Body Weight Perception and Quality of Life in Nurses of Nantong City, China: A Cross-Sectional Study

doi:10.21203/rs.3.rs-93142/v2

Background To explored associations of body weight perception with body mass index and quality of life among nurses.

Methods A total of 456 nurses (18-55 years old） were surveyed in a cross-sectional study in a hospital. Data on social-demographic characteristics, BMI, BWP and Qol were collected.

Results 40.6% of nurses misconception their weight status. Married nurses were more likely than unmarried to underestimate their weight. Significant disparity in mental health, vitality and mental component summary scores were found in nursers who underestimate their weight compared to those correctly perceived or over or who overestimate their weight.

Conclusion Interventions should be designed to help nurse address body weight status misconception, thereby contributing to label themselves and patients as underweight, normal weight, overweight or obese correctly, and in turn, giving reasonable eating habits and physical activities health education.

Health Economics & Outcomes Research

Quality of Life

Body Weight Perception

Nantong city

Women

Obesity is a globalizing health challenge. It is also a known risk factor for the development of other diseases, including type 2 diabetes, CVD, gallstones, musculoskeletal disorders, and certain cancers.1 According to BMI, the prevalence of general obesity and overweight among Chinese women was 14.3% and 17.7%, respectively.2 However, 64% of overweight and obese women underestimated BW.3 This kind of subjective evaluation of actual weight status is called bodyweight perception (BWP).5 A correct bodyweight perception means that people know their current weight status correctly, which is essential to promote healthy lifestyle behavior, optimal weight management, and the prevention of weight-related diseases.6BWP was associated with body mass index (BMI).7 However, a previous study showed the consistency between self-perceived and actual body weight status was poor.3 Nurse practitioners have an excellent reputation for their expertise with high-quality comprehensive care provided for obese patients.8 However nurses' misperceptions of weight status could be one barrier to obesity management.9

Besides, previous studies also showed that participants who overestimate their body weight status had a comparatively low health-related quality of life (QoL).10,11 To our knowledge, the relationship between Qol and BWP in Nantong city women has not been reported in previous studies.

Thus, this study attempted to explore the relationship between BMI and BWP in Nantong city nurses. Furthermore, Qol of the participants was also explored in this study.

Study design, study setting, and participants

A self-report questionnaire was distributed to potential female participants. Exclusion criteria: (1) pregnant and lactating women; (2) with the following complications (Diabetes, hypertension, dyslipidemia, cancer, pulmonary disease, cardiovascular disease, musculoskeletal disorders, etc.) that were evaluated by annual physical examination; and (3)those who did not complete the questionnaire. In total, 456 nurses completed questionnaires.

Measures

Sociodemographic characteristics

Age, marital status, income, level of education, height, and weight were included in the present analyses.

Weight status

Nurses’ self-reported height and weight as used to estimate self-report BMI(kg/m²). Previous studies have found that self-reported height and weight provided adequate estimates for actual height and weight in population-based epidemiological studies.12,13

Sample characteristics

We investigated nurses in Nantong City. The mean age was 30.7±7.23 years. We considered 4 age groups: 18-24 years(20.0%) , 25–34 years (54.2%), 35-44 years(21.0%) and 45-55 years(4.8%). The education category was subdivided into a Diploma of higher education (30.5%) and a Bachelor degree(69.5%). The mean BMI was 21.98±2.784 kg/m2 for the overall sample. BMI revealed 8.8% to be underweight, 20.2% to be overweight and 13.6% to be obese， which was calculated by self-reported weight and height. Chi-square tests indicated significant differences in BMI category by age (χ² = 39.119, p < 0.001) and marital status (χ² = 17.406, p < 0.001). Chi-square tests revealed no significant difference in BWP by age (χ² = 10.112, p =0.341), education (χ² = 2.132, p =0.545), marital status(χ² =2.617, p=0.455) and per-capital disposable income (χ² = 4.425, p =0.619). The results are presented in Table 1.

