Marital status and body weight, weight perception, and weight management among U.S. adults

Eating Behaviors 14 (2013) 500–507

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Eating Behaviors

Marital status and body weight, weight perception, and weight management among U.S. adults Lori A. Klos ⁎, Jeffery Sobal Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

a r t i c l e

i n f o

Article history: Received 13 February 2013 Received in revised form 25 June 2013 Accepted 15 July 2013 Available online 22 July 2013 Keywords: Marriage Body weight Perceived weight Desired weight Weight management BMI

a b s t r a c t Married individuals often have higher body weights than unmarried individuals, but it is unclear how marital roles affect body weight-related perceptions, desires, and behaviors. This study analyzed cross-sectional data for 4,089 adult men and 3,989 adult women using multinomial logistic regression to examine associations between marital status, perceived body weight, desired body weight, and weight management approach. Controlling for demographics and current weight, married or cohabiting women and divorced or separated women more often perceived themselves as overweight and desired to weigh less than women who had never married. Marital status was unrelated to men's weight perception and desired weight change. Marital status was also generally unrelated to weight management approach, except that divorced or separated women were more likely to have intentionally lost weight within the past year compared to never married women. Additionally, never married men were more likely to be attempting to prevent weight gain than married or cohabiting men and widowed men. Overall, married and formerly married women more often perceived themselves as overweight and desired a lower weight. Men's marital status was generally unassociated with weight-related perceptions, desires, and behaviors. Women's but not men's marital roles appear to influence their perceived and desired weight, suggesting that weight management interventions should be sensitive to both marital status and gender differences. © 2013 Elsevier Ltd. All rights reserved.

1. Introduction Body weight is a health and appearance issue with implications for marital relationships. Prevalence of overweight and obesity remains high in the U.S. (Flegal, Carroll, Ogden, & Curtain, 2010), and obese individuals are stigmatized in many social situations, including romantic relationships and marriage markets (Puhl & Heuer, 2009). How an individual evaluates and interprets their body weight is influenced by cultural values about attractiveness, medical definitions of healthy weight, and social relationships, with variations in these evaluations between gender, age, race/ethnicity, and class. Romantic relationships are especially salient in determining body weight ideals (Tom, Chen, Liao, & Shao, 2005), but these relationships have not been well examined in conjunction with weight perceptions, desires, and management. The prevalence of overweight and obesity differs by marital status for men and women (Schoenborn, 2004; Sobal, Rauschenbach, & Frongillo, 1992). Married men are most likely to be overweight or obese of all gender and marital status categories. Less marital status

⁎ Corresponding author at: Department of Kinesiology, University of WisconsinMilwaukee, 455 Enderis Hall, Milwaukee, WI 53201, USA. Tel.: +1 414 229 3162; fax: +1 414 229 2619. E-mail address: [email protected] (L.A. Klos). 1471-0153/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.eatbeh.2013.07.008

variation exists among overweight and obese women. However, unmarried women, and to a lesser extent unmarried men, involved in dating relationships have lower body mass index (BMI) values and are less likely to be overweight than those who are unmarried but not in romantic relationships (Sheets & Ajmere, 2005; Wiederman & Hurst, 1998). These associations are likely due to the importance of body weight in defining attractiveness, especially for women (Sobal, Nicolopoulos, & Lee, 1995). Thus people seeking a partner in the marriage market may strive to attain or maintain an ideal body weight in an effort to maximize their confidence or social capital (Bove & Sobal, 2011; Shilling, 2003). Weight-related changes associated with relationship transitions also provide evidence that romantic relationships are relevant to the examination of body weight. Entering marriage is associated with weight gain, particularly among women (Dinour, Leung, Tripicchio, Khan, & Yeh, 2012; Sobal, Rauschenbach, & Frongillo, 2003). Married individuals no longer in the marriage market may experience less pressure to attain or maintain “ideal bodies” after securing a partner, and are influenced by marital activities promoting weight gain, such as shared meals and dietary temptations (Anderson, Marshall, & Lea, 2004; Sobal et al., 2003), less personal time for physical activity (Nomaguchi & Bianchi, 2004), and childbearing and childrearing (Wolfe, Sobal, Olson, Frongillo, & Williamson, 1997). Individuals in or re-entering marriage markets tend to lose weight over time (Sobal et al., 2003). This suggests that individuals may perceive their bodies differently and vary in their desired weights congruent with their marital status, and that different weight

