Does Knowing Hurt? Perceiving Oneself as Overweight Predicts Future Physical Health and Well-Being

Abstract

Self-identification as being 'overweight' may be associated with adverse health outcomes, yet prospective evidence examining this possibility is lacking. Over 7-years, we examined associations between perceived overweight and subsequent health in a sample of 3,582 US adults. Perceived overweight predicted longitudinal declines in subjective health (d =.22, p <.001), increases in depressive symptoms (d =.09, p < .05), and raised levels of physiological dysregulation (d =.24, p <.001) as gauged by clinical indicators of cardiovascular, inflammatory and metabolic functioning. These associations remained after controlling for a range of potential confounders and were observed irrespective of whether self-perceptions of overweight were accurate or inaccurate. The present research highlights the possibility that self-identification as overweight may act independently of body mass index to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight feedback interventions may have unforeseen adverse consequences.

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes

“…Overall, there was strong evidence to suggest that individuals who perceived themselves as overweight were more likely to gain weight over time than those who perceived themselves as normal weight across most participant subgroups. Results of a supplementary analysis of a subset of nine studies that assessed weight change using objectively measured BMI only (i.e. those that met quality criterion 8; Table S4a) were consistent with the main evidence synthesis: there was strong evidence to indicate that overall, perceived overweight was associated with weight gain over time.…”

“…Initial database searches identified 10,398 unique records, and an additional 41 articles were identified by authors, from the reference lists of eligible articles or from supplementary searches. Full‐text review of 366 articles was completed, and 74 articles (indicated with asterisks in reference list) that described 78 studies were included in the review (Fig. ).…”

“…There was strong longitudinal evidence for an association between perceived overweight and weight change, such that perceived overweight was associated with greater weight gain or increased likelihood of overweight/obesity onset over time. Twenty‐six findings from high‐quality studies and eight findings from low‐quality studies suggested that perceived overweight was associated with weight gain, while only a small number of null findings were included (2 from low‐quality studies and 4 from high‐quality studies ), and one low‐quality study suggested a negative relation (such that perceived overweight was associated with greater weight loss). Within most participant subgroups split by gender, objective weight status and age group, there was strong evidence for an association between perceived overweight and weight gain, except for the participant subgroup with no weight status criteria (where the evidence for a positive relationship was downgraded to moderate because of mixed findings), and in the combined adolescent subgroup (where there was moderate evidence for a positive association due to there being only one high‐quality study).…”

Parental perception of child weight and inflammation: Perceived overweight is associated with higher child c-reactive protein

“…First, parents who perceive their child as overweight might pressure the child to lose weight or at least watch what they are eating; such pressure is stressful for the child (16). Second, previous research has shown that parent perception of child overweight is associated longitudinally with the child’s self-perception of weight (4), and this weight self-perception is associated with subsequent physiological dysregulation (10). Parent perception may thus contribute to child CRP by shaping the child’s self-perceptions of their weight over time.…”

“…C-reactive protein (CRP), in particular, is a common inflammatory marker implicated in stress (7) as well as greater adiposity (8). In adulthood, the stress and stigma of overweight is associated with greater inflammation, independent of the individual’s adiposity (9, 10). Parental perception of the child’s weight may likewise be stressful and thus apparent in the child’s level of inflammation.…”