Introduction: Body weight dissatisfaction, when current and desired body mass index (BMI) do not align, is common in persons with obesity. The aim of this cross-sectional study was to explore factors associated with the differences between current and desired BMI, and ideal BMI (defined in the present study as BMI 25 kg/m2), in persons with obesity. Methods: Swedish citizens aged 20–64 years residing in the Stockholm County were randomly selected from the population register at five different and evenly separated occasions in the study period 1998–2000 and invited to provide self-reported data about their current weight, height, desired weight, and other characteristics such as depressive symptoms and alcohol intake. Among the 10,441 participants with a mean BMI of 24 kg/m2, differences between desired BMI and ideal BMI were calculated to determine the discrepancy between desired BMI and ideal BMI in participants with obesity (n = 808). The discrepancy between current and desired BMI was also determined. Using linear regression, factors associated with BMI discrepancies were determined. Results: Persons with BMI <40 kg/m2 desired a lower BMI than those with BMI ≥40 kg/m2 (26 ± 3 vs. 36 ± 14 kg/m2, p < 0.001). Women with obesity (n = 425) had a larger discrepancy between current and desired BMI, 32% ± 16, than men with obesity (n = 380), 24% ± 21 (p < 0.001). Persons with obesity and major depression had a 6.9% (95% CI: 2.5–11.4) larger discrepancy between current and desired BMI than persons with obesity but without major depression. Being born abroad, having a university degree, or hazardous alcohol use were not associated with discrepancy between current and desired BMI or desired BMI and ideal BMI (all p > 0.05). Conclusion: Desired BMI and discrepancies between current, desired, and ideal BMI vary according to current BMI, sex, and presence of major depression. This underscores the significance of a patient-centered approach in the management of obesity, where the goals and needs of each patient should be considered.

Body weight satisfaction is associated with self-reported healthy lifestyle habits, while body weight dissatisfaction is associated with unhealthy lifestyle, including lower intake of fruits and vegetables and less walking/jogging [1]. As a corollary, persons with obesity who are dissatisfied with their weight have shown to have poorer health with higher frequencies of hypertension, diabetes, and hypercholesterolemia than satisfied counterparts [2]. Body weight dissatisfaction is also more common in patients seeking obesity treatment, compared to volunteers with similar body mass index (BMI) [3]. Even in a random population sample, Muennig et al. [4] reported that desired weight loss, i.e., the discrepancy between current and desired BMI, was associated with the number of mentally unwell days. In fact, desired weight loss was a stronger predictor of unwell days than BMI.

Further, persons with obesity often suffer from social and work discrimination [5], adding to a social stress and poor psychological health [6]. Psychiatric disorders are common among patients with obesity. In a Canadian study of more than 10,000 patients seeking obesity surgery, 41% had past or present depression [7]. Previous research has established a bidirectional link between obesity and depression in both men and women as reported in a meta-analysis including 58,745 subjects [8]. Since depressive symptoms include feelings of worthlessness [9], there are reasons to believe that desired BMI is affected by the presence of depression.

To date, few studies [10‒14], with only small sample sizes, have investigated the discrepancy between desired BMI and current BMI in persons with obesity. To our knowledge, no studies have investigated if the discrepancy differed between persons with or without major depression. Our hypothesis was that persons with obesity, affected by major depression, or with a hazardous alcohol use, have a larger discrepancy between desired, current, and ideal BMI than those without major depression or hazardous alcohol intake. In this study, we aimed at determining if the discrepancy between desired BMI and ideal BMI and the discrepancy between current and desired BMI, among persons with obesity, differed across depression status, alcohol use, age, sex, BMI category, ethnicity, or socioeconomic status.

The PART Study

The PART study (Acronym for Psykisk hälsa, Arbete, RelaTioner – Mental Health, Work, and Relations) is a longitudinal population-based cohort study aiming at identifying risk and protective factors for mental health. Swedish citizens aged 20–64 at baseline (1998–2000) residing in the Stockholm County were randomly selected from the population register at five different and evenly separated occasions. We invited 19,457 persons, whereof 53% answered a postal 25-page questionnaire providing cross-sectional data. Participation rates were lower in persons with non-Nordic origin, low education, and income, who were unmarried and who had a previous psychiatric diagnosis in in- and outpatient registers [15].

In order to minimize the nonresponse, a prepaid return envelope was used to return the questionnaire. The participants were reminded by letter 2 weeks after the expected return of the questionnaire. A further reminder was made by telephone another 2 weeks later and a third reminder by letter 2 weeks after that. A fourth reminder was made by telephone a variable number of weeks later.

