Body weight perception and weight loss practices

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Weight, height and waist circumference (WC) were measured and Asian ... weight men and women reported themselves as being 'underweight'. ... obese Sri Lankan adults believe they are in right weight category or are .... much do you weigh without your shoes on?''). .... weight' and in those with normal 'Measured' BMI.
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Obesity Research & Clinical Practice (2013) xxx, xxx.e1—xxx.e9

ORIGINAL ARTICLE

Body weight perception and weight loss practices among Sri Lankan adults Ranil Jayawardena a,b,∗, Nuala M. Byrne a, Mario J. Soares c, Prasad Katulanda b, Andrew P. Hills d a

Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia b Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka c Curtin Health Innovation Research Institute, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia d Mater Mother’s Hospital, Mater Medical Research Institute and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia Received 14 March 2013 ; received in revised form 17 May 2013; accepted 19 May 2013

KEYWORDS Obesity; Weight perception; Sri Lanka; Weight losing practices; Overweight; Abdominal obesity

Summary Objectives: The purpose of the present study was to evaluate the association between self-perception of body weight, weight loss approaches and measured body mass index (BMI) and waist circumference (WC) among Sri Lankan adults. Methods: A nationally representative sample of 600 adults aged ≥18 years was selected using a multi-stage random cluster sampling technique. An intervieweradministrated questionnaire was used to assess demographic characteristics, body weight perception, abdominal obesity perception and details of weight losing practices. Weight, height and waist circumference (WC) were measured and Asian anthropometric cut-offs for BMI and WC were applied. Results: Body weight mis-perception was common among Sri Lankan adults. Two-thirds of overweight males and 44.7% females considered themselves as ‘about right weight’, moreover, 4.1% and 7.6% overweight men and women reported themselves as being ‘underweight’. Over one third of both male and female obese subjects perceived themselves as ‘about right weight’ or ‘underweight’. Nearly 32% of centrally

Abbreviations: BMI, body mass index; CVD, cardio vascular diseases; SLDCS, Sri Lanka diabetes cardiovascular study; WHO, World Health Organization; WC, waist circumference. ∗ Corresponding author at: Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.Tel.: +61 7 31386133; fax: +61 7 31386030. E-mail addresses: [email protected] (R. Jayawardena), [email protected] (N.M. Byrne), [email protected] (M.J. Soares), [email protected] (P. Katulanda), [email protected] (A.P. Hills). 1871-403X/$ — see front matter © 2013 Asian Oceanian Association for the Study of Obesity. All rights reserved.

http://dx.doi.org/10.1016/j.orcp.2013.05.003

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R. Jayawardena et al. obese men and women perceived that their WC is about right. People who perceived themselves as overweight or very overweight (n = 154) only 63.6% tried to lose weight (n = 98), and one quarter of adults sought advice from professionals (n = 39). Conclusion: Body weight misperception was common among underweight, healthy weight, overweight, and obese adults in Sri Lanka. Over 2/3 of overweight and 1/3 of obese Sri Lankan adults believe they are in right weight category or are under weight. © 2013 Asian Oceanian Association for the Study of Obesity. All rights reserved.

Introduction The prevalence of obesity has reached epidemic levels in many parts of the world. World Health Organization (WHO) estimations in 2008 indicated that 1.5 billion adults worldwide were overweight, while nearly 500 million adults were suffering from obesity [1]. Obesity has also become an emerging public health problem in Sri Lanka. Despite the limited availability of data, previous studies have demonstrated a clear upward trend in age-adjusted prevalence of obesity in Sri Lankan males and females; increasing from 7.0% (males) and 13.4% (females) in 1990 to 9.9% and 19.2%, respectively in 2000 [2]. In 2005, national level obesity prevalence data showed that 25.2% of adults were overweight (BMI ≥23 kg/m2 ) and 16.8% were obese (BMI ≥25 kg/m2 ) [3]. One quarter of the Sri Lankan adult population are suffering from central obesity, in particular, one in every two urban dwelling females are affected by abdominal obesity [3]. Katulanda et al. have reported that female gender, urban living, higher level of education, higher income and middle age are risk factors for obesity among Sri Lankans. These socio-economic factors associated with obesity amongst Sri Lankan adults are in contrast to risk factors from developed countries, where less educated, economically deprived and people living in rural area are more obese [3]. Hence, there could be unique socioeconomic factors driving the obesity epidemic in Sri Lanka. It is well documented that being overweight and obese are associated with many negative medical, psychological, social and economic consequences. Health promotion efforts aimed at overweight and obesity prevention often proceed with the assumption that most individuals prefer to be thin, and that the initial step in motivating individuals who are overweight to lose weight is to raise awareness of their present weight status and associated health risks [4]. This approach may be fitting for

