Normalization of plus size and the danger of unseen overweight and obesity in England

Objective: This study aimed to investigate trends and sociodemographic factors underlying weight misperception in adults with overweight and obesity in England. Methods: This study used descriptive and logistic regression analyses based on a pooled nationally representative cross-sectional survey, Health Survey for England, for the years 1997, 1998, 2002, 2014, and 2015 of individuals with BMI>25 (n523,459). The main outcomes were (1) weight misperception and (2) weight-loss attempts as well as the associations with demographic and socioeconomic characteristics and health status. Results: The proportion of individuals with overweight and obesity misperceiving their weight status increased over time between 1997 and 2015 (37% to 40% in men; 17% to 19% in women). There were socioeconomic disparities in the misperception of weight status, with lower-educated individuals from poorer-income households and members of minority ethnic groups being more likely to underestimate their weight. Those underestimating their overweight and obesity status were 85% less likely to try to lose weight compared with people who accurately identified their weight status. Conclusions: The upward trend in underassessment of overweight and obesity status in England is possibly a result of the normalization of overweight and obesity. Obesity prevention programs need to consider differential sociodemographic characteristics associated with underassessment of weight status