Weight Misperception among Deaf and Hard-of-Hearing Adults in the United States: Results from NHANES, 1999-2018

BACKGROUND: Weight misperception is a critical indicator of body dissatisfaction and cardiovascular risk, yet remains understudied in deaf and hard-of-hearing (DHH) populations who face unique barriers to health literacy and visual normalization. OBJECTIVE: This study aimed to examine differences in weight misperception among people who are DHH , segmented by self-reported level of hearing loss. METHODS: We used data from the National Health and Nutrition Examination Survey (1999-2018) to capture a nationally representative sample to the U.S. (unweighted n = 47,326). We used binary and multinomial logistic regression to assess odds of discordance in self-perceived weight and two objective metrics (i.e., Body Mass Index [BMI] and Waist-to-Height Ratio [WtHR]), by DHH status, adjusting for sex and age. RESULTS: In binary models, DHH individuals had higher odds of inaccurate weight perception using BMI (aORs: deaf = 1.19, HH = 1.24), but not WtHR. In multinomial models, DHH had significantly higher odds of underestimating their weight with respect to both BMI (deaf = 1.21; HH = 1.27) and WtHR (deaf = 1.52; HH = 1.26). Lower odds of overestimation were observed for WtHR (deaf = 0.70; HH = 0.78). CONCLUSIONS: Findings suggest DHH individuals may struggle with visual assessments of adiposity, supporting the visual normalization hypothesis. Future research should identify mechanisms between DHH status and weight misperception (e.g., limited health literacy).