Factors associated with overestimation of body weight among U.S. adolescents: Based on the 2009 Youth Risk Behavior Survey results

Background and Significance: Inaccurate perception of body weight can lead to unhealthy weight management practices and negative health outcomes among adolescents. Objective: To identify factors associated with inflated perception of weight status among adolescents. Methods: The analysis used an adolescent sample (12-18 years old, N =14,939) from the 2009 National Youth Risk Behavior Survey. Logistic regression was used to identify factors associated with overestimation of weight status. Results: Similar proportions of the sample were overweight or obese (gender-specific body mass index for age ≥85 percentile) (29%) and perceived themselves as overweight (28%). However, discrepancies existed between actual and perceived weight status. African Americans were least likely (5%) while Asian Americans were most likely (14%) to overestimate their weight status. Girls were more likely to overestimate weight status than boys (14.6 vs. 4.7%). Depression was also associated with inflated perception of weight (13.0 vs. 8.1%). In multiple regression, being female (odds ratio (OR) =3.34, 95% confidence interval (CI) =2.83-3.93) and being depressed (OR =1.41, 95% CI =1.22-1.63) were significantly associated with overestimation of weight status, holding age and race/ethnicity constant. All other racial/ethnic groups were more likely than African Americans to overestimate their weight status with Asian Americans presenting the largest odds (OR =3.40, 95% CI =2.60-4.45), controlling for gender, age, and depression status. Conclusion: To prevent inappropriate weight loss attempts and resultant negative health outcomes, prevention programs should target groups more vulnerable to overestimation based on the differences in perception of weight by demographic characteristics and mental health status.