Cancer Causes & Control

, Volume 26, Issue 1, pp 91–98 | Cite as

Do people know whether they are overweight? Concordance of self-reported, interviewer-observed, and measured body size

  • Catherine G. Sutcliffe
  • Kathleen Schultz
  • Julitta M. Brannock
  • Francis M. Giardiello
  • Elizabeth A. PlatzEmail author
Original paper



To evaluate associations among self-reported, interviewer-observed, and measured body size in a healthcare setting.


A total of 543 adult men and women undergoing colonoscopy were enrolled into a cross-sectional study conducted from 2002 to 2008 at the Johns Hopkins Hospital Outpatient Center. Self-reported and interviewer-observed Stunkard body size figure numbers and measured body mass index (BMI) were collected and evaluated. The body size figures and BMI were categorized as normal weight, overweight, and obese.


Correlation between self-reported and interviewer-observed body size figure numbers (r = 0.62) was lower than the correlation between self-reported (r = 0.72) or interviewer-observed (r = 0.84) body size figure number and BMI. Participants underestimated body size by about one figure compared with the interviewers (mean 0.92 ± 1.25). Agreement on normal weight, overweight, and obese between the interviewer-observed body size figures and BMI categories (kappa = 0.40) was higher than for the self-reported body size figures and BMI categories (kappa = 0.23). Among participants who judged themselves in the normal weight category by the figures, 38 and 13 % were overweight and obese, respectively, as measured by BMI. Among participants who judged themselves overweight by the body size figures, 57 % were obese as measured by BMI.


Although self-reported body size and measured body size were well correlated, participants underestimated their body size in comparison with interviewers. Many individuals misperceive themselves as normal weight when they are overweight or obese by BMI, which may hinder prevention and control efforts.


