|Year : 2015 | Volume
| Issue : 1 | Page : 96-100
Accuracy of body weight perceptions among students in a medical school in Central Delhi, India
Tanu Anand1, Shekhar Grover1, Sneh Tanwar2, Rajesh Kumar3, GS Meena4, GK Ingle5
1 Senior Resident, Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
2 Intern, Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
3 Associate Professor, Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
4 Director Professor, Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
5 Director Professor and Head, Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
|Date of Web Publication||31-Jul-2015|
H-1/7, Malviya Nagar, New Delhi - 110 017
Source of Support: None, Conflict of Interest: None
Background: Body image is an important aspect of the complex creation of one's self-identity. The relationship between nutritional disorders, like obesity, and one's perception of her or his body is well documented. Obesity among medical students and health personnel is on the rise. Identifying and measuring the magnitude of distortion in body image self-perception among medical students is particularly relevant, as they are future healthcare providers. This paper assesses self-perceptions of body mass index (BMI) and physical activity among medical undergraduate students in an Indian medical school. Methods: A cross-sectional study was conducted among 161 sixth semester medical undergraduate students in a school in Delhi, India. A pretested questionnaire was used. Anthropometric measurements were taken. The participation rate was 93.6%. Results: Out of the total 161 students, there were 60.9% males and 39.1% females. Most participants were classified as normal (55.9%) according to BMI. The proportions of actual obese, overweight and underweight students were 4.4%, 30.4% and 9.3%, respectively. However, the proportion of students perceiving themselves as obese or overweight was only 37.3%. A significantly higher proportion of females (57.2%) than males (20.4%) perceived themselves as overweight (P < 0.001). The agreement between actual BMI and perceived weight was poor (kappa statistic: 0.33). Among actual overweight and obese students, only one-third were physically active. Conclusions: Students who were overweight or obese often failed to perceive themselves as such and, perhaps consequently, were not engaging in weight control practices. There is a need to develop health promotion interventions that help build healthy body habitus perceptions among this group of Indian medical students.
Keywords: Medical students, obesity, overweight, weight control behavior
|How to cite this article:|
Anand T, Grover S, Tanwar S, Kumar R, Meena G S, Ingle G K. Accuracy of body weight perceptions among students in a medical school in Central Delhi, India. Educ Health 2015;28:96-100
|How to cite this URL:|
Anand T, Grover S, Tanwar S, Kumar R, Meena G S, Ingle G K. Accuracy of body weight perceptions among students in a medical school in Central Delhi, India. Educ Health [serial online] 2015 [cited 2021 Oct 21];28:96-100. Available from: https://www.educationforhealth.net/text.asp?2015/28/1/96/161948
| Background|| |
Obesity is a global phenomenon affecting all socio-economic groups, including all ages, sexes and ethnicities.  It is evolving into a major nutritional problem in developing countries like India as well, in both adults and the young. According to National Family Health Survey-3 (NFHS-3), 10% of India's population was either overweight or obese in 2006.  Studies of urban Indian school children from selected regions also report a high prevalence of obese and overweight children. ,, This epidemic of obesity has been attributed to sedentary lifestyle and consumption of fatty and carbohydrate rich food and beverages.
Another public health concern related to eating and weight is the high prevalence of dissatisfaction with one's body, unhealthy weight control behaviors, and other disordered eating patterns among adolescents and youth, particularly college students.  Further, evidence suggests that false conceptions and a pre-occupation about one's body leads to various unhealthy dietary practices.  Body weight perception refers to the self-evaluation of one's weight as "underweight," "normal weight" or "overweight" irrespective of its formal classification by body mass index (BMI).  It is one of the motivating factors in weight control behaviors.  People who are underweight or normal weight but perceive themselves as overweight are at higher risk for eating disorders, such as anorexia nervosa.  In contrast, people who are overweight but do not perceive themselves as such are less likely to engage in weight control practices such as diet or exercise. 
