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Rapid Responses: Rapid Responses published:
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BMJ also is guilty
- John S Garrow, Rickmansworth WD3 7DQ (2 August 2008)
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Changing size changing perception?
- Sara S Smith (4 August 2008)
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Changing perceptions of weight in Great Britain: comparison of two population surveys- additional perspectives
- Minnie Faith, Gautham Pranesh Lecturer, Department of Biochemistry, Christian Medical College Vellore-632002 Tamilnadu India (6 August 2008)
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Changing Perception or Discomfort at Disclosure?
- rahul bhattacharya (8 August 2008)
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Parents are poor at perceiving when their child is overweight too
- Lauren L Parry, Sonia Saxena (Imperial College) (13 August 2008)
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John S Garrow, retired physician 93 Uxbridge Road, Rickmansworth WD3 7DQ
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Professor Wardle (BMJ 2008;337:a494) observes that in part the public fails to recognise overweight people because "Photographic illustrations often depict severely obese people, untypical of the overweight population." On the cover of today's BMJ there are two women sunbathing, one is of normal build (I guess around BMI=23) and the other is not (I guess BMI>40). I looked for information about the actual BMI of these two, but failed to find it. Did you intend this cover picture to test, or to educate your readers? It did neither, but comitted the error about which Prof Wardle was complaining. What a pity that you did not show a model of BMI=31 and ask your readers is she was obese. (The correct answer is "YES"). Competing interests: None declared |
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Sara S Smith, Consultant Psychiatrist Bushey Fields Hospital, Dudley. DY1 2LZ
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Sir, Johnson et al suggest several explanations for the increasing inability of overweight individuals to recognise themselves as such. An additional factor encouraging such misperception might be clothing size. UK ladies clothing sizes have the arbitrary classification of 10,12,14 etc. This system gives purchasers no accurate feedback about their actual size and allows scope for self-deception! For example, in my wardrobe hang a pair of size 14 trousers purchased from a leading high street merchandiser in approximately 1995. Although these trousers remain a good fit (neither too large nor too small) I now require a size 10 trouser from the same retailer. So should I believe that I am two sizes smaller than when an SHO! The fashion industry might influence in this area of public health. Realistic and consistent sizing rather than the current ever-expanding and increasingly generous system might help people both to recognise their size and take appropriate action. Without the intervention of a physician most ladies would surely pale to realise they are not the perfect 10 they have been encouraged to imagine! Yours sincerely, Sara Smith Competing interests: None declared |
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Minnie Faith, Senior Lecturer Department of Biochemistry Christian Medical College Vellore-632002 Tamilnadu India, Gautham Pranesh Lecturer, Department of Biochemistry, Christian Medical College Vellore-632002 Tamilnadu India
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The article by F Johnson et al, “Changing perceptions of weight in Great Britain: comparison of two population surveys” (1) has in an interesting way elucidated the perception change undergone by two populations over a period of time. The questions that we would like to raise are, 1) What are the different racial populations studied and their numbers within the entire number of people surveyed? As Britain has different ethnic groups, especially a large South- East Asian population, weight perceptions in these different populations tend to differ and hence further demographic composition should have been taken into consideration and stated in the study by the authors. 2) The second point that we would like to raise is the WHO recommended cut-off for normal BMI which is 18.5-24.9 (2). Recent studies have shown that Asian populations need to have a lower cut-off in their BMI to define being overweight and obesity as metabolic syndrome and the risk for diseases like diabetes and coronary heart disease are higher in these populations(3,4). If the study population has included multi-ethinic people of Caucasian, Asian and African origin, then the revised criteria should have been applied to these specific populations in the study for obesity cut-off values. 3) What is the socio-economic stratification of the people surveyed? This has not been done and could have added additional dimensions to the perception change that has occurred over the years. The perception of being overweight has an aura of unhealthiness around it. We would like to emphasize that BMI happens to be a simplistic way of assessing this parameter and is only a reflectance of body weight and not of adiposity (5). Statement of competing interests: None References 1) F Johnson, L Cooke, H Croker, Jane Wardle. Changing perceptions of weight in Great Britain: comparison of two population surveys. BMJ. 2008 July 10;337:a494 2) World Health Organization. Report of a WHO Consultation on Obesity. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization, 1998. 3) WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. 4) Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, Eriksen MP. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2008 Jun 12:1-10. [Epub ahead of print] 5) Van S Hubbard. Defining overweight and obesity: what are the issues? American Journal of Clinical Nutrition. 2000 Nov; 72(5):1067-1068 Competing interests: None declared |
