Neighborhood socioeconomic disadvantage modifies the relationship between weight status and weight-related satisfaction

Are adults living in disadvantaged communities less likely to recognize or be dissatisfied with being overweight than their counterparts in more affluent areas? Multilevel logistic regression was used to analyze a cross-sectional sample of 10 880 people aged 15 years or older selected from the 2009 wave of the 'Household, Income and Labour Dynamics in Australia'. Outcome variables included whether participants perceived themselves as 'overweight' or not, and their self-reported (dis)satisfaction with their weight. Key covariates included: (i) actual weight status, derived from the World Health Organization (WHO) criteria for 'normal', 'overweight' and 'obese' intervals of body mass index, on the basis of self-reported height and weight; and (ii) the Socio-Economic Index For Areas, an indicator of neighborhood socioeconomic disadvantage defined for Census Collection Districts. Data were analyzed in 2015. In more disadvantaged neighborhoods, self-classification as overweight or obese tended to be higher, but dissatisfaction with current weight appeared to be lower. For people who by WHO criteria are of 'normal' weight, 16.8% (95% CI 15.6, 17.9) felt dissatisfied with their weight and 11.5% (95% CI 10.5, 12.5) classified themselves as overweight or obese. For people classified as overweight or obese by these criteria, the level of dissatisfaction and perceived overweight or obese status were much higher. Overweight and obese participants in affluent areas were more likely to be dissatisfied and consider themselves overweight or obese in comparison with their peers living in disadvantaged areas. Interventions aiming to prevent weight gain and to narrow socioeconomic inequity in overweight must reconcile with the findings that people in disadvantaged communities are less likely to recognize their overweight or be dissatisfied with their weight status.