Testing Contributions of Self-Perceived Obesity to Long-Term Health in Metabolically Healthy Obesity


Cheon, Bobby; Bittner, Julia; Meegan, Smith; & Chen, Zhen (2023). Testing Contributions of Self-Perceived Obesity to Long-Term Health in Metabolically Healthy Obesity.


Background: Self-perception of overweight/obese status (SPO) has been associated with weight gain and worsening physical health, potentially via internalization of weight stigma. Among those with overweight/obesity (OV/OB), it remains unclear whether SPO contributes to these outcomes independent of physiological dysregulation produced by excess adiposity itself. Here, we targeted the metabolically healthy overweight/obese phenotype for disentangling the contributions of SPO relative to excess adiposity to long term weight gain and declining cardiometabolic health.
Methods: Metabolically healthy participants from the Add Health Study were classified into categories of those with normal weight (NW), OV, and OB at Wave IV (ages 24–33). We tested whether SPO at Wave IV mediated the relationship between weight category and outcomes of BMI (n = 901) and progression to metabolic syndrome (MetS, n = 788) 7–11 years later at Wave V (ages 33–44) in separate mediation models.
Results: Compared to having NW, both OV and OB were associated with higher SPO in both models (BMI model: OV β = 0.84 [95% CI: 0.73, 0.96], OB β = 1.41 [1.28, 1.55]; MetS model: OV β = 0.82 [0.70, 0.93], OB β = 1.38 [1.24, 1.53]). OB was directly associated with lower BMI (β = −0.23 [−0.41, −0.05]) and both OV and OB were directly associated with progression to MetS (OV odds ratio (OR) = 3.85 [1.86, 7.94]; OB OR = 9.12 [5.01, 16.63]). However, there was no indirect effect via SPO for either of the two mediation models (BMI model: OV β = 0.07 [−0.25, 0.39], OB β = 0.12 [−0.31, 0.55]; MetS model: OV OR = 0.96 [0.21, 4.32], OB OR = 0.94 [0.24, 3.67]).
Conclusions: Although there were higher odds of developing MetS among the group with OV/OB relative to the group with NW among metabolically healthy adults, this decline in health may not be independently attributable to SPO. The subjective experience of having excess adiposity (internalization of having OV/OB) may not increase risk of MetS among healthy individuals with OV/OB beyond long-term physiological dysregulation generated by this excess adiposity.





Reference Type

Conference paper

Book Title

The Obesity Society's 41st Annual Scientific Meeting


Cheon, Bobby
Bittner, Julia
Meegan, Smith
Chen, Zhen

Year Published


City of Publication

Dallas, TX



Reference ID