Overweight, obesity, and body weight perception among Czech adolescents: a two-decade analysis, HBSC study 2002-2022

Excess body weight and weight misperception in adolescents are associated with various physical and mental health risks. This study analysed trends in overweight, obesity, body image, and body weight perception among Czech adolescents between 2002 and 2022, considering gender, age and socioeconomic status (SES).

Data were retrieved from the questionnaire of the Health Behaviour in School-aged Children (HBSC) study conducted in 2002, 2006, 2010, 2014, 2018 and 2022 (N = 52,363; 49.9% girls). The difference test between two proportions was used to assess time trends in weight status (WS), body image and body weight perception across gender and SES groups. Logistic regression analysis was performed to examine the likelihood of being overweight/obese, and underestimating or overestimating WS.

Between 2002 and 2022, overweight and obesity increased significantly, while non-overweight rates declined across both genders and SES groups, with a greater rise among boys and adolescents from low SES backgrounds. In 2022, more adolescents, regardless the gender and SES, perceived their body as "too thin" compared to 2002. Over the 20-year period, underestimation of WS increased while overestimation decreased among both girls and boys and across all SES groups. Accurate perception of WS rose among girls but worsened among boys. Girls were less likely than boys to be overweight/obese or to underestimate their WS but had higher odds of overestimating it.

The significant rise in overweight and obesity, especially in boys and adolescents from low SES backgrounds, during the last 20 years points out to socioeconomic disparities and should be taken into account when creating new policies. An improvement in correct perception of WS among girls and a decline in overestimating WS across genders and SES groups could help reduce risks of developing mental health problems/eating disorders. Conversely, an increase in underestimation of WS may contribute to weight-related health risks.