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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.*

Journal of Pediatric Gastroenterology and Nutrition: March 2014 - Volume 58 - Issue 3 - p 368–375
doi: 10.1097/MPG.0000000000000231
Original Articles: Hepatology and Nutrition

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.

*Department of Epidemiology and Public Health

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Chadi Ibrahim, MD, PhD, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood Street, Howard Hall, 102B, Baltimore, MD 21201 (e-mail:

Received 5 January, 2013

Accepted 24 October, 2013

This article has been developed as a Journal CME Activity by NASPGHAN. Visit to view instructions, documentation, and the complete necessary steps to receive CME credit for reading this article.

C.I. was supported by National Institutes of Health award T32 DK067872 and AG00262.

The authors report no conflicts of interest.

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