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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0000000000000231
Original Articles: Hepatology and Nutrition

Inaccurate Weight Perception Is Associated With Extreme Weight-Management Practices in US High School Students

Ibrahim, Chadi*; El-Kamary, Samer S.; Bailey, Jason*; St George, Diane M.*

Continued Medical Education
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Objective: 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.

Methods: WPA, overassessment, and underassessment were determined by comparing self-reported BMI and weight perception among US 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.

Results: 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.

Conclusions: 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.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,


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