|Year : 2017 | Volume
| Issue : 10 | Page : 45-51
Self-perception of body size among adults in Delta State, Nigeria
Ejiroghene Martha Umuerri1, Christiana Omotola Ayandele2
1 Department of Medicine, Delta State University, Abraka; Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
2 Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
|Date of Web Publication||13-Feb-2018|
Ejiroghene Martha Umuerri
Department of Medicine, Delta State University Teaching Hospital, Oghara
Source of Support: None, Conflict of Interest: None
Background: Obesity is a lifestyle disease with enormous public health challenges. Accurate self-perception of body size is essential to maintain a healthy lifestyle and a healthy body size. Aim: The aim of this study is to describe self-perception of body size among adults in Delta State, Nigeria, and determine the level of misperception. Settings and Design: This was a cross-sectional exploratory survey of apparently healthy adults living in Delta State, Nigeria. Materials and Methods: Data on demography, self-perception of body size, and means of assessing body size were reported and documented. Height, weight, and waist circumference (WC) were measured and body mass index (BMI) calculated. Actual body size was compared with self-perceived body size. Results: About 85% of the respondents reported normal/healthy self-perceived weight while <10% indicated that they were overweight or obese. One-third of respondents misperceived their weight, 24.8% underestimated, while 8.8% overestimated their self-perceived weight using BMI. Female respondents had a higher BMI than males (P < 0.001). Body size defined by BMI was significantly different from self-perceived weight (P < 0.001) with obese females and overweight males having a higher rate of misperception of weight. Urban respondents had a higher rate of misperception than their rural counterparts (P < 0.001). BMI and WC were identified as means of weight assessment in 7.6% and 0.0% of the respondents, respectively. Conclusion: The rate of misperception of weight among adults is high in Delta State, Nigeria, especially among those who were male, overweight, and urban dwellers. Lack of recognition of actual weight status may hinder public health initiatives to effectively deal with obesity.
Keywords: Adult, body size, misperception, Nigerians
|How to cite this article:|
Umuerri EM, Ayandele CO. Self-perception of body size among adults in Delta State, Nigeria. N Niger J Clin Res 2017;6:45-51
| Introduction|| |
Obesity is an increasing global public health problem that has been linked to chronic diseases such as type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and some cancers., The burden of obesity and indeed other noncommunicable diseases is worse off in developing countries, especially as they are already plagued with infectious diseases, corruption, and poverty in epidemic proportions. Obesity has been described as a lifestyle disease.,
Perception of body size has been defined as the picture of one's body formed in mind. This may be influenced by multiple factors that are interrelated. Factors such as age, gender, educational status, socioeconomic status, and body mass index (BMI) have been reported to influence the way people perceive their body weight.,, Other factors influencing the perception of body size are sociocultural disposition and ethnicity, opinion of significant others such as peers and relative, and the mass media. In some developing countries like Nigeria and India, having a heavily built body may be perceived by some as conferring a status of affluence.,, There is a gradual shift toward approving lean stature in developing countries, especially among young elite females. This may not be unrelated to the influence of the mass media and Westernization. In the Western world, slim built is portrayed as beautiful while obesity is generally frowned at.
Misperception is a wrong perception of one's actual body size. It can either be over- or under-estimated. Gaining an understanding of the body size, perceptions held by people have important health implications considering that obesity is a lifestyle disease. Self-perceived weight status has been shown to correlate more than actual BMI with intentions and actions to avoid weight gain. Individuals with wrong body size image may be less motivated to lose weight and maintain a healthy weight. Indeed, body size misperception has been described as a novel cardiovascular risk factor needing multifaceted interventions both in the clinical settings and at community levels. Encouraging people to perceive their weight accurately may be an effective method for managing body weight.
This study aimed at describing self-perception of body weight and the various means of weight assessment among apparently healthy adults living in Delta State, Nigeria.
| Materials and Methods|| |
This was a cross-sectional exploratory study of adults in Delta State carried out between February and March 2015. This study was carried out in line with the Helsinki Declaration of 1975 after obtaining ethical approval from the Health Research and Ethics Committee of Delta State University Teaching Hospital. The study sites, Warri (urban) and Jesse (rural), were purposively selected, and the study participants were recruited from these sites using cluster sampling technique. Consenting adults who had lived in study location for at least 1 year were recruited. Nonconsenting adults, visitors, and those who had lived less than a year in study location were excluded from the study.
