What Does Self-rated Health Mean? Changes and Variations in the Association of Obesity with Objective and Subjective Components Of Self-rated Health

Abstract

There are concerns about the meaning of SRH and the factors individuals consider. To illustrate how SRH is contextualized, we examine how the obesity-SRH association varies across age, periods, and cohorts. We decompose SRH into subjective and objective components and used a mechanism-based APC model approach with four decades (1970s-2000s) and five birth cohorts of NHANES data (N=26,184). Obese adults rate their health more negatively than non-obese when using overall SRH with little variation by age, period, or cohort. However, when we decomposed SRH into objective and subjective components, the obesity gap widened with increasing age in objective SRH, but narrowed in subjective SRH. Additionally, the gap narrowed for more recently-born cohorts for objective SRH, but widened for subjective SRH. The results provide indirect evidence that the relationship between obesity and SRH is socially patterned according to exposure to information about obesity and the availability of resources to manage it.

Gender and genetic contributions to weight identity among adolescents and young adults in the U.S.

“…Because certain individuals’ health assessments are relatively rigid even in the face of new information about changes in objective health status (Boardman, 2006), scholars have argued that these measures tap into a more complex phenomenon that has been characterized as a “health identity” (McMullen and Luborsky, 2006). This argument is in line with the results of a recent study by Altman, Van Hook, and Hillemeier (2016), who show that obesity status is a critical part of the subjective component of health assessments, and that this relationship is consistent regardless of historical period. Grover, Keel, and Mitchell (2003) have argued that “weight identity” is, like health identity, a stable component of personal identity.…”

“…More recently, researchers have made it clear that current health, health lifestyles, and healthcare interactions are all important components of overall health identity (Kelleher and Leavey, 2004). Critically, physical weight is consistently linked to overall health assessment (Altman, Van Hook, and Hillemeier, 2016; McMullen and Luborsky, 2006), and lifestyle indicators such as food choice are increasingly important signals of one’s health identity (Stead et al, 2011). Further, the connection between health self-assessments and identity is important to medical sociology and social epidemiology.…”

Becoming Overweight without Gaining a Pound: Weight Evaluations and the Social Integration of Mexicans in the United States

“…To evaluate the hypotheses, we employed a binational study design to compare Mexican nationals with Mexicans living in the United States by multiple indicators of US integration and educational attainment. The tendency to self‐evaluate as overweight could increase with US integration as a consequence of social integration as hypothesized, but could also derive from secular increases in actual body weight and exposure to obesity‐related health messages (Altman, Van Hook, and Hillemeier, forthcoming). Therefore, we employed a rigorous set of controls, including the respondents' CDC‐defined weight classification (following standard practice of Chang and Christakis ), birth cohort, health insurance coverage, and whether a doctor ever told the respondent she was overweight.…”

Research in and Prospects for the Measurement of Health Using Self-Rated Health

“…"Where and how" SRH can be used to examine group differences in health when SRH is used as a proxy for more objective health has been addressed with methods that attempt to make SRH "more objective" by controlling for some aspect of subjectivity. These methods include anchoring vignettes (King et al 2004;Grol-Prokopczyk, Freese, and Hauser 2011;Grol-Prokopczyk et al 2015;Bzostek et al 2016;Xu and Xie forthcoming), controlling for more objective health measures in analysis, attempting to isolate particular parts of evaluative frameworks and their differences across groups (Layes, Asada, and Kephart 2012;Hardy, Acciai, and Reyes 2014;Altman, Van Hook, and Hillemeier 2016), and influencing the definition of health respondents use by preceding the presentation of SRH with specific health items . Each method seeks to standardize SRH for cross-group comparison (either by standardizing the researcher's interpretation of SRH answers using other measures as calibration or by standardizing respondents' interpretations of SRH when the item is administered), and each has particular assumptions, strengths, and weaknesses.…”