Objective: To measure weight perception among Haitian American outpatients in Miami-Dade County, and to compare weight perception by gender, body mass index (BMI) status, socioeconomic status, marital status and duration of United States residency.

Design: A cross-sectional survey utilizing a BMI-based silhouette matching test. Setting: Recruitment and data collection were performed at four urban medical centers in Miami-Dade County. 

Participants: A convenience sample of 160 adults of Haitian descent, 18 years and older.

Variables measured: Perceived BMI, self-classified weight status, height, weight, desired BMI, occupation, duration of United States residency, income, and education levels.

Analysis: BMI was calculated and categorized according to the National Institutes of Health’s Clinical Guidelines. Wilcoxon signed ranked tests, Tukey post-hoc, t-tests, and one way analysis of variance were performed. Significance was set at p < .05.

Results: Weight misperception was more common among overweight and obese than normal weight patients (p < .001). Men were more satisfied with their body image than women (p < .001).

Conclusions: This study establishes an unprecedented estimate of weight misperception rates among Haitian American outpatients in South Florida. Further research and culturally sensitive interventions are needed to help Haitian American outpatients overcome the barrier of weight misperception.

Weight perception; Weight status; Weight reduction

Magnus M, Guillaume F (2016) Weight Perception among Haitian American Outpatients. JSM Health Educ Prim Health Care 1(2): 1012.

BMI: Body Mass Index

Weight perception is underestimation of weight category based on BMI silhouettes. Nationally representative and local studies have revealed higher prevalence of weight perception among racial and ethnic groups compared to Whites since the 1990s.In order to effectively help individuals maintain healthy weight levels it is important that those individuals have the correct knowledge and perception of healthy weight status. Overweight individuals may be at risk of obesity if they perceive themselves as having normal weight [1]. Overweight is usually a precursor to obesity and its multiple adverse consequences, such as cardiovascular disease and type 2 diabetes [2]. Obesity among adults, children and adolescents alike has been unwavering over the past 12 years in the United States, with a prevalence of 35.5% among adult men and 35.8% among adult women in 2009-2010[3], and a prevalence of 16.9% among children and adolescents for that same period [4].

Studies conducted throughout the past decade have also consistently shown weight misperception to be very common in the United States [1,5-7]. It has been suggested that educating individuals on healthy weight levels may be critical toward tackling the problem of obesity5 . Healthy weight advantage-the protective effect of immigrant status on body mass index—was shown to dissipate with childrens’ age among 6392 9-12 year old immigrant children in Montreal, Canada [8]. On average, body mass index increased by 0.59, 0.73, and 0.82 kg/m2 with each year of age among first generation immigrant, second generation immigrant, and native-born children respectively. As immigrants of various ethnic and racial backgrounds integrate into the American lifestyle and, in some cases, lose the healthy weight advantage they had upon arrival [9], it becomes crucial to understand the dynamics of the acculturation process in relation to weight perception.

Weight misperception has been shown to vary by ethnicity/ race. Dorsey et al. [5], examined data from 17,270 adults who were over 20 years old in the 1999-2006 National Health and Nutrition Examination Survey to determine how prevalence of weight perception varied by ethnicity and race. The researchers calculated BMI, and assessed weight perception by asking participants to classify their weight status as “overweight”, “underweight”, or “about the right weight”5 . Individuals were considered to have a weight misperception if they self-reported a weight category other than their calculated weight category [5]. In this nationally representative sample, weight misperception was found to be more common among both the overweight and obese for men and women, more prevalent among racial/ ethnic minorities, men, and both men and women with lower education levels [5]. Among the overweight and obese, both nonHispanic Blacks and Mexican Americans were found to have a higher prevalence of weight misperception when compared to non-Hispanic Whites (55.4 and 49.1% vs. 33.9% of overweight individuals, and 15.0 and 12.5% vs. 6.0% of obese individuals) [5]. Data analysis from 5,440 adults who participated in the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey found that selfperceived overweight—accurate weight perception—was higher among persons having a higher household income versus lower household income (50.2% vs. 44.2%) [1]. The odds ratio of (accurate) perceived overweight was e significantly higher in women than in men (25.5% versus 8.7%) among those of normal weight and among those who were overweight (77.3% versus 47.8%), and among those who were normal weight and those who were obese (90.0% versus 82.8%). With regard to race, the odds ratio of (accurate) perceived overweight was significantly higher in whites (20.1% of normal weight, 64.8% of overweight, and 88.8% of obese individuals) than in Blacks (4.7% of normal weight, 46.3% of overweight, and 79.3% of obese individuals) or Hispanics (17.0% of normal weight, 45.6% of overweight, and 84.8% of obese individuals) [1].

