Weight Perception and Lifestyle Awareness in Children and Adolescents: Insights from a Cross-Sectional Study

Background: Misperception of body weight has been found to negatively impact both diet and physical activity levels, particularly in youth with overweight and obesity. Objectives: This study assessed consistency between actual and perceived weight status and lifestyle factors in a sample of 455 children and adolescents (55% males, 8-13 years) attending a summer camp in Northern Italy. Methods: Weight status was defined applying Body Mass Index (BMI) cut-offs. Adherence to the Mediterranean Diet (MD), physical activity level, sleep duration, and sleep quality were assessed through validated questionnaires. Self-perception was evaluated through 5-point Likert scales, with graphical representations. Results: Comparison between self-perceived and assessed parameters revealed a poor concordance across all types of variables. Approximately half of participants (43-55%) correctly rated their weight status (κ = 0.12; 95% CI: 0.05-0.19), diet quality (κ = 0.09; 95% CI: 0.02-0.15), physical activity level (κ = 0.18; 95% CI: 0.11-0.26), sleep time (κ = 0.10; 95% CI: 0.03-0.17), and sleep quality (κ = 0.18; 95% CI: 0.12-0.24). Participants 12-13 years old were more likely to have a greater weight status perception compared to younger subjects (OR = 2.13; 95% CI: 1.08-4.21). Being in a condition of overweight or obesity significantly decreased the odds of correct weight perception (OR = 0.13; 95% CI: 0.08-0.21). Similarly, subjects with higher adherence to the MD, adequate sleep time, and low sleep quality were more conscious about their diet and sleep patterns. Conclusions: Overall, these findings highlight a certain degree of misclassification, especially in subjects who need to improve their lifestyles, highlighting the potential relevance of fostering accurate self-perception during developmental age.