The questionnaire was completed by telephone interview only in case of missing answers. The personnel calling the participants were healthcare personnel, such as psychologists and behavior therapists, and they were specifically trained for this task. They had to follow a strict pre-written protocol and were not allowed to add any extra questions or speak with the participants outside of the protocol. If the personnel felt that the participant had a need for extra medical or psychological support, the participant received contact information to the nearest primary or psychiatric care.

Exposure Variables

The exposure variables were self-reported: age, sex, weight, and height (used for the BMI calculation), as defined according to the World Health Organization (WHO), born in Sweden or abroad, socioeconomic status defined by educational degree (graduated from university or not), hazardous alcohol use, and presence of major depression or not. Hazardous alcohol use was identified using Alcohol Use Disorders Identification Test (AUDIT) [16], with a cut-off score of ≥8 for men and ≥6 for women. The Major Depression Inventory was used to assess major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria [9]. If the participant met the following criteria, i.e., had had at least 5 depressive symptoms in the previous 2-week period, in combination with at least one of the following: either depressed mood or loss of interest/pleasure for a duration exceeding 2 weeks, and that the symptoms had caused clinically significant impairment or disability, then the person was classified as having major depression.

The Major Depression Inventory, AUDIT, and the symptom checklist depression and anxiety subscales were validated in a subsample (n = 1,100). Through interviews by psychiatrists using Schedules for Clinical Assessment in Neuropsychiatry, we found that the Major Depression Inventory was more accurate for more severely depressed individuals. As a way to increase the specificity, the impairment/disability criterion was suggested to be used in population-based studies [17]. We also found that AUDIT had high validity in terms of identifying dependency, alcohol use disorder, and risk drinking [18], and we found that depression and anxiety subscales were suitable instruments for proxies of depression and anxiety disorder in a general population sample [19].

Outcome Variables

Absolute and relative (%) differences between desired BMI and ideal BMI (defined as 25 kg/m2 in accordance to the American Society for Metabolic and Bariatric Surgery outcome reporting standards [20]) were calculated to determine the discrepancy between desired BMI and ideal BMI in persons with obesity. The outcome calculations are described in Table 1, defining the outcomes: difference between desired weight and ideal weight (kg), difference between desired BMI and ideal BMI (kg/m2), and difference between desired BMI and ideal BMI (%). In a similar manner, absolute and relative (%) differences between current and desired BMI were calculated to determine the discrepancy between current and desired BMI in persons with obesity.

Table 1.

Definitions of outcome variables

Outcome variableUnitDefinition
Ideal weight kg 25 × (reported height/100) × (reported height/100) 
Difference between desired weight and ideal weight kg Desired weight – ideal weight (corresponding to BMI 25 kg/m2
Difference between desired BMI and ideal BMI kg/m2 Desired BMI – 25 kg/m2 
Difference between desired BMI and ideal BMI [(Desired BMI – 25 kg/m2)/BMI] × 100 
Outcome variableUnitDefinition
Ideal weight kg 25 × (reported height/100) × (reported height/100) 
Difference between desired weight and ideal weight kg Desired weight – ideal weight (corresponding to BMI 25 kg/m2
Difference between desired BMI and ideal BMI kg/m2 Desired BMI – 25 kg/m2 
Difference between desired BMI and ideal BMI [(Desired BMI – 25 kg/m2)/BMI] × 100 

Current height and desired weight (i.e., the answer to the question “How much would you like to weigh?”) were used to determine desired BMI. The ideal weight (kg) was calculated according to the ideal BMI for every participant with obesity (Table 1). Height, weight, or desired weight, which were not reported, were treated as missing values and excluded from the corresponding analyses.

Statistical Analysis

Descriptive statistics were reported as mean and standard deviation for continuous variables and frequency and percentage for categorical variables, and presented for the entire study population, as well as stratified by BMI groups. Differences in desired BMI and in the discrepancies (desired vs. ideal BMI and current vs. desired BMI, respectively) between subgroups (based on BMI, sex, ethnicity, educational status, hazardous alcohol use, and presence of major depression) were determined using two-sided Student’s t test assuming normally distributed data. Continuous variables were transformed into categorical variables if required. To investigate the importance of BMI, we divided the data into two groups: BMI <40 kg/m2 and BMI ≥40 kg/m2, which is often categorized as “severe” obesity and corresponds to obesity class III.

Finally, we identified factors associated with higher or lower relative (%) difference between desired BMI and ideal BMI, as well as between current BMI and desired BMI, among participants with obesity. We conducted univariate and multivariate linear regression and reported 95% confidence intervals (95% CI) and standard deviations. All statistical analyses were performed using the STATA 16.0 software. The null hypothesis was rejected at p < 0.05.

