Gender and race/ethnic differences in inaccurate weight perceptions among U.S. adolescents

Association between lifestyle-related risk behaviors, chronic diseases, and body image distortion: gender differences in follow-up 1 of the ELSA-Brasil cohort

Aim

To determine the prevalence of body image accuracy/distortion in Brazilian men and women and to investigate sociodemographic and lifestyle-related factors, and the presence of chronic diseases associated with body image distortion.

Methods

Data from 6,357 men and 7,657 women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were collected using a multidimensional questionnaire covering sociodemographic characteristics, health behaviors, heath conditions and body image perception.

Results

Most participants (53.5% of the women and 54.7% of the men) were found to have an accurate self-perception of their body. When the factors associated with the perception of being heavier than reality were investigated, adopting weight loss measures and not being hypertensive proved protective against this distortion, both in women and men. Conversely, the perception of being lighter than reality was associated, in both women and men, with better education, being black or of mixed race, adopting weight loss measures and not being hypertensive or diabetic. Additional factors associated with underestimating weight were not consuming alcohol (only in women) and belonging to a lower social class (only in men).

Conclusion

These findings may contribute to the implementation of public health policies and interventions to promote health and well-being in the Brazilian population.

[Body image perception, socioeconomic characteristics, and lifestyle in women participating in ELSA-Brasil in Bahia, Brazil]

Body image distortion is an alteration in the perception of the body that can have repercussions on health. This study aims to estimate the prevalence of body image accuracy and distortion among women participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) living in Bahia State, Brazil, and to investigate associations with socioeconomic characteristics, lifestyle, and gynecological care seeking. A total of 609 women aged 50 to 69 years participated in the study, who answered face-to-face questionnaires from 2012 to 2014. The Stunkard silhouette scale was used to investigate accurate or distorted perception for more or less weight. The relative risk ratio (RR) was calculated by multinomial logistic regression using Stata 13. Most participants have an accurate perception of their own bodies (53.7%). Among those with distorted perception, there is a tendency to distort towards less weight (38.1%). In the multinomial regression analysis, the variables race/skin color and education remained associated with the distortion towards underweight. The race/skin color variable was positively associated with the distortion towards underweight among Mixed-race women (RR = 1.89; 95%CI: 1.13-3.16) and black (RR = 2.10; 95%CI: 1.25-3.55), while the education variable among those with up to high school education (RR = 1.65; 95%CI: 1.18-2.33). There were no associations with the other variables or with distortion for more weight. The results contribute to explaining the relationships between body image perception and socioeconomic factors, revealing that women of different races/skin colors and varying educational levels are influenced in different ways by social discourses, impacting the perception of their body image.

Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors

This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.

Dietary Patterns, Weight Perception and Obesity Status, among 10-12-Year-Old Children; an Epidemiological Study in Greece

Adherence to certain dietary patterns influences obesity status in both children and adults. Weight perception influences dietary habits. The aim of this study was to examine children’s dietary habits and obesity status, in relation to weight perception. One thousand seven hundred Greek students enrolled in this study during 2014–2016. Children’s characteristics were assessed through validated questionnaires, and weight status was classified according to the criteria of the International Obesity Task Force. Dietary patterns were assessed through exploratory factor analysis. Overall, 52.2% of children characterized themselves as normal weight, 34.5% as low weight, and 13.3% as overweight/obese; 52.5% of children were in accordance with their actual weight status, with girls being more likely to overestimate their weight. Children followed three dietary patterns, i.e., starchy and protein foods, unhealthy/high-fat foods, and healthy foods. Children who followed the healthy dietary pattern and had accurate weight perception (in accordance with their actual weight), had lower odds of being overweight/obese (p < 0.001). Accurate weight perception in conjunction with healthy dietary habits may play a determinant role in the prevention of obesity. From a public health perspective, early identification of children’s weight misperception along with healthy dietary habit promotion shape a crucial role in childhood obesity confrontation.

Weight Misperception among African American Adolescents: The Jackson Heart KIDS Pilot Study

Background

Weight misperception is a common problem among adolescents; however, few studies have examined contributing factors among an exclusively African American population. The purpose of this study was to examine factors associated with weight misperception among 12- to 19-year-old participants in the Jackson Heart KIDS Pilot Study (JHS-KIDS).

Methods

Data were drawn from JHS-KIDS, a prospective, observational examination of cardiovascular-related risk factors among African American adolescents who were children or grandchildren of participants in the Jackson Heart Study. Adolescent weight misperception - discordance between measured weight status and perceived weight status - was the primary outcome of interest. Self-reported weight control behaviors, parent concerns about adolescents' weight, parent-perceived responsibility for adolescent's weight and daily hassles were the primary independent variables of interest.

Results

The analytic sample was equally divided by females (n=107) and males (n=105) and one third of study participants (33.5%) had discordance between their actual and perceived weight. Results from fully adjusted sex-stratified modified Poisson regression models indicated that weight behavior control was significant among females (PR = .66, 95%CI:1.20-2.30). Parental concerns about child weight were significant for males. Each additional point increase in the parent's concern about their weight score was associated with a 9% increase in the adjusted prevalence of weight misperception among males (95%CI: 1.03-1.16).

Conclusions

The sex-specific patterns in this study highlight heterogeneity among African American adolescents and an urgent need to consider sex and gender when developing targeted interventions for youth who are at high risk for weight misperceptions and unhealthy weight control practices.

Factors Associated with Tendency for Weight Loss in a Representative Sample of Children and Adolescents: The CASPIAN-V Study

Background:

This study aims to determine the factors affecting the tendency to lose weight (TLW) and its methods in Iranian children and adolescents.

Methods:

In this cross-sectional nationwide study 14800 students, aged 7–18 years, living in 30 provinces of Iran were selected via multistage cluster random sampling method. The dietary and physical activity habits and TLW as well as psychosocial health status, anxiety, self-satisfaction, and change in dietary behaviors were assessed by the global school-based student health survey (WHO-GSHS) questionnaire. Multivariate logistic regression model was used to identify factors influencing TLW.

Results:

Overall, 14274 students (participation rate of 99%), consisting of 51% boys and 71.4% urban residents, completed the study. Of them, 37.7% (51.4% Girls and 48.6% boys) tended to lose weight. In multivariate model, the odds for TLW was 12% higher in students aged 13–18 years than those aged 6–12 years (OR = 1.12, 95% CI: 1.02 to 1.23; P < 0.001). Students with high anxiety level were 43% more likely to have TLW (OR = 1.43, 95% CI: 1.28–1.59; P < 0.001). The odds of increasing physical activity for weight loss was 22% lower in obese than in normal weight students (OR = 0.78, 95% CI: 0.66 to 0.93; P < 0.001).

Conclusions:

TLW was significantly higher in girls, as well as in those with higher anxiety level. In addition to dietary change, increasing physical activity should be encouraged among children and adolescents with excess weight. Public education regarding proper lifestyle change for reaching healthy weight should be underscored.

