Perceived health risk of excess body weight among overweight and obese men and women: Differences by sex

doi:10.1016/j.ypmed.2008.01.008

Preventive Medicine

Volume 47, Issue 1, July 2008, Pages 46-52

https://doi.org/10.1016/j.ypmed.2008.01.008 Get rights and content

Abstract

Objectives

To describe perceptions of health risk from excess body weight among adults, and assess if lack of perceived risk was associated with trying to lose weight.

Methods

Sex-specific logistic regression models were used to determine odds of disagreement that one's weight is a health risk and odds of trying to lose weight among overweight (BMI = 25.0–29.9 kg/m², n = 1296) and obese (BMI ≥ 30 kg/m², n = 1335) adult participants in the 2004 Styles' surveys.

Results

Men were more likely than women to disagree their body weight was a health risk (among the overweight, 62% vs. 43%; the obese 20% vs. 14% obese). Disagreement with risk was associated with good health status and race/ethnicity among both sexes and lower education and income among women. Odds of currently trying to lose weight were significantly lower among obese men who disagreed, and overweight men and women who were neutral or disagreed that their body weight was a health risk.

Conclusions

Many overweight and obese adults do not perceive their weight to be a health risk; this perception was associated with lower prevalence of trying to lose weight, particularly among men. Discussion by clinicians about the health risks of excess weight may alter perceived risk and help promote weight loss efforts.

Introduction

More than two-thirds of American adults are overweight or obese (Ogden et al., 2006). Excess body weight has been associated with a multitude of morbidities, including heart disease, diabetes, hypertension, and certain cancers (Must et al., 1999, Field et al., 2001), yet studies suggest that many people do not consider obesity to be a serious concern (Lee and Oliver, 2002, Margetts et al., 1999), and are unaware of associated health risks (Ziebland et al., 2002).

Perceived overweight has been associated with trying to lose weight, but does not seem to be enough to motivate weight loss for many (Horm and Anderson, 1993, Wardle and Johnson, 2002). Previous studies have found a range of additional motivators for trying to lose weight, including appearance/attractiveness (Brink and Ferguson, 1998, O'Brien et al., 2007), health (Hankey et al., 2002, O'Brien et al., 2007) and physician's advice (Bish et al., 2005). The complexities behind motivation for behavioral change are evident from the numerous conceptual models that have been proposed (Baranowski et al., 2003, Fishbein and Ajzen, 1975). The Health Belief Model (Janz et al., 2002) and Protection Motivation Theory (Rogers, 1983) both emphasize risk perception as a motivation for adopting risk-reducing behaviors.

Perceived risk of chronic disease has been associated with attempted weight loss (Mainous et al., 2005, Gorin et al., 2004, Doherty et al., 1998) and perceived risk of a child's weight has been associated with parental action (Rhee et al., 2005). A greater perception of weight-related health risks has been associated with intending to prevent weight gain (Wammes et al., 2005) and with being at an advanced stage of readiness to lose weight (Wee et al., 2005), but there is scant research on how perceived risk of one's excess weight affects attempted weight loss; such information will be valuable for refining health promotions for weight loss.

Overweight and obese persons who do not recognize the health risks of their excess weight likely pose a larger public health challenge for promoting healthy behaviors than those who do recognize such risk. Therefore, in this analysis we focus on describing characteristics associated with disagreement with one's body weight as a health risk. Previous research suggests that men are more likely than women to underestimate their weight (Kuchler and Variyam, 2003), less likely to be trying to lose weight (Bish et al., 2005), and more likely to be motivated to lose weight by physical health limitations (Bish et al., 2006), thus we conducted sex-specific analyses. Our objectives were 1) to describe perceptions of one's body weight as a health risk among overweight and obese adults, 2) to describe demographic and health factors associated with disagreement that body weight is a health risk, and 3) to assess if participants that disagree with the health risk of their body weight are less likely to be trying to lose weight.

Section snippets

Sample population

Data for these analyses came from the 2004 Porter Novelli HealthStyles and ConsumerStyles databases, also referred to as Styles. The purpose of the Styles survey is to examine health behavior and knowledge to inform development of communication and health promotion planning. Volunteer participants were recruited through quota sampling of households in a consumer mail panel (N = 600,000) that represents a range of sociodemographic characteristics including sex, age, race, education, household size

Results

Sample characteristics are presented in Table 1; approximately half (51%) our sample was overweight (BMI 25–29.9 kg/m²) and half (49%) was obese (BMI ≥ 30 kg/m²). Nearly half (47%) had one or more of the following conditions: diabetes, heart disease, elevated blood pressure, or elevated cholesterol; even so, 87% of men and 76% of women were in good-to-excellent self-rated health. Among men, 44% disagreed and 34% agreed, while among women 27% disagreed and 47% agreed that their current body weight

Discussion

In our analysis of overweight and obese adults, we found that men were more likely than women to disagree that their excess weight was a health risk. This sex difference has been reported in response to a variety of health risks, with men tending to believe risks are less common and less of a problem than do women (World Health Organization, 2002). Men have also been found to under-assess their true weight status more so than women (Kuchler and Variyam, 2003) and perceived weight status has

Conclusion

Many overweight and obese men and women do not perceive their weight to be a health risk. Among men, factors associated with this lack of perception included being non-Hispanic black or other race/ethnicity. Among women, factors included being non-Hispanic black or other race/ethnicity, having a high school education or less, and having a low household income. Health care professionals ought to discuss the health risks of excess weight among obese patients to alter misperceptions and thus, to

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^☆: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Perceived health risk of excess body weight among overweight and obese men and women: Differences by sex☆

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Sample population

Results

Discussion

Conclusion

Prev. Med.

J. Am. Diet. Assoc.

Eat Behav.

Am. J. Clin. Nutr.

Are current health behavioral change models helpful in guiding prevention of weight gain efforts?

Obes. Res.

Human body composition and the epidemiology of chronic disease

Obes. Res.

Diet and physical activity behaviors among Americans trying to lose weight: 2000 Behavioral Risk Factor Surveillance System

Obes. Res.

Health-related quality of life and weight loss among overweight and obese U.S. adults, 2001 to 2002

Obesity (Silver Spring)

The decision to lose weight

West. J. Nurs. Res.

Readiness to change health behaviours among patients at high risk of cardiovascular disease

J. Cardiovasc. Risk

Impact of overweight on the risk of developing common chronic diseases during a 10-year period

Arch. Intern. Med.

Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research

Why lose weight? Reasons for seeking weight loss by overweight but otherwise healthy men

Int. J. Obes. Relat. Metab. Disord.

Who in America is trying to lose weight?

Ann Intern Med

The health belief model