The final cohort included 10,441 participants. The mean age was 41 years (±13) and there were 4,657 (45%) male participants. In total, 1,120 (11%) participants were born outside of Sweden, 3,009 (29%) had a university degree, 747 (7%) suffered from major depression, and 2,105 (21%) reported hazardous alcohol use. The mean BMI for the study population was 24 (±4) kg/m2. There were 2,963 (29%) overweight participants. Among the participants with obesity (n = 808, 8%), 618 had a BMI of 30–34.9 kg/m2, 122 had a BMI of 35–39.9 kg/m2, and 68 had a BMI ≥40 kg/m2. Among those with BMI ≥40 kg/m2, the prevalence of major depression was 16% and hazardous alcohol use was 20% (Table 2).

Table 2.

Characteristics of participants in the PART study

All participants (n = 10,441)BMI <18.5 kg/m2BMI 18.5–24.9 kg/m2BMI 25–29.9 kg/m2BMI ≥30 kg/m2BMI 30–34.9 kg/m2BMI 35–39.9 kg/m2BMI ≥40 kg/m2
underweight (n = 212, 2%)normal weight (n = 6,359, 62%)overweight (n = 2,963, 29%)obesity (n = 808, 8%)obesity (n = 618, 6%)obesity (n = 122, 1%)obesity (n = 68, 1%)
Age, years (mean±SD) 41±13 34±11 40±12 45±12 46±12 46±12 47±11 43±12 
Sex, male, n (%) 4,657 (45) 45 (21) 2,476 (39) 1,711 (58) 381 (47) 306 (50) 42 (34) 33 (49) 
Weight*, kg (mean±SD) 73±15 51±6 67±9 82±10 98±17 94±12 103±14 120±35 
Height*, cm (mean±SD) 173±10 171±8 173±9 174±9 170±13 172±10 167±11 157±25 
BMI, kg/m2 (mean±SD) 24±4 17±2 22±2 27±1 34±6 32±1 37±1 49±9 
Desired weight, kg (mean±SD) 68±12 56±10 65±10 74±10 77±15 77±12 75±12 85±29 
Desired BMI, kg/m2 (mean±SD) 23±3 19±2 22±2 24±2 27±5 26±2 27±4 36±14 
Born abroad, yes, n (%) 1,120 (11) 19 (9) 602 (10) 348 (12) 132 (16) 103 (17) 19 (16) 10 (15) 
University degree, yes, n (%) 3,009 (29) 53 (25) 2,011 (32) 774 (27) 152 (20) 119 (20) 20 (18) 13 (20) 
Diagnosis of major depression**, yes n (%) 747 (7) 24 (12) 418 (7) 209 (7) 82 (10) 55 (9) 16 (13) 11 (16) 
Hazardous alcohol use***, yes, n (%) 2,105 (21) 40 (20) 1,312 (21) 589 (20) 151 (19) 119 (20) 19 (16) 13 (20) 
All participants (n = 10,441)BMI <18.5 kg/m2BMI 18.5–24.9 kg/m2BMI 25–29.9 kg/m2BMI ≥30 kg/m2BMI 30–34.9 kg/m2BMI 35–39.9 kg/m2BMI ≥40 kg/m2
underweight (n = 212, 2%)normal weight (n = 6,359, 62%)overweight (n = 2,963, 29%)obesity (n = 808, 8%)obesity (n = 618, 6%)obesity (n = 122, 1%)obesity (n = 68, 1%)
Age, years (mean±SD) 41±13 34±11 40±12 45±12 46±12 46±12 47±11 43±12 
Sex, male, n (%) 4,657 (45) 45 (21) 2,476 (39) 1,711 (58) 381 (47) 306 (50) 42 (34) 33 (49) 
Weight*, kg (mean±SD) 73±15 51±6 67±9 82±10 98±17 94±12 103±14 120±35 
Height*, cm (mean±SD) 173±10 171±8 173±9 174±9 170±13 172±10 167±11 157±25 
BMI, kg/m2 (mean±SD) 24±4 17±2 22±2 27±1 34±6 32±1 37±1 49±9 
Desired weight, kg (mean±SD) 68±12 56±10 65±10 74±10 77±15 77±12 75±12 85±29 
Desired BMI, kg/m2 (mean±SD) 23±3 19±2 22±2 24±2 27±5 26±2 27±4 36±14 
Born abroad, yes, n (%) 1,120 (11) 19 (9) 602 (10) 348 (12) 132 (16) 103 (17) 19 (16) 10 (15) 
University degree, yes, n (%) 3,009 (29) 53 (25) 2,011 (32) 774 (27) 152 (20) 119 (20) 20 (18) 13 (20) 
Diagnosis of major depression**, yes n (%) 747 (7) 24 (12) 418 (7) 209 (7) 82 (10) 55 (9) 16 (13) 11 (16) 
Hazardous alcohol use***, yes, n (%) 2,105 (21) 40 (20) 1,312 (21) 589 (20) 151 (19) 119 (20) 19 (16) 13 (20) 

SD, standard deviation.