The nurses were classified into 3 groups, namely underestimation, consistency, and overestimation. The prevalence of nurses who underestimated their weight status accurately perceived their weight status, and overestimated their weight status were 22.6%, 59.4%, and 18.0% respectively. Chi-square tests showed significant differences in consistency of BMI and BWP category by marital status (χ2 = 6.872, p < 0.05) and BMI categories (χ2 = 175.145, p < 0.001). Married nurses were more likely than single nurses to overestimate their weight. Moreover, no significant difference was found between age, education, and per-capital disposable income the consistency of BMI and BWP. The results are presented in Table 2.

Table 3 provides a consistency analysis of BMI and BWP. The percentages of nurses who perceived themselves as underweight, normal weight, overweight and obese were 65.0%, 66.4%, 64.1%, and 19.4%, respectively.

One-way between-subjects ANOVAs were conducted to compare the impact of overestimation, consistency, and underestimation of body weight on physical and mental health as measured by the SF-36 sub-scales. There was a significant main effect for MH, VT, and MCS at the p < 0.05 level (see Table 4). Post hoc comparisons using the LSD test indicated that the mean scores for the underestimation group were significantly higher than the overestimation group on MH, VT, and MCS. The underestimation group was significantly higher than the consistency group for MH, VT, MCS, and GH. (see Table 4).

We found that married nurses were more likely than single nurses to overestimate their actual weight status，which may be influenced by the weight labeling from their partners. Recent a study has pointed that the experience of weight labeling(i.e., merely being told one is“too fat” by others) might influence the self-perception of body weight status.17 Moreover their partners’ weight labeling may likely originate in the stereotypical image of slim girls. Married nurses had more chances to be told they are fat by partners in this traditional image. It is logical that married nurses are easier to overestimate their body weight status than single nurses.

Previous studies have found that the accuracy of BWP was associated with age, education, and per-capital disposable income.18-20 These associations were not revealed in our 456 nurses. We expect that this is due to relatively low power, caused by the relatively low number of cases experiencing depressive symptoms. This is the main limitation of our study. Besides, variations in study design and participants’ demographic characteristics might also be the reasons for the discrepancy.

The prevalence of body weight underestimation was 0.0%, 9.2%, 31.5%, and 80.6%. Additionally, We also found that a mismatch exists between BMI and BWP, consistent with previous studies.21,22

Some studies stated that obesity can lead to psychological, social, and medical problems that may negatively affect QoL.23,24

This was the first study to examine Chinese healthy nurses’ misconceptions of weight status. The rate of nurses’ interceptions of weight status was 40.6%, lower than another study from the US,25 but higher than another study from the UK.21 The different rates of weight status misconception described by these studies may be explained by diversity in sample characteristics. However, nurses were health professionals, whose misconception of their body weight could affect their identification of overweight patients.21 Although BMI is one of the admission assessment items, medical staffs prefer to use body perception as the basis of body weight management. It was necessary to help nurses overcome personal weight-related obstacles that may enable them to become better health educators for achieving healthy weight in their patients.

Our study showed that a discrepancy exists between BMI and BWP. Married women were more likely than single women to overestimate their weight. Women who overestimate their body weight with lower mental health, vitality, and mental component summary scores, GH. Thus, Interventions should be designed to help nurses improve weight management awareness and increase their awareness of actual weight categories.

Acknowledgments

Not applicable.

Authors' contributions

Study design: Xu Wang, Xiaohua Yang. Data collection: Xu Wang, Xiaohua Yang. Data analysis: Xu Wang,Xiaohua Yang. Study supervision: Hongmei Chu, Chunyan Ge. Manuscript writing: Xu Wang, Hongmei Chu. Critical revisions for important intellectual content: Hongmei Chu, Chunyan Ge. All authors read and approved the final manuscript.

Funding

This work was supported by the Nantong Science and Technology Board (JCZ20025) and the Affiliated Haian Hospital of Nantong University(202010).