Trained research assistants obtained data from the study participants using questionnaire as the research instrument. Demographic data on age, sex, educational status, and marital status were recorded. Anthropometric data on weight, height, and waist circumference (WC) were measured using standard protocols. Before measurement, participants were asked to remove footwear, head dressings, heavy outer clothing, and empty their pockets. Weight was measured to the nearest 0.1 kg using the Detecto PD300DHR Digital-ProDoc (USA) weighing scale, and height was measured to the nearest 0.1 cm using the Prestige HM0016D (India) stadiometer. The BMI was calculated thereafter as weight in kilograms divided by the square of the height in meters.
Nonelastic tape was used to measure the WC. The WC was measured midway between the lower rib and the iliac crest on the horizontal plane to the nearest 0.1 cm at the end of normal expiration horizontal.
Using the World Health Organization (WHO) criteria, BMI was categorized as underweight (<18.5 kg/m 2), normal weight (18.5–24.9 kg/m 2), overweight (25.0–29.9 kg/m 2), and obese (≥30.0 kg/m 2). The cutoff value for central obesity using WC was set at 102 cm for males and 88 cm for females.
Misperception of weight was defined as: (i) underestimated if the actual body size by anthropometric measurements was more than the reported self-perceived body size and (ii) overestimated if the actual body size by anthropometric measurements was less than the reported self-perceived body size.
Data were extracted from questionnaires into the Microsoft Excel spreadsheet before exporting to the Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA) software for analysis. Percentages, means, and standard deviation were used to summarize numerical variables. Chi-square test was used to test the differences between categorical variables. The level of significance was set at P < 0.05.
| Results|| |
A total of 866 participants were recruited for the study, but only 712 responded to the questions on self-perception of body size and means of assessing body weight, making the response rate 82.2%. The characteristics of the study population are shown in [Table 1].
There were more females than males in a ratio of 1.42:1. The mean age of respondents was 42.99 (±16.5) years with male participants being significantly older (P = 0.017). More than half of the respondents have had at least 12 years of schooling, having completed secondary education. There was no statistically significant difference between the educational levels of males and females.
The mean BMI of the study population was 23.02 (±4.98) kg/m 2. Female respondents had a significantly higher BMI than males (P < 0.001) [Table 1]. About a third of the respondents were either overweight or obese, having a BMI >25.0 kg/m 2.
A third of the respondents had abnormal WC that puts them at significant risk of cardiovascular disease.
Self-perception of weight
Majority (84.8%) reported their self-perceived body size as normal/healthy while <10% of the respondents indicated that they were overweight/obese. More females than male reported being overweight/obese (P = 0.033) [Table 1].
Means of assessing body size
More than half of the respondents (54.8%) admitted to assessing body size using cloth size/fitness while 19.8% based their assessment on personal feelings. Calculation of BMI was the means of assessing body size by 7.6% of the respondents. Without being prompted, 6.3% of respondents indicated the use of weighing scale as means of assessing body size. None of the respondents reported the measurement of waist/abdominal circumference as a means of assessing body size. This option was also not suggested to respondents. There was no statistically significant difference in the means of assessing body size among males and females [Table 1].
Two hundred and sixty-five (37.2%) respondents misperceived their body size when compared with actual BMI. Underestimated misperception of body size was 28.4% (202/712) while 8.8% (63/712) overestimated their perceived body size [Table 2].
|Table 2: Comparison of actual anthropometric measurements of body size (using body mass index and waist circumference) with self-perceived body size|
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Over 90% of respondents with normal body size as defined by BMI perceived their weight to be normal. The majority of overweight respondents (86.7%) and obese respondents (58.2%) misperceived their weight as being normal. Body size defined by BMI was significantly different from self-perceived body size (P < 0.001).
Majority of the respondents significantly misperceived their body size when compared to WC [Table 2].