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management styles may occur between episodes of an individual's marital status. Surprisingly few studies examine associations between marital status and body weight perceptions, desires, and behaviors. How an individual interprets and evaluates their body weight status has been recognized as an important determinant of weight management-related behaviors (e.g., Lemon, Rosal, Zapka, Borg, & Andersen, 2009; Powell et al., 2010). In the current sociocultural climate where leanness is idealized (Tiggemann, 2011) and excess weight is stigmatized (Puhl & Heuer, 2009), the perception of being overweight or obese has been considered a proxy for body weight dissatisfaction. Several population-based studies have examined a number of demographic and socioeconomic factors (e.g., gender, socioeconomic status, race/ethnicity) associated with weight perception, misperception (perceiving one's weight discordant from objective measures such as body mass index), and weight management efforts. After adjustment for initial differences in actual body weight, selfperceived overweight status was more likely among women, Caucasians, and those with higher income and education (e.g., Paeratakul, White, Williamson, Ryan, & Bray, 2002). Weight misperception (e.g., an individual with a BMI in the overweight range who perceives their weight as “about right”) is prevalent in the U.S. (Chang & Christakis, 2003; Kjærbye-Thygesen, Munk, Ottesen, & Krüger Kjær, 2004; Wardle & Johnson, 2002). This is important in the context of the obesity epidemic (World Health Organization, 1998) because weight misperceptions also influence desire to change (or not change) weight and weight management behaviors (Anton, Perri, & Riley, 2000; Duncan et al., 2011; Wardle & Johnson, 2002). For example, examination of data from a nationally-representative sample of adults found that overweight and obese adults who did not perceive their weight status as overweight were less likely to want to weigh less, and were less likely to be attempting weight loss (Duncan et al., 2011). Public beliefs suggest that people remain thin to attract marital partners, but weight becomes less important once wed (Tom et al., 2005), although weight perceptions and weight management behavior have rarely been studied in relation to marital status. Of studies examining weight perception-related constructs in nationally-representative samples, most did not evaluate marital status as a possible predictor variable, although some adjusted for it in statistical models (e.g., Bennett & Wolin, 2006). Chang and Christakis (2003) found that women's marital status (married, previously married, or never married) was unrelated to their perceived weight, while married men were more likely to perceive their weight status as heavier than men who had never been married. Another study found no relationship between marital status and weight perception, although only two relationship categories were examined: married and not married (Chang & Christakis, 2001). However, other studies examining romantic relationship status and weight evaluation revealed mixed findings. One study found that married adults perceive themselves as heavier, but still consider achieving an “ideal” body less important, compared to single individuals (Tom et al., 2005). However, a large survey of Consumer Reports readers found body dissatisfaction to be unrelated to marital status (Friedman, Dixon, Brownell, Whisman, & Wilfley, 1999). These inconsistent associations may be related to the relationship categories researchers examined in their analyses, and the way in which researchers operationalized the evaluation of body weight and shape (e.g., weight perception, body dissatisfaction, ideal body importance). Some studies selectively focused on certain relationship types like married or unmarried romantic couples. For example, among married adults, women were dissatisfied with their bodies more than their husbands were (Markey, Markey, & Birch, 2004), consistent with findings about gender differences in body satisfaction (Feingold & Mazzella, 1998), but the study design did not permit comparison to other relationship types. Weight perception is a contributing factor in the desire to modify body weight and in the engagement in behavior(s) to do so. While a number of studies have described the approaches to weight

501

management used by adults (e.g., Lowry et al., 2000; Weiss, Galuska, Kettel Khan, & Serdula, 2006), marital status has not been thoroughly explored as a possible predictor for desired or attempted weight change. In one study of U.S. adults trying to lose weight, marital status was unrelated to the likelihood of using recommended weight-loss strategies (i.e., eating fewer calories and exercising more; Kruger, Galuska, Serdula, & Jones, 2004). However, a recent in-depth analysis of recently married couples reveals that weight is a salient topic within the context of relationships (Bove & Sobal, 2011). Also, the relevance of weight appears to change with changes in marital status, and is important for understanding an individual's behaviors related to weight, diet, and exercise. Newly married adults described a relaxation in weight concern once involved in committed relationships, compared to when they sought marital partners, and described subsequent weight gain due to a reduction in active weight management efforts (along with other changes associated with commensality, such as shared meals). These findings provide support for a closer examination of marital status and weight management in larger samples of adults. These few studies suggest that types of marital relationships may influence weight evaluation, body dissatisfaction, and weight management behavior. Adult associations between romantic relationships and weight perception, desire to change body weight, and weight management behaviors are unclear, particularly across a range of relationship types including never married, living with a partner, married, separated, divorced, and widowed. Weight perceptions and weight change desires are important because they predict weight management attempts (and the types of behaviors used to change weight), even after accounting for objective weight status (e.g., Powell et al., 2010). Marriage and weight perceptions, desired weight, and weight management need further study to provide knowledge for weight management policies, programs, and clinical work that consider romantic relationship contexts. The objective of this cross-sectional study was to examine associations between marital status and the perception of body weight, desired weight change, and weight management approach in a nationally-representative sample of U.S. adults controlling for important sociodemographic variables such as age, race/ethnicity, and socioeconomic status.