*Missing values for weight (n = 45), desired weight (n = 69) and height (n = 29).

**The Major Depression Inventory was used to assess major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria.

***Hazardous alcohol use was defined as Alcohol Use Disorders Identification Test (AUDIT) score ≥8 for men and ≥6 for women.

All participants with overweight or obesity desired a lower BMI. Among those with obesity (n = 808), the mean desired BMI was 27 kg/m2 (±5). Persons with BMI <40 kg/m2 desired a lower BMI than those with BMI ≥40 kg/m2 (26 ± 3 vs. 36 ± 14 kg/m2, p < 0.001) (Table 3).

Table 3.

Weight, ideal weight, desired weight, BMI, and desired BMI in participants with obesity in the PART study

Participants with obesity (BMI ≥30 kg/m2) (n = 808)Weight, kg (mean±SD)Height, cm (mean±SD)BMI, kg/m2 (mean±SD)Ideal weight, kg (mean±SD)Desired weight, kg (mean±SD)Desired BMI, kg/m2 (mean±SD)
98±17170±1334±673±1177±1527±5
Obesity BMI ≥40 kg/m2 (n = 68) 120±35 157±25 49±9 63±19 85±29 36±14 
Obesity BMI ≥30–<40 kg/m2 (n = 740) 96±13 171±11 33±2 73±9 76±12 26±3 
 p value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 
Male (n = 381) 106±18 177±13 34±6 79±11 86±13 28±6 
Female (n = 427) 91±14 164±10 34±5 67±7 69±11 26±5 
 p value <0.001 <0.001 0.9783 <0.001 <0.001 <0.001 
Born abroad (n = 132) 95±16 168±12 34±4 71±10 76±15 27±5 
Born in Sweden (n = 674) 98±18 170±13 34±6 73±11 77±15 27±6 
 p value 0.02 0.03 0.53 0.02 0.32 0.60 
University degree (n = 152) 98±19 170±14 34±6 73±11 78±16 27±6 
No university degree (n = 625) 98±17 170±13 34±6 73±11 77±13.8 27±5 
 p value 0.60 0.62 0.90 0.59 0.61 0.93 
Hazardous alcohol use* (n = 151) 100±17 172±13 34±6 74±11 79±15 27±6 
No hazardous alcohol use (n = 635) 97±17 169±13 34±6 72±11 77±14 27±5 
 p value 0.11 0.06 0.94 0.04 0.08 0.89 
Diagnosis of major depression** (n = 82) 99±17 170±12 35±5 72±10 75±12 26±5 
No diagnosis of major depression (n = 718) 98±17 170±13 34±6 73±11 77±15 27±5 
 p value 0.37 0.80 0.30 0.75 0.09 0.17 
Participants with obesity (BMI ≥30 kg/m2) (n = 808)Weight, kg (mean±SD)Height, cm (mean±SD)BMI, kg/m2 (mean±SD)Ideal weight, kg (mean±SD)Desired weight, kg (mean±SD)Desired BMI, kg/m2 (mean±SD)
98±17170±1334±673±1177±1527±5
Obesity BMI ≥40 kg/m2 (n = 68) 120±35 157±25 49±9 63±19 85±29 36±14 
Obesity BMI ≥30–<40 kg/m2 (n = 740) 96±13 171±11 33±2 73±9 76±12 26±3 
 p value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 
Male (n = 381) 106±18 177±13 34±6 79±11 86±13 28±6 
Female (n = 427) 91±14 164±10 34±5 67±7 69±11 26±5 
 p value <0.001 <0.001 0.9783 <0.001 <0.001 <0.001 
Born abroad (n = 132) 95±16 168±12 34±4 71±10 76±15 27±5 
Born in Sweden (n = 674) 98±18 170±13 34±6 73±11 77±15 27±6 
 p value 0.02 0.03 0.53 0.02 0.32 0.60 
University degree (n = 152) 98±19 170±14 34±6 73±11 78±16 27±6 
No university degree (n = 625) 98±17 170±13 34±6 73±11 77±13.8 27±5 
 p value 0.60 0.62 0.90 0.59 0.61 0.93 
Hazardous alcohol use* (n = 151) 100±17 172±13 34±6 74±11 79±15 27±6 
No hazardous alcohol use (n = 635) 97±17 169±13 34±6 72±11 77±14 27±5 
 p value 0.11 0.06 0.94 0.04 0.08 0.89 
Diagnosis of major depression** (n = 82) 99±17 170±12 35±5 72±10 75±12 26±5 
No diagnosis of major depression (n = 718) 98±17 170±13 34±6 73±11 77±15 27±5 
 p value 0.37 0.80 0.30 0.75 0.09 0.17 

SD, standard deviation.