Western populations that value thinness in women and lean muscular physiques in men, and highly health literate societies that recognize that abdominal obesity is a risk factor for many deleterious metabolic consequences such as diabetes. However, this assumption needs testing in Sri Lanka context where traditionally abdominal obesity has been considered a sign of wealth and status. This feature is commonplace in many non-western cultures which traditionally recognize that a large body size, especially abdominal obesity in either males or females is a sign of prosperity, wealth and health [5]. That culture influences weight perception preference has been the rationale for many studies researching the association between weight perception and obesity among different ethnic groups. Many of these studies have either focused on minority immigrant populations in affluent countries [6] or primarily adolescent age groups [7]. Sri Lanka is a country in nutritional transition with epidemic levels of obesity mainly in urban areas and considerable under-nutrition and nutritional deficiencies also commonplace [8]. Although there is an increased interest in the prevention of obesity and associated non-communicable diseases by health authorities, professional associations and the mass media, there are no national level data on body weight perception and weight loss practices among Sri Lankan adults. The success of a public health intervention is dependent upon the people’s awareness of the health issue and their motivation to change. Selfperception of body weight is a strong determinant of nutritional habits and weight management [6]. A skewed perception of body weight may be a barrier to successful weight loss [9] and healthy weight management goals should be set taking into consideration an individual’s weight perception [10]. The purpose of the present study was to assess the association between self-perception of body weight and WC with BMI and WC cut-offs among Sri Lankan adults. In addition, we report the knowledge of their body weight, concept about the BMI and weight loss approaches among Sri Lankan adults.

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Body weight perception and weight loss practices among Sri Lankan adults

Materials and methods Study population and sampling Data were collected from a subset (n = 600) of a previously conducted nationally representative study, the Sri Lankan Diabetes Cardiovascular Study (SLDCS) using a multi-stage, stratified, random sampling procedure during January to March 2011. The details of sampling of the SLDCS are described elsewhere [11]. Data relevant to the present study were obtained in community settings and included demographic, socio-economic, self-reported diabetes mellitus, anthropometric measurements, body weight and waist circumference perception, and weight loss practices. This study was approved by the Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka.

Anthropometric measurements Height was measured using a portable Holtain Stadiometer (Chasmors Ltd, London, UK) to the nearest 0.1 cm. Body weight was measured using a SECA electronic scale (Hamburg, Germany) to the nearest 0.1 kg. Most of the participants were weighed wearing light clothes and after overnight fasting. BMI was calculated as body weight (kg) divided by the square of height (m). For participants with heavy clothing, their body weight was calculated by subtracting the weight of similar clothing to that worn by the participant during the measurement. WC was measured using a tape to the nearest 0.1 cm at the midpoint between the lower costal border and the top of the iliac crest, at the end of normal expiration.

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weight, overweight, and very overweight [6,10]. However, for analysis, very underweight and underweight were merged to form one group. Similarly, with regard to abdominal obesity, the question asked was, ‘‘How do you describe your waist circumference?’’ answers were; low, about right, and high. In addition, self-reported weight and height, presence/absence of diabetes mellitus, details of weight loss practices and knowledge of BMI were also collected.

Statistical analysis Analysis was undertaken using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Subjects were classified into four groups according to their ‘Measured’ BMI values as follows: underweight: 90 cm for males and >80 cm for females [12]. For categorical variables, Pearson’s chi-square test was used. Percentages of responses were reported according to BMI and WC level and respective weight and WC perception. A multiple logistic regression analysis was carried out with perceived overweight as the dependent variable and age, ‘Measured’ BMI, ethnicity, gender, and education as independent variables. All independent variables were simultaneously included in the regression model regardless of their statistical significance. A similar regression was carried out for knowledge of BMI. In all analyses a P value < 0.05 was considered statistically significant.