In a study conducted among women at an inner-city familyplanning clinic, Potti et al. [6], found that Black and Hispanic women significantly underestimated actual body size, with overweight participants underestimating their body size by approximately 12%, and obese participants, by approximately 20%. Miller et al. [7], conducted a study among people living in the Southeastern United States with a large majority Black population – known as the Stroke Belt – and found elevated odds of weight misperception among Blacks in the overweight and obese population. Among overweight and obese individuals, Blacks had more than twice the odds of identifying oneself as having normal weight compared to Whites recording an odds ratio of 2.34for overweight and 2.31 for obese individuals [7-9].

Evaluations of various instruments involving a BMI-based silhouette-matching test derived from – or including – the initial Stunkard figure rating scale [10] to assess body image perceptions have confirmed the validity and reliability of this method in various populations [11-15]. Tehard et al. [11], tested the Stunkard figure rating scale on a sample of 152 French women for the validation study of self-reported anthropometric measurements and selected 91,815 women to examine misreporting of body silhouettes. The researchers concluded that body silhouettes are simple and useful indicators of body mass index [11]. Bulik et al. [12], conducted a landmark study on a sample of 16,728 female and 11,366 male Caucasians aged 18 to 100 years, using the Stunkard figure rating scale, and set the norms for researchers and clinicians to make associations between an individual’s choice of a particular silhouette and his or her self-reported height and weight. Peterson et al., tested the validity of the BMI silhouettes among 170 undergraduate students and revealed that the validity coefficients using Pearson r correlations ranged from 0.69 to 0.84 for comparisons between BMI values for the BMI-SMT, and actual BMI measures [14]. Based on the Stunkard silhouette-matching principle, Pulvers et al., developed and validated (Cronbach’s alpha = 0.95) a culturally relevant body image instrument was developed and based on the Stunkard silhouette-matching principle among urban African Americans [15,16]. Body image an individual’s subjective mental image of one’s own body is an importantfactorinfluencingweight relatedperceptionsandactivities16.An extensive literature search focusing on body image perceptions among Haitians living in the US revealed no published studies on weight perception. However, Strickman-Stein et al. [9], analyzed demographic and anthropometric characteristics of 250 Haitian children aged 2 to18 years, using data from their medical records dating from January 2004 and July 2006. The researchers found that Haitianborn children had a lower BMI percentile (68th percentile) than did US-born Haitian children (81st percentile), but Haitian–born children experienced a 3.7% increase in BMI percentile for each year of US residency [9]. There are no published studies on weight perception among adult Haitians living in the US. Body weight is related to eating habits and since the eating habits of parents, mothers in particular, affect the eating habits of their children [17]. It is important to investigate weight perceptions of Haitian Americans in order to begin to plan culturally sensitive overweight prevention programs for that population. In a crosssectional study among Haitian Americans and African Americans with and without type 2 diabetes using the Healthy Eating Index 2005 (HEI-05) and the Alternate Healthy Eating Index (AHEI), Huffman et al. [17], found marked differences in dietary patterns between Haitian Americans and African Americans, with African Americans having less favorable dietary patterns than Haitian Americans [18]. The HEI-05 has 12 dietary components and measures compliance to the 2005 Dietary Guidelines (DGA) for Americans in terms of diet quality [19] (DGA), and the AHEI is a modified version of the HEI which measures diet quality in terms of adherence to the 2005 and 2010 DGAs, using 9 dietary components [17,19]. On the HEI-05, African Americans scored lower than Haitian Americans in total fruit intake (3.9 vs. 4.3 out of 5) and total vegetable intake (3.8 vs. 4.6 out of 5) [17]. On the AHEI, African Americans also scored lower than Haitian Americans in fruit and vegetable intakes (5.4 vs. 6.1 out of 10, and 5.5 vs. 7.5 out of 10, respectively) [17,20]. Huffman et al., recommended that future research could examine the differences in eating habits between different ethnicities to facilitate the planning of culturally sensitive dietary counseling aimed at primary and secondary prevention of type 2 diabetes [17]. In addition to a sound understanding of particular eating habits of Haitians living in the US, a good comprehension of weight perception in relation to weight status in that population might facilitate culturally sensitive dietary interventions aimed 

at preventing diet-related diseases in that particular group. In 2009, an estimated 830,000 persons of Haitian ancestry were living in the US, and 45% of whom lived in Florida [21]. In summary, prevalence of weight perception has been shown to be higher among persons who are overweight and obese (compared to ideal weight), among men (compared to women), among those with minimal education (compared to well-educated persons). There are no published studies weight perceptions and marital status or length of stay in the US, or among non-pregnant adult Haitian Americans.

