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Decoding unintentional weight loss: How the right questions make a difference.

Jos W Borkent1, Barbara S van der Meij1, Marian A E de van der Schueren1

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Clinical Nutrition (Edinburgh, Scotland)
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Summary

Malnutrition screening questions about unintentional weight loss (UWL) may be misinterpreted by individuals aiming to lose weight. This can lead to underestimating malnutrition prevalence in those with higher body mass index (BMI).

Keywords:
Body imageGLIMInvoluntary weight lossMisclassificationScreening tools

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Area of Science:

  • Clinical Nutrition
  • Public Health
  • Epidemiology

Background:

  • Malnutrition screening tools frequently assess unintentional weight loss (UWL).
  • Accurate interpretation of UWL questions by individuals desiring weight loss or perceiving themselves as overweight is uncertain.
  • Potential misclassification of UWL in these populations requires investigation.

Purpose of the Study:

  • To assess the accuracy of unintentional weight loss (UWL) reporting in individuals who intentionally desire to lose weight or perceive themselves as overweight.
  • To identify potential misclassification bias in malnutrition screening tools.

Main Methods:

  • Analysis of data from the Lifelines cohort (n=125,000, age >18).
  • Calculation of prevalence ratios (PRs) for UWL, with desire to lose weight and body weight perception as independent variables.
  • Stratification by body mass index (BMI) and adjustment for comorbidities, demographics, and quality of life.

Main Results:

  • Among normal weight individuals, 30.3% desired weight loss, 37.9% perceived themselves as too heavy, and 5.1% reported UWL.
  • Among overweight/obese individuals, 80.1% desired weight loss, 92.7% perceived themselves as too heavy, and 2.7% reported UWL.
  • Both groups showed approximately 60% lower UWL prevalence (PRs 0.40-0.43, p<0.05) if they desired weight loss or perceived themselves as too heavy.

Conclusions:

  • Lower reported UWL prevalence in individuals aiming to lose weight or perceiving themselves as overweight suggests misinterpretation.
  • Malnutrition screening tools using UWL questions may underestimate malnutrition prevalence in higher BMI individuals.
  • This misinterpretation highlights a need for refined screening questions for diverse populations.