareness, physical activity; Chen et al., 2014, Edwards et al., 2010, Eichen et al., 2012, Fredrickson et al., 2015, Yang et al., 2014, Yost et al., 2010). Recent data from a nationally representative cross-sectional study indicated that youth with overweight/obesity who misperceived their weight status to be “healthy” self-reported less engagement in any (healthy or unhealthy) weight control behaviors (Datar & Chung, 2015). In contrast, youth with overweight/obesity who accurately perceived their weight status were more likely to report engagement in both healthy and unhealthy weight control behaviors relative to those who misperceived their weight status (Chen et al., 2014, Edwards et al., 2010, Eichen et al., 2012, Fredrickson et al., 2015, Yang et al., 2014, Yost et al., 2010). Unhealthy weight control behaviors are associated with subsequent weight gain (Neumark-Sztainer et al., 2006, Neumark-Sztainer et al., 2012), thus, understanding the motivational consequences of weight status perceptions may clarify the counterintuitive association between weight status misperception and less weight gain among youth with overweight/obesity.
Weight loss intention and accurate weight status perception frequently are assumed to be necessary antecedents to weight loss because they should prompt engagement in healthy weight control behaviors. Indeed, the theory of planned behavior posits that behavioral intention is an essential predictor of engagement in various behaviors (Ajzen, 1991). Two recent meta-analyses found medium associations between weight loss intention and dietary behaviors, regardless of whether targeted dietary behaviors were healthy, restricted, or unhealthy, among youth (McDermott et al., 2015, Riebl et al., 2015) and adults (McDermott et al., 2015). Though intention to lose weight is associated with self-reported engagement in weight loss behaviors, it is unclear the extent to which these behaviors are healthy and/or effective. Thus, questions remain about the risks (e.g., engagement in unhealthy and potential weight gain) and benefits (e.g., objectively measured healthy behavior change with resulting weight loss) of intention to lose weight.
As may be expected, youth with overweight/obesity who misperceive their weight status to be “healthy” report less intent to lose weight, which is consistent with their reports of fewer weight control behaviors more generally (Datar & Chung, 2015). In contrast, youth with overweight/obesity who accurately perceive their weight status are more likely to report intention to lose weight (Chen et al., 2014, Edwards et al., 2010, Eichen et al., 2012, Fredrickson et al., 2015, Yang et al., 2014, Yost et al., 2010). No studies simultaneously have examined associations among accurate weight status perception, weight loss intention, and subsequent weight loss behavior among youth with overweight/obesity. To this end, this work extends our understanding of how weight status perception may longitudinally impact BMI by testing a theoretically-supported and commonly held hypothesis that, among youth with overweight/obesity, accurate weight status perception is associated with subsequent decrease in BMI via weight change intention.
Section snippets
Participants and design
Data were drawn from Waves II and IV of the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative study of adolescents in the United States. Participants were enrolled in grades 7–12 at initial recruitment in 1994–1995 (Wave I). Wave II, collected in 1996, was the first wave to objectively measure height and weight and is the baseline of the current study. Follow-up data are from Wave IV, which was collected in 2007–2008 when participants were aged 24–32
Descriptive statistics
Descriptive statistics by weight status perception category are presented separately by gender in Table 1A, Table 1B. Significant differences (p < 0.001) in weight status perception were observed across intention to change weight among females and males. The vast majority of females (87.8%; n = 962) and males (79.0%; n = 520) reporting intention to lose weight were accurate weight status perceivers. Although BMI change did not vary significantly by weight status perception among females or males, the
Discussion
Using a large nationally representative sample, we examined whether weight loss intention is on the longitudinal pathway between weight status perception and weight change. While previous findings demonstrating that weight status misperception protects against BMI gain in males and females were replicated (Robinson et al., 2015, Sonneville et al., 2015), intention to lose weight unexpectedly had neither an indirect nor direct association with actual BMI change. This runs contrary to the common
Acknowledgements
This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from grant P01-HD31921 for this analysis.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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