Maternal perceptions of weight and obesity in an urban population

Pre-pregnancy obesity and gestational weight gain are linked to adverse neonatal and obstetric outcomes. As pre-pregnancy weight is a significant modifier of weight gain in pregnancy, we sought to determine whether prenatal patients at 2 Bronx health clinics accurately perceived their overweight status. Data are from participants in 2 randomized, controlled trials of prenatal-care based breastfeeding promotion interventions. 941 women with 12-26 week, singleton pregnancies, were enrolled from 2008-2010. In face-to-face enrollment interviews, subjects reported if they had any of a list of health conditions, including overweight/obesity. Those with pre-pregnancy self-reported weight and height available were included. The WHO Body Mass Index (BMI) was used to assign overweight or obese status. Chi-squared analysis was done to compare perceived overweight/obesity status to calculated BMI, and demographics of overweight/obese women (BMI >25) grouped by perception of weight status. 734 participants met inclusion criteria; 64% (n=473) were obese (BMI>30); 20% (n= 96) identified as such. Of the 19% (n=143) of women who were overweight (BMI 25-30), 2.1% (n=3) reported they were overweight. 16% (n=118) of women were normal or underweight; none misperceived their weight. US-born women were more likely to correctly assess weight status; other demographics did not differ between women with a BMI >25 based on perception of weight (Table). Diabetic women were more likely to accurately assess their overweight/obese status (31% v. 15%; p=0.0015).TableDemographic characteristics of overweight/obese women who accurately perceive their overweight/obese status versus those who do not.Demographic CharacteristicOverweight/Obese Accurately Perceived (n=99)Overweight/Obese Not Perceived (n=517)P-valueUtilization of WIC52 (53%)268 (52%)0.8241Born in US81 (84%)324 (63%)<0.0001Currently Employed56 (57%)271 (43%)0.4829RaceBlack25 (25%)94 (18%)0.4232White27 (27%)156 (31%)Hispanic45 (45%)242 (48%)Other2 (2%)17 (3%)High school graduate83 (84%)410 (80%)0.3329 Open table in a new tab In a large, urban prenatal population, 84% of women were overweight/obese, yet only 16% perceived themselves to be so. This weight-perception disparity is more pronounced in foreign-born women. As expected, diabetic women, likely educated about obesity, more accurately assessed their overweight/obesity status. Accurate perception of weight status is the basis for lifestyle change. To improve both maternal and fetal health outcomes among overweight women, practitioners must understand a patient's perception of her own weight.