Contributions of Anthropometrics and Lifestyle to Blood Pressure in Japanese University Students : Investigation by Annual Health Screening

Background : High blood pressure (BP) is a healthcare problem in young persons. There are racial differences in anthropometrics, dietary habit and lifestyle relating to BP. Therefore, this study investigated the relationship between anthropometrics, lifestyle and BP obtained in the Japanese university students. Materials and Methods : Participants were recruited in annual health screening including questionnaire, measurements of BP and anthropometrics calculating body mass index (BMI). Totally, 14,280 students (10,273 males and 4,007 females) were eligible. Multiple regression analyses were applied to predict contributors to high BP. Results : BMI was the most powerful contributor to high BP in many subgroups divided by gender and graduation (p < 0.001). In lifestyle, contribution of lack of exercise to high BPs was observed in the undergraduates. Smoking, drinking and breakfast skipping had no significant impact on high BP. However, smoking and drinking permeated and exercise habit declined after graduation. Prevalence of obesity (BMI ≥ 25 kg / m2) and hypertension ( ≥ 140 / 90 mmHg) increased in subgroups with advanced age (p < 0.001). Conclusion: BMI was found to be the most powerful contributor to high BPs. Health literacy to modify lifestyle is important to prevent hypertension for university students who are exposed to social trends of unhealthy lifestyle. J. Med. Invest. 67 : 174-181, February, 2020.

Body Weight Misperception and Psychological Distress Among Children and Adolescents: The CASPIAN-V Study

Objectives

Misperception of weight status is a risk factor that affects psychological health. The aim of this study was to evaluate the association between weight misperception patterns and psychological distress among Iranian children and adolescents.

Methods

This was a cross-sectional nationwide study where data was collected from 14,440 students, aged 7–18 years who participated in the national school-based surveillance program (CASPIAN-V). The students’ weight perception and psychological distress were assessed by validated questionnaires. Weight misperception was classified as misperception of being either underweight or overweight with respect to actual weight.

Results

The rate of weight misperception in all study participants was 59.1%. In groups with a perception of being underweight or overweight, the risks of worthlessness, being worried, experiencing aggression, insomnia, or depression, were significantly higher than groups with an accurate weight perception (p < 0.05). The risk of anxiety in girls of normal weight who perceived themselves as underweight, decreased by 57% compared to girls with an accurate weight perception (OR: 0.43; 95% CI, 0.28–0.66).

Conclusion

Weight misperception is highly prevalent among Iranian children and adolescents and is associated with their psychological health status. Appropriate education intervention needs to be developed to improve the children and adolescents’ perception of their body weight status.

Body Weight Misperception and Weight Disorders among Chinese Children and Adolescents: A Latent Class Analysis

Body misperception plays an important role in the development of weight and dietary disorders among children and adolescents. A school-based health promotion program (2014-2015) was conducted to promote the school health education and improve the teenagers' physical health among Chinese children and adolescents. Based on this program, we intended to examine weight status and weight misperception among Chinese children and adolescents and to explore the relationship between weight misperception and lifestyle behaviors. A total of 10 708 Chinese children and adolescents in 3rd and 7th grade from Shandong and Qinghai province participated in the program. The participants' dietary and activity patterns were clustered by latent class analysis (LCA). Logistic regression analysis was undertaken to explore the relationship between weight perception and demographic factors or dietary and activity patterns. Given the gender-specific difference of children and adolescents, analyses were separately conducted among boys and girls. The total prevalence of weight misperception was 44.50%. Boys, especially those in higher grade and living in wealthier district, were more likely to misperceive body weight. Girls were more likely to overestimate their weight (26.10%) while boys tended to underestimate the weight (28.32%). Three latent dietary and activity patterns including obesogenic pattern, malnourished pattern and healthy pattern were derived. The participants who had weight misperception were more likely to choose unhealthy dietary and exercise activities. The high prevalence of weight misperception was closely related to the unhealthy weight pattern and unhealthy dietary or exercise patterns. Our research found that most children and adolescents failed to perceive their weight correctly and boys tended to underestimate their weight while girls were subjected to overestimation. So, comprehensive intervention programs should focus on improving self-weight awareness, and appropriate guidance should be made to lead the adolescents to more healthy weight pattern.

Is obesity associated with depression in children? Systematic review and meta-analysis

OBJECTIVES

To compare the odds of depression in obese and overweight children with that in normal-weight children in the community.

DESIGN

Systematic review and random-effect meta-analysis of observational studies.

DATA SOURCES

EMBASE, PubMed and PsychINFO electronic databases, published between January 2000 and January 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Cross-sectional or longitudinal observational studies that recruited children (aged <18 years) drawn from the community who had their weight status classified by body mass index, using age-adjusted and sex-adjusted reference charts or the International Obesity Task Force age-sex specific cut-offs, and concurrent or prospective odds of depression were measured.

RESULTS

Twenty-two studies representing 143 603 children were included in the meta-analysis. Prevalence of depression among obese children was 10.4%. Compared with normal-weight children, odds of depression were 1.32 higher (95% CI 1.17 to 1.50) in obese children. Among obese female children, odds of depression were 1.44 (95% CI 1.20 to 1.72) higher compared with that of normal-weight female children. No association was found between overweight children and depression (OR 1.04, 95% CI 0.95 to 1.14) or among obese or overweight male subgroups and depression (OR 1.14, 95% CI 0.93 to 1.41% and 1.08, 95% CI 0.85 to 1.37, respectively). Subgroup analysis of cross-sectional and longitudinal studies separately revealed childhood obesity was associated with both concurrent (OR 1.26, 95% CI 1.09 to 1.45) and prospective odds (OR 1.51, 95% CI 1.21 to 1.88) of depression.

CONCLUSION

We found strong evidence that obese female children have a significantly higher odds of depression compared with normal-weight female children, and this risk persists into adulthood. Clinicians should consider screening obese female children for symptoms of depression.

BACKGROUND

Childhood mental illness is poorly recognised by healthcare providers and parents, despite half of all lifetime cases of diagnosable mental illness beginning by the age of 14 years. ¹ Globally, depression is the leading cause of disease burden, as measured by disability-adjusted life years, in children aged 10-19 years. ² Untreated, it is associated with poor school performance and social functioning, substance misuse, recurring depression in adulthood and increased suicide risk, which is the second leading cause of preventable death among young people. ^3-6 The resulting cost to the National Health Service of treating depression is estimated at over £2 billion, and the wider social and economic impact of depression is likely to be considerable. ⁷.

