Estimation of weight status and weight-loss efforts in Korean adults with non-obesity considering metabolic syndrome

  • Kayoung LeeEmail author
Original Article



To examine whether metabolic syndrome (MetS) is related to estimation of weight status and weight-loss efforts in Korean adults with non-obesity.


In 4345 men and 6387 women in non-obese Koreans (age 49.2 ± 16.7 years, BMI < 25 kg/m2) participating in the 2011–2013 Korean National Health and Nutrition Examination Survey, the presence/absence of MetS using the harmonized criteria, and weight perception and weight-loss efforts using questionnaires were assessed. Estimation of weight status was determined as underestimation, correct estimation, and overestimation based on differences between perceived weight categories and BMI-based categories.


15.7% in men and 12.6% in women with BMI < 25 kg/m2 had the MetS. After adjusting for sociodemographic factors, health-related behaviors, treatment of cardiovascular diseases and cardiovascular risk factors, and BMI-based categories, correct estimation and overestimation of weight status in men [odds ratio (95% CI), 1.58 (1.29–1.92); 2.82 (1.48–5.38)], and women [1.53 (1.26–1.86); 1.59 (1.09–2.31)] were positively associated with the presence of MetS compared to those with underestimation of weight status. After adjusting for weight estimation, sociodemographic factors, health-related behaviors, and treatment of cardiovascular diseases and cardiovascular risk factors, weight-loss efforts were positively associated with the presence of MetS [1.66 (1.33–2.08) in men, 1.31 (1.07–1.61) in women] in all subjects, and number of MetS components [1.28 (1.02–1.62) per 1 more component] in those with MetS.


In non-obese individuals, correct estimation and overestimation of weight status may be more likely to identify individuals with MetS and concurrent MetS may increase weight-loss efforts regardless of weight estimation.

Level of evidence

Level III, evidence obtained from a case–control observational study.


Weight estimation Weight loss Metabolic syndrome Metabolically obese non-obese weight (MONW) Non-obesity 



This work was supported by the National Resarch Foundation of Korea Grant funded by the Korean Government (NRF-2017S1A5B8066096).

