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Analysis of Cardiometabolic Outcomes Associated with Self-Perceived Obesity in Korean Adults

A growing body of evidence is suggesting that self-perception of overweight/obese status is associated with poor cardiometabolic outcomes, above and beyond actual body weight. This study, conducted in Korea, used survey data from 21,629 people to determine whether there was a correlation between self-perceived obesity and metabolic syndrome (MetS) and cardiometabolic risk factors (CMRs).

In South Korea there has been a worsening of metabolic health indicators over the past decade, with obesity increasing as well as the prevalence of MetS and CMRs. This study found that individuals who identified their weight status as being slightly/very obese (vs. normal weight), were 18-54% more likely to meet MetS criteria. This was greater in men compared with women.

The findings were also in line with previous evidence showing a protective association of perception of normal weight with weight change and depressive symptoms among adolescents and young adults with overweight and obesity.

Recent studies have focussed on emotional responses related with perception of size when trying to understand the link between weight perception, cardiometabolic and emotional responses. They suggest that due to negative societal values towards obesity, self-evaluation of being obese could be associated with weight bias internalization, low self esteem and body dissatisfaction. Weight stigma is prevalent across diverse social groups and weight discrimination can induce sustained psychological distress and maladaptive coping behaviours, which can lead to biological alterations, such as prolonged activation of the hypothalamic-pituitary-adrenal axis and cortisol secretion.

Although this data can not infer any reverse causality between weight perception and metabolic outcomes, it does add to the growing body of evidence that these two are related and it is also the first to demonstrate this in a solely Asian study population. Their findings raise concerns regarding awareness orientated weight management approaches, such as BMI cards, as these may have the unintended consequence of “accurate” perception among individuals with obesity, leading to side-effects on the psychological and metabolic health of the patient. The implication of these findings on clinical practice, could be that clinicians should now take information on patients weight perception, when assessing risk of cardiometabolic dysregulation. Furthermore at policy level, intervention strategies could place the emphasis on lifestyle adjustments, such as healthy eating and increased physical activity, rather than just on the weight aspect.

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