The association between rate of misperception of body size and demographic factors is shown in [Table 3]. Female respondents had a higher rate of misperception of body size compared with males (χ2 = 4.080, df = 1, P = 0.043, odds ratio [OR] = 0.725, 95% confidence interval [CI]: 0.531–0.991).
|Table 3: Association between demographic factors and body size misperception|
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Gender comparison of anthropometric indices and self-perceived body size is shown in [Table 4]. Overweight male respondents had the highest rate of underestimated misperception (89.5%), and normal weight male respondents had the lowest rate of overestimation (2.1%). The association between self-perceived body size and BMI as well as WC did not show any statistically significant difference when stratified by gender [Table 4].
|Table 4: Gender comparison of anthropometric indices (body mass index and waist circumference) and self-perceived body size|
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[Table 5] shows the rural–urban comparison of misperception by BMI category. Urban respondents were more likely to misperceive their body size than rural respondents (χ2 = 15.463, P < 0.001, OR = 1.847, 95% CI: 1.358–2.512). A significant difference in misperception was found only among obese respondents. Urban (86.8%) more than rural (13.2%) obese respondents significantly underestimated their self-perceived weight (P = 0.033).
|Table 5: Rural-urban comparison of anthropometric indices (body mass index and waist circumference) and self-perceived body size|
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The association between self-perceived body size and WC did not show any statistically significant difference when stratified by place of residence [Table 5].
There was a significant correlation between self-perception of weight and BMI (Pearson's correlation coefficient = −0.316, P < 0.001).
There was a negative but significant correlation between self-perceived body size and WC (Pearson's correlation coefficient = −0.121; P = 0.002).
Logistic regression was used to analyze the relationship between self-perception of weight and demographic factors: age group, sex, educational status, marital status, and place of residence. Only place of residence was significantly associated with misperception of weight (P = 0.021).
| Discussion|| |
This study has shown a high prevalence of misperception of body size (37.2%), underestimation being predominant. Misperception of body size can negatively impact on healthy lifestyles as the motivation and reason to maintain a normal/healthy body size is lacking. In this study, misperceived underestimation of body size, defined by BMI, was more among overweight and obese respondents compared with normal weight respondents. Similar finding have been reported in Africa ,,, and around the world.,,,,, Overweight more than obese respondents underestimated their perceived weight. Previous reports have shown that obese persons are less likely to misclassify their body weight.,, This finding may, therefore, suggest an over-acceptance of overweight as being normal, especially if the prevailing culture as in some parts of Nigeria affirms such body size as normal and a sign of good living. Indeed, socioeconomic, sociocultural, and environmental factors have been shown to influence weight perception in previous studies.,, Majority (~80%) of respondents with central obesity could not also identify that they were obese and wrongly perceived themselves as being normal weight. These misperceptions may not be unrelated to the reported means by which weight is assessed. BMI and WC are simple and objective tools used to assess body fat and general and central obesity, respectively. There are cutoff values set by the WHO to indicate body fat levels that portend increased cardiovascular risk. In this study, only 7.6% of the respondents agreed to calculate their BMI, and none of the respondents mentioned abdominal circumference as a means of assessing weight. Perhaps, if the measurement of WC was included in the check list, it may have reminded some respondents. The vast majority relied on their cloth size/fitness and other subjective means to assess their weight. The means of assessing weight was not different among gender. However, a statistically significant difference was found among rural and urban dwellers (P < 0.001) with rural dwellers relying more on cloth size and personal opinion and less on BMI compared with the urban dwellers.
One of the strengths of this study, besides being a population study and using measured BMI rather than reported BMI, is that it compared and stratified body size misperception based on the place of residence. Previous studies ,,,,,,, have reported that self-perceived body size is related to and influenced by male gender, age, race/ethnicity, level of education, and place of residence (rural versus urban). Similarly, this study observed that males underestimated their weight more than females although the difference was not statistically significant. Obese urban dwellers were observed to misperceive their weight more than obese rural dwellers. However, age and level of education (using 12 years of schooling as cutoff) were not observed to be associated with misperception.
These inferences on the determinants of misperceived body size are made cautiously as this study is cross-sectional in design. This study is also limited in not providing a visual aid for the different body size categories as was done by Akinpelu et al. in their study. We, therefore, recommend a longitudinal study with visual aids to further understand the determinants of misperception in Nigeria.
| Conclusion|| |
This study has shown a high prevalence of misperception of weight among adults living in Delta State, Nigeria, with underestimation of body size predominating, especially among male gender, overweight, and urban dwellers. A huge gap between the objective ways of determining body size recommended by the WHO and the reported practice of respondents which was largely subjective was observed. There is, therefore, a need for health education not only to correct misperception but also to educate on the standard ways of determining body size both at the individual and community levels.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]