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Background  Perceptions of illness are important determinants of health behaviour. A better understanding of perceptions of obesity might allow more effective interventions that challenge these perceptions through lifestyle modification programs. Although several studies have evaluated causal attributions with regard to obesity, other domains of illness perception, such as the perceived consequences of obesity and perceived controllability, have not yet been studied. The aim of the current study was to explore perceptions regarding causes, consequences, control, concerns and time course of obesity of centrally obese adults, with and without an elevated cardiometabolic risk and with or without weight loss, 3 years after screening for metabolic syndrome, and to compare these perceptions.    Methods  Three groups were selected from a longitudinal study dependent on the baseline and 3-year follow-up profiles: individuals with central obesity and metabolic syndrome at both time points (‘persistent cardiometabolic-risk group’,  n  = 80), those with central obesity but without metabolic syndrome on either occasion (‘persistent obese group’,  n  = 63), and formerly obese individuals (‘improved cardiometabolic-risk group’,  n  = 49). Perceptions of obesity were assessed using an adapted version of the Brief Illness Perception Questionnaire (BIPQ, range 0–10). Chi-square and Kruskal-Wallis tests were performed to compare the ‘persistent cardiometabolic risk’ group with the other two groups with regard to patient characteristics and BIPQ scores.    Results  Both males and females who improved their cardiometabolic risk perceived their obesity as shorter (median (IQR): 3.0 (4.0) vs. 6.0 (3.0),  p  < 0.001) and experienced greater personal control over their weight (7.0 (3.0) vs. 5.0 (3.0),  p  = 0.002) compared to those who did not improve. Females who improved their cardiometabolic risk experienced fewer identity and illness concerns, this was not found for males. Other scores did not differ between groups.    Conclusion  Obese adults with an improved cardiometabolic risk profile felt greater personal control and considered their obesity to be of shorter duration. Persistence of central obesity with additional cardiometabolic risk factors had a larger impact on female than male participants with respect to identity and illness concerns. Whether discussing ‘personal control’ is a favourable element in lifestyle intervention should now be assessed in the setting of a controlled trial.

bmc public health

Comparison of perceptions of obesity among adults with central obesity with and without additional cardiometabolic risk factors and among those who were formally obese, 3 years after screening for central obesity