O iginal Resea ch
Sel -pe cei ed body weigh and weigh s a us: analysis o
conco dance by age g oup and sex
A. Blanco-Fe ei o
a
, C. Candal-Ped ei a
a
,
b
,
d
,
*
, B. Send
on
a
, M.I. San iago-P
e ez
c
,
J. Rey-B anda iz
a
,
d
, L. Va ela-Lema
a
,
b
,
d
, N. Mou ino
a
, A. Ruano-Ra ina
a
,
b
,
d
, G. Ga cía
a
,
M. P
e ez-Ríos
a
,
b
,
d
a
Depa men o P e en i e Medicine and Public Heal h, Uni e si y o San iago de Compos ela, San iago de Compos ela, Galicia, Spain
b
Heal h Resea ch Ins i u e o San iago de Compos ela (Ins i u o de In es igaci
on Sani a ia de San iago de Compos ela-IDIS), San iago de Compos ela,
Galicia, Spain
c
Epidemiology Depa men , Di ec o a e-Gene al o Public Heal h, San iago de Compos ela, Spain
d
Conso ium o Biomedical Resea ch in Epidemiology and Public Heal h (CIBER de Epidemiología y Salud Pública-CIBERESP), Mad id, Spain
a icle in o
A icle his o y:
Recei ed 18 Sep embe 2023
Recei ed in e ised o m
29 Decembe 2023
Accep ed 9 Feb ua y 2024
A ailable online 5 Ma ch 2024
Keywo ds:
Body mass index
Body-weigh pe cep ion
Sel -pe cep ion
Adolescen s
Adul s
abs ac
Objec i es: P e ious s udies sugges ha he e is disco dance be ween ac ual weigh s a us and body-
weigh pe cep ion. This ac has implica ions when i comes o designing public heal h in e en ions.
The aim o his s udy was o es ima e he p e alence o he di e en ca ego ies o weigh s a us and
body-weigh pe cep ion and o analyse hei conco dance in a ep esen a i e Spanish popula ion sample.
S udy design: C oss-sec ional s udy.
Me hods: Da a we e sou ced om he 2018 Galician Risk Beha iou Da a Sys em, wi h he a ge pop-
ula ion being all pe sons aged 16 yea s and abo e. We collec ed da a on sel -pe cei ed body weigh and
assessed weigh s a us on he basis o body mass index (BMI). BMI was es ima ed using sel - epo ed
measu es o weigh and heigh . To es ima e conco dance, Cohen's kappa coe ficien , bo h unweigh ed
and weigh ed wi h Cicche i weigh s, was calcula ed.
Resul s: Da a we e ob ained o 7853 indi iduals aged 16 yea s and abo e, whe eas he o e all un-
weigh ed conco dance was 0.393 (95%CI: 0.377e0.409), wi h an ag eemen pe cen age o 61.6%,
weigh ed conco dance was 0.503 (0.490e0.517), wi h an ag eemen pe cen age o 86.6%. The highes
conco dance be ween sel -pe cei ed body weigh and weigh s a us was obse ed in women. By age
g oup, he highes conco dance was obse ed in he younges g oup (16e24 yea s) o he BMI ca ego ies
o unde weigh and o e weigh , and in he 45e64 age g oup o he ca ego y o obesi y.
Conclusions: The esul s highligh he exis ence o di e ences be ween sel -pe cei ed body weigh and
weigh s a us, acco ding o sex and age.
©2024 The Au ho s. Published by Else ie L d on behal o The Royal Socie y o Public Heal h. This is an
open access a icle unde he CC BY license (h p://c ea i ecommons.o g/licenses/by/4.0/).
In oduc ion
Since he publica ion o E ikson's heo y o psychosocial s ages
o de elopmen ,
1
he influence o body image on he cons uc ion
o pe sonal sel -concep has been widely s udied, and he ela-
ionship be ween body and iden i y seems o be clea ly es ab-
lished.
2
“Body image”is a mul idimensional cons uc defined as “a
pe son's pe cep ions, hough s, and eelings abou his o he body”
and depends on di e en ac o s, such as he cul u al con ex , sex,
social class, and e hnic o igin.
3,4
Fu he mo e, app ecia ion and
sel -assessmen o he body di e s be ween di e en ages and
e i o ies.
5e10
Body-image dis u bance has a clea influence on
pe sonal, psychological, and social li e p ocesses and di ec ly a ec s
quali y o li e.
11e13
Body-image dis u bance is defined as he mispe cep ion o he
ac ual body image and includes wo componen s: he pe cep ual
componen and he a i udinal componen . The pe cep ual
componen can be defined as he dis u bance in he way a pe son
expe ienced he o his own body weigh o shape.