Results Body weight and waist circumference perception An interviewer-administrated questionnaire was used which included items such as self-reported height and weight, body weight perception, abdominal obesity perception and details of weight loss practices. Specifically, these questions asked subjects to report their height in feet and inches or meters (‘‘How tall are you without your shoes on?’’) and weight in kilograms or pounds (‘‘How much do you weigh without your shoes on?’’). Self-reported height and weight were converted to metric units for calculation of ‘Self-reported’ BMI. The weight perception question asked was ‘‘How do you describe your weight?’’ Choices included: very underweight, underweight, about the right

Four hundred and ninety adults participated in the study (response rate — 82%). Table 1 shows the socio-demographic characteristics and obesity prevalence of the study population. The majority of participants were female (n = 321, 65.5%) and the mean age was 48.4 ± 15.6 year for males and 48.1 ± 14.1 year for females. Overall, there was a preponderance of Sinhalese (M: 71.1%; F: 80.1%), with most residing in rural areas (M: 60.4%; F: 57.6%). In the study population, 10.6% males and 12.8% females had self-reported diabetes mellitus. The prevalence of overweight and obesity in males was 14.2% and 20.2%, and in females, 20.2% and 35.9%, respectively. Nearly 45% of females had abdominal obesity; however, in contrast, only 13% of males had abdominal obesity.

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R. Jayawardena et al. Socio-demographic characteristics, BMI and abdominal obesity categories.

Variables % (n)

Males (169)

Female (321)

Age (years) (mean ± s.d.)

48.4 ± 15.6

48.1 ± 14.1

Area of residence Urban Rural Estate

27.8 (47) 60.4 (102) 11.8 (20)

36.2 (116) 57.6 (185) 6.2 (20)

Ethnicity Sinhalese Sri Lankan Tamil Indian Tamil Muslim

71.1 11.8 12.4 4.7

80.1(257) 7.2(23) 5.5(18) 7.2(23)

Education level No Schooling Upto 5 years Upto 11 years Upto 13 years Graduate

6.5 (11) 27.2 (46) 34.9(59) 27.2(46) 4.2(7)

6.5 (21) 25.2(81) 40.6(130) 22.7(73) 5.0(16)

Prevalence of diabetes mellitus Underweight (BMI < 18.5 kg/m−2 ) Normal weight (18.5 ≥ BMI < 22.9 kg/m−2 ) Overweight (23.0 ≥ BMI < 24.9 kg/m−2 ) Obesity (BMI > 25.0 kg/m−2 ) Abdominal obesitya

10.6 18.3 47.4 14.2 20.1 13.0

12.8 13.4 30.6 20.2 35.9 44.9

a

(120) (20) (21) (8)

(18) (31) (80) (24) (34) (22)

(41) (43) (98) (65) (115) (144)

Abdominal obesity (M: 90 cm > WC; F: 80 cm > WC).

In this sample, 54.7% (n = 268) were aware of their own body weight and only 24.7% (n = 121) correctly predict their weight close to the measured weight (±2 kg). Similar to body weight, 51.0% (n = 245) population were aware of their height and 32.4% (n = 159) of subjects reported height close to the measured values (±5 cm) (Table 2). Moreover only 57 adults (M = 27, F = 30) predicted both height (±5 cm) and weight (±2 kg) correctly. Only 94 adults (19.2%) had knowledge of what is meant by BMI, there was no significant difference between knowledge levels of males (21.3%) and females (18.1%). Younger age (p < 0.001), living in urban area (p < 0.03) and higher education (p < 0.001) was significantly associated with knowledge of BMI.

Table 2

Weight misperception varied among BMI groups (Table 3). According to ‘Measured’ BMI categories, majority of underweight adults perceived themselves correctly as being ‘underweight’. However, subjects who had normal ‘Measured’ BMI values misperceived their body weight; about one third of these adults perceived themselves as being ‘underweight’ and in those with normal ‘Measured’ BMI 9.9% males and 11.2% females reported that they are overweight or very overweight. One third of overweight males and 44.7% females considered themselves as ‘about right weight’, moreover, 4.1% and 7.6% overweight men and women reported themselves as being ‘underweight’. Over one third of both male and female obese subjects

Awareness of body weight and height. Number of participants (%) All

Male

Female

Body weight Awareness Prediction of weight ± 2 kg

268 (54.7%) 121 (24.7%)

104 (61.5%) 47 (27.8%)

164 (51.1%) 74 (23.1%)

