As Stuart Smalley was fond of saying no matter how badly things were going or how overweight he was, "I'm good enough. I'm smart enough. And doggone it, people like me." Apparently, a fair number of women heard that message, at least based on the results of a recent study out of the University of Texas in Galveston. The research, involving 2,224 women ages 18 to 25, found that a whole lot of overweight women aren't worried about being fat because they don't know they are -- or choose to overlook it, ala Stuart Smalley. According to an article in the December issue of Obstetrics & Gynecology, 25 percent of the overweight subjects rated their weight as normal. The study also found that 70 percent of those who were obese considered themselves merely overweight, as did 40 percent of the subjects who were morbidly obese.
While Mr. Smalley, as an advocate of high self-esteem, might celebrate these results, public health workers express concern. "Overweight women who were misperceivers are less likely to have healthy weight-loss behaviors," says researcher Dr. Mahbubur Rahman. And the study director, Dr. Abby Berenson, adds, "These patients are at risk for cardiovascular disease, type 2 diabetes and other serious problems."
To obtain results, the researchers asked subjects how they would describe their body weight. Respondents could choose either "very underweight, slightly underweight, about the right weight, slightly overweight, and very overweight." In addition to the overweight subjects who thought they were normal, some of the normal weight subjects also were deluded about their body size. In fact, sixteen percent of the normal-weight subjects rated themselves fat, and that also worried the researchers. That's because the normal-weight women who believed they were fat were far more likely to engage in unhealthy weight-loss activities such as inducing vomiting, taking diet pills, going on fad diets, skipping meals, and even smoking.
Of greater concern, though, are those women who don't have a clue that they've tipped the scales, mostly because there are so many of them. Currently, about 58 percent of Caucasian women are overweight or obese, as are an astounding 82 percent of African-American women and 75 percent of Mexican-American women. Compared to the Caucasian women, a significantly higher proportion of the African-American women in the study -- 30 percent more -- believed their weight was just fine, as did 25 percent more of the Hispanic subjects.
What's causing the widespread delusion? Many experts believe that as we collectively put on pounds, we change our perception of what fat bodies look like. "It might very well be if you look around and you're not fatter than anyone you hang out with, then you don't perceive yourself as being overweight," says Dr. Cheryl Rock, a professor at the University of California San Diego School of Medicine, "You look like everyone else."
Dr. Berenson agrees. "People compare themselves to those closest to them," she says. She also theorizes that the greater preponderance of minority women who don't know they're overweight may be due to media influences. "It's more acceptable in the media to be overweight if you're African American, for example," she says.
The delusional factor isn't limited to women, though. In fact, men are worse, according to a study published in Epidemiology in 2009. That study found that a full half of the overweight men thought that they were either normal or even underweight, compared to only 22 percent of the overweight women (and that's still plenty). Of the obese men, 12 percent actually thought they either were underweight or normal. Add to that the fact that far more men over the age of 20 are fat, compared to women (74.4 percent of Caucasian men compared to 57.5 percent of Caucasian women), and there's truly something to worry about.
But as worrisome as these trends might be, they take a back seat compared to a problem I wrote about a few years ago -- parents denying that their overweight kids are, in fact, overweight. The study I referred to at that time surveyed 2000 parents of kids aged six to 11, and found that 43 percent of those with grossly overweight offspring claimed that their children were "about the right weight," while seven percent went as far as to indicate that their kids were " slightly underweight. And that study wasn't looking at kids carrying a few extra pounds -- these were morbidly obese youngsters at risk of developing serious adult diseases because of their weight.
Given that the study found that overweight women who had gone to college and who used the Internet had more accurate self-perception, it would seem enhanced health education might help us to collectively "get real" about weight. The study authors think it would help, too, if doctors consistently talked to patients about weight. Too many don't bother because they're too rushed, the experts contend. Plus, as Dr. Berenson points out, "Many physicians worry about offending their patients," and so they say nothing about the expanding waistline.
Certainly recognizing the problem is an essential step in solving it. But as we collectively fatten up -- and we're continuing to do so -- it becomes increasingly difficult to remember what normal is supposed to look like. After all, when everybody is fat, fat does become the norm. It's sort of like that old Twilight Zone episode, "Eye of the Beholder," where the main character undergoes an operation to make her look normal…like everyone else. The skillful camera work keeps her face obscured until the very end, when the surgery fails and viewers discover that the woman actually is very beautiful and everyone else is utterly hideous. At the rate we're going, in another 50 years those who remain trim may have reverse liposuction surgeries to add weight on, begging their doctors to make them look "normal."