*Hazardous alcohol use was defined as Alcohol Use Disorders Identification Test (AUDIT) score ≥8 for men and ≥6 for women.

**The Major Depression Inventory was used to assess major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria.

In participants with obesity, men desired a higher BMI than women (28 ± 6 vs. 26 ± 5 kg/m2, p < 0.001) (Table 3). Desired BMI was not associated with being born abroad (27 ± 5, p = 0.60), having a university degree (27 ± 6, p = 0.93), reported hazardous alcohol use (27 ± 6, p = 0.89), or being diagnosed with major depression (26 ± 5, p = 0.17).

The mean discrepancy, i.e., relative difference, between desired BMI and ideal BMI was 7% (±22), and the mean discrepancy between current BMI and desired BMI was 28% (±19), in participants with obesity (Table 4). There was a significantly larger discrepancy between desired BMI and ideal BMI in persons with BMI ≥40 kg/m2 (n = 68, 44% ± 54) than in persons with BMI <40 kg/m2 (n = 737, 4% ± 11), p < 0.001). There was also a significant difference in the discrepancy between current BMI and desired BMI between those with BMI ≥40 kg/m2 and those with BMI <40 kg/m2 (48% ± 41, vs. 26% ± 14, p < 0.001). Women (n = 425) had a larger discrepancy between current and desired BMI than men (n = 380), 32% ± 16 vs. 24% ± 21, (p < 0.001), while men had a larger discrepancy between desired BMI and ideal BMI than women 11% ± 24 versus 4% ± 19, (p < 0.001).

Table 4.

Differences between desired, ideal, and current BMI in participants with obesity in the PART study

Participants with obesity (BMI ≥30 kg/m2) (n = 808)Difference desired weight-ideal weightDifference desired BMI-ideal BMIDifference desired BMI-ideal BMIDifference current weight-desired weightDifference current BMI-desired BMIDifference current BMI-desired BMI
kg (mean±SD)kg/m2 (mean±SD)% (mean±SD)kg (mean±SD)kg/m2 (mean±SD)% (mean±SD)
5±122±57±2221±137±428±19
Obesity BMI ≥40 kg/m2 (n = 68) 21±27 11±14 44±54 36±30 13±10 48±41 
Obesity BMI ≥30–<40 kg/m2 (n = 737) 3±7 1±3 4±11 19±9 7±3 26±14 
 p value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 
Male (n = 380) 7±12 3±6 11±24 20±16 6±5 24±21 
Female (n = 425) 2±11 1±5 4±19 22±10 8±4 32±16 
 p value <0.001 <0.001 <0.001 0.05 <0.001 <0.001 
Born abroad (n = 131) 5±11 2±5 8±19 19±9 7±3 26±13 
Born in Sweden (n = 672) 4±12 2±6 7±22 21±13 7±5 29±20 
 p value 0.39 0.60 0.60 0.06 0.16 0.10 
University degree (n = 151) 5±13 2±6 7±24 21±12 7±4 28±17 
No university degree (n = 623) 4±11 2±5 7±21 21±13 7±4 28±19 
 p value 0.92 0.93 0.93 0.82 0.84 0.94 
Hazardous alcohol use* (n = 150) 5±12 2±6 8±23 21±12 7±4 28±18 
No hazardous alcohol use (n = 633) 4±11 2±5 7±21 21±13 7±5 28±20 
 p value 0.79 0.89 0.89 0.75 0.99 0.90 
Diagnosis of major depression** (n = 82) 2±10 1±5 4±19 25±13 9±4 34±18 
No diagnosis of major depression (n = 715) 5±12 2±5 8±22 20±13 7±4 28±19 
 p value 0.07 0.17 0.17 0.0018 0.0027 0.0024 
Participants with obesity (BMI ≥30 kg/m2) (n = 808)Difference desired weight-ideal weightDifference desired BMI-ideal BMIDifference desired BMI-ideal BMIDifference current weight-desired weightDifference current BMI-desired BMIDifference current BMI-desired BMI
kg (mean±SD)kg/m2 (mean±SD)% (mean±SD)kg (mean±SD)kg/m2 (mean±SD)% (mean±SD)
5±122±57±2221±137±428±19
Obesity BMI ≥40 kg/m2 (n = 68) 21±27 11±14 44±54 36±30 13±10 48±41 
Obesity BMI ≥30–<40 kg/m2 (n = 737) 3±7 1±3 4±11 19±9 7±3 26±14 
 p value <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 
Male (n = 380) 7±12 3±6 11±24 20±16 6±5 24±21 
Female (n = 425) 2±11 1±5 4±19 22±10 8±4 32±16 
 p value <0.001 <0.001 <0.001 0.05 <0.001 <0.001 
Born abroad (n = 131) 5±11 2±5 8±19 19±9 7±3 26±13 
Born in Sweden (n = 672) 4±12 2±6 7±22 21±13 7±5 29±20 
 p value 0.39 0.60 0.60 0.06 0.16 0.10 
University degree (n = 151) 5±13 2±6 7±24 21±12 7±4 28±17 
No university degree (n = 623) 4±11 2±5 7±21 21±13 7±4 28±19 
 p value 0.92 0.93 0.93 0.82 0.84 0.94 
Hazardous alcohol use* (n = 150) 5±12 2±6 8±23 21±12 7±4 28±18 
No hazardous alcohol use (n = 633) 4±11 2±5 7±21 21±13 7±5 28±20 
 p value 0.79 0.89 0.89 0.75 0.99 0.90 
Diagnosis of major depression** (n = 82) 2±10 1±5 4±19 25±13 9±4 34±18 
No diagnosis of major depression (n = 715) 5±12 2±5 8±22 20±13 7±4 28±19 
 p value 0.07 0.17 0.17 0.0018 0.0027 0.0024 