14,15
Body-weigh
pe cep ion, defined by p e ious s udies as he pe sonal assessmen
*Co esponding au ho . Depa amen o de Medicina P e en i a y Salud Pública,
Facul ad de Medicina, Uni e sidad de San iago de Compos ela, C/ San F ancisco s/n
15782, San iago de Compos ela, Spain. Tel.: þ34881812278.
E-mail add ess: [email p o ec ed] (C. Candal-Ped ei a).
Con en s lis s a ailable a ScienceDi ec
Public Heal h
jou nal homepage: www.else ie .com/loca e/puhe
h ps://doi.o g/10.1016/j.puhe.2024.02.007
0033-3506/©2024 The Au ho s. Published by Else ie L d on behal o The Royal Socie y o Public Heal h. This is an open access a icle unde he CC BY license (h p://
c ea i ecommons.o g/licenses/by/4.0/).
Public Heal h 229 (2024) 160e166
o a pe son's weigh as “unde weigh ”,“no mal weigh ”,o “o e -
weigh ",
16
ega dless o he ac ual body mass index (BMI), media es
in pe sonal assessmen , sel -es eem, die , physical ac i i y,
17,18
and
e en sexuali y and a ec s all pe sons o e hei li e ime, om
childhood o old age.
19
The dis u bance o body-weigh pe cep ion
can also influence social ac i i y o in e ac ion wi h o he people,
pa icula ly in indi iduals who ha e a body ha does no con o m
o he socie al s anda d.
20
Ea lie s udies in di e en coun ies concluded ha body-
weigh pe cep ion is ela ed o he BMI,
22e25
and some o hem
sugges ed he disco dance be ween ac ual weigh s a us and body-
weigh pe cep ion.
26e31
I should be no ed ha ocussing on body weigh loss and
weigh con ol o p omo e a heal hy s a us may comp omise
heal hy body image. The e o e, some au ho s p opose o change
his app oach and encou age ha heal h and well-being can be
achie ed ega dless o weigh . Thus, ea ing nu i ious oods, s op-
ping ea ing when sa ia ed, o p ac icing spo s a e ecommended
as s a egies o p omo e a heal hy s a e.
32
Howe e , i is also
impo an o no e ha he po en ial disco dance be ween eal and
pe cei ed body weigh may has implica ions as i could encou age
he adop ion o unheal hy o e en dange ous li es yles and be-
ha iou s.
33,34
In his con ex , wi h he aim o implemen ing public
heal h in e en ions adap ed o he con ex o each coun y, i
could be use ul o asce ain conco dance be ween ac ual weigh
s a us, using BMI and body-weigh pe cep ion a a popula ion le el.
To his end, he e a e su eys a ailable ha can u nish popula ion
da a ha cha ac e ise he popula ion by e e ence o i s BMI. E en
so, such su eys may ha e limi a ions, in a case whe e he popu-
la ion p o ides inaccu a e in o ma ion abou i s weigh o heigh ,
o whe e hese measu es do no pe se eflec weigh s a us.
Al hough body-weigh pe cep ion, o ou knowledge, has no been
explo ed as a eliable measu e o weigh s a us. Conside ing bo h
BMI and body-weigh pe cep ion in s udies and su eys could be
use ul o he implemen a ion o e ec i e s a egies o con ol
o e weigh and obesi y.
To da e, ou s udies ha e analysed he conco dance be ween
body-weigh pe cep ion and weigh s a us in Spain. Two o hese
we e unde aken in a hospi al con ex , one on pa ien s isi ing he
die i ian and ano he on pa ien s a ending hospi al cou ses on
obesi y;
28,29
wo s udies we e conduc ed on uni e si y s u-
den s.
27,30
The e a e hus no s udies ha ha e analysed his aspec
in a ep esen a i e popula ion sample by sex and age in Spain. The
main aim o his s udy was he e o e o es ima e he p e alence o
he di e en ca ego ies o weigh s a us defined on he basis o sel -
epo ed weigh and heigh , and o body weigh pe cep ion, and
analyse he conco dance be ween he wo in a ep esen a i e
Spanish popula ion sample aged 16 yea s and abo e.
Me hods
This is a c oss-sec ional s udy based on he 2018 Galician Risk
Beha iou Da a Sys em (Sis ema de In o maci
on sob e Conduc as de
Riesgo/SICRI).
35
Since 2005, 11 c oss-sec ional s udies ha e been
conduc ed wi hin he SICRI amewo k on he esiden popula ion
o Galicia (Spain) aged 16 yea s and abo e, based on elephone
su eys adminis e ed by a compu e -assis ed elephone in e -
iewing sys em.
