Association Between Weight‐related Health Behaviors and Weight Perception in Adolescents with Overweight or Obesity

Abstract

Weight misperception is the belief that one is of a normal or healthy body weight despite being overweight or obese. Weight misperception has been established as protective against further weight gain in adolescents, in comparison to those who accurately perceive their elevated weight status. However, less is known about the individual factors that may contribute to this relationship. Therefore, our objective was to identify health and weight related behaviors that may contribute to weight misperceivers gaining less weight over time. Using data from the Youth Risk Behavior Survey, a nationally representative sample of adolescents enrolled in grades 9–12, we specifically examined those that met the criteria with overweight and obesity (n=4,536). Participants were classified as either accurate perceivers of their overweight or obese weight status (n=1368), or misperceivers (n=3103). Logistic regression analyses were run using SPSS, using weight misperception as the exposure variable, and examining various weight related health behaviors as the outcomes, controlling for sex, race/ethnicity, and grade. Adolescents who misperceived their weight were less likely to be trying to lose weight (OR: 0.169, 95% CI: 0.144–0.199, p<0.001). Weight misperceivers were also more likely to eat vegetables at least two times per day (OR: 1.235, 95% CI: 1.067–1.430, p=0.005), and to eat fruit or drink 100% fruit juice at least two times per day (OR: 1.169, 95% CI: 1.015–1.346, p=0.030). Weight misperceivers were less likely to spend three or more hours per day playing computer games (OR: 0.169, 95% CI: 0.144–0.199, p<0.001). Adolescents who misperceived their weight were more likely to regularly eat breakfast (OR: 1.125, 95% CI: 0.969–1.305), and less likely to spend three hours per day watching television (OR: 0.995, 95% CI: 0.859–1.153), but the odds ratios were not statistically significant. Weight misperceivers were also more likely to drink at least one soda per day (OR:1.158, 95% CI: 0.991–1.354), but this was not significant. Adolescents with overweight or obesity who misperceive their weight as normal are more likely to engage in a number of healthy weight‐related behaviors, which may be a potential explanation for why those that misperceive their weight, gain less weight over time. Identifying both positive and negative health behaviors that differ based on perception status that may lead to weight change, can help researchers determine possible intervention targets that focus on health behaviors for adolescents who are overweight or obese.