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

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.

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.

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.

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.