36
In 2018, he sample was selec ed by s a ified andom sampling,
aking he Heal h-Ca d Holde Regis e , which has a popula ion
co e age o 97%, as he sampling amewo k. The sample size was
calcula ed o each sex and age g oup, assuming a 50% p e alence,
an absolu e e o o 3.5%, a 95% confidence le el, and a design e ec
o 1.25. This esul ed in a heo e ical size o 980 indi iduals o each
g oup, leading o a o al sample size o 7840. The s udy design made
i possible o ensu e ep esen a i eness by sex and age g oup
(16e24, 25e44, 45e64, and 65 yea s and o e ).
Collec ion o an h opome ic da a was based on sel - epo ed
weigh (in kilog ammes) and heigh (in cen ime es) wi hou
clo hes o shoes. Wi h espec o body-weigh pe cep ion, pa ici-
pan s we e asked which o he p oposed exp essions came closes
o hei opinion abou hei body: “I hink I'm a ”;“I hink I'm a li le
o e weigh ”;“I hink my weigh 's abou igh ”;“I hink I'm a li le
hin”; and “I hink I'm e y hin”.
Using he an h opome ic measu es o weigh and heigh , BMI
was calcula ed by means o he exp ession, BMI ¼
weigh ðkgÞ
heigh ðmÞ
2
. The
di e en ca ego ies ha define weigh s a us a e hose included by
in e na ional ag eemen , i.e., unde weigh (BMI <18.5 kg/m
2
),
no mal weigh (18.5 BMI <25 kg/m
2
), o e weigh (25 BMI <30
kg/m
2
), and obesi y (BMI 30 kg/m
2
).
37
In his s udy, excess weigh
was defined as o e weigh o obesi y.
We fi s es ima ed p e alences o each o he a o emen ioned
weigh -s a us ca ego ies, accompanied by hei 95% confidence
in e als (95%CIs), bo h o e all and by sex and age. P e alences and
hei 95%CIs we e likewise calcula ed o he di e en ca ego ies o
body-weigh pe cep ion. The conco dance be ween he wo a i-
ables was hen analysed. The ca ego ies we e es ablished by
ma ching: unde weigh o he combina ion o “I'm e y hin”and
“I'm a li le hin”; no mal weigh o “I hink my weigh 's abou igh ”;
o e weigh o “I'm a li le o e weigh ”; and obesi y o “I'm a ”.To
analyse he conco dance be ween body-weigh pe cep ion and
weigh s a us measu ed wi h BMI, Cohen's kappa coe ficien , un-
weigh ed and weigh ed wi h Cicche i weigh s, was calcula ed o
he case o wo obse e s wi h ou classifica ion ca ego ies.
38
Conco dance was calcula ed, bo h o e all and by sex and age
g oup, along wi h he espec i e 95%CIs. In addi ion, he pe cen age
o disag eemen due o unde es ima ion o o e es ima ion o he
body weigh was analysed.
We also analysed he conco dance be ween he mos ex eme
ca ego ies (unde weigh , o e weigh , and obesi y), conside ing
wo obse e s and classifica ions in wo ca ego ies. Unde weigh
was defined as ha ing a BMI <18.5 kg/m
2
o he sel -pe cep ion,
“I'm e y hin”o “I'm a li le hin”; o e weigh was defined as
ha ing a BMI 25 kg/m
2
o he sel -pe cep ion, “I'm a li le o e -
weigh ”o “I'm a ”; and obesi y was defined as ha ing a BMI 30
kg/m
2
o he sel -pe cep ion, “I'm a ”. Fo each o he ca ego ies
analysed, conco dance was calcula ed, bo h o e all and by sex and
age g oup, along wi h he espec i e 95%CIs.
Fo in e p e a ion o kappa-coe ficien esul s, we used he scale
p oposed by Landis and Koch. This scale classifies ag eemen as
sligh (0.01e0.20), ai (0.21e0.40), mode a e (0.41e0.60), sub-
s an ial (0.61e0.80), o almos pe ec (0.81e1.00).
39
Obse ed
pe cen age ag eemen was also calcula ed.
Da a analysis was pe o med using he S a a 17 and Epida 4.2.
compu e so wa e packages.
