The Fatter we Get, the Less We Seem to Notice

Does this look "normal" to you?

A significant number of overweight and obese individuals believe their body weight to be appropriate or normal and are satisfied with their body size. Misperception of overweight status is most common among the poor vs wealthy, African Americans vs white Americans, and men vs women. The unfortunate consequence is that overweight individuals who perceive themselves to be of normal weight are less likely to want to lose weight in contrast to overweight individuals with accurate perceptions. Such individuals are also more likely to smoke, have a poor diet, and be physically inactive.

An interesting hypothesis tested by Burke and colleagues in a recent Obesity journal article is that misperception of overweight status can actually increase over time in response to the secular increase in the average BMI of the US population. In other words, due to a possible anchoring effect, the more overweight the people around you become, the more one's sense of "normal" weight is raised upwards, and thus the less likely you are to consider yourself overweight, even though you actually may be. Indeed, given that most individuals you interact with on a regular basis are likely to be overweight or obese, it becomes tough to define what someone with a normal weight looks like.

To answer the question at hand, the authors compared two representative cohorts of the United States population (NHANES) - one surveyed in the early 90's and the other surveyed in the early 2000's. Stated simply, they divided each cohort by gender and weight status (BMI) and compared the general perceptions of the individual's weight.

What did they find?

Just as the researchers predicted, overweight individuals today are less likely to classify themselves as "overweight" in contrast to overweight individuals surveyed over a decade ago. For example, the proportion of overweight women who perceive their weight o be "about right" increased from 14% to 21%, and that among overweight men from 41 to 46%. This latter point also well illustrates the gender bias of weight misclassification.

Interestingly it was among individuals aged 20-25 that the greatest shift towards inaccurate weight classification occurred - overweight individuals in this age group were most likely to see themselves as "normal" weight.

Additionally, independent of the effect of time, this study confirmed a number of factors influencing one's ability to accurately gauge their own weight status: those who are educated are more likely to self-classify as overweight than those who are not, those with higher incomes are more likely to feel overweight than those with the lowest incomes, married people are more likely to feel overweight than never-married people, and members of minority groups are less likely than whites to consider themselves overweight.

So there you have it - as a population, we are all getting fatter. Making matters worse, the fatter we all get, the less we seem to notice and the less likely we are to do anything about our bulging waistlines.

These are dangerous trends.


Originally posted on

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I think focusing on the problem at the national level actually confuses people in the 20-25 age bracket.
I've got a remarkably low and healthy BMI compared to average American woman. On the other hand, I feel ridiculously fat everytime I go to the campus gym.

At BMI = 25, I look average in a normal every day crowd, occasionally even on the small side, but I look comparatively huge in the gym. Some of that may be fewer clothes, more exposed. The gym seems to have fewer overweight people (except right after New Year), then general population. Probably on a beach, it would be worse, luckily it's never warm enough to swim where I live.

becca & julie:
An obvious example of self-selection. If you consider your weight as OK, then you feel less inclined to do anything about it. If you see yourself as overweight, then you won't want to embarrass yourself. If you see yourself as lean, you want to keep it that way.
Then there are the anorexics whose perceptions of themselves fail in the opposite direction - even though they might have a BMI of less than 19, they perceive themselves to be too fat, and will even, when asked to pick a silhouette that most closely resembles themselves, will pick out one that is slightly overweight.
We're good at fooling ourselves. See Dunning-Kruger Effect.

By natural cynic (not verified) on 21 May 2010 #permalink

So rich, well-educated women do better? And people do better when they are surrounded by friends who are doing well?

Well, I see two possible solutions for me.

1. I need to become a rich, well-educated woman. Not so easy for me.
2. I need to be surrounded by rich, well-educated women.

How can I find a bunch of rich, well-educated women to hang out with?

What exactly is a normal weight? The people who decide what is and is nto normal have been adjusting the values downwards for decades. And how can a couple of pounds one way or other magically put someone into a different category?

For most people, normalcy is what they think it is.

I agree 100% with your information and just one observation: While the statistic used for the U.S. is 66% of the population is either overweight or obese, my eyes tell me that it is much higher.