The present study was undertaken to assess the relationship between perceived and actual BMI among undergraduate medical students in Delhi, India. Medical undergraduates are a particularly important population in which to study obesity issues, because obesity for them is becoming common  and medical schools' time-demanding curricula promotes a sedentary lifestyle for students and greater chance of becoming overweight or obese.  It is also important to assess the magnitude of body image misperceptions and exercise among medical students, as these can influence their future patient care.  The relationship between physical activity and medical students' actual and perceived BMI were also explored. Little is known about the relationship between weight, weight perceptions and exercise among medical students in India.
| Methods|| |
Study setting and study participants
This was a cross-sectional study conducted among the undergraduate medical students of a medical college in central Delhi. Every year, 180 students are admitted to the medical college. The entire MBBS course is divided into nine semesters. This study was undertaken with all undergraduate students of the sixth semester who agreed to participate. Approval from institutional ethics committee was received.
Sampling and sample size
Taking correct perception of weight to be 50% among the adolescents,  the sample size was calculated to be 100 to yield a precision of 10% with 95% confidence intervals. Out of the 172 sixth semester students, 161 returned completed forms and were included in analysis, for a 93.6% participation rate.
We developed a semi-structured questionnaire that addressed (i) participant age and gender, (ii) students' perceived BMI and (iii) their participation in weight control behaviors such as any physical activity. The questions on perception of body weight were adapted from validated Youth Risk Behavior Surveillance National Survey 2011 of US Centers for Disease Control and Prevention.  The questions on type of physical activity were adapted from World Health Organization (WHO) STEPS questionnaire.  The questionnaire was pretested with 20 students of a different semester and suitably modified. Internal consistencies of the items on perception of body weight were obtained through a Cronbach's alpha coefficient (0.74). Students' height and weight were measured using validated methods. 
The study subjects were contacted and the purpose of the study was explained to them and confidentiality promised. After taking informed consent of the subjects, the questionnaire was handed to the study subjects and they were asked to complete and return it within three days. Non-respondents were re-contacted twice. Students who returned forms with missing information were asked to complete the questionnaire. 
BMI was calculated as kg/m 2 after metric conversion of measured height and weight. The students were classified as overweight if their BMI was ≥23.0 kg/m 2 but less than 27.4 kg/m 2 and underweight when BMI was <18.5 kg/m 2 . Obesity was defined as BMI ≥27.5 kg/m 2 . , These cut-offs are appropriate for Asian populations, for whom evidence suggests there are different thresholds between BMI, percentage of body fat and health risks than for European populations. 
Consistent with WHO guidelines, recommended moderate physical activity was defined as physical activity for at least 60 min/day on at least five days per week. Recommended vigorous physical activity was that done for at least 20 min/day on at least three days per week. ,
Data were analyzed using the Statistical Package for the Social Sciences (Windows version 16.0; SPSS Inc, Chicago [IL], USA). Descriptive statistics including means, standard deviations and ranges were used to characterize the study population. Differences between the means of two groups were assessed using the independent t-test. Differences in proportions were analyzed using the Chi-square test where appropriate. Kappa statistics were used to measure the strength of agreement between categorical variables. For all inferential tests, a P value of ≤ 0.05 was considered statistically significant.
| Results|| |
Of the 161 study subjects, there were more males (n = 98; 60.9%) than females (n = 63; 39.1%). The mean age of the study group was 21.1 ± 0.8 years (range = 20-24 years). The mean weight, height and BMI of males were significantly greater than females (weight: 66.3 ± 9.7 kg vs. 54.1 ± 10.7 kg, respectively; P < 0.001; height = 171.2 ± 6.7 cm vs. 160.5 ± 6.6 cm; P < 0.001; BMI = 22.6 ± 2.9 vs. 21.3 ± 3.0; P = 0.008).
According to calculated BMI, 9.3% students were classified as underweight while 30.4% () and 4.4% were overweight and obese, respectively. There were 90 (55.9%) participants who had normal BMI. There was no gender difference in prevalence of overweight and obesity (Chi-square = 1.1; P = 0.3) among the medical students.
