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Blind for kilos - when we normalize being overweight

Being overweight or even obese has become a global health issue, one which is spreading rapidly, affecting large parts of the population in many places around the world. Along with this development, it is becoming  increasingly difficult for people to recognize excess weight and give it the necessary attention.

By now, every third person is overweight. According to the World Health Organization (WHO), about two billion adults and almost 400 million children and adolescents were affected by overweight (BMI> 25 kg / m²) and obesity (BMI> 30 kg / m²) in 2016. Thus, the number of overweight people has almost tripled since 1975. Following this trend, weight-associated diseases such as Type 2 diabetes mellitus and diseases of the cardiovascular system frequently occur.

For this reason, researchers are already warning of a global epidemic of adiposity. In addition, scientific evidence suggests that people progressively lose the ability to recognize being overweight or obese.

Studies from the UK and the US show that a significant proportion of overweight individuals are subject to this misjudgment. Thus, about 50% of overweight men and about 30% of women incorrectly rate their weight as normal. A similarly impaired self-perception is evident in obese people. In addition to a small proportion of obese people that still sees themselves as being of normal weight, there are indications that the majority do not adequately assess the severity of their condition.

Researchers of the University College London evaluated surveys conducted in the UK in 2007 and 2012 and found that only about 10% of respondents identified as obese or very overweight, despite their self-reported body weight and height corresponding to a BMI of > 30 kg / m2. Not only self-perception but also external perception seems to be changing. There is evidence that, for example, parents often misjudge the nutritional state of their children. A meta-analysis published in 2014 evaluated data from 69 studies and found that more than 50% of parents underestimate the nutritional state of their overweight or obese children.

The correct assessment of strangers is difficult for us. Various studies with images of strangers showed that participants systematically underestimated the weight of the people shown; in many cases, they do not recognize that the people in the pictures are overweight or obese.

This misjudgment is not only subject to lay people, but also medical professionals. Several studies have found that primary care physicians visually misjudge a significant portion of their patients. A nationwide study conducted in Germany in 2004, which enrolled 1912 physicians and more than 45,000 patients, showed that physicians correctly identified only about 20-30% of overweight and 50-65% of obese patients. Researchers in Australia came to similar conclusions in Great Britain and Israel. As a result, it is believed that weight issues are rarely addressed or adequately treated.

An adaptation of visual body norms is believed to be one of the main causes of this development. In many ways, society is a point of reference and defines what is acceptable. With the growing number of overweight people, excess weight has become common in many places in recent years. The more often and more overweight a society is as a whole, the less likely it is for individuals to recognize it as a deviation from the norm. This assumption could already be supported by various works. It could be shown that the visual perception differs between countries and regions. In areas of high prevalence of obesity, people tend to visually underestimate body weight. Similarly, the immediate environment determines which body shape is considered "normal". Other factors influencing perception include gender, ethnicity, socioeconomic status, and education.

Women underestimate their weight significantly less often than men. The main reason is the omnipresence of slender female bodies in the media and the dominating ideal of beauty. The influence of ethnicity has been examined in US studies, which revealed that African-Americans and especially Hispanics are more likely to perceive overweight bodies as normal. The explanation is again for a higher incidence of obesity in these population groups. However, among the factors that reduce the likelihood of misjudgment are high levels of education and socioeconomic status, as these are often associated with increased health awareness and a healthier lifestyle.

In the context of growing risks that accompany overweight and obesity, education and diagnosis play a key role. Only those who recognize overweight in themselves or others and recognize it as a pathological deviation, are generally willing to take measures into their own hands to lose their excess weight. For this reason, regular weight checks are crucial. These should be done not only in the home environment, but also with every doctor visit. Doctors should not rely on their perception, but should routinely weigh all patients with suitable scales. By doing this, changes in weight can be detected and action taken earlier.

Health risks are not only caused by externally visible fat deposits. Similarly, an increase in visceral adipose tissue has been identified as a distinct risk factor for a variety of diseases. However, visceral obesity can also occur in lean people of normal weight. Therefore, it cannot be diagnosed by weighing alone. A non-invasive and reliable method for measuring visceral adipose tissue is the analysis of body composition using seca mBCA (TOFI - lean on the outside, fat on the inside).

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