E hical aspec s
This s udy was conduc ed in acco dance wi h he s anda ds o
good p ac ice. E hics commi ee app o al was no equi ed due o
he specific na u e o his s udy. Acco ding o Spanish na ional and
ins i u ional legisla ion, obse a ional s udies ha only use anon-
ymous o anonymised da a do no equi e e hics commi ee
au ho isa ion. In addi ion, he da a used o his s udy a e pa o a
public heal h p og am and depend on he Galician public admin-
is a ion. The pa icipa ion in his s udy was olun a y and anon-
ymous, gua an eeing o al confiden iali y o all pa icipan s. All
pa icipan s we e equi ed o gi e hei exp ess e bal consen a
he da e o he su ey. The s udy included elephone in e iews,
A. Blanco-Fe ei o, C. Candal-Ped ei a, B. Send
on e al. Public Heal h 229 (2024) 160e166
161
and he ac ha pa icipan s ag eed o pa icipa e in he esea ch
au oma ically implied hei consen . Pa icipan s we e ully
in o med o he pu pose and objec i es o he s udy p io o hei
pa icipa ion.
Resul s
Da a we e ob ained o 7853 indi iduals aged 16 yea s and abo e,
wi h a 70% esponse a e; 50% o he sample we e women; and he
median age was 45 yea s (in e qua ile ange: 25e65 yea s).
In e ms o weigh s a us, BMI ob ained on he basis o sel -
epo ed weigh and heigh showed ha 1.6% (95%CI: 1.4e1.9) o
he popula ion we e unde weigh , 42.0% (95%CI: 40.8e43.1) we e
no mal weigh , 39.9% (95%CI: 38.8e41.1) we e o e weigh , and
16.5% (95%CI: 15.6e17.4) we e obese. When i came o body-weigh
pe cep ion, 8.6% (95%CI: 8.0e9.3) saw hemsel es as being unde -
weigh , and 46.0% (95%CI: 44.9e47.2) saw hemsel es as being
no mal weigh , whe eas 37.8% (95%CI: 36.7e39.0) and 7.6% (95%CI:
7.0e8.3) saw hemsel es as being o e weigh and obese, espec-
i ely. The highes p e alence o unde weigh , aking bo h BMI and
body-weigh pe cep ion in o accoun , was ound among women;
he highes p e alence o o e weigh was egis e ed in men,
hough his was only aking BMI in o accoun (Table 1).
The mean BMI o hose who pe cei ed hemsel es as hin was
22.0 kg/m
2
(95%CI: 21.8e22.3) in men and 20.5 kg/m
2
(95%CI:
20.2e20.8) in women. The mean BMI o hose who saw hemsel es
as a was 31.9 kg/m
2
(95%CI: 31.4e32.5) and 32.3 kg/m
2
(95%CI:
31.7e32.9) in men and women, espec i ely (Fig. 1).
When he BMI and body-weigh pe cep ion ca ego ies (unde -
weigh , no mal weigh , o e weigh , and obesi y) we e aken in o
accoun , he kappa coe ficien anged om ai o mode a e on
applying Landis and Koch's c i e ia (0.330e0.457) (Table 2).
Weigh ing wi h Cicche i weigh s esul ed in a ise in conco dance,
bo h o e all and o all sex and age g oups. The highes conco -
dance was obse ed in women (kappa index: 0.555 [95%CI:
0.537e0.574]) and in indi iduals aged 16e24 yea s (kappa index:
0.518 [95%CI: 0.487e0.549]) (Table 2).
The unweigh ed pe cen age o ag eemen obse ed be ween he
ca ego ies o weigh s a us and body-weigh pe cep ion was 61.6%.
Table 3 shows he pe cen age o disag eemen o unde es ima ion
and o e es ima ion o body weigh o e all, by sex and by age g oup.
O he 38.4% o indi iduals who did no pe cei e hei weigh o be
he same as hei BMI, 30.8% had an unde es ima ion o hei weigh ,
and 7.5% had an o e es ima ion. Unde es ima ion was mo e com-
mon in men and in he olde age g oup and o e es ima ion, among
women and in he younge age g oup (Table 3).
Table 4 shows he analysis o conco dance be ween BMI and
body-weigh pe cep ion in he ex eme ca ego ies (unde weigh ,
o e weigh , and obesi y). When he ca ego y o unde weigh was
conside ed, he conco dance anged om sligh o ai . Conco dance
was ai only o o e all, women, and he younges indi iduals (age:
16e44 yea s). In he case o o e weigh , he kappa coe ficien
anged om sligh o mode a e. Conco dance was mode a e only o
he women and he younges indi iduals (age: 16e44 yea s). In he
obesi y ca ego y, conco dance was ai o all he ca ego ies ana-
lysed. Pe cen age ag eemen anged om 59.9% o 95.0% (Table 4).
Table 1
P e alences o weigh s a us ca ego ies, defined on he basis o sel - epo ed BMI, and body-weigh pe cep ion ca ego ies, wi h 95% confidence in e als (95%CI), bo h o e all
and by sex and age g oup.
