Differential Association Between Actual and Perceived Obesity Between African Americans and Whites in the United States

Although actual and perceived obesity are associated, some research has shown that this association may differ across racial and ethnic groups. Accordingly, this cross-sectional study tested racial differences regarding the association between actual and perceived obesity among American adults. The Health Information National Trends Survey (HINTS 5- Cycle 3) is a representative survey of American adults conducted in 2019. A total number of 3731 adults entered our analysis, including 3054 (81.9%) non-Hispanic Whites and 677 (18.1%) African Americans (AAs). The independent variable was actual obesity, which was defined as a body mass index of 30 or greater. The outcome was perceived as obesity. In addition, age, gender, marital status, education, and income were considered as control variables (confounders), and the race was the focal effect modifier. Finally, logistic regressions without and with interaction terms were utilized to analyze the data. Overall, actual and perceived obesity were associated, with obese individuals having higher odds of seeing themselves as obese (odds ratio [OR] = 25.82, 95% CI = 18.58-35.89, P < 0.001). Furthermore, race showed a statistical interaction with actual on perceived obesity (OR = 0.27, 95% CI = 0.14-0.55, P < 0.001), indicating a weaker link between the two for AAs compared to non-Hispanic Whites. Race-stratified models also confirmed the same pattern with the actual and perceived obesity, showing a weaker association for AAs (OR = 15.61, 95% CI = 9.53-25.59, P < 0.001) in comparison with non-Hispanic Whites (OR = 46.23, 95% CI = 27.01-709.14, P < 0.001). AAs compared to non-Hispanic Whites differed in the effect of their actual obesity on their perceived obesity. This may explain the looser association of obesity and depression in AAs as compared to Whites.