Body Size Misperception and Overweight or Obesity among Saudi College-Aged Females

The aim of the study was to investigate the associations between perceived and desired body size and overweight and obesity among college-aged females. A multistage stratified cluster random sample was used to select 907 healthy females from a major Saudi public university. The Stunkard Figure Rating Scale (FRS) was used for body size assessment. Overweight/obesity classification was based on BMI less than or equal to/greater than 25 kg/m2. Overweight plus obesity prevalence was 28.1%. There were significant differences between females with overweight/obesity and those without overweight/obesity in both perceived and desired body size scores. Compared with only 4% of females without overweight/obesity, 37% of the participants with overweight/obesity scored higher than five (median) in the FRS. The perceived body size correlated more strongly with many of the selected variables than did the desired body size, especially with BMI (r=0.679; p < 0.001), body weight (r=0.652; p < 0.001), and weight loss attempts (r=0.466; p < 0.001). Also, there was a significant relationship between BMI and weight loss attempts (r=0.370; p < 0.001). BMI and weight loss attempts appear to predict the perceived body size and the discrepancy between perceived and desired body size scores. Psychosocial and lifestyle factors that might influence female's body misperception need to be addressed in future studies.

Perceived Weight and Bullying Victimization in Boys and Girls

BACKGROUND

Research suggests that perceived weight poses separate risks from objective weight on adolescents' risks of being bullied. We examined if the prevalence of bullying victimization differed by perceived and objective weight status, and how these associations varied by sex.

METHODS

Data were analyzed for 6716 8th and 11th graders from the School Physical Activity and Nutrition project, a Texas statewide survey of public school students. Participants reported demographics, bullying victimization, and weight perceptions. Height and weight were measured.

RESULTS

In the last 6 months, 10.8% of students reported being bullied. Nearly 70% of normal weight and overweight and 50% of obese adolescents perceived themselves as weighing the right amount. Perceiving oneself as weighing too little or too much was significantly associated with increased bullying victimization (p < .05 for both), whereas objective weight was not. Statistical interactions between perceived weight and sex were significantly associated with victimization (p < .05) among boys only; boys who perceived themselves as weighing too little had higher predicted probabilities of victimization.

CONCLUSIONS

Perceived weight may play a greater role in bullying victimization than objective weight, especially among boys. Interventions to prevent bullying should consider adolescents' self-perceptions of weight to effectively identify those at greater risk for victimization.

Parental and Self-Weight Perceptions in U.S. Children and Adolescents, NHANES 2005-2014

This study aimed to describe the parental and child self-weight perceptions and their associated sociodemographic factors. The 2005-2014 National Health and Nutrition Examination Survey (NHANES) sample of 16,869 children aged 2 to 17 years was used. For overweight/obese children aged 2 to 15 years, 61.2% of parents underestimated their child’s weight. For overweight/obese children aged 8 to 17 years, 55.2% underestimated their own weight. For children aged 8 to 15 years, 77.8% parents and children agreed on the weight classification. Parents of boys and those with low income were more likely to underestimate their child’s weight. Girls, older children, and those living in larger or high-income families were less likely to underestimate their own weight. Hispanic and Black children tended to underestimate their weight. With increasing child age, parents and children were more likely to disagree on the child’s weight. Future efforts should focus on low-income families with larger number of children and Hispanic and Black young children who were more likely to underestimate their weight.

Desire to Be Underweight: Exploratory Study on a Weight Loss App Community and User Perceptions of the Impact on Disordered Eating Behaviors

Background

Mobile health (mHealth) apps for weight loss (weight loss apps) can be useful diet and exercise tools for individuals in need of losing weight. Most studies view weight loss app users as these types of individuals, but not all users have the same needs. In fact, users with disordered eating behaviors who desire to be underweight are also utilizing weight loss apps; however, few studies give a sense of the prevalence of these users in weight loss app communities and their perceptions of weight loss apps in relation to disordered eating behaviors.

Objective

The aim of this study was to provide an analysis of users’ body mass indices (BMIs) in a weight loss app community and examples of how users with underweight BMI goals perceive the impact of the app on disordered eating behaviors.

Methods

We focused on two aspects of a weight loss app (DropPounds): profile data and forum posts, and we moved from a broader picture of the community to a narrower focus on users’ perceptions. We analyzed profile data to better understand the goal BMIs of all users, highlighting the prevalence of users with underweight BMI goals. Then we explored how users with a desire to be underweight discussed the weight loss app’s impact on disordered eating behaviors.

Results

We found three main results: (1) no user (regardless of start BMI) starts with a weight gain goal, and most users want to lose weight; (2) 6.78% (1261/18,601) of the community want to be underweight, and most identify as female; (3) users with underweight BMI goals tend to view the app as positive, especially for reducing bingeing; however, some acknowledge its role in exacerbating disordered eating behaviors.

Conclusions

These findings are important for our understanding of the different types of users who utilize weight loss apps, the perceptions of weight loss apps related to disordered eating, and how weight loss apps may impact users with a desire to be underweight. Whereas these users had underweight goals, they often view the app as helpful in reducing disordered eating behaviors, which led to additional questions. Therefore, future research is needed.

Agreement Between Actual and Perceived Body Weight in Adolescents and Their Weight Control Behaviors

Background

To investigate the agreements between actual and perceived body weight status among adolescents and to identify the associations of disagreements with their weight control behaviors.

Methods

This study used the secondary data of a sample survey (n=13,871) of the Seoul Student Health Examination among middle and high schools in 2010. Agreements between actual (underweight, normal, overweight, and obese, according to 2007 Korean National Growth Charts) and perceived body weight status (underweight, normal, overweight, and obese) were examined using Chi-square and Cohen’s kappa agreement, and then multinomial logistic regression including gender, grade, and attempt of weight control or method of weight control was done.

Results

Agreements between actual and perceived body weight status were only 45.2%, and disagreements were up to 54.8%, including mild over- (20.4%), severe over- (1.8%), mild under- (29.5%), and severe under-estimation (3.1%). The kappa coefficient of agreement was only 0.19. The odds ratios on severe over-estimated perception were 1.59 (95% CI, 1.22–2.07) in female subjects, 1.78 (95% CI, 1.36–2.34) in diet control behaviors, and 1.53 (95% CI, 1.18–2.00) in exercise. The odds ratios on severe under-estimated perception were only 0.40 (95% CI, 0.32–0.50) in female subjects but 5.77 (95% CI, 3.68–9.06) in taking medication.

Conclusion

There were associations of body weight control behaviors with disagreements of actual and perceived weight status. Therefore, further study is needed to identify the weight disagreement-related factors and to promote the desired weight control behaviors for adolescents.

Self-perception of weight status and its association with weight-related knowledge, attitudes, and behaviors among Chinese children in Guangzhou

Background

How weight perception influences weight-related knowledge, attitudes, and behaviors in Chinese children is unknown. We investigated self-perception of body weight and its correlates, and analyzed the relationship between weight perception and weight-related knowledge, attitudes, and behaviors in children in Guangzhou, China.

Methods

We assessed self-reported weight perception, weight-related knowledge, attitudes, and behaviors in 3752 children aged 7–12 years. Underweight or overweight was defined using the Chinese criteria based on body mass index (BMI). Binary logistic regression analyses were performed to assess correlates of weight underestimation.

