Elsevier

Nutrition

Volume 30, Issue 6, June 2014, Pages 679-684
Nutrition

Applied nutritional investigation
Body mass index through self-reported data and body image perception in Spanish adults attending dietary consultation

https://doi.org/10.1016/j.nut.2013.11.006Get rights and content

Abstract

Objectives

The aim of this study was to explore, based on sex and age, knowledge regarding weight, height, and the perception of body shape in Spanish adults who attend dietary consultation. We also wanted to determine the participants' desired body shapes and what they considered their best health status.

Methods

The sample consisted of 8100 women and 1220 men from Spain. They were between the ages of 18 and 75 y. Weight (kg) and height (cm) were measured and body mass index (BMI) was calculated. Participants were nutritionally classified following the cutoffs proposed by the World Health Organization. Each individual was asked about his or her weight and height and self-reported BMI was calculated. They also answered a test of body image perception through drawings of human silhouettes that corresponded to an exact BMI. With this, perceived BMI, desired BMI, and BMI considered healthy were estimated. Parametric statistic tests for contrast of mean and percentages were applied.

Results

Self-reported and perceived BMI underestimate the BMI obtained through anthropometry. Differences between measured and self-reported BMI are lower in women and increase with age in both sexes. The same result was obtained when comparing measured BMI with perceived BMI through silhouette test. On average, desired BMI and healthy BMI were in the limits of normal weight for all ages and both sexes. However, the difference between them was also lower in women.

Conclusion

Age and sex influence the perception of excess weight and body image. This could condition the demand of dietary treatment to improve the nutritional status.

Introduction

Being overweight has been recognized as a major cause of chronic non-communicable diseases that affect human population. In general, excess weight is related to an increase in mortality from all causes [1] and is well known its role in the development of hypertension, type 2 diabetes, and certain types of cancer is well known [2], [3]. Obesity also affects self-esteem and decreases the quality of life of the obese individual [4].

Thus, most public health interventions are focused on the treatment and prevention of obesity at different levels. However, their success largely depends on subjective aspects such as individual perception of health status or the understanding of the pathologic meaning of having excess weight. In order to treat obese patients it is necessary that they take the initiative and start recognizing themselves as obese, and for this, it is imperative that they have an actual and conscious perception of their own body.

Several studies have focused on evaluating the knowledge that individuals have about their actual height and weight [5], [6], [7]. Other similar studies have analyzed the perception that people have of their body through self-identification with silhouettes that represent different body mass indexes (BMIs) [8], [9], [10]. The results of these studies demonstrated a mismatch between the reality and the perception with a tendency is to underestimate weight and to overestimate height, although young people tended to be more accurate than older individuals and women more than men [11], [12], [13].

In this context, the aim of this study was to explore the knowledge of the weight, height, and body image perceptions of Spanish adults who were participating in a dietary consultation program. We also wanted to determine what body silhouette they desired and what they identified as representing the best health status. We assessed differences based on sex and age.

Section snippets

Materials and methods

The study was conducted in the framework of the cooperation between Arkopharma Pharmaceutical laboratories and EPINUT Research Group of the Complutense University of Madrid (reference 920325) and with the collaboration of the Spanish Society of Dietetics and Food Sciences. The data were collected in 46 of the 50 Spanish provinces between February and November 2011 in nutrition consultations located in pharmacies. The sample consisted of 9320 individuals of whom 86.9% were women (n = 8100) and

Results

Excess weight affected 77.5% of women and 88% of men. It was above 60% in all age groups in both sexes. The prevalence of overweight and obesity in the entire sample was 43.7% and 35.1%, respectively (Fig. 2). Compared with women, men had higher rates of obesity (43% versus 30.4%) and morbid obesity (3.9% versus 3%). This extreme obesity (BMI > 40 kg/m2) increased markedly with age in both sexes. It is interesting to note that, from a relatively early age (36 y), more than 50% of men have

Discussion

The prevalence of excess weight obtained for the entire sample (43.7% overweight and 35.1% obesity), was higher than the prevalence reported for the general Spanish population, as would be expected in patients who are attending a dietary consultation program. This percentage differs from those obtained in a 2005 study [18], which presented percentages of 34.2% overweight and 13.6% obesity and that those reported in 2011 [19] of 39.2% and 15.5% respectively. Moreover, the Spanish National Health

Limitations and strengths

Individuals participating in this study were recruited from a dietary counseling program; therefore they are not representative of the general population in terms of percentages of overweight and obesity, nor in terms of knowledge of their weight, height, or body image. The sample is, in addition, not homogenous with regard to distribution of sexes and age groups. However, the sample size is very large and representative of all Spanish geography and can reflect the profile of individuals who

Conclusion

Of the individuals attending a dietary consultation program, 77.5% of the women and 88% of the men were overweight. BMI calculated from self-reported data and, especially, the BMI estimated by the silhouette test, underestimated the actual BMI obtained by anthropometry. The discrepancy with reality was greater in men and increased with age.

Although the participants in the study identified themselves with images more stylized of their actual body shape, they clearly identified the silhouettes

Acknowledgments

This research was conducted under the established collaboration project between EPINUT-UCM Research Group, Spanish Society of Dietetics and Food Sciences, and Arkopharma Pharmaceutical Laboratories. The authors especially acknowledge the work done by the 133 registered dietitians who participated in the data collection.

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    PA was responsible for the statistical treatment, drafting and preparation of the manuscript. NL-E and MDC conducted the anthropometric training of dietitians; oversaw data collection; and assisted in the drafting and preparation of the manuscript. IA-G, JRM-Á, and AV coordinated and designed the study; and supervised the collection of data. DM coordinated and designed the study; was responsible for the statistical treatment and drafting and preparation of the manuscript. The authors declare no conflicts of interest.

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