While some weight perception studies used logistic regression to express variation in weight perception as odds ratios [1,5,7], Potti et al., developed a body image discrepancy score-the discrepancy between body image perception and actual BMI [6]. Each silhouette was converted to the BMI standardized by the population-based norms linking BMI to the nine silhouettes, as described by Bulik et al. [12]. A body image discrepancy score was then calculated for each subject by subtracting the subject’s perceived silhouette-linked BMI value from the measured BMI. The body image discrepancy score was then analyzed by demographic and socioeconomic variables.

The purpose of this study was to use a BMI-based silhouettematching test to measure body image perceptions among Haitian American outpatients, and to determine participants’ actual BMI, gender, length of US residency, marital status, education, occupation, age, and to evaluate how this group fares on the issue.

The main hypotheses under consideration include:

1. Weight misperception in Haitian Americans is more common among overweight and obese individuals than normal weight individuals.

2. Weight misperception in Haitian Americans is more common in men than women.

3. Weight misperception in Haitian Americans is more common among those with fewer than 20 years of US residency than those with more than 20 years of US residency.

4. Weight misperception in Haitian Americans is more common among those with a lower education level than those with a higher education level.

5. Weight misperception in Haitian Americans is more common among single than among married individuals.

Sample size calculations through a priori analysis indicate that the minimum sample size required to obtain 80% power in a one way analysis of variance (ANOVA) for a medium size effect (d=.25) and an alpha =.05 was 160 outpatients. A convenience sample of 160 outpatients of Haitian descent was recruited for this study. The inclusion criteria were: a) being of Haitian descent -- Haitian-born, born of Haitian parents and raised in a household with at least one Haitian-born parent, b) 18 years of age or older and c) being English- or Creole-speaking. The exclusion criteria included: pregnancy, being physically or mentally disabled, and being unable comprehend English or Haitian Creole. Outpatients were recruited at a convenience sample of four urban medical centers which serve a high percentage of Haitian and Haitian Americans in South Florida. Physicians’ approval was obtained for each medical center. Approval for the study was granted by Florida International University’s Institutional Review Board. To increase validity, the principal investigator who is bilingual, translated the consent form and survey instrument into Haitian Creole, then a different translator back-translated the Haitian Creole versions into English without having seen the originals, and both versions of each document were compared to ensure clarity and accuracy of the translation before conducting the study. Outpatients were interviewed and chart data on height and weight were derived from outpatients’ charts. All outpatients were informed of the procedures and purpose of the study. They completed and signed the informed consent form.

The study design was a cross-sectional survey. The study was pilot-tested on a sample of 16 eligible outpatients from one of the data collection sites. No problems were identified.

The instrument

The instrument utilized consisted of a two-part, twelveitem questionnaire. Part 1 of the instrument contained sociodemographic questionnaire assessing weight, height, age, marital status, socioeconomic status, length of United States residency, and perceived weight status. Part 2 of the instrument consisted of the Pulvers et al., ethnically neutral and gender-specific figure rating [22]. The instrument is presented in Appendix A. The Pulvers et al. figure rating scale consists of nine drawings of adult women and nine drawings of adult men ranging from extremely thin to extremely obese. The drawings span a BMI of roughly 16 to 40 in increments of 3 BMI points [15]. Outpatients received the gender-appropriate version of the instrument. In Part 2 of the instrument outpatients were asked to identify which figure most closely resembles their own body shape, which one they think had ideal weight, which one they would like to have, which one weighed too much, and which one was most likely to get sick. Responses to the questions consisted of both Likert scalelike and closed-ended format. The Pulvers figure rating scale was evaluated among urban African-Americans for validity and reliability and was found to have good convergent and concurrent validity and excellent internal consistency among raters (Cronbach’s alpha = 0.95) [15].