Height Awareness Prediction of height ± 5 cm

245 (49.9%) 159 (32.4%)

116 (68.6%) 80 (47.3%)

129 (40.2%) 79 (24.6%)

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Table 3 Percentage of adults in each category of weight perception, by BMI category calculated from measured height and weight. BMI categories (n)

Weight perception category Underweight (%)

About the right weight (%)

Underweight Male (31) Female (43)

54.9 62.7

41.9 37.3

3.2 0

Normal Male (80) Female (98)

31.3 31.6

58.8 57.2

8.7 11.2

1.2 0

Overweight Male (24) Female (65)

4.1 7.6

66.7 44.7

29.2 46.2

0 1.5

Obese Male (34) Female (115)

2.9 3.4

38.2 30.4

55.9 48.7

3.0 17.5

perceived themselves as ‘about right weight’ or ‘underweight’. Only 3% of obese males reported themselves as being ‘very overweight’, however in contrast, 17.5% of females who were obese considered themselves as ‘very overweight’. Table 4 shows the percentage of abdominally obese adults who reported that they were having ‘low’, ‘about right’ and ‘high’ waist circumference. Nearly 32% of centrally obese men and women perceived that their WC is about right. Despite having high WC, small percentage of (M: 4.5%; F: 2.1%) adults believed that they were having a ‘low’ WC. People who perceived overweight or very overweight (n = 154) only 63.6% tried to lose their body weight (n = 98), and quarter of adults seek advices from professionals (n = 39). In this population, almost all obtained weight reduction advices from medical doctors (Doctor: Nutritionist = 38:1). Table 5 shows the multiple logistic regression models for under perception, correct perception and over perception of body weight. The Hosmer—Lemeshow goodness-of-fit test was not significant for all three models. Older age was a significant predictor of under perception of body weight (OR = 1.02; 95% CI = 1.01—1.03). However in contrast correct perception was significantly associated with younger age (OR = 0.98; 95%

Table 4

Overweight (%)

Very overweight (%)

0

CI = 0.97—0.99). None of other variables were significantly associated with both under perception and correct perception. However for over perception of body weight, there was a significant association with male gender (OR = 1.85; 95% CI = 1.00—3.40). People from ethnic groups other than Sinhalese also tends to over perceive their body weight (OR = 2.36; 95% CI = 1.25—4.45).

Discussion To our knowledge, this is the first study to measure body weight and WC perception and weight loss practices in a nationally representative sample of Sri Lankan adults. Most South Asian countries, particularly in urban populations, have shown evidence of an epidemic of obesity [3,13,14]. In addition, unlike their Western counterparts, South Asians suffer from obesity-associated metabolic complications at very low BMI levels [15]. Accurate body weight and waist circumference perception, knowledge of BMI and weight loss initiatives are important indicators of population’s concern and attitudes toward obesity and weight control. This study provides valuable details regarding body weight and waist circumference perceptions, and attitudes

Percentage of adults in each category of waist circumference perception, according to WC cut-offs.

WC perception categories Abdominal obesity (n)

Low WC (%)

About right WC (%)

High WC (%)

Male (22) Female (144)

4.5 2.1

31.8 31.9

63.7 66.0

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R. Jayawardena et al. Logistic regression model of under perception, correct perception and over perception of body weight.

Variables

Age (years) Female (Ref.) Male Urban (Ref.) Rural Graduate (Ref.) No. schooling Upto 5 years Upto O/L Upto A/L Sinhala (Ref.) Others

Under perception

Correct perception

Over perception

OR (95%CI)

P value

OR (95%CI)

P value

OR (95%CI)

P value

1.02 1 0.77 1 0.80 1 1.21 2.29 1.95 0.95 1 1.02

(1.01—1.03)

0.003

(0.97—0.99)

0.002

(0.53—1.12)

0.18

(0.71—1.52)

0.85

(1.00—3.40)

0.25

(0.70—1.51)

0.9

(0.91—3.90)

0.086

(0.41—3.60) (0.92—5.68) (0.80—4.73) (0.38—2.36)

0.73 0.075 0.14 0.90

(0.27—2.47) (0.30—1.88) (0.35—2.06) (0.80—5.00)

0.72 0.54 0.72 1.35

(0.27—3.69) (0.09—1.00) (0.12—1.09) (0.06—0.79)