I would estimate that it's closer to 90%. I know that when I go in to a room full of my peers...age 50+ most of the bellies are hanging over the belt.

Ken Leebow

P.S. And, speaking of normal, most people think that our current food environment is normal. It's not. Dr. David Katz explained it beautifully: We're like Polar Bears in the the Sahara Desert.

I think part of the disconnect is that the word normal is deliberately vague: everything between the extreme outliers can justifiably be considered "normal". That said, last night one of my friends said to the other that they were both normal weight when the truth is that both are morbidly obese.

I think there needs to be clarification around the term "normal." I think most people assume it probably means "average" or somewhere in the middle.

I guess the author's point is that if the majority of people in the US are overweight (according to some regulating body), then average is actually overweight too.

But what does it all matter? Probably this has been discussed and I'm only recently a regular reader, so I apologize in advance, but perhaps we need to have a posting on what is a "healthy" weight, and how do we define what that is?

It's certainly a complex issue and using terminology like "normal," implies its a vanity or preference problem, and doesn't help the public's understanding of the relationship between weight and health.

I've got the over-educated female thing down... still working on rich. But it's the people around me who have the disconnect. I know I'm overweight. Heck, I can work a ruler and a calculator: with a BMI of 31, I know I'm obese. On those occasions when it has come up in conversation, it's shocking the degree to which those around me rush to assure me that I'm perfectly normal. They seem terribly concerned about my thinking that I could afford to lose weight. And they say I've got lots of muscle, so the BMI is wrong. And that I'm terribly fit so I won't be impacted by the health problems that go along with obesity. Even if they're right about me having extra muscle, or big bones, or whatever, they can't acknowledge that there's no way I have 40 pounds of extra muscle. I've only ever gotten one interlocutor to admit that, yeah, I probably don't have 40 pounds of extra muscle. It's as though acknowledgment of fatness is a conversation that's not allowed to happen. The fat acceptance promoters have made sufficient progress that weight loss has become the taboo. In this environment, with the litany of fat-denial from everyone else the minute the subject is broached, it's hard imagine reversing the perception of normal.

Do you think it could be better in terms of health results for people to start focusing on something like their activity levels instead of how overweight they are? If people focus just on their weight, it can be counterproductive to addressing it because of associated self-consciousness issues, such as "I can't go to the gym because people will laugh at me because I'm fat", and "I can't go jogging out on the street because people will heckle me for being a fat jogger", for instance. Focusing on activity level is less shaming - if someone sees you jogging on the street, there's no way for them to tell if it's your first mile or your fifth.

I couldn't agree more. Another issue is that sustainable weight loss can be very difficult, and people may quit their exercise program simply because they are not seeing as much weight loss as they'd like - without realizing all of the other health benefits they are experiencing regardless of their body weight. With the Health At Every Size movement, as well as the Exercise Is Medicine concept that is being promoted by the American College of Sports Medicine, there are a lot of people working to get the focus onto positive behaviours (e.g. exercise) and away from outcomes like body weight.


Hm. Interesting topic. It occurs to me, though, that there's a difference between "believing your body weight to be appropriate or normal" and "being satisfied with your body size." A reasonable person might recognize that they're medically overweight, and recognize that there are health risks associated with that -- and still decide that they're okay with that risk, and aren't willing to do what it would take to reduce it. An analogy might be with someone who plays extreme sports: they know it's risky, but giving it up would decrease their quality of life too much.

I speak as someone who's lost 55 pounds in the last year. I'm very happy with my decision -- but I won't deny that it's been very difficult. I can see how an overweight person (not morbidly obese, just regular overweight) might reasonably decide that the kinds of changes I've had to make in my life to lose the weight aren't changes they're willing to make. I think a reasonable person might decide, "Yes, I'm overweight -- but I'm okay with that, I'm satisfied with my body size the way it is."

Not saying we shouldn't encourage people to lose weight, or that we shouldn't change public policy to make weight loss easier and prevent weight gain in the first place. Just that if we're going to be evidence-based about this topic, one of the pieces of evidence we have to take into consideration is just how difficult weight loss is.

