A cross-sectional analysis of NHANES (National Health and Nutrition Examination Survey) data found that more than 40% of U.S. adults with overweight and nearly 10% with obesity did not consider themselves to be overweight. This trend has increased over the last two decades and was especially true of non-Hispanic Blacks and persons with low socioeconomic status. The findings are published in Annals of Internal Medicine.

The researchers from the University of Chicago Medicine analyzed NHANES data to investigate the trends of overweight and obesity self-awareness among U.S. adults with overweight or obesity. They also looked at factors associated with obesity self-awareness and weight loss attempts among adults with obesity. Survey participants were asked about self-perception of weight using the question: "Do you consider yourself to be overweight, underweight, or about the right weight?" They found that more than a significant proportion of those with overweight or obesity did not recognize the issue.

The authors say that as BMIs of Americans increase, people adjust their views on normal weight range to promote positive body images, and suggest use of varying BMI cutoffs to define overweight and obesity may be necessary when comparing varying demographic subsets. The authors still emphasize that this study data showed persons with obesity who did not view their weight to be overweight were less likely to try to lose weight and this may contribute to increasing obesity rates in the United States. The authors also found that health professional-guided education on weight improved both obesity self-awareness and attempts to lose weight among persons with obesity. However, having health insurance did not affect obesity self-awareness, suggesting health professionals are not routinely providing weight counseling to patients with obesity.

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