Data collection and analysis

Participants completed the survey in their language of preference: English or Haitian Creole the National Institutes of Health’s Clinical Guidelines [23] were used to categorized outpatients by BMI for the purpose of analysis. SPSS Statistics 24.0 (IBM Corp., 2015, Armonk, NY) was used to analyze the data.

Cross-tabulations, one-way ANOVA and Wilcoxon signed ranked tests were used to compare Body Size Discrepancy (the difference between actual and perceived BMI) among normal weight, overweight and obese outpatients. Student’s t-test was used to determine whether there were any statistically significant differences in Body Size Discrepancy and demographic and socioeconomic variables. Demographic variables included: gender, age, education and marital status. Socioeconomic variables include: occupation, annual income, length of stay in the US. Body Size Discrepancy, a continuous variable, was determined by calculating the difference between actual and perceived BMI. Hape A Student’s t-test was also used to determine any statistically significant difference in Shape Discrepancy-the difference between perceived and desired BMI and demographic and socioeconomic variables.

While Body Size Discrepancy reflects weight misperception, the difference between actual and perceived BMI, it does not represent the individual’s weight preference and potential readiness to change weight status. In this study, an additional indicator, a Shape Discrepancy (SD) score (perceived BMI – desired BMI) was derived to quantify body image satisfaction with one’s perceived shape. The Shape Discrepancy score offers the client’s weight perspective.

Approximately59% of Haitian American outpatients who were asked to participate in the study agreed to be measured and to complete the survey. Table (1) presents the demographic characteristics of the outpatientsand Table (2) presentssocioeconomic characteristics.The difference between actual and perceived weight status varied among outpatients by weight status (Table 3). Approximately 27.85% of 158 Haitian American outpatients were obese, 49.37% were overweight, 21.25% were at ideal body weight, and 1.26% was underweight. A Wilcoxon Signed Ranks Test revealed that 6.96% of outpatients over estimated weight status (perceived themselves as being in a heavier category than they actually were). The majority (62.03 %) perceived themselves as being in a lower weight category than actual weight status. Only 31.01% accurately perceived themselves as being in their actual weight category. Obese outpatients had the largest gap between actual and perceived weight status. Only 2.5% of the 44 obese outpatients perceived themselves as being obese.

The indicatorBody shape discrepancy (BSD) was developed as a measure to compare actual weight and perceived weight and was calculated as: actual BMI (weight in pounds x 703/ height in in2 ) – perceived BMI. BSD is measured in kg/m2 . When outpatients were asked: “Which shape looks the most like you?”, the BMI of the selected silhouette was compared to their actual BMI. For example if a respondent’s actual BMI was 27, but the respondent selected silhouette C (BMI=22), then the body shape discrepancy would be +5. If the respondent’s actually BMI was 22 and the respondent selected silhouette C, then the body shape discrepancy would be 0. If a respondent’s actual BMI was 22 but selected silhouette D (BMI=25) then the body shape discrepancy would be -3.

One-way ANOVA revealed a significant difference in mean body shape discrepancy BSD (the difference between actual and perceived BMI) by BMI category, F (2,155) = 21.63, p < .001 (Figure 1). A Tukey post-hoc comparison revealed that obese outpatients had the highest mean BSD 4.11 ± 4.37 indicating underestimation of weight status (p<.05). Outpatients who were in the underweight category (n=2) were excluded from the analysis due to small group size.

Weight misperception by gender, length of us residency, education level, and marital status

Independent samples t-tests revealed no significant differences in BSD by gender, duration of US residency (<20 versus ≥ 20 years), education (some high school education versus some college education), or marital status (Table 4). Outpatients who had only a primary school education were excluded from the analysis due to small group size (n=21).

Body image satisfaction according to length of us residency

A Shape Discrepancy (SD) score (perceived BMI – desired BMI) was derived to quantify body image satisfaction with one’s perceived shape. A SD score of 0 indicates satisfaction with one’s perceived shape. A SD score > 0 indicates one’s desired shape being thinner than one’s perceived shape, and a SD score < 0 indicates one’s desired shape being heavier than one’s perceived shape. For example, if a respondent’s perceived shape was silhouette E (BMI=28) and desired shape was silhouette C (BMI=22), then SD would be + 6 kg/m2 . If a respondent’s perceived shape was silhouette E and desired shape was silhouette G (BMI=34), then SD would be -6 kg/m2 .