0.99 0.05 0.07 0.02

(0.67—1.56)

0.92

(0.45—1.06)

0.09

1.00 1 1.85 1 1.89 1 1.00 0.31 0.36 0.22 1 2.36

0.98 1 0.048

(0.55—1.17)

0.98 1 1.04 1 1.03 1 0.81 0.75 0.85 2.00 1 0.68

(1.25—4.45)

0.008

(0.98—1.02)

OR: odds ratio.

toward weight loss practices among Sri Lankan adults. The results have practical implications for future weight management approaches. Half of the Sri Lankan adults surveyed were unable to report (correctly or wrongly) their body weight or height, despite Sri Lanka having one of the highest levels of literacy and numeracy among developing countries. More seriously, only less than quarter of adults could predict their body weight correctly although most of subjects were screened for body weight and weight circumference in SLDCS several years back. Lack of concern regarding body weight may put such individuals at risk for further weight gain and associated health consequences [16]. The ability to identify unhealthy weight changes, knowledge of one’s own weight, measuring body weight frequently and keeping records of body weight is recognized as essential in the prevention of unhealthy weight gain [17]. BMI is widely considered an easy tool to identify obesity but less than 20% of Sri Lankan adults surveyed had knowledge of concept of BMI. Presently, details of BMI have been included in the school curriculum and pregnancy records, therefore such initiatives may help to improve the knowledge and understanding of younger generations in this important area. In addition, increased awareness of obesity in the mass media may have an impact on the urban and educated population over time. Findings highlight that weight misperception is highly prevalent among Sri Lankan adults with over 70% of overweight and 41% of obese males and over 50% overweight females and one third of obese females not perceiving themselves as overweight. Among US adults, 40% of overweight and 8% of obese adults considered themselves to be ‘about the right weight’ [18]. Similarly, in 2007 53%

of the British population had a BMI in the overweight or obese range, of whom only 75% reported as being overweight, very overweight, or obese [19]. A related study on a group of adolescent girls in Sri Lanka reported that in those who were overweight, 5.6% perceived themselves as being underweight, and 11.1% as normal-weight. These values are lower than our findings, however, in contrast to the present study these investigators have used WHO cut-offs to categorize overweight [20]. It is reported that Sri Lankan adults get increased risk for CVD starting from BMI of 21 kg/m2 [15]. Thus, it is appropriate to use lower BMI cut-offs for primary prevention of obesity. Although they are subject to metabolic complications [15] and have a high body fat percentage [21] at a low BMI, overweight and obese Sri Lankan adults may not perceive their excess body weight due to several reasons. Sri Lankans’ are a lean population (3.9% ≥30 kg/m2 ) and low obesity perception in the population is reasonable. Historically, overweight people were wealthy and powerful and on the other hand lean people were poor manual workers. Many societies still consider overweight as a sign of wealth and power. Similarly, among a group of South African black women, being moderately overweight was considered to be acceptable, and was associated with dignity, respect, health, wealth and strength [22]. In some societies fat women are considered to be a sign of well-caring by their husbands [16]. Prevalence of diabetes is extremely common in urban, middle aged adults, one in every third adult is having diabetes amongst over 50 years and significant portion is undiagnosed [11]. Therefore, low body weight or weight lose may have a negative social stigma among this society due to weight lose associated with undiagnosed diabetes.

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Body weight perception and weight loss practices among Sri Lankan adults Similarly, in South Africa, weight loss has socially negative stigma due to HIV infection [23]. Two-thirds of centrally obese Sri Lankan adults perceived themselves as having higher WC. Abdominal obesity misperception being lower than body weight misperception indicates that Sri Lanka adults are much aware of their own waist circumference compared to body weight. Changes in waist circumference can be easily identified by clothing; however, body weight has to measure by a weight scale. Sri Lankan males have a higher prevalence of weight misperception than females, most notably with a higher proportion of overweight and obese males incorrectly under assessing their weight category. In general, female are more weight conscious and seek for weight control strategies [24]. Although there is reasonable agreement between BMI estimated from reported weight and height and BMI calculated from measured same variables in this population, there is a limited practical value of self-reported weight and height for clinical practices. Rowland reported that obese people underestimate their weight and overestimate height [25]. BMI calculated from self-reported height and weight had greater association with weight perceptions than did BMI calculated from measured height and weight. Among adolescents self-reporting of height and weight is probably influenced to some degree by body weight perception [6]. This is due to underestimating their weight and overestimating their height compared with measured values. Still when weight perceptions were compared with BMI calculated from self-reported values, significant numbers of adults misperceived their weight status. It is reported that obese individuals with body size misperception have a lower awareness of obesity associated health risk [9]. However a large proportion of adults who are overweight or obese fail to perceive themselves as such and, consequently, are unlikely to seek for weight reduction practices such as dieting and exercise that might help them to lose weight. Surprisingly, among those who tried to lose body weight, less than half seek professional advices. It is evident that weight management requires professional support, preferably from a multi disciplinary team [26]. Limited facilities for nutrition counseling and weight management in Sri Lanka are a hindrance to successfully combat against obesity epidemic. Data on socio-economical association in the body weight perception is limited. In this population, age has opposite odd for under perception and correct perception. Young people perceive correct body weight on the other hand old people under perceive their body weight. This indicates that young generations