Results

In total, 27.3% of children underestimated and 6.7% overestimated their weight status. Weight underestimation was common among normal-weight (34.1%) and overweight children (25.3%). Older age, female sex, and child BMI z-score were negatively associated with normal-weight children's underestimation, whereas older age, paternal obesity, maternal obesity, and child BMI z-score were negatively associated with overweight children's underestimation. Correct answers on weight-related knowledge questions ranged from 81.5% to 98.6% and did not differ by weight perception within BMI categories. Although negative perceivers (i.e., those who perceived themselves as underweight or overweight) had a higher intention to change weight, they behaved more unhealthily on fruit intake, breakfast, screen time, and daily moderate-to-vigorous physical activities time than counterparts.

Conclusion

Weight underestimation was prevalent in normal-weight and overweight children in Guangzhou. Negative perceivers had stronger willingness to change weight but tended to behave more unhealthily on certain behaviors than positive perceivers. Childhood obesity interventions should incorporate health education and practical support to promote healthy eating and physical activity.

•

Over one third of children misperceived their weight status in Guangzhou, China.

•

Underestimation of body weight was much more prevalent than overestimation.

•

Underestimation was common in younger children, girls, and those with obese parents.

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Children perceived as underweight/overweight had a higher intention to change weight.

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Children perceived as normal weight behaved more healthily on certain behaviors.

Overweight or about right? A norm comparison explanation of perceived weight status

Objectives

Body‐weight norms may explain why personal evaluations of weight status are often inaccurate. Here, we tested a ‘norm comparison’ explanation of weight status perceptions, whereby personal evaluations of weight status are biased by perceived body‐weight norms.

Methods

Study 1 examined whether perceptions of how one's own body weight compares to an average person predict personal evaluations of weight status. Study 2 examined whether manipulating perceptions of how one's own body weight compares to an average person influences whether or not a person identifies their own weight status as being overweight.

Results

In Study 1, if participants rated their body weight as being similar to the body weight of an average person, they were less likely to identify their weight status as being overweight. In Study 2, participants that were led to believe that their body weight was heavier than the average person were more likely to perceive their own weight status as being overweight.

Conclusions

Personal perceptions of weight status are likely to be shaped by a ‘norm comparison’ process. As overweight becomes more normal, underestimation of weight status amongst individuals with overweight and obesity will be more common.

Misperception of weight status in the pacific: preliminary findings in rural and urban 11- to 16-year-olds of New Caledonia

Background

Adolescent obesity is prevalent in Pacific region ethnic groups (European, Melanesian and Polynesian) living in both urban and rural areas. Although body perception is an important factor of weight gain or loss, little is known about the body self-perceptions of Pacific region adolescents. This study therefore evaluated adolescent perceptions of body weight according to ethnicity (European, Melanesian or Polynesian), socioeconomic status (low, intermediate or high) and living area (rural or urban) in New Caledonia.

Methods

Sociodemographic and anthropomorphic data from 737 adolescents (351 boys and 386 girls) with ages ranging from 11 to 16 years were collected and analysed. The International Obesity Task Force (IOTF) standards were used to define weight status as normal-weight, underweight or overweight/obese. Weight perception was assessed from detailed questionnaires, with adolescents rating their own weight with the following descriptors: ‘about the right weight’, ‘too heavy’, or ‘too light’.

Results

Results showed that only 8.5% of normal-weight adolescents (7% boys and 10% girls) identifying themselves as ‘too heavy’. Normal-weight Melanesian adolescents were less likely than their European counterparts to assess themselves as too heavy (OR = 0.357). However, half the overweight/obese adolescents underestimated their weight status (53% boys and 48% girls). Weight misperception was associated with ethnicity, socioeconomic status and living area, with gender-specific differences.

Conclusions

The results of this study suggest that these sociodemographic factors should be taken into account when designing public health policies and health education school programmes in New Caledonia and, more broadly, the Pacific region.

The association between discrepant weight perceptions and objectively measured physical activity

BACKGROUND

Some individuals perceive themselves as being normal weight, despite having an excess body fat percentage (e.g., underestimate weight). Conversely, other individuals perceive themselves as being overweight, despite having a normal body fat percentage (e.g., overestimate weight). When perceived and actual weight statuses are incongruent, individuals possess a discrepant weight perception. The association between discrepant weight perceptions and engagement in moderate-to-vigorous physical activity (MVPA) has not been thoroughly investigated, which was this study's purpose.

METHODS

For this cross-sectional study, data from the 2003-2006 National Health and Nutrition Examination Survey were utilized (N=5462 adults). MVPA was assessed via accelerometry. Based on measured body mass index and whether participants considered themselves as overweight, underweight, or about the right weight, we classified individuals as accurate perception, overestimate weight (discrepant), or underestimate weight (discrepant). A negative binomial logistical regression was used to assess the association between discrepant weight perception (independent variable) and engagement in MVPA (outcome variable).

RESULTS

Females who said that they are normal weight, but were in fact overweight based on body mass index, engaged in 13% less MVPA (rate ratio=.87, 95% confidence interval: .769-.999, P=.05). Also, older adults (>60yrs) who said that they are normal weight, but were overweight based on body mass index, engaged in 23% less MVPA (rate ratio=.77, 95% confidence interval: .616-.965, P=.025).

CONCLUSION

Discrepant weight perceptions were associated with less objectively measured MVPA. Interventions should take weight perceptions into consideration when designing and evaluating intervention impact.

Weight perceptions, disordered eating behaviors, and emotional self-efficacy among high school adolescents

Although emotional disorders and disordered eating behaviors are known to be related, the relationship between emotional self-efficacy (ESE) and disordered eating is unknown. This study examined the relationship between ESE and disordered eating in a statewide sample of public high school adolescents (n=2566). The Centers for Disease Control Youth Risk Behavior Survey and an adolescent ESE scale were utilized. Logistic regression adjusted for key covariates explored the relationship between low ESE and disordered eating among selected race and gender groups. Self-perceived weight as underweight or overweight; and dieting, vomiting or taking laxatives, taking diet pills, and fasting to lose weight were each associated (p<.05) with lower levels of ESE for certain race/gender groups. Findings provide increased justification for tailoring disordered eating interventions and treatments to accommodate the highest risk groups. Measures of ESE should be considered for adolescent mental health assessments in fieldwork, research, and evaluation efforts.

Weight perception and its association with socio-demographic and health-related factors among Korean adolescents

BACKGROUND

Adolescence is a time of rapid growth with dramatic changes in physical appearance. The body image established at this time could affect their physical and mental health throughout their entire life. However, adolescents sometimes perceive themselves as underweight or overweight irrespective of actual weight status. The purpose of the present study was to examine the extent of weight misperception for Korean adolescents, to explore socio-demographic factors associated with weight misperception, and to examine gender-specific differences in the relationships between weight misperception and health-related factors.

METHODS

We selected data on 3321 adolescents aged 12-18 years from the five-year Korea Health and Nutrition Examination Survey (KNHANES) datasets (2007-2011). Self-perceived weight status was compared with measured weight status by cross-tabulation. The generalized logit model was used to explore the socio-demographic factors associated with weight misperception, and separate logistic regression models were fitted to examine gender-specific differences in the relationships between weight misperception and health-related factors.