Weigh s a us (% and 95%CI) Body-weigh pe cep ion (% and 95%CI)
Unde weigh Sel -pe cep ion o being hin
All 1.6 (1.4e1.9) 8.6 (8.0e9.3)
Men 0.6 (0.4e0.8) 7.8 (7.0e8.7)
Women 2.6 (2.1e3.1) 9.3 (8.4e10.3)
16e24 yea s 6.7 (5.6e7.8) 15.9 (14.3e17.6)
25e44 yea s 1.9 (1.4e2.6) 9.7 (8.4e11.0)
45e64 yea s 0.7 (0.4e1.2) 5.9 (4.9e7.0)
65 yea s and abo e 0.9 (0.5e1.4) 8.5 (7.4e9.9)
No mal weigh Sel -pe cep ion o being no mal weigh
All 42.0 (40.8e43.1) 46.0 (44.9e47.2)
Men 37.1 (35.5e38.6) 48.5 (46.9e50.2)
Women 46.4 (44.8e48.1) 43.8 (42.1e45.4)
16e24 yea s 71.1 (69.0e73.1) 62.6 (60.4e64.8)
25e44 yea s 53.2 (51.0e55.4) 51.6 (49.3e53.8)
45e64 yea s 36.1 (34.0e38.2) 41.3 (39.1e43.5)
65 yea s and abo e 29.0 (27.0e31.0) 41.2 (39.0e43.3)
O e weigh Sel -pe cep ion o being o e weigh
All 39.9 (38.8e41.1) 37.8 (36.7e39.0)
Men 46.0 (44.4e47.7) 37.0 (35.4e38.6)
Women 34.3 (32.8e35.9) 38.6 (36.9e40.2)
16e24 yea s 17.6 (16.0e19.4) 19.6 (17.9e21.4)
25e44 yea s 34.2 (32.2e36.3) 33.9 (31.8e36.0)
45e64 yea s 43.5 (41.4e45.7) 42.5 (40.3e44.7)
65 yea s and abo e 47.8 (45.6e50.0) 41.6 (39.4e43.8)
Obesi y Sel -pe cep ion o being a
All 16.5 (15.6e17.4) 7.6 (7.0e8.3)
Men 16.3 (15.1e17.6) 6.7 (5.9e7.6)
Women 16.7 (15.5e18.0) 8.4 (7.5e9.4)
16e24 yea s 4.7 (3.8e5.7) 1.9 (1.4e2.7)
25e44 yea s 10.6 (9.4e12.1) 4.9 (4.0e6.0)
45e64 yea s 19.6 (17.9e21.4) 10.3 (9.0e11.7)
65 yea s and abo e 22.3 (20.5e24.2) 8.8 (7.6e10.1)
Abb e ia ions: BMI ¼body mass index; CI ¼confidence in e al.
A. Blanco-Fe ei o, C. Candal-Ped ei a, B. Send
on e al. Public Heal h 229 (2024) 160e166
162
Discussion
The esul s o his s udy highligh he exis ence o di e ences
be ween body-weigh pe cep ion and weigh s a us based on BMI.
O e all, he highes conco dance is seen in women and indi iduals
aged 16e24 yea s; howe e , when obesi y is conside ed, he
highes conco dance occu s in women and in he mos ad anced
age g oups (45 yea s and abo e). These di e ences may well ha e
impo an implica ions o public heal h and he o mula ion o
heal h policies. To ou knowledge, his s udy is he only one o be
conduc ed in Spain in which he sample was ep esen a i e by sex
and age o he popula ion.
The esul s ob ained indica e ha , o e all, he e is an o e -
es ima e in he sel -pe cep ion o hinness, and an unde es ima e in
he sel -pe cep ion o o e weigh , and o obesi y in pa icula .
Impo an sex- ela ed di e ences in disco dance a e obse ed be-
ween sel -pe cep ionand BMI-based weigh s a us. In gene al, men
mo e equen ly pe cei e hei weigh as no mal, and a less
equen ly, as excessi e. Women, o hei pa , display a con a y
end, wi h a p edisposi ion o conside hemsel es o e weigh .
This finding is in line wi h he li e a u e,
40e43
wi h he anscul u al
ac o ha cha ac e ises his dynamic as p edominan ly wes -
e n,
5,9,44
and wi h a simila s udy conduc ed in Spain.
45
These e-
sul s sugges ha he di e ences be ween men and women espond
o he social cons uc o gende and he oles de i ing om his, and
no o a me e biological ques ion.