Availability of supporting data

Data is available upon request to corresponding authors.

Ethical Approval and Consent to participate

The participants provided written informed consent. The Academic and Ethics Committee of Affiliated Haian Hospital of Nantong University, China, reviewed and approved this study (reference 170825).

Consent for publication

Not applicable.

Competing interests

The authors have no conflict of interest regarding this study.

BMI: Body Mass Index; BWP: bodyweight perception; QoL: quality of life; PF: physical functioning; SF-36: the 36-Item Short-Form Health Survey questionnaire; RP: role physical; BP: body pain; GH: general health; VT: energy/fatigue; SF: social functioning; RE: role emotional; MH: mental health; PCS: Physical Component Summary; MCS: Mental Component Summary

1 Finucane MM, Stevens GA, Cowan MJ et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet (London, England) 2011;377:557-567.

2 Wang H, Wang J, Liu MM et al. Epidemiology of general obesity, abdominal obesity and related risk factors in urban adults from 33 communities of northeast china: The chpsne study. BMC public health 2012;12:967.

3 Monteagudo C, Dijkstra SC, Visser M. Self- perception of body weight status in older dutch adults. The journal of nutrition, health & aging 2015;19:612-618.

4 Lynch EB, Kane J. Body size perception among african american women. Journal of nutrition education and behavior 2014;46:412-417.

5 Hayward J, Millar L, Petersen S et al. When ignorance is bliss: Weight perception, body mass index and quality of life in adolescents. International journal of obesity (2005) 2014;38:1328-1334.

6 Lemon SC, Rosal MC, Zapka J et al. Contributions of weight perceptions to weight loss attempts: Differences by body mass index and gender. Body image 2009;6:90-96.

7 Liu S, Fu MR, Hu SH et al. Accuracy of body weight perception and obesity among chinese americans. Obesity research & clinical practice 2016;10 Suppl 1:S48-s56.

8 Deravin L, Anderson J (2019). Chronic care nursing. Cambridge University Press.

9 Perrin E M, Flower K B, Ammerman A S. Pediatricians' own weight: self-perception, misclassification, and ease of counseling. Obesity, 2012, 13(2):326-332.

10 Herman KM, Hopman WM, Rosenberg MW. Self-rated health and life satisfaction among canadian adults: Associations of perceived weight status versus bmi. Quality of life research 2013;22:2693-2705.

11 Hidalgo-Rasmussen CA, Hidalgo-San Martin A, Rasmussen-Cruz B, et al. quality of life according to self-perceived weight, weight control behaviors, and gender among adolescent university students in mexico. Cadernos de saude publica 2011;27:67-77.

12 Fonseca H, Silva AM, Matos MG et al. Validity of bmi based on self-reported weight and height in adolescents. Acta Pã¦diatrica 2010;99:83-88.

13 Bowring AL, Peeters A, Freak-Poli R et al.Measuring the accuracy of self-reported height and weight in a community-based sample of young people. Bmc Medical Research Methodology 2012;12:175.

14 Tan K. Appropriate body-mass index for asian populations and its implications for policy and intervention strategies. Lancet (London, England) 2004;363:157-163.

15 Tian Y, Jiang C, Wang M, et al. BMI, leisure-time physical activity, and physical fitness in adults in China: results from a series of national surveys, 2000-14. Lancet Diabetes Endocrinol, 2016, 4(6):487-497.

16 Wang S, Fan WJ, Yu WQ et al. analysis on reliability and validity of sf-36 scale in urban residents. Zhonghua liu xing bing xue za zhi 2016;37:344.

17 Unger ES, Kawachi I, Milliren CE et al. Protective misperception? Prospective study of weight self-perception and blood pressure in adolescents with overweight and obesity. Journal of Adolescent Health Official Publication of the Society for Adolescent Medicine 2017;60:680.