2. Method 2.1. Design and sample The present study is a secondary analysis of the data from the 1999– 2002 National Health and Nutrition Examination Survey (NHANES)—a cross-sectional, nationally-representative sample of the U.S. civilian, non-institutionalized population. Data are collected through medical examinations, questionnaires, and interviews that include measurements of height and weight. An extensive description of NHANES can be found elsewhere (National Center for Health Statistics, 2012). This analysis examined data from 10,291 adults aged 20 or older. For this study, participants were excluded from the analytical sample if their marital status was unknown (n = 441), if they did not complete the medical examination (n = 820), or if their height and weight data were unavailable (n = 19). Similar to other researchers' approach with this dataset (e.g., Dorsey, Eberhardt, & Ogden, 2009), we excluded participants who self-classified their race or ethnicity as “Other or multiracial” (n = 256) due to relatively low representation in the sample. Women who were currently pregnant or of undetermined pregnancy status (n = 627) were also excluded, as were those with missing values for other study-related variables (n = 50), with the exception of education and income. Missing values for education (n = 14) and income (n = 824) were imputed using expectation–maximization procedures (Allison, 2002). The final analytical sample (n = 8,078) was comprised of 4,089 men and 3,989 women.

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2.2. Measures 2.2.1. Marital status Participants self-reported their current marital status as married, widowed, divorced, separated, never married, or living with a partner (cohabiting). Due to small sample sizes within some response categories, those living with a partner (217 men, 184 women) were combined with married individuals, and separated participants (112 men, 188 women) were combined with those who were divorced.

2.2.2. Height, weight, and body mass index (BMI) For most participants in the dataset, their height and weight were measured by trained staff during a medical examination. Given the high correlation between measured and self-reported height (r = .93) and weight (r = .97) among participants in this sample, self-reported height and weight were used (n = 335) when measured values were not available. BMI was calculated by dividing respondents' weight (kilograms) by their height (meters), squared. BMI values were constrained to 50 kg/m2 (n = 51) to avoid the undue influence of outliers at the upper end of the distribution. Using standard BMI categories, respondents were classified as underweight (b 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and

obese (≥30.0 kg/m2) (World Health Organization, 1998). The relatively small number of underweight respondents (n = 144) were combined with normal weight respondents to form a “not overweight” category (b 25.0 kg/m2) for some analyses. 2.2.3. Weight perception and desired weight change Prior to being weighed during the NHANES medical exam, participants were asked, “Do you consider yourself to be overweight, underweight, or about the right weight?” Desired weight change was assessed by the question, “Would you like to weigh more, less, or stay about the same?” 2.2.4. Weight management approach Participants were classified into one of five weight management categories based on both their body weight history and their response to two weight management-related questions. Participants with a current body weight ten or more pounds less than their weight one year ago were asked if the weight loss was intentional. If it was, participants were defined as those who intentionally lost weight, otherwise they were defined as those who unintentionally lost weight. Participants with a current body weight within 10 lb of their weight one year ago were asked, “During the past 12 months, have you tried to lose weight?”

Table 1 Demographic characteristics and weight-related variables by marital status among men. Characteristic

Age (years), M, SE Race/ethnicity (%) White Black Hispanic Education (%) Less than high school High school graduate Some college or greater Annual family income (%) b$10,000 $10,000–19,999 $20,000–34,999 $35,000–54,999 $55,000–74,999 ≥$75,000 BMI (kg/m2), M (SE) BMI Category (%) Not overweight Overweight Obese Perceived weight status (%) About right Overweight Underweight Desired weight change (%) Weigh same Weigh more Weigh less Weight management approach (%) Not managing weight Preventing weight gain Attempting weight loss Intentionally lost weight Unintentionally lost weight

Marital status Total

NM

M/C

D/S

W

(n = 4089)

(n = 690)

(n = 2797)

(n = 407)

(n = 195)

p

45.6 (0.4)

31.1 (0.8)

48.5 (0.5)

47.4 (0.7)

72.7 (1.4)

⁎⁎⁎

74.9 10.4 14.6

67.0 16.4 16.6

78.2 7.3 14.5

70.5 16.2 13.3

79.2 14.6 6.2

⁎⁎⁎ ⁎⁎⁎

21.6 27.2 51.2

21.1 24.5 54.3

21.3 25.3 53.4

26.4 27.7 45.9

39.3 26.1 34.6

⁎⁎

7.5 15.5 19.7 20.8 13.9 22.6 27.8 (0.1)

15.6 19.0 22.8 18.4 10.4 13.8 26.6 (0.3)

3.9 11.5 17.9 23.7 15.6 27.4 28.3 (0.2)

12.7 18.4 25.8 20.3 11.4 11.4 27.1 (0.5)

10.5 35.9 25.1 21.2 5.2 2.2 27.4 (0.4)