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rahul bhattacharya, specialist registrar in psychiatry, charing cross scheme St Charles Hospital, Exmoor Street, London W10 6DZ
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Johnson et al have interpreted reduced self-reporting by over-weight or obese individuals as 'a marked decline in sensitivity with respect to individuals' detection of their own weight'. I would like to propose an alternative hypothesis for interpreting these results. The results do show people who are 'not' over weight or obese were actually more aware of their 'achievement', hence the results show increased specificity. In recent years, we have seen an increase in social pressure to be thin with the rise of the size zero culture. This can potentially have stigmatizing effect on those who do not possess the perfect body. This might have added to the burden of shame on these individuals and could have further marginalized them from disclosing their honest perceptions. The lack of sensitivity found in this study might have been a reflection of their psychological defense where they have used minimization strategies to avoid blame from society for their weight. Moreover, during this time the World Health Organization lowered the cut-off for the 'normal' BMI from 20 to 18.5. This attempt at coming up with a 'one-size-fit' for the whole world have also added to increased pressures to be thin. While obesity has increased shockingly, incidences for conditions such as bulimia nervosa are also increasing. There is little to tell us about the prevalence of conditions such as binge eating disorder in the general population or in obese or over-weight people. If public health campaigns come across as harsh and critical they risk further pushing away these already estranged and vulnerable people, and would fail to offer true help. Campaigns should be motivational and sensitive to have a wide appeal and to avoid breaking the first rule of medicine in avoiding doing harm to people. On this matter, I was appalled at the lack of sensitivity of BMJ cover for the issue. Competing interests: None declared |
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Lauren L Parry, ST1 GP VTS trainee Kings College Hospital, London SE5 9RS, Sonia Saxena (Imperial College)
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Dear Editor, Our recent research echoes concerns raised by F Johnson et al (1) for public health campaigns aimed at reducing obesity, if overweight individuals do not perceive themselves to be overweight and therefore fail to “identify themselves as targets”. We systematically reviewed the parental perception of overweight status in overweight children (2). We identified the proportion of parents able to recognize overweight status in their children, who were recorded as being overweight by internationally recognized standards. In twenty-three studies, representing 3864 overweight children from 7 countries, we found that more than half of parents were unable to recognize when their child was overweight. 17/ 23 studies defined overweight status in children using body mass index (BMI) > 95th centile or the International Obesity Task Force criteria (3), but in total 5 distinct standard definitions of overweight status were reported. Parental recognition of their child's overweight status ranged from 6.2% to 73%, but in 19 of 23 studies, it was less than 50%. This low rate of recognition is even more alarming than findings from Johnson et al’s adult survey (1) but both research pieces highlight that in this increasingly overweight nation, despite increasing media coverage, we cannot rely on individuals to refer themselves or their children for weight-reduction interventions. This also presents difficulties for health professionals who opportunistically raise the issue of health risk from being overweight, particularly in children where definitions for overweight status are inconsistently applied. We predict as populations get fatter that perceptions will adjust to accept overweight morphology as the norm and therefore reliance on individuals to seek weight-reduction interventions is likely to be increasingly ineffective. A more systematic approach to identify overweight children through population, primary care or school based screening would avoid reliance on parents to come forward. Currently the paucity of successful weight reduction interventions in children who are already overweight and at risk of obesity means that such screening does not meet WHO criteria. Further research into interventions that tackle overweight and prevent obesity must be a research priority. References: 1.Johnson F, Cooke L, Croker H, Wardle Jane. Changing perceptions of weight in Great Britain: comparison of two population surveys. BMJ 2008;337:a494 2.Parry L, Netuveli G, Parry J, Saxena S. A Systematic Review of Parental Perception of Overweight Status in Children. J Ambul Care Manage 2008 Jul-Sep;31(3):253-68) 3.Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240-1243 Competing interests: None declared |
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