RESULTS

Overall, 25.8 % of boys (overestimation 17.1 %; underestimation 8.6 %) and 29.3 % of girls (overestimation 24.0 %; underestimation 5.3 %) misclassified their weight status according to the objective standards. Weight overestimation was particularly prominent among underweight girls. Weight misperception was associated with socio-demographic factors such as gender, age, BMI, place of residence, and maternal education level. Weight overestimation and underestimation in boys and weight overestimation in girls were significantly related to inappropriate weight control practice. However, weight underestimation in girls seems to be negatively linked to inappropriate weight control practice.

CONCLUSIONS

Based on the results of the present study, comprehensive intervention programs for adolescents and their parents could be devised to raise self-awareness of their weight status, to overcome weight misperception, and to prevent obesity and its related health risks.

The Role of School Contexts in Adolescents' Weight-Loss Behaviors and Self-Perceptions of Overweight

Using the National Longitudinal Study of Adolescent to Adult Health and multi-level modeling, this study investigates the role high schools social contexts play in the development of adolescents' weight-loss behaviors and overweight self-perceptions. Overall, the results indicate that there is an important association between adolescents' weight-loss behaviors and self-perceptions of overweight and the weight-related context of their school. For example, both adolescent boys and girls are less likely to engage in weight-loss behaviors when overweight is prevalent among their same-sex schoolmates. However, gender differences are also found. For example, while adolescent boys' self-perceptions of overweight are significantly associated with their same-sex schoolmates' characteristics and behaviors, this is not the case for adolescent girls. Overall, these findings suggest that meso-level social contexts - like schools - may be particularly important to how individuals incorporate macro-level beliefs or values - like gendered body ideals - into their own behaviors and self-concepts.

Anthropometric characteristics of primary school-aged children: accuracy of perception and differences by gender, age and BMI

BACKGROUND

Body perception has been mainly studied in adolescents and adults in relation to eating disorders and obesity because such conditions are usually associated with distortion in the perception of body size. The development of body perception in children was rather neglected despite the relevance of this issue in understanding the aetiology of health eating problems. The main aim of this study was to investigate body weight and body height perception in children by gender, age and body mass index (BMI), taking into account differences among underweight, healthy weight, overweight and obese children.

METHODS

A school-based sample of 572 Italian children (49% boys) aged 6-10 were involved in a cross-sectional survey. Current weight and height were measured by standard protocols, and BMI was calculated and converted in centile categories using the Italian growth curves for children. Perceived weight and height were assessed using visual methods (figures representing children of different weight and height).

RESULTS

About a third of the children do not show to have an accurate perception of their weight and height (weight: 36%; height: 32%): as for weight, an error of underestimation prevails and as for height, an error of overestimation prevails. In general, children who have different weight and height from the average tend to perceive their physical characteristics closer to average. However, overweight children underestimate their weight much more than obese children.

CONCLUSIONS

Distortions in the perception of their physical features, weight and height, appear to be related to the aesthetic models of Western culture. The tendency to underestimate weight, particularly in overweight children, has implications in interventions for health promotion and healthy lifestyle in school-aged children.

Weight perceptions in a population sample of English adolescents: cause for celebration or concern?

OBJECTIVES

To examine the proportion of normal-weight adolescents who consider themselves to be too heavy (size overestimation), and the proportion of overweight or obese adolescents who consider themselves to be about the right weight or too light (size underestimation), in large population-based samples collected over 8 years in England.

METHODS

Data were from the Health Survey for England between 2005 and 2012: an annual survey of households representative of the English population. We analysed data from 4979 adolescents (2668 boys, 2311 girls) aged 13 to 15 years old whose weight status was defined as normal weight or overweight/obese based on body mass index standard deviation scores (BMI-SDS) derived from objective measurements of height and weight and using International Obesity Task Force standards. Weight perception was based on the adolescent's choice from the following descriptors: 'about the right weight', 'too heavy' or 'too light'.

RESULTS

The majority of normal-weight adolescents (83% of boys, 84% of girls) correctly identified themselves as 'about the right weight'. Overestimation was uncommon, with only 7% of normal-weight teens (4% of boys, 11% of girls) identifying themselves as 'too heavy'. In contrast, only 60% of overweight/obese adolescents (53% of boys, 68% of girls) correctly identified themselves as 'too heavy', whereas 39% (47% of boys, 32% of girls) underestimated, identifying themselves as 'about the right weight' or 'too light'. There were no significant changes in BMI-SDS or body size estimation over time (2005-2012).

CONCLUSIONS

Overestimation of body weight among normal-weight adolescents is relatively uncommon; potentially a cause for celebration. However, almost half of boys and a third of girls with a BMI placing them in the overweight or obese BMI range perceived themselves to be about the right weight. Lack of awareness of excess weight among overweight and obese adolescents could be a cause for concern.

Weight perceptions, misperceptions, and dating violence victimization among U.S. adolescents

Dating violence is a major public health issue among youth. Overweight/obese adolescents experience peer victimization and discrimination and may be at increased risk of dating violence victimization. Furthermore, given the stigma associated with overweight/obesity, perceptions and misperceptions of overweight may be more important than actual weight status for dating violence victimization. This study examines the association of three weight indices (weight status, perceived weight, and weight perception accuracy) with psychological and physical dating violence victimization. The 2010 baseline survey of the 7-year NEXT Generation Health Study used a three-stage stratified clustered sampling design to select a nationally representative sample of U.S. 10th-grade students (n = 1,983). Participants who have had a boyfriend/girlfriend reported dating violence victimization and perceived weight. Weight status was computed from measured height/weight. Weight perception accuracy (accurate/underestimate/overestimate) was calculated by comparing weight status and perceived weight. Gender-stratified regressions examined the association of weight indices and dating violence victimization. Racial/ethnic differences were also examined. The association of weight indices with dating violence victimization significantly differed by gender. Overall, among boys, no associations were observed. Among girls, weight status was not associated with dating violence victimization, nor with number of dating violence victimization acts; however, perceived weight and weight perception accuracy were significantly associated with dating violence victimization, type of victimization, and number of victimization acts. Post hoc analyses revealed significant racial/ethnic differences. White girls who perceive themselves (accurately or not) to be overweight, and Hispanic girls who are overweight, may be at increased risk of dating violence victimization. These findings suggest a targeted approach to dating violence victimization prevention.

Longitudinal associations among change in overweight status, fear of negative evaluation, and weight-related teasing among obese adolescents

OBJECTIVE

To examine longitudinal bidirectional associations between changes in adolescents' weight status and psychosocial constructs.

METHOD

118 obese adolescents aged 13-16 years participated in a behavioral weight control intervention. Percent overweight (OW), fear of negative evaluation (FNE), and frequency of weight-related teasing (WRT) were collected at baseline, end of intervention, and 12 and 24 months post-randomization. 3 multivariate latent change score models were estimated to examine longitudinal cross-lagged associations between: (1) OW and FNE; (2) OW and WRT; and (3) FNE and WRT.