46,47
Hence, a sys ema ic e iew
ha assessed body dissa is ac ion in obese indi iduals as compa ed
o no mal-weigh indi iduals, obse ed ha he emale gende
displayed g ea e body dissa is ac ion han did he male gende ,
48
hough i should be no ed he e ha he conco dance analysed in
his s udy was in all cases highe o women, ega dlesso age g oup.
These esul s ag ee wi h p e ious s udies ha assessed conco dance
be ween body-weigh pe cep ion and objec i ely measu ed BMI
and concluded ha , o e all, he pe cen age ag eemen was highe in
women han in men.42
,
49
,
50
,
51
Fig. 1. Dis ibu ion o sel - epo ed BMI acco ding o ca ego ies o body-weigh pe cep ion in men and women. Abb e ia ion: BMI ¼body mass index.
Table 2
Obse ed pe cen age ag eemen and kappa coe ficien s, bo h unweigh ed and
weigh ed wi h Cicche i weigh s, wi h 95% confidence in e als, be ween weigh
s a us ca ego ies defined on he basis o sel - epo ed BMI, and ca ego ies o sel -
pe cei ed body-weigh pe cep ion.
Ag eemen (%) Kappa 95%CI
Unweigh ed
All 61.6 0.393 (0.377e0.409)
Men 57.5 0.330 (0.308e0.353)
Women 65.7 0.457 (0.435e0.479)
16e24 yea s 71.0 0.430 (0.394e0.466)
25e44 yea s 64.2 0.388 (0.356e0.420)
45e64 yea s 59.5 0.373 (0.340e0.405)
65 yea s and abo e 65.1 0.421 (0.389e0.453)
Weigh ed wi h Cicche i weigh s
All 86.6 0.503 (0.490e0.517)
Men 85.3 0.452 (0.434e0.471)
Women 87.9 0.555 (0.537e0.574)
16e24 yea s 90.2 0.518 (0.487e0.549)
25e44 yea s 87.8 0.465 (0.439e0.492)
45e64 yea s 86.1 0.491 (0.464e0.517)
65 yea s and abo e 82.4 0.510 (0.483e0.538)
Abb e ia ions: BMI ¼body mass index; CI ¼confidence in e al.
A. Blanco-Fe ei o, C. Candal-Ped ei a, B. Send
on e al. Public Heal h 229 (2024) 160e166
163
Di e ences a e also obse ed in e ms o age. The younges pe -
sons who p esen wi h obesi y end o pe cei e hei weigh as
excessi e, hough hey also end mo e equen ly o see hemsel es
as hinwhen in eali y hey a e no . This endency o a mispe cep ion
o he body weigh il ed owa ds slimness, especially among he
obese popula ion, is a widesp ead phenomenon ha does no occu
only in his s udy.
43,52
Young people can be mo e exposed o cu en
beau y s anda ds, which o en p omo e slim bodies as he ideal,
especially nowadays wi h he ise in social ne wo ks.
53
This may
accen ua e adolescen s' dissa is ac ion wi h hei body weigh o
body image. Among he 34 s udies analysed in a 2022 sys ema ic
e iew, a 2015 s udy in ol ing B azilian adolescen s aged 10e17
yea s epo ed he highes p e alence o body-weigh dissa is ac ion,
eaching 56.6%. Ac oss all included s udies, gi ls consis en ly showed
highe le els o dissa is ac ion han boys.
21
Fu he mo e, a 2017
sys ema ic e iew, ocussing on child en and adolescen s, ound ha
sel - epo ed body-weigh dissa is ac ion was mo e p e alen
among o e weigh /obese indi iduals ( anging om 44% o 83%) han
among hose classified as unde weigh ( anging om 1.7% o 37%).
54
Adolescen s and young adul s o en wan o fi in osocialg oupsand
may be awa e o he ac ha ha ing a body weigh wi hin he anges
conside ed no mal is mo e socially accep ed and be e alued.
Consequen ly, e en i hey a e o e weigh o obese, hey may
none heless ha e a endency o see hemsel es as hin, in o de o fi
in wi h hese social no ms. Fu he mo e, body-weigh pe cep ion
can be influenced by subjec i e ac o s, such as he way in which a
pe son sees himsel /he sel in he mi o o how he/she eels wi h
espec o his/he body. This can be applied bo h o he ac ha
o e weigh o obese indi iduals may see hemsel es as hinne and
o he ac ha unde weigh indi iduals may see hemsel es as a e
han hey eally a e. Addi ionally, i should be bo ne in mind ha
sel - epo ed an h opome ic measu es can ep oduce his obse ed
endency o unde es ima e weigh and/o o e es ima e heigh .