When asked about perception of BMI, most students considered themselves to be normal weight (50.3%) [Table 1]. Only 12.4% students perceived themselves to be underweight, while there were 34.8% and 2.5% participants who perceived themselves as overweight and obese, respectively. Gender wise analysis showed that significantly higher proportion of females perceived themselves as overweight than males (P < 0.001).
|Table 1: Self-perceptions of body proportions among the study participants (n=161)|
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There were 66.7% of the students who were actually underweight by BMI and perceived themselves to be of normal weight, while more han half (57.1%) of the students who were actually obese students considered themselves to be underweight. The strength of agreement between perceived BMI and actual BMI was poor (kappa statistic = 0.3) [Table 2]. While the strength of agreement between perceived and actual BMI was fairly good among the males (kappa statistic = 0.5), it was poor among females (kappa statistic = 0.1) [Table 3].
|Table 2: Agreement between perceived and actual BMI among the study participants (n=161)|
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|Table 3: Agreement between perceived weight and actual BMI among male and female participants|
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The recommended levels of physical activity among the actual and perceived overweight male participants were similar [Table 4]. In contrast, females who reported themselves to be involved in the target level of physical activity were more likely to be overweight than those who just perceived to be overweight, though the difference was not significant.
|Table 4: Physical activity levels among overweight (actual) and (perceived) participants|
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| Discussion|| |
In the past two decades, obesity has emerged as a growing concern even in developing countries like India. The present study finds a high prevalence of overweight and obesity among undergraduate medical students. Gopalakrishnan et al., found among Malaysian medical students a similar prevalence of overweight and obesity, specifically 30.7% and 5.2%, respectively.  In contrast, Gupta et al.  in 2009 from West Bengal and Chabbra et al.  in 2006 from Delhi found lower rates of obesity among their medical students. These studies point to a need to encourage medical students to practice healthy lifestyle to lower their risk of developing obesity-related health problems. There is also evidence that physicians' health behaviors affect their interactions with patients.  Encouraging healthy lifestyles among medical students could create both healthier and more effective physicians. 
More male than female students in this medical school were found to be overweight and obese, consistent with a recent similar population in Malaysia.  Interestingly, within the general population in India there is a higher prevalence of obesity among women than men due to various genetic and cultural reasons.  But higher academic year or status of education has been linked with higher prevalence of obesity and overweight among male medical students.  More studies are needed to better understand this reverse gender-obesity relationship within Indian medical students.
Our findings are similar to those in other parts of the world, in that body weight perceptions tend to be inaccurate when comparedcalculated BMI based on measured height and weight , as evident in the present study where in more male overweight and obese students in the perceived them to be of normal weight. This has an important implication as the overweight participants are unlikely to engage in weight control practices such as exercise. Especially, the agreement between actual (measured) BMI and perceived weight was poor in females and fair in males. More females than males considered themselves to be overweight while more males considered them to be of normal weight. The result is consistent with a study done by Stigler et al., in 2011 among high school adolescents in Delhi.  Further, evidence suggests concerns about excess weight are more common among females than males, globally. , Understanding the reasons for these gender differences is pertinent to facilitate students in making appropriate decisions about adopting weight control strategies.
There was no difference observed in level of physical activity according to actual or perceived body weight among the study participants. The finding is in contrast to Cheung et al. who showed that weight control behaviors are guided by perceived body weight rather than actual body weight.  This unexpected finding requires further study.
This study has limitations. Because of its cross-sectional nature, causality could not be inferred between perceived BMI, actual BMI and physical activity. The study was further limited by the use of a single question to measure how respondents perceived their weight. Specifically, this question did not provide information about what reference point respondents were using when reporting whether they were underweight, overweight or about the right weight.  Another study limitation was that we did not assess students' other weight control behaviors, such as dieting, purging, taking pills.
Despite study limitations, we conclude that body weight perceptions among medical students in our setting often did not agree with students' actual weight. This discrepancy was greater among female students. There is a worldwide need to develop interventions to prevent obesity without causing excessive pre-occupation with weight.  Maintaining a healthy weight should be part of a medical curriculum that stresses health promotion and a healthy lifestyle.  Encouraging healthy lifestyles among medical students could help create healthy physicians who, in turn, are more likely to instill healthy behaviors within their patients.
| Acknowledgment|| |
The authors would like to thank Indian Council of Medical Research (ICMR) for providing the financial assistance for the study.
| References|| |
Raj M, Kumar RK. Obesity in children and adolescents. Indian J Med Res 2010;132:598-607.
Gothankar JS. Prevalence of obesity and its associated co-morbidities amongst adults. Natl J Community Med 2011;2:221-4.