RESULTS

Decreases in OW were prospectively associated with subsequent decreases in both FNE and WRT; however, changes in FNE and WRT were not prospectively associated with subsequent change in OW. Decreases in FNE were prospectively associated with subsequent decreases in WRT.

CONCLUSION

Moderate weight loss in the context of a behavioral weight control intervention has positive long-term implications for obese adolescents' peer relations.

Prevalence and sociodemographic trends of weight misperception in Korean adolescents

BACKGROUND

Rapid physical and emotional growth occurs during youth. Adolescence is one of the most important periods for adapting to body change and establishing an ideal body image. Body change is an important and sensitive concern for adolescents, and the values and self-conception established at this time affect various aspects of the entire life. This study aimed to investigate the prevalence and trends of weight misperception among adolescents in Korea.

METHODS

We analyzed raw data from the 2011 Korea Youth Risk Behaviour Web-based Survey-VII (KYRBWS-VII), in which 73,474 adolescents from the middle-school first grade to the high-school third grade (aged 12-18) participated. For the multivariate logistic regression model, the dependent variable was existence of misperception (yes/no) and independent variables were sociodemographic factors.

RESULTS

We found that the prevalence of weight misperception was 49.3% (overestimation, 23.7%; underestimation, 25.6%). Among male students, 65.0% underestimated their weight, whereas 62.2% of female students overestimated their weight. Multivariate logistic regression analysis revealed that gender (OR = 1.254; 95% CI = 1.214-1.294; p < 0.001) and socioeconomic status (OR = 1.173; 95% CI = 1.121-1.228; p < 0.001) were significantly associated with weight misperception. Compared with overweight/obese adolescents, adolescents whose BMI-based body weight was underweight or normal showed 2.386-times higher (OR = 2.386; 95% CI = 2.045-2.783, p < 0.001) and 32.804-times higher (OR = 32.804; 95% CI = 29.829-36.077, p < 0.001) body shape misperception, respectively.

CONCLUSIONS

An effective obesity intervention program for adolescents must reflect and monitor body shape perception as well as BMI, and should include subjects who overestimate as well as underestimate their weight.

Weight misperception and its association with dieting methods and eating behaviors in South Korean adolescents

BACKGROUND/OBJECTIVES

There is little information on the association between weight misperception and eating behavior in Korean adolescents. Therefore, we investigated the association of food intake habits and dieting method and disturbed eating behavior (DEB) in relation to weight misperception.

SUBJECTS/METHODS

Data was collected by using a nationwide online panel survey from 6,943 adolescents enrolled in middle/high school. DEB was measured with the Eating Attitudes Test (EAT-26) and those who scored ≥ 20 on the EAT-26 were considered to have eating disorder. Logistic regressions were conducted to examine the association between weight misperception based on self-reported weight status and dieting method and eating behaviors.

RESULTS

The proportion of weight underestimation was 23.5% and that of overestimation was 24.0%. Weight overestimating girls were more likely to engage in various unhealthy dieting practices (OR = 1.69 for fasting; OR = 1.88 for laxative or diuretic use; OR = 2.05 for self-induced vomiting after meals; P < 0.05). Moreover, there was a strong association between overestimation and undesirable eating behaviors, especially among girls, e.g.: having breakfast (OR = 0.85), high consumption of fast foods (OR = 1.28) and regular sodas (OR = 1.39), but not among boys. In both genders, weight overestimation appears to be a major risk factor for DEB (OR = 1.34 for boys and OR = 1.41 for girls; P < 0.05).

CONSLUSIONS

Weight overestimation is associated with unhealthy weight control practices and eating behaviors. We particularly found a significant association between weight overestimation and DEB among nationwide Korean adolescents.

Inaccurate weight perception is associated with extreme weight-management practices in U.S. high school students

OBJECTIVE

The objective of the present study was to examine whether adolescents' weight perception accuracy (WPA) was associated with extreme weight-management practices (EWPs) in differing body mass index (BMI) categories.

METHODS

WPA, overassessment, and underassessment were determined by comparing self-reported BMI and weight perception among U.S. high school students in the 2009 National Youth Risk Behavior Survey. BMI was classified as follows: underweight (<5th percentile), healthy weight (5th to <85th), overweight (≥85th to <95th), and obese (≥95th). WPA was considered inaccurate if BMI and weight perception were discordant. Overassessors thought they were heavier than they were (among underweight/healthy groups); underassessors thought they were lighter than they were (among healthy/overweight/obese groups). EWPs included ≥1 of fasting, use of diet pills, or purging/laxative use. Logit models were fitted for different BMI sex strata.

RESULTS

In the final sample of 14,722 US high school students with complete data, 20.2%, 85.7%, 5.8%, and 80.9% of those who were underweight, healthy weight, overweight, and obese, inaccurately assessed their weight, respectively. In turn, 11.4% and 17.6% of accurate and inaccurate assessors engaged in EWPs, respectively. After adjustment, underweight girls who overassessed their weight had 12.6 times higher odds of EWPs (95% confidence interval 3.4-46.6). Moreover, there were elevated odds of EWPs among healthy weight students who overassessed their weight.

CONCLUSIONS

Overassessing healthy weight students and underweight girls had higher odds of ≥1 EWPs, likely related to an unhealthy desire to lose weight. The present study demonstrates a need to further educate clinicians on WPA and its relation to EWPs even among those of healthy weight who may be seen as not at risk.

Body weight misperception patterns and their association with health-related factors among adolescents in South Korea

OBJECTIVE

Examined body weight misperception and its association with health-related factors among South Korean adolescents.

DESIGN AND METHODS

The 2009 Korea Youth Risk Behavior Web-based Survey data from 72,399 adolescents aged 12-18 years were used. Based on agreements between weight status assessed according to self-reported BMI and self-perceived weight status, adolescents were classified as weight underestimate, accurate, and overestimate. Logistic regression models examined the associations controlling for covariates.

RESULTS

Over 50% adolescents misclassified their own weight status: underestimation (23.4%) and overestimation (26.8%). Boys had a higher underestimation rate than girls (30.3% vs. 15.6%) and a lower overestimation rate (21.3% vs. 33.0%). In girls, overestimation was higher in high-income families and well-educated parents (41.0%). Compared to those with accurate weight perception, participants who underestimated their weight were more likely to have an unhealthy diet as indicated by higher daily consumption (≥once/day) of fast food [OR = 1.18 (1.00, 1.39)] and unhealthy snacks [OR = 1.11 (1.03, 1.19)]. Girls who overestimated their weight had more screen time [≥2 h/day, OR = 1.12 (1.03, 1.22)]. Participants who overestimated their weight were more likely to be stressed [OR = 1.24 (1.18, 1.31)] and depressed [OR = 1.18 (1.21, 1.25)].

CONCLUSIONS

Over half of Korean adolescents had misperception on own weight status, the rates varied by gender and socioeconomic status. Weight misperception is associated with health-related outcomes compared to peers with accurate perceptions about own weight status.