SD, standard deviation.

*Hazardous alcohol use was defined as Alcohol Use Disorders Identification Test (AUDIT) score ≥8 for men and ≥6 for women.

**The Major Depression Inventory was used to assess major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria.

Difference between current weight and desired weight, i.e., desired weight loss, was larger in persons with obesity affected by major depression (n = 82) than those without major depression (n = 715, 25 kg ± 13 vs. 20 kg ± 13, p = 0.0018). The corresponding discrepancy between current and desired BMI was thereby also larger in persons with obesity affected by major depression than those who were not (34% ± 18 vs. 28% ± 19, p = 0.0024). There was no such association with major depression in the discrepancy between desired BMI and ideal BMI (4% ± 19, p = 0.17). Being born abroad (n = 131, 26% ± 13, p = 0.10; 8% ± 19, p = 0.60), having a university degree (n = 151, 28% ± 17, p = 0.94; 7% ± 24, p = 0.93), or hazardous alcohol use (n = 150, 28% ± 18, p = 0.90; 8% ± 23, p = 0.89) were not associated with discrepancy between current and desired BMI or desired BMI and ideal BMI (Table 4).

A higher BMI and male sex were associated with a larger discrepancy, and major depression with a smaller discrepancy between desired BMI and ideal BMI in persons with obesity. In the multivariable analysis, men had a 7.2% (95% CI: 5.1–9.3) larger discrepancy than women and the discrepancy increased by 2.6% (95% CI: 2.4–2.7) for each increment of BMI (Table 5). Overall, the univariable analysis showed similar results, with the exception of major depression which was nonsignificant (−3.4%, 95% CI: −8.3 to 1.5). The opposite was found when analyzing the differences between current and desired BMI; being a man was associated with a smaller discrepancy (−7.6%, 95% CI: −10.3 to −5.0), while persons with obesity and major depression had a 6.9% (95% CI: 2.5–11.4) larger discrepancy than persons with obesity, but without major depression in the multivariable analysis (Table 5). The univariable analysis showed overall similar results.

Table 5.

Univariable and multivariable analyses of BMI discrepancy (%) between desired BMI and ideal BMI, as well as between current BMI and desired BMI, in persons with obesity in the PART study