⁎⁎⁎ ⁎⁎⁎ ⁎⁎ ⁎ ⁎⁎ ⁎⁎⁎ ⁎⁎⁎

31.6 41.1 27.3

45.9 31.6 22.5

26.1 44.3 29.6

40.9 37.2 21.9

35.3 41.8 22.9

⁎⁎⁎ ⁎⁎⁎ ⁎⁎

45.7 47.4 7.0

52.6 33.9 13.5

42.9 52.3 4.8

49.5 41.0 6.6

51.1 42.3 9.5

⁎⁎ ⁎⁎⁎ ⁎⁎⁎

36.8 10.0 53.2

39.6 21.6 38.8

34.9 6.7 58.5

41.6 11.5 46.9

50.6 4.9 44.4

⁎ ⁎⁎⁎ ⁎⁎⁎

52.3 9.7 22.1 10.0 5.8

56.2 8.7 18.0 10.2 6.8

51.1 10.7 23.1 9.9 5.2

50.9 6.1 24.6 10.8 7.6

61.5 4.6 16.5 8.0 9.4

⁎ ⁎ ⁎

⁎

Note. Sample sizes (ns) are unweighted while percentages are weighted to reflect a nationally-representative sample; NM = Never married; M/C = Married or cohabiting; D/S = Divorced or separated; W = Widowed. Differences in means or percentages by marital status categories were tested using ANOVA and chi-square analyses, respectively. ⁎ p b .05. ⁎⁎ p b .01. ⁎⁎⁎ p b .001.

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Table 2 Demographic characteristics and weight-related variables by marital status among women. Characteristic

Age (years), M, SE Race/ethnicity (%) White Black Hispanic Education (%) Less than high school High school graduate Some college or greater Annual family income (%) b$10,000 $10,000–19,999 $20,000–34,999 $35,000–54,999 $55,000–74,999 ≥$75,000 BMI (kg/m2), M (SE) BMI category (%) Not overweight Overweight Obese Perceived weight status (%) About right Overweight Underweight Desired weight change (%) Weigh same Weigh more Weigh less Weight management approach (%) Not managing weight Preventing weight gain Attempting weight loss Intentionally lost weight Unintentionally lost weight

Marital status

p

Total

NM

M/C

D/S

W

(n = 3989)

(n = 566)

(n = 2165)

(n = 610)

(n = 648)

47.7 (0.5)

32.2 (0.9)

46.6 (0.4)

48.4 (0.6)

72.9 (0.6)

⁎⁎⁎

74.2 11.7 14.0

57.1 22.6 20.3

80.3 7.2 12.5

63.2 19.2 17.6

78.6 11.8 9.6

⁎⁎⁎ ⁎⁎⁎ ⁎⁎⁎

22.0 26.0 51.9

20.2 20.2 59.7

18.7 26.1 55.2

25.1 26.5 48.4

38.4 32.4 29.3

⁎⁎⁎ ⁎ ⁎⁎⁎

11.7 17.5 20.5 19.3 11.9 19.2 28.2 (0.2)

21.6 24.6 21.0 16.7 8.2 8.0 28.1 (0.4)

4.5 11.1 18.9 22.0 15.7 27.8 28.1 (0.2)

20.2 23.5 25.8 17.9 6.2 6.4 28.9 (0.3)

26.1 34.7 21.1 9.7 3.8 4.5 28.3 (0.5)

⁎⁎⁎ ⁎⁎⁎

38.1 27.9 34.0

44.2 22.7 33.1

39.5 27.4 33.1

30.4 31.5 38.1

32.7 32.9 34.3

⁎⁎ ⁎⁎

31.1 65.7 3.2

36.6 59.0 4.4

28.8 69.0 2.2

28.0 68.2 3.8

40.8 53.3 5.9

⁎⁎⁎ ⁎⁎⁎ ⁎⁎

23.6 3.0 73.4

26.8 5.0 68.2

20.4 2.2 77.4

23.1 2.6 74.4

37.6 5.4 57.1

⁎⁎⁎ ⁎⁎ ⁎⁎⁎

38.1 9.0 36.4 10.4 6.2

38.4 8.9 33.4 10.8 8.5

35.6 9.9 40.4 9.9 4.2

38.1 7.8 34.3 13.3 6.6

50.8 5.6 21.8 8.8 13.0

⁎⁎⁎ ⁎ ⁎⁎⁎

⁎⁎⁎ ⁎⁎⁎ ⁎⁎⁎

⁎⁎⁎

a

Note. Sample sizes (ns) are unweighted while percentages are weighted to reflect a nationally-representative sample; NM = Never married; M/C = Married or cohabiting; D/S = Divorced or separated; W = Widowed. Differences in means or percentages by marital status categories were tested using ANOVA and chi-square analyses, respectively. ⁎ p b .05. ⁎⁎ p b .01. ⁎⁎⁎ p b .001.

