Weight perception among US adults predicts cardiovascular risk when controlling for body fat percentage

Previous research has revealed that increased obesity prevalence in the US has occurred in concert with an increase in those in overweight and obese BMI categories perceiving their weight as "about right" since the 1980s. Using biological normalcy as a framework, we assess whether individual weight perception is related to the risk of cardiovascular disease (CVD) when controlling for body fat percentage (BF%).

Data from the National Health and Nutrition Examination Survey (1999-2006) included weight perception, BF%, covariates, and variables to calculate Framingham Risk Score (CVD risk) among 9489 US Americans aged 20-79 years.

Logistic regression revealed that those perceiving themselves to be "overweight" had a significantly higher cardiovascular risk score compared to those considering their weight to be "about right" (OR = 1.54; 95% CI = 1.12-2.11, P = .008) after controlling for BF%, age, gender, ethnicity, poverty-index-ratio, education, family history of myocardial infarction, smoking status, and physical activity.

Perceiving one's own weight as "overweight" was significantly associated with increased 10-year risk of a cardiovascular event when compared to those perceiving their weight to be "about right," regardless of body composition. This suggests that recent changes in normative beliefs in response to increased obesity prevalence over the past several decades could play a role in the distribution of CVD risk in the US, whereby perceiving oneself as "about right" rather than "overweight" may result from decreases in internalization of fat stigma.