In a study conducted among people with diabetes, McTigue et al. (1) reported that although most overweight people with diabetes accurately perceived their weight as higher than ideal for health, many overestimated the weight that would be the healthiest for them. This result suggests that people with diabetes (and health care professionals and diabetes educators who should persuade them otherwise) see their weight as something of low importance. This could be the beginning of a trend toward reducing the importance of losing weight among health care providers. In 2004 and 2005 in Baja California, Mexico, we conducted a survey among 205 elementary school teachers, 80 parents, and 138 physicians working in Tijuana and Ensenada. The purpose of the survey was to compare their actual BMI with how they consider their weight status. We assessed how well they could estimate the healthy body size of an adult by asking them to pick the healthiest body size from the Stunkard (2) pictograms, modified by Rand and Wright for 35- to 45-year-old adults and 6- to 10-year-old boys and girls (3). The numbers of the scale are categorized into five groups (4): images 1 and 2 = underweight, images 3 and 4 = correct weight, images 5 = slightly overweight, images 6 and 7 = moderately overweight, and images 8 and 9 = very overweight.

A trained research assistant measured teachers’ and parents’ height and weight, and the physician estimated their own. Participants were asked how they consider their weight status with three possible answers: thin, in normal weight range, and overweight or obese. BMI measures were categorized by standard clinical definitions (4). The results showed that 67% of teachers and parents and 74% of physicians were either overweight or obese, 69% of teachers and parents and 73% of physicians in the normal weight range accurately perceived their weight status, and 87% of teachers and parents and 76% of physicians with overweight or obesity perceived themselves as overweight. A total of 22, 47, and 43% of the physicians picked as the healthy body size for an adult, boy, and girl, respectively, the equivalent of the slightly overweight figure. Thus, as in the study of McTigue et al. (1), most Mexican teachers and physicians living in the Mexico-U.S. border adequately identified their weight status and figure size, but many also overestimated the size that would be healthiest. In addition, many overestimated the weight that would be the healthiest for adults, boys, and girls. This suggests that Mexican teachers’, parents’, and physicians’ overestimation of the healthiest size might inadequately influence the identification of healthy size, overweight, and obesity. Hence, in a society with a high prevalence of diabesity (5), of which even health care professionals are affected, this could prevent early diagnosis and effective preventive actions toward reducing the incidence of diabesity. Additionally, since Mexican health care personnel are mostly overweight, the Mexican population with diabetes might be more hesitant to take action to improve their lifestyles.

McTigue K, Hess R, Bryce CL, Fitzgerald K, Olshansky E, Sacco D, Fischer G: Perception of “healthy” body weight by patients with diabetes.
Diabetes Care
Stunkard AJ, Sorensen T, Schulsinger F: Use of a Danish adoption register for the study of obesity and thinness. In
The Genetics of Neurological and Psychiatric Disorders
. Kety SS, Rowland LP, Sidman RL, Matthysse SW, Eds. New York, Raven Press, 1983, p. 115–120
Rand SW, Wright BA: Continuity and change in the evaluation of ideal and acceptable body sizes across a wide age span.
Int J Eat Disord
Bhuiyan AR, Gustat J, Srinivasan SR, Berenson GS: Differences in body shape representations among young adults from a biracial (black-white), semirural community.
Am J Epidemiol
National Heart, Lung, and Blood Institute:
NHLBI Obesity Education Initiative: Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report
. Bethesda, MD, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 1998 (NIH publ. no. 98-4083).
Jiménez-Cruz A, Bacardi-Gascon M: The fattening burden of type 2 diabetes to Mexicans: projections from early growth to adulthood.
Diabetes Care