Independent samples t-test revealed no significant difference in shape discrepancy between Haitian Americans who had lived in the US for more than 20 years and those with fewer than 20 years of US residency. There was no difference in body satisfaction, as measured by Shape Discrepancy, in relation to years of residence in the US (Table 5).

Body image satisfaction comparison by gender

Independent samples t-test revealed significant difference in SD by gender, p = .000. Females had a higher mean SD (M = 4.08 ± 4.22) than males (M = 1.15 ± 3.56). Female outpatients indicated a stronger preference for a thinner shape than males. The difference in BSD score between males and females was not significant. In summary, Hypotheses 1 and 7 have been accepted. Hypotheses 2 through 6 have been rejected.

Approximately59% of Haitian American outpatients who were asked to participate in the study agreed to be measured and to complete the survey. Table (1)

Table 1: Demographic Characteristics of Haitian American Outpatients.

presents the demographic characteristics of the outpatientsand Table (2)

Table 2: Socioeconomic Characteristics of Haitian American Outpatients.

presentssocioeconomic characteristics.The difference between actual and perceived weight status varied among outpatients by weight status (Table 3).

Table 3: Perceived and Actual Weight Status among Haitian American Outpatients

Approximately 27.85% of 158 Haitian American outpatients were obese, 49.37% were overweight, 21.25% were at ideal body weight, and 1.26% was underweight. A Wilcoxon Signed Ranks Test revealed that 6.96% of outpatients over estimated weight status (perceived themselves as being in a heavier category than they actually were). The majority (62.03 %) perceived themselves as being in a lower weight category than actual weight status. Only 31.01% accurately perceived themselves as being in their actual weight category. Obese outpatients had the largest gap between actual and perceived weight status. Only 2.5% of the 44 obese outpatients perceived themselves as being obese.

The indicatorBody shape discrepancy (BSD) was developed as a measure to compare actual weight and perceived weight and was calculated as: actual BMI (weight in pounds x 703/ height in in2 ) – perceived BMI. BSD is measured in kg/m2 . When outpatients were asked: “Which shape looks the most like you?”, the BMI of the selected silhouette was compared to their actual BMI. For example if a respondent’s actual BMI was 27, but the respondent selected silhouette C (BMI=22), then the body shape discrepancy would be +5. If the respondent’s actually BMI was 22 and the respondent selected silhouette C, then the body shape discrepancy would be 0. If a respondent’s actual BMI was 22 but selected silhouette D (BMI=25) then the body shape discrepancy would be -3.

One-way ANOVA revealed a significant difference in mean body shape discrepancy BSD (the difference between actual and perceived BMI) by BMI category, F (2,155) = 21.63, p < .001 (Figure 1).

Figure 1: Actual and Perceived BMI by BMI category in response to the question “How would you describe your weight now?” (N=158).

A Tukey post-hoc comparison revealed that obese outpatients had the highest mean BSD 4.11 ± 4.37 indicating underestimation of weight status (p<.05). Outpatients who were in the underweight category (n=2) were excluded from the analysis due to small group size.

Weight misperception by gender, length of us residency, education level, and marital status

Independent samples t-tests revealed no significant differences in BSD by gender, duration of US residency (<20 versus ≥ 20 years), education (some high school education versus some college education), or marital status (Table 4). Outpatients who had only a primary school education were excluded from the analysis due to small group size (n=21).

Table 4: Body Size Discrepancy (BSD) and Shape Discrepancy (SD) by Gender, Age, Education, and Marital Status among Haitian American Outpatients.

Body image satisfaction according to length of us residency

A Shape Discrepancy (SD) score (perceived BMI – desired BMI) was derived to quantify body image satisfaction with one’s perceived shape. A SD score of 0 indicates satisfaction with one’s perceived shape. A SD score > 0 indicates one’s desired shape being thinner than one’s perceived shape, and a SD score < 0 indicates one’s desired shape being heavier than one’s perceived shape. For example, if a respondent’s perceived shape was silhouette E (BMI=28) and desired shape was silhouette C (BMI=22), then SD would be + 6 kg/m2 . If a respondent’s perceived shape was silhouette E and desired shape was silhouette G (BMI=34), then SD would be -6 kg/m2 .

