Where we live, who we are, or what we think? Epidemiological studies on the interplay between neighbourhood socioeconomic circumstances, gender, and actual and perceived weight status

Abstract

Inequities in body mass index may be driven by where people live, their personal characteristics and perceptions. Multilevel analyses of multiple waves of the Household Income and Labour Market Dynamics in Australia (HILDA) panel survey; a source of data that included self-reported height and weight, weight-related perceptions, a range of socioeconomic indicators and linked to area-level disadvantage. Higher mean BMI was observed among men and (especially) women living in disadvantaged areas after control for confounding. This inequity was present at age 18 to 25 and widened well into middle-age. Behavioural risk factors did not explain the patterning of BMI by area-level disadvantage. People in more affluent areas who were overweight or obese were more likely to have accurate perceived weight status and more likely to be dissatisfied with their weight compared to their peers in disadvantaged areas. Those who were overweight but relatively lighter than the area mean BMI tended to have lower odds of feeling dissatisfied with or perceiving themselves as overweight. No mean weight gain or reduction over a 5-year period was observed among overweight participants who perceived themselves as overweight or expressed dissatisfaction with their weight. These stable weight trajectories were not modified by socioeconomic disadvantage. However, men and women who over-perceived their WHO-classified ‘normal’ BMI experienced a mean increase in BMI across 5-years, especially those in socioeconomically disadvantaged areas. Men and women in disadvantaged areas tend to have higher BMI. If overweight, they appear less likely to perceive they are overweight or express dissatisfaction with their BMI. Early intervention is crucial to prevent widening socioeconomic inequities in adulthood. Correcting under-perceived overweight may not lead to weight loss. Correcting over-perceived BMI to prevent future weight gain may be important, especially among people living in disadvantaged areas.