Chhatwal J, Verma M, Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr 2004;13:231-5.
Marwaha RK, Tandon N, Singh Y, Aggarwal R, Grewal K, Mani K. A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr 2006;43:943-52.
Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatr 2002;39:449-52.
Neumark-Sztainer D, Story M, Hannan PJ, Perry CL, Irving LM. Weight-related concerns and behaviors among overweight and nonoverweight adolescents: Implications for preventing weight-related disorders. Arch Pediatr Adolesc Med 2002;156:171-8.
Augustine LF, Poojara RH. Prevalence of obesity, weight perceptions and weight control practices among urban college going girls. Indian J Community Med 2003;28:187-90.
Cheung PC, Ip PL, Lam ST, Bibby H. A study on body weight perception and weight control behaviours among adolescents in Hong Kong. Hong Kong Med J 2007;13:16-21.
Cash TF, Pruzinsky T. Body Image: Development, Deviance, and Change. New York: Guilford Press; 1990. p. 20-4.
Desmond SM, Price JH, Gray N, O′Connell JK. The etiology of adolescents′ perceptions of their weight. J Youth Adolesc 1986;15:461-74.
Strauss RS. Self-reported weight status and dieting in a cross-sectional sample of young adolescents: National Health and Nutrition Examination Survey III. Arch Pediatr Adolesc Med 1999;153:741-7.
Selvaraj K, Sivaprakasam S. A study on the prevalence of overweight and obesity among medical students of Kanchipuram district. Natl J Res Community Med 2013;2:140-4.
Aggarwal N, Anand T, Kishore J, Ingle GK. Low back pain and associated risk factors among undergraduate students of a medical college in Delhi. Educ Health (Abingdon) 2013;26:103-8.
Anand T, Tanwar S, Kumar R, Meena GS, Ingle GK. Knowledge, attitude, and level of physical activity among medical undergraduate students in Delhi. Indian J Med Sci 2011;65:133-42.
World Health Organization. WHO Recommendations: Obesity: Preventing and Managing the Global Epidemic (Technical Report Series No. 894). Geneva: World Health Organization; 2000.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
World Health Organization. Global Recommendations on Physical Activity for Health. Geneva: World Health Organization; 2010.
Gopalakrishnan S, Ganeshkumar P, Prakash MV, Christopher, Amalraj V. Prevalence of overweight/obesity among the medical students, Malaysia. Med J Malaysia 2012;67:442-4.
Gupta S, Ray TG, Saha I. Overweight, obesity and influence of stress on body weight among undergraduate medical students. Indian J Community Med 2009;34:255-7.
Chhabra P, Grover VL, Aggarwal K, Kanan AT. Nutritional status and blood pressure of medical students in Delhi. Indian J Community Med 2006;31:248-51.
Frank E, Segura C, Shen H, Oberg E. Predictors of Canadian physicians′ prevention counseling practices. Can J Public Health 2010;101:390-5.
Kalra S, Unnikrishnan AG. Obesity in India: The weight of the nation. J Med Nutr Nutraceuticals 2012;1:37-41.
Ekpanyaskul C, Sithisarankul P, Wattanasirichaigoon S. Overweight/Obesity and related factors among Thai medical students. Asia Pac J Public Health 2013;25:170-80.
Kaplan SL, Busner J, Pollack S. Perceived weight, actual weight, and depressive symptoms in a general adolescent sample. Int J Eat Disord 1988;1:107-13.
Stigler MH, Arora M, Dhavan P, Shrivastav R, Reddy KS, Perry CL. Weight-related concerns and weight-control behaviors among overweight adolescents in Delhi, India: A cross-sectional study. Int J Behav Nutr Phys Act 2011;8:9.
Wardle J, Haase AM, Steptoe A. Body image and weight control in young adults: International comparisons in university students from 22 countries. Int J Obes (Lond) 2006;30:644-51.
Brener ND, Eaton DK, Lowry R, McManus T. The association between weight perception and BMI among high school students. Obes Res 2004;12:1866-74.
Neumark-Sztainer D, Hannan PJ. Weight-related behaviors among adolescent girls and boys: Results from a national survey. Arch Pediatr Adolesc Med 2000;154:569-77.
[Table 1], [Table 2], [Table 3], [Table 4]