The review articles by Chai NC et al[1, 2] comprehensively address obesity and headache, conditions associated with a substantial personal and societal impact. This association is particularly relevant given that both conditions are potentially modifiable. Limitations of physical exercise and an unhealthy nutrition relationship are linked with different behavioral profiles. Also different body weight and illness perceptions can concur in the development and establishment of obesity and of associated conditions, such as arterial hypertension. Perceived weight status, therefore, is a better predictor of weight control behavior than actual weight status. Moreover, and of interest, perceptions of food choices in a local neighborhood, along with perceptions of heavy traffic on local streets and concern about road safety, may be indirect influences on weight and obesity.
The relationship between juvenile and adolescent arterial hypertension with obesity is well known, with likely shared mechanisms of development and maintenance throughout the human lifespan.[5, 6] In the work we are undertaking, we aim to investigate if the perception of weight status and, in particular, if the true or false perception of overweight-obesity (body mass index [BMI] ≥25.0) is associated with different prevalence of headache in teens and young adults. We are presently studying 882 youngsters (523F, 359M, range 13–30 years old), BMI 22.44 ± 3.27, to investigate the relationship, if any, of perceived and reported body size and, concurrently, of objectively measured weight and height with headache. Other relationships explored include: sleep deprivation; six different types of environmental noise exposure; and road accidents. Studied urban settings include: the home; work/school; night leisure time; musical events; sporting activities, and public buildings. We also are attempting to distinguish results with reference to noise from machines, human voices, and music. Noise perception is being assessed by 1–10 Likert's scales. Sleep duration and the time of falling asleep are recorded on single days and related back to specific activities. Alcohol intake, coffee, cigarette smoking, illicit and stimulating drugs habits, and work and school achievements are also considered.
Among all the considered variables, greater odds of headache are more significantly associated with gender (female) and greater exposure to noise (human voices). Prevalence of erroneous perception of overweight-obesity is 173/713 (24.3%) in normal weight subjects, whereas erroneous perception of normal weight is 63/169 (37.3%) among overweight-obese subjects. Headache is more prevalent in 57/106 subjects with truly perceived overweight-obesity (53.8%) than in 27/63 subjects without this perception (42.9%). Also in normal weight subjects, headache is more prevalent (106/173; 61.3%) in those with perceived overweight-obesity than in those with a true perception of normal weight (227/540; 42.0%).
Actual overweight-obesity in young populations, defined by weight/height measurement and by BMI criteria, is not significantly associated with headache (χ2 0.380, P = .537, OR 1.128 [CI 0.806–1.577]). Conversely, perceived overweight-obesity, defined by the perception of the subjects, is significantly associated with headache (χ2 20.332, P < .0001, OR 1.931 [CI 1.448–2.575]).
Considering only young populations with actual overweight-obesity, defined by weight/height measurement and by BMI criteria, perceived overweight-obesity is not significantly associated with headache (χ2 1.472, P = .225, OR 1.551 [CI 0.827–2.907]). Young populations with actual normal weight, defined by weight/height measurement and by BMI criteria, perceived overweight-obesity is significantly associated with headache (χ2 18.710, P < .0001, OR 2.181 [CI 1.537–3.097]).
According to our results, headache does not have a straightforward association with overweight-obesity in youngsters when considering the objective measurement criterion. We observed a greater association of an individual perception of overweight-obesity with headache. As Chai and colleagues appropriately address in their review, it is possible that epidemiological reports could be biased by the actual definition of overweight-obesity, namely by the self-reported and not actually measured weight and height.
Since headache is reported with a greater frequency in younger population groups with an erroneous perception of excessive weight, the challenge could be that prevention programs designed to address specific behaviors that can affect the development of obesity should take into account the behavioral correlates of body weight perception. This demands the planning of a more articulated approach when targeting subgroups, considering also the possible effects of both environment and habits.