Participants with obesity BMI ≥30 kg/m2Univariable analysisMultivariable analysis*
coefficient95% CIcoefficient95% CI
Difference desired and ideal BMI (%) 
 Age (years) −0.1 −0.2 to 0.0 −0.0 −0.1 to 0.0 
 Sex, male 7.3 4.4–10.3 7.2 5.1–9.3 
 BMI (kg/m22.6 2.4–2.8 2.6 2.4–2.7 
 Born abroad 1.1 −3.0 to 5.1 1.5 −1.5 to 4.4 
 University degree 0.2 −3.7 to 4.0 0.0 −2.7 to 2.7 
 Hazardous alcohol use 0.3 −3.5 to 4.1 −0.1 −2.8 to 2.6 
 Major depression diagnosis −3.4 −8.3 to 1.5 −5.1 −8.7 to −1.5 
Difference current and desired BMI (%) 
 Age (years) −0.0 −0.2 to 0.1 −0.0 −0.1 to 0.1 
 Sex, male −8.1 −10.7 to −5.5 −7.6 −10.3 to −5.0 
 Born abroad −3.0 −6.6 to 0.6 −2.8 −6.4 to 0.9 
 University degree −0.1 −3.4 to 3.2 −0.0 −3.3 to 3.3 
 Hazardous alcohol use** −0.2 −3.6 to 3.2 −0.2 −3.6 to 3.1 
 Major depression diagnosis*** 6.8 2.4–11.1 6.9 2.5–11.4 
Participants with obesity BMI ≥30 kg/m2Univariable analysisMultivariable analysis*
coefficient95% CIcoefficient95% CI
Difference desired and ideal BMI (%) 
 Age (years) −0.1 −0.2 to 0.0 −0.0 −0.1 to 0.0 
 Sex, male 7.3 4.4–10.3 7.2 5.1–9.3 
 BMI (kg/m22.6 2.4–2.8 2.6 2.4–2.7 
 Born abroad 1.1 −3.0 to 5.1 1.5 −1.5 to 4.4 
 University degree 0.2 −3.7 to 4.0 0.0 −2.7 to 2.7 
 Hazardous alcohol use 0.3 −3.5 to 4.1 −0.1 −2.8 to 2.6 
 Major depression diagnosis −3.4 −8.3 to 1.5 −5.1 −8.7 to −1.5 
Difference current and desired BMI (%) 
 Age (years) −0.0 −0.2 to 0.1 −0.0 −0.1 to 0.1 
 Sex, male −8.1 −10.7 to −5.5 −7.6 −10.3 to −5.0 
 Born abroad −3.0 −6.6 to 0.6 −2.8 −6.4 to 0.9 
 University degree −0.1 −3.4 to 3.2 −0.0 −3.3 to 3.3 
 Hazardous alcohol use** −0.2 −3.6 to 3.2 −0.2 −3.6 to 3.1 
 Major depression diagnosis*** 6.8 2.4–11.1 6.9 2.5–11.4 

*Adjusted for all other independent variables in the model.

**Hazardous alcohol use was defined as Alcohol Use Disorders Identification Test (AUDIT) score ≥8 for men and ≥6 for women.

***The Major Depression Inventory was used to assess major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria.

In this population-based study, a higher BMI and male sex were associated with a larger discrepancy between desired BMI and ideal BMI, while presence of major depression was associated with a lower discrepancy. A higher BMI, female sex, and presence of major depression were associated with a larger discrepancy between current and desired BMI.

Our results are in line with a large American study with self-reported weight and height from 700,000 persons, which showed that while overweight men desired 4.5% lower weight and men with obesity desired 15% lower weight, overweight women had a larger discrepancy between current and desired weight. They desired 12% lower weight and women with obesity desired twice that, i.e., 24% lower weight [13]. A Norwegian study of almost 9,000 persons showed that only normal-weight men were satisfied with their weight, but normal-weight women were not and with increased BMI, the discrepancy between desired and current weight increased, for both men and women.

A similar pattern is found in patients with obesity that chose to undergo bariatric surgery. Women and those with a higher initial BMI have a larger discrepancy between current and desired BMI [21]. However, while persons waiting for obesity surgery can wish for a weight loss of more than 100% of excess body weight [21], our participants, recruited from the general population, desired more realistic BMI levels; persons with a BMI equal to or above 30 kg/m2 desired on average a BMI of 26 kg/m2, which still corresponds to overweight, and persons with a BMI equal to or above 40 kg/m2 desired on average a BMI of 36 kg/m2, which corresponds to class II obesity. This underscores the crucial role of being patient-centered when addressing obesity in treatment. Weight loss goals should be discussed and based on individualized goals and needs of each patient.

We found that persons with obesity, affected by major depression, tended to wish for a BMI closer to the ideal BMI and further from their current BMI, as compared to participants with obesity, but without major depression. Studies on BMI discrepancies in persons with obesity and major depression are scarce. The discrepancies we observed may be proxies for body weight dissatisfaction, which has been associated with depression in all BMI categories [22]. Due to our cross-sectional study design, we cannot draw any conclusions about the directions of causality, i.e., whether body weight dissatisfaction could be a risk factor for major depression or a consequence of major depression in persons with obesity.