and, “During the past 12 months, have you done anything to keep from gaining weight?” Participants answering “yes” to either question were classified accordingly as either attempting weight loss or preventing weight gain, respectively. Participants responding “no” to both weight management questions were considered to be not managing weight. 2.2.5. Demographics Gender, age, race/ethnicity, education, annual family income, and smoking status were obtained through self-report. Participants selfclassified their race/ethnicity as non-Hispanic White (White), nonHispanic Black (Black), Mexican American and other Hispanic (Hispanic), and Other or multiracial. Due to limited numbers of participants selfclassifying their race/ethnicity as “Other or multiracial,” only the first three categories are reported in this paper. Highest level of education achieved was categorized as less than high school, high school graduate (or equivalent), or some college or greater. Annual family income was reported on an eleven-point scale from $0 to $4,999 through $75,000 and above, and re-coded into six categories for descriptive purposes. 2.3. Analysis NHANES used complex, stratified, multistage, probability sampling. Greater detail on the sampling frames and sample section procedures

are described in detail elsewhere (National Center for Health Statistics, 2012). Four-year sample weights were used to adjust for unequal probability of selection, and weights were recalculated for this analytical sample so the total weighted n equaled the sample size. Variances were corrected for complex sampling using masked strata and pseudo sampling units from NHANES. SPSS (version 14.0, Chicago, IL) and the corresponding complex samples module were used for this analysis. Chi-square and ANOVA tests were used to examine differences in demographic variables and BMI by marital status. For ANOVA tests to compare differences in means (i.e., age and BMI), never married individuals were considered the reference category. Linear and multinomial logistic regression was used to examine marital status differences in mean BMI and BMI classification, respectively, adjusting for age, race/ ethnicity, education, and annual family income. To examine associations between marital status and weight evaluation and weight managementrelated variables, multinomial logistic regression analyses were used to examine associations between marital status and (1) perceived weight status, (2) desired weight change, and (3) weight management approach. Regression models used to examine associations between marital status and weight evaluation and weight management-related variables were adjusted for demographic factors including age, race/ethnicity, and socioeconomic status and BMI. As previous studies suggest that men and women interpret and manage weight differently, and also experience

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marriage differently (Kiecolt-Glaser & Newton, 2001), all analyses were conducted separately by gender.

3. Results 3.1. Demographic characteristics by marital status The weighted data mirrors national patterns of adults in the U.S. with the majority of participants being middle-aged, White, with at least a high school education. Tables 1 and 2 present the demographic variables by marital status for men and women, respectively. Nearly every demographic variable examined in this study varied significantly across marital status categories for both men and women. Married or

Table 3 Regression analyses examining men's marital status as a predictor of weight perception, desired weight change, and weight management approach (n = 4089). Variable Perceived weight status About right (Ref.)

Overweight

Underweight

Desired weight change Weigh same (Ref.)

Weigh more

Weigh less

Weight management approach Preventing weight gain

Intentionally lost weight

Attempting weight loss

Not managing weight (Ref.)

Unintentionally lost weight

Marital statusa

n

%

ORb

95% CI

Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced

384 1303 112 211 220 1350 68 154 86 144 15 42

52.6 42.9 51.1 49.5 33.9 52.3 42.3 41.0 13.5 4.8 6.6 9.5

– – – – Ref. 1.29 1.04 1.47 Ref. 0.99 1.03 1.16

– – – – – [0.89, 1.86] [0.63, 1.71] [0.89, 2.42] – [0.55, 1.75] [0.36, 2.90] [0.46, 2.90]

Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced

301 1135 110 188 138 179 12 49 251 1483 73 170

39.6 34.9 50.6 41.6 21.6 6.7 4.9 11.5 38.8 58.5 44.4 46.9

– – – – Ref. 0.83 0.87 0.94 Ref. 1.26 0.94 1.50

– – – – – [0.53, 1.32] [0.32, 2.38] [0.41, 2.12] – [0.91, 1.75] [0.52, 1.71] [0.93, 2.43]

Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced

58 255 8 23 60 262 14 45 119 599 29 85 404 1492 123 217 49 189 21 37

8.7 10.7 4.6 6.1 10.2 9.9 8.0 10.8 18.0 23.1 16.5 24.6 56.2 51.1 61.5 50.9 6.8 5.2 9.4 7.6

Ref. 0.65 0.25 0.59 Ref. 0.65 0.50 1.06 Ref. 0.87 0.64 1.44 – – – – Ref. 0.76 0.91 1.11

– [0.44, .097] [0.12, 0.56] [0.29, 1.21] – [0.41, 1.04] [0.22, 1.15] [0.62, 1.84] – [0.64. 1.18] [0.35, 1.20] [0.96, 2.17] – – – – – [0.48, 1.20] [0.44, 1.89] [0.62, 1.99]

Note. To facilitate readability, statistically significant associations (p b .05) have been presented in bold text; OR = odds ratio; CI = confidence interval; Ref = reference category for regression analyses. a Married category also includes cohabiting individuals; divorced category also includes separated individuals; never married (reference category). b ORs and corresponding 95% CI's represent results from adjusted regression models which include BMI, age, education, income, and race/ethnicity as covariates.

