Ethnicity, migration, and weight misperception: a Born in Bradford study

Background Weight perception may differ by ethnicity but is not well-understood, particularly among migrants to the United Kingdom (UK). It is also unknown whether a figure rating scale (FRS) or perceived weight question (PWQ) is more accurate for assessing body weight perception. Methods At 24-months postpartum, women in the Born in Bradford cohort (Bradford, UK) completed the 9-item Stunkard FRS and a 7-category PWQ. Both scales were condensed to weight categories representing the World Health Organisation cut-offs. Weighted kappa statistics assessed agreement between measured and perceived weight categories. χ 2 and Fisher’s exact tests assessed categories of misperception by ethnicity and migration and logistic regression was used to examine odds of underestimation. Results Thirty percent of white British and 23% of Pakistani-origin women had obesity. Agreement between measured and perceived weight categories were similar for white British women using either a visual scale or weight question (FRS: κ [95%CI]: 0.61 [0.56, 0.65]; PWQ: 0.61 [0.55, 0.68)]. Overall agreement was lower for Pakistani-origin women with the visual scale performing better (FRS (0.58 [0.52, 0.63]) vs PWQ (0.47 [0.40, 0.54]). Pakistani-origin women, particularly those born outside the UK, were more likely to underestimate their body weight compared to white British women; this was greater with the PWQ (18% vs 10%; p<0.001) than FRS (14% vs 6%; p<0.001). Pakistani-origin women were 154% more likely to underestimate their body weight compared to white British women with the FRS and 111% more likely to underestimate when using the PWQ. Conclusion We observed ethnic differences in weight misperception with Pakistani-origin women more likely to underestimate their weight compared to white British women. Our findings suggest visual scales, rather than perceived weight questions, are more appropriate for the self-assessment of body weight.