55e57
Some hing simila occu s wi h inc easing age, bu he easons
may be di e en . In he oldes age g oup, he e is an o e es ima e o
he “ igh ness”o weigh , a g ea e di ficul y o pe cei e o e -
weigh , and an unde es ima e o obesi y. These esul s ag ee wi h
p e ious s udies.
58
This may be due o a ious ac o s. Olde pe -
sons may be influenced by s e eo ypes and cul u al belie s linked o
weigh and body-weigh pe cep ion. Fo ins ance, hey may in e -
nalise he idea ha ca ying a li le ex a weigh is no mal o e en a
sign o good heal h. Mo eo e , as people g ow olde , hey may
possibly de elop a g ea e accep ance o hemsel es and a highe
sel -es eem, ega dless o hei weigh o body shape, o al e na-
i ely, he impo ance ha hey a ach o body-weigh pe cep ion
may dec ease wi h age.
59
These ac o s can lead o an o e es ima e
o he “ igh ness”o weigh and an unde es ima ion o obesi y
among olde adul s. Inadequa e pe cep ion o o e weigh , along
wi h he inc eased p e alence o seden a y li es yles and wo se
die a y habi s, can lead o he main enance o o an inc ease in
obesi y and ela ed diseases.
58
A en ion should be paid o he young popula ion, whose body-
weigh pe cep ion ende s hem especially ulne able when i
comes o igge ing isk beha iou s o he appea ance o ela ed
diseases. This ulne abili y is e en g ea e o women, who, in
addi ion o hei own sel -pe cep ion, ha e o deal wi h he p e-
ailing aes he ic p essu e.
60
A p e ious s udy conduc ed on uni-
e si y s uden s, which desc ibed he ela ionship be ween body-
weigh pe cep ion and BMI, concluded ha o e weigh and obese
s uden s we e he ones who mos unde es ima ed sel -pe cep ion
o o e weigh , whe eas no mal-weigh and unde weigh s uden s
o e es ima ed i . By sex, 66.4% o women wi h no mal weigh
o e es ima ed hei body-weigh pe cep ion e sus 12.7% o men.
30
Mo eo e , his disco dance may ha e an impac on peoples’li e-
s yles. A p e ious s udy unde aken a schools in China showed
ha pupils who had a mispe cep ion o hei body-weigh
pe cep ion we e mo e p one o ha e unheal hy die a y and phys-
ical exe cise habi s.
61
Howe e , his may be con ex -dependen
since a s udy conduc ed on US s uden s obse ed he opposi e,
i.e., obese subjec s who saw hemsel es as hinne we e mo e likely
o engage in heal hie beha iou s.
62
All he a o emen ioned may ha e implica ions when i comes o
designing public heal h in e en ions. Knowledge o weigh s a us
is necessa y o p omo e a shi in beha iou owa ds heal hie
habi s. In iew o he findings o his s udy, he e is a need o
s a egies ha in o m people abou hei weigh s a us. Heal h
p og ams and in e en ions should also be a ge ed a he in o-
duc ion o pic o ial ools, such as he one designed by Collins
63
o
p eadolescen child en, o imp o e pe cei ed body image and
weigh , especially in he mos ex eme age g oups, and a he
adop ion o heal hy die a y and exe cise guidelines.
The main ad an age o his s udy lies in he sample's ep e-
sen a i eness and size, which allow o analysis by sex and age
g oup. This s udy's main limi a ion is no ha ing objec i e and
di ec an h opome ic measu es and ha ing used sel - epo ed
measu es. I mus be bo ne in mind ha sel - epo ed
Table 3
Unweigh ed obse ed pe cen age disag eemen be ween weigh s a us ca ego ies
and body-weigh pe cep ion ca ego ies due o unde es ima ion o o e es ima ion o
he body weigh .
Disag eemen (%)
Unde es ima ion
o he body weigh
O e es ima ion
o he body weigh
All 30.8 7.5
Men 37.5 5.0
Women 24.2 10.1
16e24 yea s 20.5 8.5
25e44 yea s 26.8 8.2
45e64 yea s 32.3 8.2
65 yea s and abo e 43.5 5.4
Table 4
Obse ed pe cen age ag eemen and unweigh ed kappa coe ficien , wi h 95% con-
fidence in e als, be ween weigh -s a us ca ego ies defined on he basis o sel -
epo ed BMI and ex eme body-weigh pe cep ion ca ego ies.