Compliance with ethical standards

Conflict of interest

This work was supported by the National Rsearch Foundation of Korea Grant funded by the Korean Government (NRF-2017S1A5B8066096).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Lopez-Miranda J, Perez-Martinez P (2013) It is time to define metabolically obese but normal-weight (MONW) individuals. Clin Endocrinol (Oxf) 3:314–315CrossRefGoogle Scholar
  2. 2.
    Conus F, Rabasa-Lhoret R, Peronnet F (2007) Characteristics of metabolically obese normal-weight (MONW) subjects. Appl Physiol Nutr Metab 1:4–12CrossRefGoogle Scholar
  3. 3.
    Choi KM, Cho HJ, Choi HY, Yang SJ, Yoo HJ, Seo JA et al (2013) Higher mortality in metabolically obese normal-weight people than in metabolically healthy obese subjects in elderly Koreans. Clin Endocrinol (Oxf) 3:364–370CrossRefGoogle Scholar
  4. 4.
    Fan J, Song Y, Chen Y, Hui R, Zhang W (2013) Combined effect of obesity and cardio-metabolic abnormality on the risk of cardiovascular disease: a meta-analysis of prospective cohort studies. Int J Cardiol 5:4761–4768CrossRefGoogle Scholar
  5. 5.
    Lee K (2009) Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: characteristics and health behaviors. Asia Pac J Clin Nutr 2:280–284Google Scholar
  6. 6.
    Choi J, Se-Young O, Lee D, Tak S, Hong M, Park SM et al (2005) Characteristics of diet patterns in metabolically obese, normal weight adults (Korean National Health and Nutrition Examination Survey III. Nutr Metab Cardiovasc Dis 2012;7:567–574Google Scholar
  7. 7.
    Choi JY, Ha HS, Kwon HS, Lee SH, Cho HH, Yim HW et al (2013) Characteristics of metabolically obese, normal-weight women differ by menopause status: the Fourth Korea National Health and Nutrition Examination Survey. Menopause 1:85–93CrossRefGoogle Scholar
  8. 8.
    Dvorak RV, DeNino WF, Ades PA, Poehlman ET (1999) Phenotypic characteristics associated with insulin resistance in metabolically obese but normal-weight young women. Diabetes 11:2210–2214CrossRefGoogle Scholar
  9. 9.
    Badoud F, Perreault M, Zulyniak MA, Mutch DM (2015) Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals. FASEB J 3:748–758CrossRefGoogle Scholar
  10. 10.
    Guglielmi V, Sbraccia P (2017) Obesity phenotypes: depot-differences in adipose tissue and their clinical implications. Eat Weight DisordGoogle Scholar
  11. 11.
    Mogre V, Abedandi R, Salifu ZS (2014) Distorted self-perceived weight status and underestimation of weight status in diabetes mellitus type 2 patients. PLoS One 4:e95165CrossRefGoogle Scholar
  12. 12.
    Baur DM, Christophi CA, Tsismenakis AJ, Jahnke SA, Kales SN (2012) Weight-perception in male career firefighters and its association with cardiovascular risk factors. BMC Public Health 480-2458-12-480Google Scholar
  13. 13.
    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. 20-5868-8-20Google Scholar
  14. 14.
    Lee K (2016) Parental and offspring factors in offspring’s weight-loss efforts. Eat Weight Disord 4:679–685CrossRefGoogle Scholar
  15. 15.
    Peltzer K, Pengpid S (2015) Trying to lose weight among non-overweight university students from 22 low, middle and emerging economy countries. Asia Pac J Clin Nutr 1:177–183Google Scholar
  16. 16.
    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 (Lond) 8:1063–1070CrossRefGoogle Scholar
  17. 17.
    Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk?. Obes Rev., 2015:7–18Google Scholar
  18. 18.
    Guidelines for heath survey (2013) The Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-1), 2013, Korea Centers for Disease Control and PreventionGoogle Scholar
  19. 19.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 16:1640–1645CrossRefGoogle Scholar
  20. 20.
    The International Association for the Study of Obesity and the International Obesity Task Force (2000) The Asia–Pacific perspective: redefining obesity and its treatment. IASO and IOTF, AustraliaGoogle Scholar
  21. 21.
    Gregory CO, Blanck HM, Gillespie C, Maynard LM, Serdula MK (2008) Perceived health risk of excess body weight among overweight and obese men and women: differences by sex. Prev Med 1:46–52CrossRefGoogle Scholar
  22. 22.
    Gregory CO, Blanck HM, Gillespie C, Maynard LM, Serdula MK (2008) Health perceptions and demographic characteristics associated with underassessment of body weight. Obesity (Silver Spring) 5:979–986CrossRefGoogle Scholar
  23. 23.
    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 (Lond) 4:644–651CrossRefGoogle Scholar
  24. 24.
    Wang B, Zhuang R, Luo X, Yin L, Pang C, Feng T et al (2015) Prevalence of metabolically healthy obese and metabolically obese but normal weight in adults worldwide: a meta-analysis. Horm Metab Res 11:839–845Google Scholar
  25. 25.
    Acevedo P, Lopez-Ejeda N, Alferez-Garcia I, Martinez-Alvarez JR, Villarino A, Cabanas MD et al (2014) Body mass index through self-reported data and body image perception in Spanish adults attending dietary consultation. Nutrition 6:679–684CrossRefGoogle Scholar
  26. 26.
    Wang ML, Haughton CF, Frisard C, Pbert L, Geer C, Lemon SC (2017) Perceived weight status and weight change among a US adult sample. Obesity (Silver Spring) 1:223–228CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Family Medicine, Busan Paik Hospital, College of MedicineInje UniversityBusanRepublic of Korea

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