Biopsychosocial correlates of weight status perception in Australian adolescents

This study examined the utility of the biopsychosocial model to predict accuracy of weight status perception among Australian adolescents. The factors included in this framework were: age, gender, and BMI-z (biological factors); satisfaction with body weight and shape (psychological factors); socioeconomic status, peer weight (social factors). Cross-sectional data, including measured height and weight, and self-reported weight status, was obtained from 2954 adolescents (mean age=14.6, 56% male) who participated in the It's Your Move! study. Accuracy of weight status perception was associated with gender, BMI-z, SES, and weight and shape satisfaction. Gender differences in weight status perception were moderated by satisfaction with weight. In boys, weight satisfaction was associated with perceived healthy weight; in girls, it was associated with perceived healthy weight and underweight. Moderately overweight adolescents are most at risk of underestimating their weight status and could benefit from education about the boundaries of the healthy weight range.

Perceived weight, not obesity, increases risk for major depression among adolescents

This study examined the association between major depression, obesity and body image among adolescents.

METHODS

Participants were 4175 youths 11-17 years of age sampled from the community who were interviewed using the Diagnostic Interview Schedule for Children and Adolescents, Version IV, completed a self-report questionnaire, and had their weight and height measured. There were 2 measures of body image: perceived weight and body satisfaction. Obesity was associated with increased risk of depression, with no controls for covariates. However, when the association was examined in models which included weight, major depression, and body image measures and covariates, there was no association between major depression and body weight, nor between body satisfaction and major depression. Perceived overweight was strongly and independently associated with body weight (O.R. = 2.62). We found no independent association between major depression and body weight. If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image. Future research should focus on the role of depression and body image in the etiology of obesity.

Residency and racial/ethnic differences in weight status and lifestyle behaviors among US youth

PURPOSE

Elevated risk for obesity is found in rural environments and in some minority populations. It is unclear whether living in rural or nonmetropolitan areas and being a minority compound the risk of obesity beyond that of either factor acting alone. Our purpose was to examine adolescent obesity in light of the potential concomitant influences of race/ethnicity, residency, and obesity-related lifestyle behaviors.

METHODS

We assessed obesity prevalence, physical activity, consumption of fatty snack foods, and screen time in 8,363 US adolescents based on variation in race/ethnicity and residency. Descriptive, bivariate, and multivariate statistics were used to: (1) calculate race- and residency-based rates of obesity and obesity-related lifestyle behaviors and (2) generate race- and residency-based obesity odds ratios as a function of those same behaviors.

FINDINGS

The results indicated that nonmetropolitan black youth had the highest risk of obesity (26%), rate of consuming fatty snack foods on more than 2 days/week (86%), and rate of spending more than 2 hours/day in screen time (91%) compared to white metropolitan youth. Compared to their metropolitan counterparts, black nonmetropolitan youth had greater odds of being obese if they exercised less than daily (1.71 times), ate fatty snack foods on more than 2 days/week (1.65 times), or spent more than 2 hours/day in screen time (1.64 times).

CONCLUSIONS

Race/ethnicity and residency may have a compounding effect on the risk of obesity. Prevention and intervention must be viewed in a socioecological framework that recognizes the importance of culture and community on obesity-related behaviors.

Underestimation of weight status in Californian adolescents

BACKGROUND

Overweight and obese adolescents commonly underestimate their weight status, considering themselves to be at a healthy weight or underweight. These adolescents are more likely to be male, older, and Latino, black, or Native American. Associations with acculturation have not been previously assessed. The goal of this study was to identify the prevalence of underestimation of weight status in Californian adolescents and to identify factors associated with this underestimation, in particular examining relationships with race/ethnicity and acculturation.

METHODS

Secondary data analysis of the 2005 Adolescent California Health Interview Survey.

RESULTS

A total of 36.6% of overweight and obese Californian adolescents underestimated their weight status. Adolescents not born in the United States had increased odds of underestimating their weight status compared to those born in the United States [adjusted odds ratio (aOR)=1.94, 95% confidence interval (CI) 1.08, 3.49; p=0.03]. No significant associations with race/ethnicity were found. An age-sex interaction was observed with older adolescent males having increased odds compared to younger females.

CONCLUSIONS

Identification of individuals at increased odds of underestimating their weight status may be important in developing and targeting appropriate counseling and interventions to ameliorate long-term health risks of excess weight.

Accuracy of child and adolescent weight perceptions and their relationships to dieting and exercise behaviors: a NHANES study

OBJECTIVE

Recent public health and media attention on child obesity may have altered accuracy of self-perception of obesity and associated weight control behaviors in children and adolescents. Thus, we examined whether accuracy of weight perceptions were associated with weight loss behaviors.

METHODS

We examined children 8 to 15 years old in the National Health and Nutrition Examination Survey (2005-2010) who reported themselves as "overweight/too fat," "about right," or "underweight/too thin." Children reported on efforts to lose weight and engagement in specific weight control behaviors, including how frequently he or she had been on a diet, starved, cut back on eating, skipped meals, or exercised to lose weight. We categorized obesity on the basis of measured body mass index, and we determined the accuracy of weight perceptions. We used chi-square tests to examine age- and sex-based differences in accuracy of perceptions and relationship to weight loss behaviors.

RESULTS

Girls and older children more accurately perceived weight status. Both girls and boys of all ages who perceived themselves as overweight were more likely to engage in weight loss behaviors. Children who were overweight engaged in more weight loss behaviors than healthy weight children perceiving themselves as overweight. Among children who reported themselves as "about right," overweight children engaged in more weight loss behaviors than healthy weight children but less so than those who accurately perceived themselves as being overweight.

CONCLUSIONS

The perception of being overweight and actual overweight status are both strongly associated with weight loss behaviors. These findings have important implications for counseling patients who may have inaccurate weight perceptions.

Language spoken at home and parental birthplace moderate the association of race/ethnicity and distorted weight perception

Distorted weight perception (DWP), specifically overestimating weight status, is common in adolescents and may lead to eating disorders. The authors examined the role of acculturation proxies as effect modifiers of the relationship between race/ethnicity and DWP in a diverse adolescent population. Analysis of the 2005 California Health Interview Survey showed that of 2955 adolescents with underweight or healthy weight status, 10.6% reported DWP. Latino adolescents had increased odds of DWP compared with white adolescents (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [CI] = 2.00, 4.57). Latinos who spoke English and other language(s) at home (aOR = 3.38; 95% CI = 2.11, 5.41) and Latino (aOR = 5.00; 95% CI = 2.34, 10.72) and Asian (aOR = 3.10, 95% CI = 1.15, 8.35) adolescents who spoke no English at home had increased odds of DWP compared with white, English-only speakers. Latino adolescents had increased odds (aOR = 3.98, 95% CI = 2.45, 6.47) of DWP if neither parent was US born. Assessing acculturation proxies may help identify adolescents at risk of DWP.