previously married adults were significantly older than those who had never married. Among married or cohabiting participants, the majority was White (78%) and only 6% were Black. Attainment of a high school diploma (or equivalent) did not vary by marital status, while widows were somewhat less likely to have attended college than members of other marital groups. Married/cohabiting adults also tended to represented most frequently in the highest family income bracket, illustrating the economic advantage of marriage/cohabitation. 3.2. Body mass index and marital status The relationship between marital status and body weight varied between men and women. Men who were married/cohabiting had significantly higher BMIs than men who had never married (Table 1), and this finding remained significant after adjustment for age, race/ethnicity, education, and income. The mean BMI of previously married men did not differ from never married men. After adjustment for demographic factors, married/cohabiting men were more likely to be overweight (OR = 1.78, 95% CI: 1.29–2.43) or obese (OR = 1.73, 95% CI: 1.20–2.52) than never married men. Previously married men did not differ from never married men when examining BMI categorically. The mean BMI observed in this sample of women did not vary by marital status (Table 2), and this finding remained consistent after adjusting for demographic variables. Women's marital status was generally unrelated to their BMI when BMI was treated as a categorical variable with one exception: divorced/separated women were more likely to be overweight than never married women (OR = 1.63, 95% CI: 1.14–2.32). 3.3. Weight perception The majority of married or cohabiting men (Table 1), and the majority of women in all marital status categories (Table 2), perceived themselves as overweight. About half of never married, divorced/ separated, and widowed men perceived their weight status as “about right,” as did about 29% to 41% of women in this sample depending upon their marital status. Few individuals within any marital category considered themselves underweight. However, multivariate analyses revealed that marital status was not significantly related to weight perception among men (Table 3), and was only marginally significant among women, after adjusting for demographic factors and BMI (Table 4). More specifically, compared to never married women, married/cohabiting and divorced/separated women were more likely to consider themselves overweight than about the right weight. Marital status was unrelated to women's perception of being underweight.

3.4. Desired weight change The majority of never married and widowed men desired to stay about the same body weight, while the majority of married/cohabiting and divorced/separated men wanted to weigh less (Table 1). Most women across all marital status categories, especially married women, desired to weigh less. Men who had never been married most frequently wanted to weigh more, while few women in any marital category desired weight gain. Among men, the relationships between marital status and the desire for a different body weight were not statistically significant the multivariate model, adjusting for demographic variables and BMI (Table 3). Among women, marital status was unrelated to the desire to weigh more. However, married/cohabiting women and divorced/separated women were both about 1.6 times more likely to desire to weigh less than to stay the same weight, compared to women who had never married, controlling for demographics and current BMI (Table 4).

L.A. Klos, J. Sobal / Eating Behaviors 14 (2013) 500–507 Table 4 Regression analyses examining women's marital status as a predictor of women's weight perception, desired weight change, and weight management approach (n = 3989). Variable Perceived weight status About right (Ref.)

Overweight

Underweight

Desired weight change Weigh same (Ref.)

Weigh more

Weigh less

Weight management approach Preventing weight gain

Intentionally lost weight

Attempting weight loss

Not managing weight (Ref.)

Unintentionally lost weight

Marital statusa

n

%

ORb

95% CI

Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced

210 642 283 190 330 1467 320 400 26 56 45 20

36.6 28.8 40.8 28.0 59.0 69.0 53.3 68.2 4.4 2.2 5.9 3.8

– – – – Ref. 1.66 1.10 1.61 Ref. 0.84 0.91 1.10

– – – – – [1.15, 2.40] [0.62, 1.94] [1.13, 2.28] – [0.41, 1.73] [0.36, 2.30] [0.51, 2.39]

Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced

167 484 266 164 35 62 45 16 364 1619 337 430

26.8 20.4 37.6 23.1 5.0 2.2 5.4 2.6 68.2 77.4 57.1 74.4

– – – – Ref. 0.80 0.68 0.60 Ref. 1.66 1.10 1.60

– – – – – [0.38, 1.71] [0.27, 1.67] [0.26, 1.39] – [1.10, 2.50] [0.65, 1.87] [1.04, 2.46]

Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced Never married Married Widowed Divorced

42 189 33 37 56 204 53 79 186 828 129 198 243 836 348 248 39 108 85 48

8.9 9.9 5.6 7.8 10.8 9.9 8.8 13.3 33.4 40.4 21.8 34.3 38.4 35.6 50.8 38.1 8.5 4.2 13.0 6.6

Ref. – – – Ref. 0.99 1.47 1.63 Ref. 1.33 1.09 1.32 – – – – Ref. 0.71 1.51 0.88

– – – – – [0.60, 1.67] [0.72, 3.03] [1.01, 2.45] – [0.94, 1.87] [0.64, 1.86] [0.88, 1.97] – – – – – [0.38, 1.32] [0.68, 3.37] [0.41, 1.87]

Note. To facilitate readability, statistically significant associations (p b .05) have been presented in bold text; OR = odds ratio; CI = confidence interval; Ref = reference category for regression analyses. a Married category also includes cohabiting individuals; Divorced category also includes separated individuals; Never married (reference category). b ORs and corresponding 95% CI's represent results from adjusted regression models which include BMI, age, education, income, and race/ethnicity as covariates.