Ag eemen (%) Kappa
a
95%CI
Unde weigh - Sel -pe cep ion o being hin
All 91.1 0.256 (0.220e0.293)
Men 90.5 0.129 (0.086e0.171)
Women 91.7 0.364 (0.311e0.416)
16e24 yea s 86.7 0.347 (0.287e0.407)
25e44 yea s 91.1 0.220 (0.149e0.290)
45e64 yea s 94.4 0.144 (0.062e0.226)
65 yea s and abo e 92.2 0.130 (0.065e0.196)
O e weigh - Sel -pe cep ion o being o e weigh o a
All 71.1 0.367 (0.346e0.389)
Men 67.6 0.314 (0.284e0.344)
Women 74.6 0.426 (0.397e0.456)
16e24 yea s 84.6 0.490 (0.440e0.540)
25e44 yea s 74.5 0.430 (0.389e0.472)
45e64 yea s 65.9 0.305 (0.262e0.347)
65 yea s and abo e 59.9 0.194 (0.151e0.236)
Obesi y - Sel -pe cep ion o being a
All 87.6 0.345 (0.314e0.375)
Men 87.3 0.318 (0.274e0.361)
Women 87.9 0.370 (0.327e0.414)
16e24 yea s 95.0 0.217 (0.118e0.320)
25e44 yea s 89.6 0.283 (0.214e0.353)
45e64 yea s 83.9 0.380 (0.326e0.433)
65 yea s and abo e 82.1 0.332 (0.282e0.382)
Abb e ia ions: BMI ¼body mass index; CI ¼confidence in e al.
a
The kappa coe ficien s shown we e no weigh ed using Cicche i weigh s, since
only wo ca ego ies a e compa ed.
A. Blanco-Fe ei o, C. Candal-Ped ei a, B. Send
on e al. Public Heal h 229 (2024) 160e166
164
an h opome ic measu es gi e ise o an unde es ima e o
weigh ,
64,65
wi h he esul ha he e migh be a g ea e deg ee o
disco dance han ha obse ed in his s udy. I is impo an o
highligh he ac ha BMI was used as he only measu e o es i-
ma ion o weigh s a us and ha i does no disc imina e be ween
a mass and muscle mass. Hence, i canno be uled ou ha
conco dance migh p o e di e en i i we e o be e alua ed agains
o he an h opome ic measu es, such as isce al a . Tha said,
ha ing da a on such measu es on a sel - epo basis is di ficul .
Addi ionally, he cha ac e isa ion o he popula ion based on he
BMI cu -o poin s has been pe o med by applying he same cu -o
poin s ega dless age. I should be aken in o accoun ha he
eanalysis o da a using he classifica ion p oposed by Cole
66
in he
popula ion unde 18 yea s o age (5.8% o he sample) has shown
negligible changes in he esul s ob ained (da a no shown).
In b ie , body-weigh pe cep ion appea s o a y depending on
age and sex. Due o he scan conco dance obse ed be ween ac ual
weigh s a us, measu ed on he basis o BMI, and body-weigh
pe cep ion, sel -pe cep ion would no seem likely o be a use ul
measu e o es ablishing weigh s a us a a popula ion le el o a
eliable indica o o s udies ela ing o obesi y and o e weigh . In
ligh o he esul s, heal h p og ammes and in e en ions should
also be a ge ed a he in oduc ion o ools designed o imp o e
pe cei ed body-weigh pe cep ion, especially in he mos ex eme
age g oups, and a he adop ion o heal hy die a y and exe cise
guidelines. Mo e esea ch along hese lines is called o , in o de o
be able o implemen isk-beha iou p e en ion campaigns
consis en wi h he conc e e in e es s and needs o he popula ion
and public heal h measu es adap ed o he na ional con ex .
Au ho s a emen s
Acknowledgemen s
None.
E hical app o al
This s udy was based on publicly a ailable anonymised da a-
bases, and hus exemp om e hical compliance.
Funding
This s udy did no ecei e any unding.
Compe ing in e es s
The au ho s decla e ha he e a e no conflic s o in e es ha
a e ele an o he publica ion o his pape .
A ailabili y o da a
The da a ha suppo he findings o his s udy a e openly
a ailable om h ps://www.se gas.es/Saude-publica/SICRI-2018-
Mic oda os.
Au ho ship and o iginali y
The co esponding au ho wa an s ha all a o emen ioned au-
ho s ulfil he c i e ia o au ho ship (h p://www.icmje.o g/
ecommenda ions/b owse/ oles-and- esponsibili ies/defining- he-
ole-o -au ho s-and-con ibu o s.h ml# wo)asdefined by he In-
e na ional Commi ee o Medical Jou nal Edi o s. The co esponding
au ho u he wa an s ha he wo k desc ibed in his manusc ip
has no been published be o e and is no (no will be) unde
conside a ionelsewhe ewhileunde e iewwi h hisjou nal; ha all
au ho s app o ed he p esen submi ed e sion and ha hei in-
s i u ions ha e no objec ions o he manusc ip 's con en s.
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