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are much more aware of their body weight than older generations in Sri Lanka.

Future perspective It is an urgent public health necessity to initiate health awareness programs to identify healthy body weight, negative health consequences of excess body weight and practical lifestyle strategies for the general public. Causes for weight misperception could be complex, and hence public health interventions should be a multifaceted [9]. There should be encouragement for people to measure their own body weight, WC and maintain BMI records in every hospital or general practitioner visit. Furthermore, identified cases should be referred to necessary health care centers for early treatment. It is reported that patients cite physicians as the most credible source of nutrition information and ahead of nutritionists [27]. In Sri Lanka, most obese adults seek weight reduction advice from doctors. Therefore, medical professional associations and medical schools must initiate training programs to improve the competence of nutritional and lifestyle knowledge and skills of the doctors. The General Medical Council (UK) recognized that all medical graduates should obtain satisfactory knowledge on the role of lifestyle and human nutrition promoting health and prevent disease and human nutrition should be treated as a discrete medical discipline for clinicians to specialize [28]. It is timely to build a professional body for obesity in the country along with international collaborations such as International Association for the Study of Obesity (IASO). More studies should be conducted to obtain a better understanding of erroneous perception of body weight and poor weight loss practices in this population. It is widely reported that distorted weight perception and body image among adolescents is negatively associated with unhealthy eating habits and disordered eating behavior [6,29]. Inability to self perceive body weight among adults, may be an indicator for misjudgment of their children’s body weight. Therefore, future studies are needed to obtain data on weight perception of adolescent and children.

Limitations Data collection was at community settings in the day time, considerable portions of eligible male participants were not present on data collection times mainly due to occupational commitments, on the other hand, females enthusiastically participated in this study. This invariably caused poor male representation and higher female participation in

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xxx.e8 this study. We could not obtain accurate details of their economic status or household income, which could have an association with weight perception. Metabolic parameters were not measured, abnormal body weight and WC could have been associated with adverse metabolic risk. Moreover, details of perception of body shape/image and details of weight lose strategies were not obtained in this study. As this was a cross-sectional study, causality could not be inferred between perceived weight, actual (estimated) BMI, and weight loss practices. Future studies are needed to identify whether correct perception of own body weight has positive impact for weight reduction behavior and healthy weight maintenance in this population.

Conclusion Body weight misperception, was common among underweight, healthy weight, overweight, and obese adults in Sri Lanka. Over 2/3 of overweight and 1/3 of obese Sri Lankan adults believe that they are in the right weight or under-weight category. Minorities were more likely to have an over perception of their body weight, as well as males and people with lower educational levels. As perception of overweight or obesity is an important determinant of life style habits and weight reduction, many overweight and obese Sri Lanka are unlikely to engage in weight control practices. A minor percentage of Sri Lankans was aware of their own body weight and height correctly, knowledge of the BMI concept was also poor. Surprisingly, although some recognized themselves as being overweight they did not obtain any advices from health care providers. Increasing awareness of the medical definition of overweight, obesity and abdominal obesity may improve precision of body weight and obesity, which will lead to healthier lifestyles.

Conflict of interest The authors declare that they have no conflicts of interest

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Please cite this article in press as: Jayawardena R, et al. Body weight perception and weight loss practices among Sri Lankan adults. Obes Res Clin Pract (2013), http://dx.doi.org/10.1016/j.orcp.2013.05.003