Independent samples t-test revealed no significant difference in shape discrepancy between Haitian Americans who had lived in the US for more than 20 years and those with fewer than 20 years of US residency. There was no difference in body satisfaction, as measured by Shape Discrepancy, in relation to years of residence in the US (Table 5).

Table 5: Body Size Discrepancy (BSD) and Shape Discrepancy (SD) by Occupation, Income, and Length of US Residency among Haitian American Outpatients.

Body image satisfaction comparison by gender

Independent samples t-test revealed significant difference in SD by gender, p = .000. Females had a higher mean SD (M = 4.08 ± 4.22) than males (M = 1.15 ± 3.56). Female outpatients indicated a stronger preference for a thinner shape than males. The difference in BSD score between males and females was not significant. In summary, Hypotheses 1 and 7 have been accepted. Hypotheses 2 through 6 have been rejected.

This study established an unprecedented estimate of the rate of weight misperception among Haitian American outpatients in South Florida. It reveals that Haitian American outpatients have the highest documented prevalence of weight misperception surpassing African Americans (62.8%), surpassing nonHispanic African Americans [5] (55.4%). Public health and nutrition professionals who plan weight reduction programs need to offer multiple strategies which help Haitian American outpatients to overcome the barrier of weight misperception. A literature search of interventions which have attempted to correct weight misperception revealed that despite the fact that weight perception has been documented since 2002, there are no published reports on interventions which have attempted to correct weight misperception. The short-term and long-term health risks of being overweight or obese may need to be may need to be emphasized [24,25]. Given the documented relationship between employment discrimination and obesity and race, it may also be valuable to remind Haitian Americans that unlike race, weight status is totally under their control. Providing practical strategies which can help to overcome barriers to weight loss and maintenance may be essential.

The shape discrepancy scores (M = 4.08 ± 4.22 for women and M = 1.15 ± 3.56for men) revealed that women in this study were significantly less satisfied (p < .001 in an independent samples t-test) with their body image than men. Approximately 31% of men and 57% of women desired a healthy body weight (M = 22.82 ± 2.84 for men and M = 23.63 ± 3.14 for women). This may indicate a willingness to achieve and maintain healthy weight, a revelation which is particularly important for planners of weight reduction programs. Further research is warranted on strategies which are effective for helping Haitian American outpatients to achieve and maintain recommend weight status.

The shape discrepancy scores (M = 4.08 ± 4.22 for women and M = 1.15 ± 3.56for men) revealed that women in this study were significantly less satisfied (p < .001 in an independent samples t-test) with their body image than men. Approximately 31% of men and 57% of women desired a healthy body weight (M = 22.82 ± 2.84 for men and M = 23.63 ± 3.14 for women). This may indicate a willingness to achieve and maintain healthy weight, a revelation which is particularly important for planners of weight reduction programs. Further research is warranted on strategies which are effective for helping Haitian American outpatients to achieve and maintain recommend weight status.

Program planners in weight reduction for this population may also need to acknowledge the differences in food ways between African Americans and Haitian Americans, and offer culture-specific dietary recommendations. Although one study documented a prevalence of overweight of 14.9% and an obesity rate of 14.9% among Haitian American children in Miami [8], there are no published national or random sample estimates of prevalence of overweight and obesity among Haitian Americans. Future research may need to estimate the prevalence data of overweight/obesity in communities with substantial Haitian American populations--New York and South Florida. In Golden Glades, FL a satellite of Miami FL, 27.3% of the population is Haitian American [26].

Increases in the non-African American Black population have outpaced the African American population growth in recent years [27]. Between 1990-2000, nearly 25% of the growth of the Black population in the U.S. was attributed to newcomers from Africa and the Caribbean. While the number of African-Americans increased by 10% to 31 million in the 1990s, the number of Caribbean-Americans increased by 63% to more than 1.5 million, and the number of Africans in America more than doubled to 537,000. Furthermore, the Caribbean American population is growing faster than any other ethnic group in Broward County (Fort Lauderdale) and Palm Beach counties, exceeding even the booming Hispanic population [28]. Since weight misperception is highest among Haitian American outpatients, planners of overweight prevention and weight maintenance programs may need to target predominantly Haitian American communities in order to assess the prevalence of weight misperception, overweight and obesity, and provide interventions which reduce obesity-related morbidity.

The authors wish to thank Haitian American physicians and outpatients for their willingness to participate.

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