Cultural ideals could potentially influence the discrepancy between current and desired BMI. For example, despite the fact that North African female immigrants in Italy underestimated their weight, their ideal desired figure was thinner than that of Italian women [23]. In our study, however, we did not find any associations between current/desired or desired/ideal BMI and being born outside Sweden. It should be acknowledged though that we did not know how long participants had lived in Sweden; acculturation leads to internalizing the ideal prominent in the new country [24]. Further, we did not know the country of origin of the participants born outside Sweden. Most likely the majority of participants were born in the neighboring Nordic countries. Persons from other Nordic countries make up the largest immigrant group in Sweden, and they are likely to have similar views on desired BMI as persons born in Sweden.

Hazardous alcohol intake has been shown to be more common in adolescents with body dissatisfaction than in adolescents without such dissatisfaction [25]. In this adult population, we did not find an association between hazardous alcohol intake and current/desired or desired/ideal BMI.

The study has several strengths. First, the study is population-based with a large sample size representative of the population residing in the Stockholm County [26]. The prevalence of obesity was 8%, which represents the prevalence in Sweden at the time of data collection [27]. Second, we used both relative (%) and absolute difference to calculate BMI discrepancies. The same absolute difference means a smaller relative difference for participants with a higher baseline BMI. Another advantage of our study is the use of validated questionnaires designed explicitly for the assessment of major depression (the Major Depression Inventory) and alcohol intake (the AUDIT questionnaire).

On the other hand, among the limitations is the fact that the question on weight was vaguely formulated: “about how much do you weight?” Among the potential limitations is the small sample size in the BMI ≥40 kg/m2 category, which may limit generalizability and reduce statistical power. Furthermore, there was a risk of information bias when using self-report. Self-reported height corresponds better than weight when compared to measured data [28]. Persons with a BMI corresponding to overweight or obesity tend to report a lower than current weight [28, 29]. This is likely due to the sensitive nature of providing weight information. Nevertheless, the latest systematic review suggests that the clinical- and research impact of this type of under-reporting may be limited [30]. In a study of more than 18,000 American women, only 3% of participants with obesity under-reported their weight by >10% [28]. In a validation study of self-reported height and weight in a large, nationwide cohort of US adults by Hodge et al. [31], it was concluded that BMI computed from self-reported height and weight is a valid measure in men and women, as well as across different sociodemographic groups. Therefore, the advantages of using questionnaires to collect data in large studies may outweigh the possible limitations of a subjective measurement method such as self-reported weight and height.

Finally, while the BMI span of 18.5–24.9 kg/m2 is regarded as the ideal BMI by WHO, we used 25 kg/m2 in our analyses to define ideal BMI, in accordance to established reporting standards. This may have led to nondifferential misclassification, but since we primarily examined relative (%) values, it should not alter our conclusions [32].

Our study revealed that overweight persons or persons with obesity want to lose weight, but they do not necessarily desire the ideal BMI but strive for a higher, potentially more realistic BMI target. Persons with BMI equal to or above 40 kg/m2 and men tended to desire a BMI significantly higher than the ideal BMI. Women, persons with obesity, and those affected by major depression desired a lower than current BMI and had a higher discrepancy between current and desired weight than men, those without obesity or major depression. This underscores the significance of adopting a patient-centered approach in the management of obesity, wherein tailored weight loss strategies should be guided by the goals and needs of each individual patient. Qualitative studies could further explore possible reasons for this, and longitudinal studies are encouraged to reveal the possible direction of the association between BMI discrepancies and major depression.

The authors thank all participants who answered the questionnaire and all persons who participated in the collection of the data. The authors also thank Dr. Jeremy Meyer, University Hospitals of Geneva, and Ass. Professor Mats Fredrikson, Linköping University, for their advice and recommendations.

Written informed consent was obtained from all participants, and the study was approved by the Ethical Committee at Karolinska Institutet, Stockholm. The study protocol was reviewed and approved by the Ethics Review Board at Karolinska Institutet, Stockholm, approval number 96-260.

The authors declared no conflict of interest.

This work was supported by grants from the Swedish Research Council for Health, Working Life, and Welfare, Swedish Medical Research Council (Y.F.) and grants from the Stockholm County Council clinical research appointment (Y.F., Y.T.L.). The funders had no role in the design, analysis, or writing of this article.

E.M., Y.T.L., K.L., and Y.F. designed the study, interpreted the data, revised the work critically for important intellectual content, and approved the final version of the article. Y.F. acquired the data. E.M. analyzed the data. E.M. wrote the first draft of the manuscript.

The data analyzed in this study is not publicly available due to ethical restrictions but is available from the principal investigator of the PART study, Professor Yvonne Forsell, on reasonable request. Further inquiries can be directed to Professor Yvonne Forsell.

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