Association between depressed mood and perceived weight in middle and high school age students: Texas 2004-2005

Research exploring the relationship between weight perception and depressed mood among adolescents is limited in the United States. The purpose of this study is to examine the association of perceived versus actual body weight and depressed mood in a representative sample of 8th and 11th grade public school students in Texas. Using data from the 2004-2005 School Physical Activity and Nutrition (SPAN) study, logistic regression analyses were conducted to assess the association of weight perception with depressed mood. Healthy weight students who perceived themselves to be a healthy weight were the reference group for all analyses. A high prevalence of misperception of body weight was observed. Overweight and obese 8th grade girls and boys who perceived themselves to be overweight had increased odds of depressed mood [Girls: OR 1.70 (95% CI: 1.07-2.69), Boys: OR 2.05 (95% CI: 1.16-3.62)]. Healthy weight 8th grade girls who perceived themselves to be overweight had 2.5 times greater odds of depressed mood (OR 2.63, 95% CI: 1.54-4.50). Healthy weight boys who perceived themselves to be underweight had more than twice the odds (OR 2.18, 95% CI: 1.23-3.89) of depressed mood. No weight category was significantly associated with depressed mood in boys or girls in 11th grade. The present study suggests that weight misperceptions are associated with depressed mood in young adolescents. Education about healthy body size is necessary to correct the common weight misperceptions observed. The high prevalence rates of depressed mood suggest a greater need for research into understanding factors that may contribute to depressed mood in adolescents.

Accuracy of weight perception, life-style behaviours and psychological distress among overweight and obese adolescents

AIM

To compare overweight and obese adolescents with accurate and inaccurate self-reported weight perception across a range of behaviours and measures of psychological well-being.

METHODS

This study uses a cross-sectional survey of grade 7-12 high school students in New South Wales, Australia, conducted in 2008 (n= 7553). Overweight and obese students based on body mass index were classified as accurate perceivers (weight perception was 'too fat') or inaccurate perceivers (weight perception was 'about right').

RESULTS

Nearly a third of adolescents had incongruity between self-perceived body weight status and body mass index-determined weight category. Compared with boys, girls were less likely to underestimate their body weight (odds ratio: 0.26; 95% confidence interval: 0.25, 0.27) and more likely to overestimate their body weight (odds ratio: 3.4; 95% confidence interval: 3.3, 3.5). Accurate body weight perception was higher in obese adolescents compared with overweight adolescents (69.5% vs. 44.0%). Compared with mis-perceivers, accurate overweight and obese perceivers had significantly higher odds of trying to lose weight and being more physically active; however, they showed a combination of unhealthy and healthy behaviours (i.e. dietary patterns and sedentary activities). Accurate weight perception among overweight and obese adolescents was associated with increased odds of feeling sad or depressed in the past 6 months.

CONCLUSIONS

Further research on social, familial and psychological factors that predict or mediate healthy and unhealthy weight-related behaviours among adolescents by accuracy of weight perception is needed. Accurate weight perception should be considered in counselling and behavioural interventions.

Weight misperception and health risk behaviors among early adolescents

OBJECTIVES

To examine associations between weight misperception and youth health risk and protective factors.

METHODS

Three thousand ten US seventh-graders (72.1% white, mean age: 12.7 years) self-reported height, weight, risk, and protective factors. Analyses were conducted to determine cross-sectional and longitudinal associations between weight overestimation and health risk and protective factors.

RESULTS

Risk and protective factors had significant cross-sectional associations with weight overestimation. However, only depressive symptoms and reduced optimism predicted weight overestimation in eighth grade. Weight overestimation did not predict engagement in risky behaviors.

CONCLUSIONS

Weight overestimation and risk factors appear to co-occur, suggesting a constellation of risk that warrants further research.

Is accuracy of weight perception associated with health risk behaviors in a diverse sample of obese adolescents?

Current evidence is equivocal as to whether adolescent's perception of weight status is linked to both healthy and risky behaviors. This study examined the association between accurate and inaccurate perception of weight and self-reported health and risk behaviors among a diverse sample of obese, urban adolescents. Data were analyzed from 1,180 participants in the 2009 Philadelphia Youth Risk Behavior Survey. Health behaviors of obese students self-identifying as very or slightly overweight were compared to obese students who underestimated their weight status. Accurate self-identifiers of weight status were significantly more likely to report trying to lose weight, bullying victimization, and suicide attempts as compared to obese students underestimating their weight status. Findings suggest that it is important for school nurses to understand that perceived weight status confers distinct risk profiles and differing needs for health-related services related to the physical, mental, and social health of adolescents.

The association between major depressive disorder and obesity in US adolescents: results from the 2001-2004 National Health and Nutrition Examination Survey

The association between major depressive disorder (MDD) and obesity was assessed in 4,150 US adolescents aged 12-19 years from the 2001-2004 National Health and Nutrition Examination Survey. Weight and height were measured by health professionals and MDD was based on a structured diagnostic interview. The prevalence of MDD in the past year among US adolescents was 3.2% and 16.8% of US adolescents were obese. After adjustment for sex, age, race/ethnicity and poverty, MDD was not significantly associated with obesity among adolescents overall (adjusted odds ratio (adjOR) = 1.6, 95% confidence interval (CI) = 0.9-2.9), but an increased odds of obesity was observed among males (adjOR = 2.7, 95% CI = 1.1-7.1) and non-Hispanic blacks (adjOR = 3.1, 95% CI = 1.1-8.3) with MDD. Future research on strategies that might reduce the risk of obesity in males and non-Hispanic black adolescents with MDD may be warranted.

Assessing body image issues and body satisfaction/dissatisfaction among Hmong American children 9-18 years of age using mixed methodology

This study investigated body image issues and the usefulness of self-reported measurements among Hmong American children, 9-18 years using mixed methodology. Twelve focus groups were conducted (n=68) and a silhouette drawing instrument and six questions pertaining to body image were administered (n=335). About 50% of the children were either overweight or obese and 23% were short statured relative to US norms. About 70% of the girls and 53% of the boys selected smaller body ideals than their perceived body sizes. Further, 21% of the girls and 31% of the boys were satisfied with their bodies. Children underestimated their weights and overestimated their heights. During focus groups children reported that parents, peers, and media influenced their body image perceptions. Our results indicate that the majority of Hmong children are dissatisfied with their bodies and tend to endorse American ideals of beauty and attractiveness rather than the heavier, traditional Hmong body ideals supported by their parents.

The image in the mirror and the number on the scale: weight, weight perceptions, and adolescent depressive symptoms

Double jeopardy and health congruency theories suggest that adolescents' joint experience of their weight and weight perceptions are associated with depressive symptoms, but each theory offers a different prediction about which adolescents are at greatest risk. This study investigates the proposed associations and the applicability of both theoretical perspectives using data from 6,557 male and 6,126 female National Longitudinal Study ofAdolescent Health (Add Health) Wave II participants. Empirically, results indicate that focusing on the intersection of weight and weight perceptions better shows which adolescents are at risk of depressive symptoms than an approach that treats both predictors as independent, unrelated constructs. Weight pessimists are at greatest risk of depressive symptoms. Thus, results support the health congruency framework, its extension to subpopulations outside of older adults, and its extension to optimism and pessimism about specific health conditions.