Interesting study; somewhat puzzling though. It does seem to me that, like so many studies about people's weight, it conflates the "overweight" and "obese" categories, which I think is problematic. Surely someone thinking their extra 10 pounds is "OK" is a different situation from someone who thinks it's OK to weigh, say, 450 pounds. Clearly we need to draw a line somewhere, at least for general guidelines, but I think we are a long way from being able to agree on what exactly constitutes a "healthy" weight.

Also, it's not clear to me from the wording of the study question, whether people were being asked if their bodies were "about right" in the sense of health risks, or functionality, or attractiveness, or what.

I am a healthcare provider. Many of my patients are overweight or obese and I struggle with how best to advise them. I have also personally lost about 50 pounds in the past year and am now working hard to maintain my weight. I don't think I could have done what I did if I didn't feel good about my body in the first place. So it's a little concerning to me to picture the medical community concluding, based on this study, that the problem with fat people is that they don't feel bad enough about themselves. There is still a lot of stigma about body size, especially for women, and weight loss and maintenance are incredibly difficult. I really do appreciate this blog for approaching these questions in an evidence based, nonjudgmental manner.

By Nurse Ingrid (not verified) on 24 May 2010 #permalink

Then again, maybe they're right. The most recent NHANES studies seem to suggest that you maximise your life expectancy if you are in tyhe 'overweight' category rather than the 'normal' category.

I really hate the whole term "normal" weight, especially in light of the recent study that showed that people who were overweight, but not obese, tended to live longer. I think what is actually normal is a little wider range than what the BMI charts would seem to indicate.

The focus really needs to be on health -- good diet, and exercise. If you tell someone they need to walk every day, that's concrete & doable. If you tell them they need to lose 10 pounds, it puts the focus on the outcome and not the process.

The process is where I believe health is achieved. I am 5'6" and weigh 171 pounds. Twenty years and forty pounds ago, I was inactive and ate terribly. Today, my blood pressure is lower than it was then, and well within normal range. My resting pulse is 60, and cholesterol on the low side. I bike or walk to work most days, and am the fruit, veggie & whole grain queen. I feel good, and I feel better about my body than I did when young. I fail to see why I should get overly worried about my weight at this point "for my health."

I can attest that this is correct. I once had a BMI of 46 and thought "I could lose a few pounds". I now have a 28.6.
I remember times when I would see myself in a mirror or a photograph. If I knew I was looking at myself, I thought I was bigger than average, but not too bad.
If, however, by some trick of multiple mirrors or photography, I did not recognize myself in the image, I thought "Wow! That guy is fat!"
I think that dis-morphia (sp?) is a big part of weight related issues, both over and under.

I disagree with your conclusion that it's dangerous to be "satisfied" with higher weight. I think that seeing oneself as "acceptable" is essential for self care of any kind. I think the reality check might be needed in terms of health behaviors, such as the amount of physical activity and in eating habits. Rather than going after self-image and associated self-esteem around body size, promoting healthy behavioral norms that people of all sizes can attain is a better route.
The ship has left the port in terms of fatness being within the range of normal. Dangerous or not, this is how it is, there isn't turning back without even more dangerous assaults on people's self-esteem that lead to much worse consequences. Increasing physical activity and improving diet are the first places to start, and encouraging people to seek preventive care and avoid harmful substances. Once people buy into those ideas -- and they can be done by people in all BMI categories -- then, people may decide, on their own, that achieving optimal health includes losing weight. People with positive self-opinions are far more likely to take action to address their health (and losing weight isn't the only action that can be taken) than people who are scolded or shamed for being "not normal."

It is scary where the obesity is heading, it became an epidemic with all those diseases that come with it.
Just adding whole grains, reducing fat and sugar to my diet and being more active made a big difference to my weight.

I've noticed - the more fat I loose, the bigger large people look. A co-worker was my size, now that I've lost 40 lbs and he hasn't, he now looks morbidly obese to me. By the way, I still feel too fat, and plan on dropping another 25 lbs within the next 5 months :)