3.5. Weight management approach Most men within each marital status category, as well as many widowed women, reported not taking any action to modify their body weight (Tables 1 and 2, respectively). Few men and women within each marital category reported successful weight loss of 10 lb or more in the past year. Similar proportions of women who were never married, married/cohabiting, and divorced/separated were either attempting to lose weight or not taking action. In multivariate models, there were few significant associations between marital status and weight management among men and women. Men who were married/cohabitating were less likely to be attempting to prevent weight gain (versus not taking action) compared to never married men, adjusting for demographics and

505

current BMI (Table 3). Divorced/separated women were more likely to have intentionally lost 10 or more pounds in the past year (versus not taking action) compared to women who had never married, adjusting for demographics and current BMI (Table 4).

4. Discussion In this nationally-representative sample of adults, men in married or cohabiting relationships had higher body weights than men who had never married, controlling for demographics including age, race/ethnicity, and socioeconomic status, consistent with previous research (Schoenborn, 2004; Sobal et al., 1992). Women in marital or cohabiting relationships were similar in weight to women who had never married, while divorced or separated women were more likely to be overweight. Expanding the body of research related to marital status and weight evaluation-related variables, we observed that weight perception, desired weight change, and approach to weight management varied somewhat by marital status, although the significant associations were observed primarily among women rather than men. Women's marital status was associated with both weight perception and desired weight change. About three-fourths of women who were married or cohabiting, or divorced or separated, viewed themselves as overweight and desired to lose weight; at the same time, this pattern of weight perception and desired weight change was significantly less common among women who had never married. For most women, pressure to negatively evaluate their body weight status (e.g., overweight weight perception) or desire for a thinner body may not lessen after marriage. In Western societies, body weight is an integral component of women's attractiveness and desirability (Jackson, 2002; Rodin, Silberstein, & Streigel-Moore, 1985), and women may continue to experience a need to focus on weight-related appearance even after entering marriage. Desiring to weigh less may be motivated by desires to satisfy their partner as well as to maintain a culturally acceptable appearance in other social situations, like with female friends and in public settings (Paquette & Raine, 2004). Another possibility is that the changes in one's physique associated with childbearing (which is more common among married women; Wildsmith, Steward-Streng, & Manlove, 2011) may contribute to women's body dissatisfaction postpartum (Heinburg & Guarda, 2002), perhaps contributing to the greater perception of being overweight and desired weight loss among married and cohabiting women. In contrast to the women in this sample, no significant associations were observed between men's marital status and their weight perception or desired weight change after adjustment for demographic and body weight differences. The lack of relationships between these variables suggests that broad marital roles may not be a salient consideration when men evaluate their weight status. Previous research suggests that body weight is not as central to defining a man's desirability as a romantic partner as it is for women, so men may not consider their relationship status when evaluating their weight and weight management approach. Additionally, men of higher body weights do not seem to experience the same degree of weight stigmatization as women in the context of romantic relationships. For example, the average BMI of non-dating women was significantly higher than those in casual or exclusive relationships, while BMI was not associated with men's dating status (Sheets & Ajmere, 2005). This suggests that there may be a social penalty for higher body weights among women but not men. Among dating or married couples, women's, but not men's, BMI was associated with worse relationship functioning (Boyes & Latner, 2009). Taken together, perhaps men evaluate their weight status similarly irrespective of their position on the marriage market as they may not glean validation pertaining to their desirability through securing a romantic partner, and they may be less likely to experience issues secondary to weight bias when seeking a partner or maintaining a relationship.

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Overall, there were very few associations between marital status and the weight management approach used by the adults in this sample. About one third of the women in this sample were attempting to lose weight, and a similar proportion reported not managing their body weight. Similar to the men in this study, women's marital status was generally unrelated to their approach to weight management with one exception: divorced or separated women were more likely than never married women to have intentionally lost weight within the past year. Men emphasize a mate's physical attractiveness more than women do (Buss, 1994), and pressure for women to attain or maintain an ideal weight may not relax even after a marital relationship is solidified, and perhaps intensify upon marital dissolution and subsequent return to the marriage market. This may lead married and previously married women to continue to view themselves as overweight and desire weight loss, but result in quantifiable (although self-reported) weight loss among women who may be seeking a new marital partner possibly because women believe that weight loss raises the likelihood of attracting a new romantic partner (Cawley, Joyner, & Sobal, 2006; Sobal et al., 2003). Interestingly, while weight-related comments by romantic partners has been reported to be common (Sheets & Ajmere, 2005) and may negatively influence women's body image (Bove & Sobal, 2011; Paquette & Raine, 2004), it was not reflected in the weight management approach used by married and cohabiting women in this sample. Broader sociocultural pressures on women to actively manage their weight, both within a relationship and outside of it, may supersede impacts of possible weight-related comments within relationships, partially explaining the overall lack of differentiation in women's weight management approaches by marital status. Despite the finding that over half of the men sampled were overweight or obese within each marital classification, the majority reported not taking any action to lose weight, and the proportion of men attempting to lose weight did not differ by marital status. However, married or cohabitating men, along with widowed men, were less likely to be attempting to prevent gaining weight (than not taking action) in comparison to never married men. To put it another way, never married men were more likely to be attempting to prevent weight gain than married/cohabitating and widowed men after adjustment for differences in demographics and body weight. The higher likelihood of attempting to prevent weight gain among never married men may reflect some concern related to body weight associated with maintaining or improving one's position in the marriage market. Because men often gain weight upon entry into marriage (Dinour et al., 2012; Sobal et al., 2003), which is reflected in the higher prevalence of overweight and obesity among married or cohabiting men in this sample, one possible explanation for this is that women may be more accepting of their partner's weight gain, and men, once in a long-term relationship, may ‘give up’ trying to manage their weight (Ziebland, Robertson, Jay, & Neil, 2002). Less social pressure may be placed on men in a relationship to achieve or maintain a leaner, muscular physique, combined with fewer social consequences of higher body weights, may partially explain the higher prevalence of overweight and obesity among married men (Schoenborn, 2004; Sobal et al., 1992). Overall, these findings suggest that adults, particularly women, within different types of marital relationships may evaluate their body weight differently (particularly what it means to be normal weight versus overweight), but actions related to weight management are fairly similar across marital status categories. However, this study has some limitations that should be considered when interpreting the findings. Relatively small sample sizes led us to combine cohabiting and married individuals as well as separated and divorced individuals, masking potential differences between these relationship categories. Subjective well-being of someone undergoing the stress of separating from a partner may be different from someone completing the divorce process (Kamp Dush & Amato, 2005), and perception and management body weight may also differ. Marital status assessment by NHANES did not

