The effect of perceived weight status and BMI perception on food attitudes and food relationships.

Context: Obesity has been a national epidemic throughout the United States due to the increasingly sedentary western lifestyle, paired with calorically dense abundant low-nutritional food options. Discussing weight necessitates the conversation of not only the numerical value (body mass index [BMI]) associated with obesity but also the perceived weight or how an individual categorizes their weight, irrespective of their calculated BMI classification. Perceived weight can influence food relationships, overall health, and lifestyle habits.

Objectives: The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes among three groups: those correctly identifying as "obese" with a BMI >30 (BMI Corrects [BCs]), those incorrectly identifying as "obese" with a BMI <30 (BMI Low Incorrect [BLI]), and those incorrectly identifying as "nonobese" with a BMI >30 (BMI High Incorrect [BHI]).

Methods: An online cross-sectional study was conducted from May 2021 to July 2021. Participants (n=104) responded to a 58-item questionnaire regarding demographics (n=9), health information (n=8), lifestyle habits (n=7), dietary habits (n=28), and food attitudes (n=6). Frequency counts and percentages were tabulated, and analysis of variance (ANOVA) testing was conducted to examine the associations utilizing SPSS V28 at a statistical significance level of p<0.05.

Results: Participants incorrectly identifying as "obese" with a BMI <30 (BLI) had higher food attitude scores, indicating worse food attitudes, behaviors, and relationships with food compared to participants correctly identifying as "obese" with a BMI >30 (BC) and incorrectly identifying as "non-obese" with a BMI >30 (BHI). When comparing BC, BLI, and BHI participants, no statistically significant differences were found in dietary habit scores, lifestyle habit scores, weight change, or nutritional supplement or diet started. However, overall, BLI participants had worse food attitude scores and consumption habits when compared to BC and BHI participants. Even though dietary habit scores were not significant, an examination of specific food items revealed significant findings, in which BLI participants had higher consumption of potato chips/snacks, milk, and olive oil/sunflower oil, compared to BHI participants. BLI participants had higher beer and wine consumption compared to BC participants. Additionally, BLI participants had higher carbonated beverages, low-calorie beverages, and margarine and butter consumption compared to BHI and BC participants. BHI participants had the lowest hard liquor consumption, BC had the second lowest hard liquor consumption, and BLI participants had the highest consumption of hard liquor products.

Conclusions: The findings of this study have shed light on the intricate relationship that exists between perceived weight status from a "nonobese/obese" perspective and attitudes toward food and the overconsumption of particular food items. Participants who perceived their weight status as "obese" despite having a calculated BMI below the CDC threshold and classification for "obesity" had poorer relationships with food, consumption behaviors, and on average consumed food items that were detrimental to overall health. Comprehending a patient's weight status perception and conducting a thorough history of their food intake could play a crucial role in addressing the patient's overall health and medically managing this population.