Underestimation of body mass index and weight misperception are common in people with HIV.

Obesity is increasingly prevalent in people with HIV (PWH) and associated with multiple metabolic derangements. Understanding body weight perceptions and discrepancies with actual body weight is an important step for better weight management interventions. The Silhouette Figure Rating Scale (SFRS) was used to assess self-perception of body weight and the Body Shape Questionnaire (BSQ) was used to rate body image concerns among participants in a low-income multiethnic HIV clinic in Houston, Texas. Of 202 participants, 60% underestimated their body mass index (BMI) category. A desired overweight silhouette was chosen by 30% of participants and an obese silhouette was desired by 7%. Only 2% of PWH and obesity perceived themselves as being obese and most (60%) were unconcerned with their current body weight. These findings highlight the importance of individualized weight loss strategies in PWH, taking into consideration desired body image.