distinguish whether or not never married individuals were actively seeking a partner, in the marriage market but not attached, or in a romantic relationship. Never married but romantically involved dating individuals may experience body weight differently than those never married and not romantically involved. While marital status is typically analyzed as a set of categorical roles, marital states are more complex. The development and dissolution of marital relationships is more of a continuum than an abrupt transition between different roles (Vaughan, 1986). Marital status also does not ascertain whether respondents are in heterosexual or homosexual couples, and differences exist in body image by sexual orientation (Conner, Johnson, & Grogan, 2004). Additionally, NHANES did not assess dimensions of relationship quality (e.g., satisfaction, romantic partner support) which have previously been shown to influence an individual's interpretation of their body weight and shape (e.g., Boyes, Fletcher, & Latner, 2007; Weller & Dziegielewski, 2005). Inferences about NHANES body weight-related variables should be made cautiously. Body mass index categories are delineated by health professionals and may not correspond to social norms about what individuals consider “attractive” or “healthy” weights. Also, it is unclear what social comparison target(s), like societal weight ideals, health professional recommendations, etc., are used when individuals are asked how they perceive their body weight. Body image and weight management are differentially associated with the choice of comparison target (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999); as such, comparison targets used across the marital relationship spectrum need to be investigated. Additionally, NHANES does not directly assess weight satisfaction. Although components of weight satisfaction can be cautiously inferred from desired weight change and weight management behavior (Neighbors & Sobal, 2007), relationships between marital status and weight satisfaction require further study. Finally, the language used in NHANES to capture information about body size-related perceptions, desires, and behavior focused on body weight. It is possible that women and men may respond differently to weight-related questions compared to those about muscularity, tone, or shape. Future work in this area should consider exploring the interrelationships between marital status, gender, and body evaluation and management beyond body weight. While parity was not included as a covariate in this analysis, previous studies have demonstrated an association with between parity and women's body weight (Wolfe et al., 1997), but not weight perception (Kjærbye-Thygesen et al., 2004). Future work in this area should elucidate the role of childbearing and childrearing on the interpretation of body weight and shape within the context of romantic relationships. Additionally, relatively small sample sizes led us to group individuals into one of three racial/ethnic categories (i.e., White, Black, or Hispanic), limiting the generalizability of this study to those populations. Future studies should more fully explore these issues in multiple racial/ethnic groups using more diverse and larger samples. Despite some limitations, this study elucidated associations between marital status and variables related to body image and weight management in a nationally-representative sample of US adults. One broad social role – marital status – was significantly associated with body weight perceptions, desired weight changes, and weight change efforts, particularly among women. Weight management interventions targeting the couple as a unit may be efficacious (Burke, Giangiulio, Gillam, Beilin, & Houghton, 2003), especially if they promote positive health behaviors for the betterment of the couple (Lewis et al., 2006). Future work in this area should include more nuanced romantic relationship categories (e.g., casually dating, exclusively dating) and relationship characteristics (e.g., satisfaction) when examining how individuals interpret and manage their body weight and shape. Given concerns about promoting healthy weight management while avoiding harm to body image, examining the influence of marital relationships on body image and weight control offers important insights about how marital status influences the importance of, and engagement in, steps taken to manage body weight.

L.A. Klos, J. Sobal / Eating Behaviors 14 (2013) 500–507 Role of funding sources There was no external funding source for this study.

Contributors Both authors participated in designing the study, interpreting data, and writing the manuscript, and Lori Klos conducted the data analysis.

Conflict of interest The authors declare no conflicts of interest for this study.

Acknowledgments The authors thank the Division of Nutritional Sciences at Cornell University for providing support for this project.

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