18 Park B, Cho HN, Choi E et al. Self-perceptions of body weight status according to age-groups among korean women: A nationwide population-based survey. PLOS ONE 2019;14:e0210486.

19 Shan L, Fu MR, Hu SH et al. Accuracy of body weight perception and obesity among chinese americans. Obesity research & clinical practice 2016;10:S48-S56.

20 Johnston DW, Lordan G. Weight perceptions, weight control and income: An analysis using british data. Economics & Human Biology 2014;12:132-139.

21 Zhu D, Norman IJ, While AE. Nurses' misperceptions of weight status associated with their body weight, demographics and health status. Public Health Nutrition 2014;17:569-578.

22 Wang Y, Liu H, Wu F et al. The association between bmi and body weight perception among children and adolescents in jilin city, china. Plos One 2018;13:e0194237.

23 Son N. Assessment of body perception, psychological distress, and subjective quality of life among obese and nonobese subjects in turkey. Nigerian Journal of Clinical Practice 2017;20:1302.

24 Kolotkin RL, Andersen JR. A systematic review of reviews: Exploring the relationship between obesity, weight loss and health-related quality of life. Clinical obesity 2017;7:273-289.

25 Perrin EM, Flower KB, Ammerman AS. Pediatricians’ own weight: Self-perception, misclassification, and ease of counseling. Obesity 2012;13:326-332.

Table 1

Demographic characteristics of the sample in body weight perception and BMI category.
Variables	Overall sample	BMI, N(%)				χ²	P	Body weight perception, N(%)				χ²	P
Variables	Overall sample	underweight	normal weight	overweight	obese	χ²	P	underweight	normal weight	overweight	obese	χ²	P
All respondents	456	40(8.8)	262(57.5)	92(20.2)	62(13.6)			50(11.0)	223(48.9)	166(36.4)	17(3.7)
Age (year)						39.119	< 0.001					10.112	0.341
18–24	91	17(18.7)	51(56.0)	17(18.7)	6(6.6)			15(16.5)	46(50.5)	27(29.7)	3(3.3)
25–34	247	22(8.9)	140(56.7)	40(16.2)	45(18.2)			27(10.9)	117(47.4)	91(36.8)	12(4.9)
35–44	96	1(1.0)	59(61.5)	28(29.2)	8(8.3)			7(7.3)	49(51.0)	39(40.6)	1(1.0)
45–55	22	0(0.0)	12(54.5)	7(31.8)	3(13.6)			1(4.5)	11(50.0)	9(40.9)	1(4.5)
Education						3.293	0.349					2.132	0.545
Diploma of higher education	139	17(12.2)	78(56.1)	28(20.1)	16(11.5)			17(12.2)	73(52.5)	45(32.4)	4(2.9)
Bachelor degree	317	23(7.3)	184(58.0)	64(20.2)	46(14.5)			33(10.4)	150(47.3)	121(38.2)	13(4.1)
Marital status						17.406	0.001					2.617	0.455
married	341	20(5.9)	194(56.9)	78(22.9)	49(14.4)			33(9.7)	169(49.6)	125(36.7)	14(4.1)
single	115	20(17.4)	68(59.1)	14(12.2)	13(11.3)			17(14.8)	54(47.0)	41(35.7)	3(2.6)
Per-capita disposable income (RMB)						7.863	0.248					4.425	0.619
< 15000	83	10(12.0)	48(57.8)	11(13.3)	14(16.9)			11(13.3)	41(49.4)	27(32.5)	4(4.8)
15000–33000	150	14(9.3)	92(61.3)	27(18.0)	17(11.3)			16(10.7)	69(46.0)	62(41.3)	3(2.0)
> 33000	223	16(7.2)	122(54.7)	54(24.2)	31(13.9)			23(10.3)	113(50.7)	77(34.5)	10(4.5)