Body size Body mass index Obesity Colon cancer 


Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638PubMedCrossRefGoogle Scholar
  2. 2.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DCGoogle Scholar
  3. 3.
    Ning Y, Wang L, Giovannucci EL (2010) A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev 11:19–30PubMedCrossRefGoogle Scholar
  4. 4.
    National Center for Chronic Disease Prevention & Health Promotion, US Centers for Disease Control and Prevention (2012) Behavioral risk factor surveillance system, prevalence and trends data, overweight and obesity (BMI)–2012. Accessed 23 Dec 2013
  5. 5.
    US Department of Health and Human Services (2008) 2008 Physical Activity Guidelines for AmericansGoogle Scholar
  6. 6.
    U.S. Preventive Services Task Force (2012) Screening for and management of obesity in adults, topic page. Accessed 25 Feb 2014
  7. 7.
    Patient Protection and Affordable Care Act. (2010). Accessed 25 Feb 2014
  8. 8.
    Paeratakul S, White MA, Williamson DA, Ryan DH, Bray GA (2002) Sex, race/ethnicity, socioeconomic status, and BMI in relation to self-perception of overweight. Obes Res 10:345–350PubMedCrossRefGoogle Scholar
  9. 9.
    Bhuiyan AR, Gustat J, Srinivasan SR, Berenson GS (2003) Differences in body shape representations among young adults from a biracial (Black-White), semirural community: the Bogalusa Heart Study. Am J Epidemiol 158(8):792–797PubMedCrossRefGoogle Scholar
  10. 10.
    Kuchler F, Variyam JN (2003) Mistakes were made: misperception as a barrier to reducing overweight. Int J Obes Relat Metab Disord 27(7):856–861PubMedCrossRefGoogle Scholar
  11. 11.
    Yaemsiri S, Slining MM, Agarwal SK (2011) Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study. Int J Obes 35:1063–1070CrossRefGoogle Scholar
  12. 12.
    Dorsey RR, Eberhardt MS, Ogden CL (2009) Racial/ethnic differences in weight perception. Obesity 17:790–795PubMedCrossRefGoogle Scholar
  13. 13.
    Hendley Y, Zhao L, Coverson DL, Din-Dzietham R, Morris A, Quyyumi AA, Gibbons GH, Vaccarino V (2011) Differences in weight perception among blacks and whites. J Womens Health 20:1805–1811Google Scholar
  14. 14.
    Fitzgibbon ML, Blackman LR, Avellone ME (2000) The relationship between body image discrepancy and body mass index across ethnic groups. Obes Res 8:582–589PubMedCrossRefGoogle Scholar
  15. 15.
    Lynch E, Liu K, Spring B, Hankinson A, Wei GS, Greenland P (2007) Association of ethnicity and socioeconomic status with judgments of body size: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol 165:1055–1062PubMedCrossRefGoogle Scholar
  16. 16.
    Duncan DT, Wolin KY, Scharoun-Lee M, Ding EL, Warner ET, Bennett GG (2011) Does perception equal reality? Weight misperception in relation to weight-related attitudes and behaviors among overweight and obese US adults. Int J Behav Nutr Phys Act 8:20. doi: 10.1186/1479-5868-8-20
  17. 17.
    Stunkard AJ, Sorensen T, Schulsinger F (1983) Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 60:115–120PubMedGoogle Scholar
  18. 18.
    Block G, Woods M, Potosky A, Clifford C (1990) Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol 43:1327–1335PubMedCrossRefGoogle Scholar
  19. 19.
    National Institutes of Health NH, Lung and Blood Institute (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 6:51S–209SGoogle Scholar
  20. 20.
    Lynch E, Liu K, Wei GS, Spring B, Kiefe C, Greenland P (2009) The relation between body size perception and change in body mass index over 13 years: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Epidemiol 169(7):857–866PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Tehard B, van Liere MJ, Com Nougue C, Clavel-Chapelon F (2002) Anthropometric measurements and body silhouette of women: validity and perception. J Am Diet Assoc 102:1779–1784PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Kaufer-Horwitz M, Martinez J, Goti-Rodriguez LM, Avila-Rosas H (2006) Association between measured BMI and self-perceived body size in Mexican adults. Ann Hum Biol 33:536–545PubMedCrossRefGoogle Scholar
  23. 23.
    Osuna-Ramirez I, Hernandez-Prado B, Campuzano JC, Salmeron J (2006) Body mass index and body image perception in a Mexican adult population: the accuracy of self-reporting. Salud Publica Mex 48:94–103PubMedCrossRefGoogle Scholar
  24. 24.
    Becker DM, Yanek LR, Koffman DM, Bronner YC (1999) Body image preferences among urban African Americans and whites from low income communities. Ethn Dis 9:377–386PubMedGoogle Scholar
  25. 25.
    Kemper KA, Sargent RG, Drane JW, Valois RF, Hussey JR (1994) Black and white females’ perceptions of ideal body size and social norms. Obes Res 2:117–126PubMedCrossRefGoogle Scholar
  26. 26.
    Smith DE, Thompson JK, Raczynski JM, Hilner JE (1999) Body image among men and women in a biracial cohort: the CARDIA Study. Int J Eat Disord 25:71–82PubMedCrossRefGoogle Scholar
  27. 27.
    Cash TF, Morrow JA, Hrabosky JI, Perry AA (2004) How has body image changed? A cross-sectional investigation of college women and men from 1983 to 2001. J Consult Clin Psychol 72:1081–1089PubMedCrossRefGoogle Scholar
  28. 28.
    Roberts A, Cash TF, Feingold A, Johnson BT (2006) Are black-white differences in females’ body dissatisfaction decreasing? A meta-analytic review. J Consult Clin Psychol 74:1121–1131PubMedCrossRefGoogle Scholar
  29. 29.
    Parnell K, Sargent R, Thompson SH, Duhe SF, Valois RF, Kemper RC (1996) Black and white adolescent females’ perceptions of ideal body size. J School Health 66:112–118PubMedGoogle Scholar
  30. 30.
    Powell AD, Kahn AS (1995) Racial differences in women’s desires to be thin. Int J Eat Disord 17:191–195PubMedCrossRefGoogle Scholar
  31. 31.
    Celio AA, Winzelberg AJ, Dev P, Taylor CB (2002) Improving compliance in on-line, structured self-help programs: evaluation of an eating disorder prevention program. J Psychiatr Pract 8:14–20PubMedCrossRefGoogle Scholar
  32. 32.
    Wardle J, Haase AM, Steptoe A (2006) Body image and weight control in young adults: international comparisons in university students from 22 countries. Int J Obes 30(4):644–651CrossRefGoogle Scholar
  33. 33.
    Kuczmarski MF, Kuczmarski RJ, Najjar M (2001) Effects of age on validity of self-reported height, weight, and body mass index: findings from the third national health and nutrition examination survey, 1988–1994. J Am Diet Assoc 101(1):28–34Google Scholar
  34. 34.
    Pulvers KM, Lee RE, Kaur H, Mayo MS, Fitzgibbon ML, Jeffries SK, Butler J, Hou Q, Ahluwalia JS (2004) Development of a culturally relevant body image instrument among urban African Americans. Obes Res 12:1641–1651PubMedCrossRefGoogle Scholar
  35. 35.
    Flynn KJ, Fitzgibbon M (1998) Body images and obesity risk among black females: a review of the literature. Ann Behav Med 20:13–24PubMedCrossRefGoogle Scholar
  36. 36.
    Patt MR, Lane AE, Finney CP, Yanek LR, Becker DM (2002) Body image assessment: comparison of figure rating scales among urban Black women. Ethn Dis 12:54–62PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Catherine G. Sutcliffe
    • 1
  • Kathleen Schultz
    • 1
  • Julitta M. Brannock
    • 1
  • Francis M. Giardiello
    • 2
    • 3
  • Elizabeth A. Platz
    • 1
    • 3
    Email author
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimoreUSA

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