Table 2

Body weight perception by age, education, marital status, per-capital disposable income and BMI.
Variables	Overall sample	Underestimation, N(%)	Consistency, N(%)	Overestimation, N(%)	χ²	P
All respondents	456	82(18.0)	271(59.4)	103(22.6)
Age (year)					7.617	0.268
18–24	91	20(22.0)	58(63.7)	13(14.3)
25–34	247	44(17.8)	144(58.3)	59(23.9)
35–44	96	14(14.6)	59(61.5)	23(24.0)
45–55	22	4(18.2)	10(45.5)	8(36.4)
Education					0.280	0.869
Diploma of higher education	139	27(19.4)	81(58.3)	31(22.3)
Bachelor degree	317	55(17.4)	190(59.9)	72(22.7)
Marital status					6.872	0.032
married	341	53(15.5)	204(59.8)	84(24.6)
single	115	29(25.2)	67(58.3)	19(16.5)
Per-capita disposable income (RMB)					5.783	0.216
< 18000	83	13(15.7)	51(61.4)	19(22.9)
18000–39000	150	36(24.0)	85(56.7)	29(19.3)
> 39000	223	33(14.8)	135(60.5)	55(24.7)
BMI					175.145	<0.001
underweight	40	0(0.0%)	26(65.0%)	14(35.0%)
normal weight	262	24(9.2%)	174(66.4%)	64(24.4%)
overweight	92	29(31.5%)	59(64.1%)	4(4.3%)
obese	62	50(80.6%)	12(19.4%)	0(0.0%)

Table 3

Consistency analysis of BMI and body weight perception.
BMI	Body weight perception				Kappa	P
	Underweight N (%)	Normal weight N (%)	Overweight N (%)	Obese N (%)
Underweight	26(65.0)	14(35.0)	0(0.0)	0(0.0)	0.357	< 0.001
Normal weight	24(9.2)	174(66.4)	63(24.0)	1(0.4)
Overweight	0(0.0)	29(31.5)	59(64.1)	4(4.3)
Obese	0(0.0)	6(9.7)	44(71.0)	12(19.4)

Table 4

Comparison between the overestimation, consistency and underestimation of body weight perception in SF-36 domain score.
QOL assessments (SF-36 domains), mean (SD)	Overestimation, mean ± SD, N = 82	Consistency, mean ± SD, N = 271	Underestimation, mean ± SD, N = 103	F	P
PF	88.35 ± 10.454	86.46 ± 13.375	86.26 ± 14.310	0.75	0.473
RP	70.43 ± 35.383	74.72 ± 35.124	80.83 ± 32.123	2.174	0.115
BP	85.56 ± 17.527	85.16 ± 17.816	88.38 ± 17.115	1.271	0.282
GH	64.45 ± 13.449	63.43 ± 13.286	67.23 ± 14.682a	2.898	0.056
VT	59.76 ± 15.008	61.75 ± 14.687	67.09 ± 14.927ab	6.693	0.001
SF	78.35 ± 18.742	80.03 ± 16.790	83.86 ± 17.206	2.683	0.069
RE	79.67 ± 35.042	79.46 ± 34.670	82.2 ± 32.944	0.246	0.782
MH	65.51 ± 15.379	66.11 ± 13.830	71.38 ± 13.966ab	5.878	0.003
PCS	77.20 ± 15.227	77.44 ± 14.546	80.67 ± 15.096	1.978	0.140
MCS	71.81 ± 16.808	72.84 ± 15.604	77.17 ± 16.156ab	3.397	0.034
a Comparison of underestimation vs. consistency of body weight perception significant at P < 0.05.
b Comparison of underestimation vs. overestimation of body weight perception significant at P < 0.05.
PCS: the physical component summary.
MCS: the mental component summary.

Body Weight Perception and Quality of Life in Nurses of Nantong City, China: A Cross-Sectional Study

Status:

Version 2

Abstract

Introduction

Methods

Results

Discussion

Conclusions

Declarations

Abbreviations

References

Tables

Status:

Version 2