BACKGROUND: Weight misperception has been documented among children although the impact on health risk behaviors is less understood, particularly among middle school students. The goals of this study were to describe sociodemographic differences in actual and perceived weight, correspondence between actual and perceived weight, and weight-related health risk behaviors, as well as to examine weight misperception and interactions with sociodemographic variables in explaining weight-related health risk behaviors. METHODS: Participants were recruited at 11 public school districts participating in the Tennessee Coordinated School Health (CSH) pilot program. A total of 10,273 middle school students completed the Centers for Disease Control and Prevention's Youth Risk Behavior Survey administered by teachers in the school setting. RESULTS: Findings revealed sociodemographic differences in actual and perceived weight as well as weight misperception. Although overestimating one's weight was significantly related to greater likelihood of weight-related health risk behaviors, significant interactions showed this relationship to be especially pronounced in females. Additional distinctions based on sociodemographic variables are indicated. CONCLUSIONS: Results highlight the importance of screening for health risk behaviors including weight misperception among middle school students. The CSH program offers an opportunity to understand health risk behaviors among students while also informing and evaluating methods for intervention. © 2014, American School Health Association.

Background: Overweight and obesity is a significant public health problem in the United States. Young adulthood is a particularly vulnerable period for excess weight gain and development of overweight/obesity. Although standard behavioral weight control programs can produce clinically significant weight losses, they routinely struggle to recruit young adults, particularly young men and African-Americans. This limits our understanding of the efficacy of these programs for these individuals. Weight misperception has been proposed as a potential barrier to attempting weight loss. Evidence also suggests education level, income status, family medical history, occupational demands, and depressive symptoms are individually associated with attempting weight loss. Against this backdrop, it is important to examine the relative influence of weight misperceptions and other contextual factors to better understand why young adults, particularly men and African-Americans, do not attempt weight loss. Objective: To determine if observed differences in weight control by race and sex are due to differences in weight status perception accuracy among black and white young adults with overweight/obesity. The associations between contextual factors and weight loss attempts are also explored. Methods: Data from 2756 young adults (20-39 years old) who participated in the 2007-2014 National Health and Nutritional Examination Survey (NHANES) were analyzed. Logistic regression models examined the effect of weight status perception accuracy and contextual factors on weight loss attempts among young adults and men specifically. Moderation by sex was assessed in the sample as a whole and moderation by race in analyses limited to young adult men. Sensitivity analyses using a higher BMI threshold (BMI ≥ 27 kg/m2) were conducted to ensure that participants with a minimal weight misperception did not unduly influence findings. Results: Overall, 31% of young adults had an inaccurate weight status perception, with a significantly higher number of men, particularly black men, reporting an inaccurate perception of their weight. Young adults, and men specifically, were significantly more likely to report a weight loss attempt if they accurately perceived their weight (OR=3.66, 95% CI 2.80-4.77, p<0.01; OR=3.73; 95% CI 2.76-5.03; p<0.01, respectively). However, there was no moderation by sex or race. Higher education level and income status were associated with weight loss attempts among young adults in models that included both sexes and in those that were limited to men. Although not significant in the larger model, greater self-reported depressive symptoms were associated with weight loss attempts in analyses limited to young adult men. Sensitivity analyses were largely consistent with these findings. Conclusion: Most young adults with overweight/obesity accurately perceive their weight status. Weight status perception accuracy and certain contextual factors are important predictors of weight loss attempts among black and white young adults. Neither sex nor race moderated the association between weight status perception accuracy and weight loss attempts. These findings have implications for future research to better understand weight status perception and improve enrollment of young adults in weight control programs. / Public Health

Excerpt:Misperceptions about personal weight are common and include both under- and overestimates.1–6 Overweight misperception is found among both males and females across different racial/ethnic and age groups but is generally more common among females. Studies also indicate that body weight misperception is common among university students.2,4,7,8 In a study assessing the prevalence of weight misperception among U.S. college students, 12.9% of students had inflated body weight perception and 15.1% considered themselves to be thinner than they actually were.7 Gender and racial/ethnic differences in weight misperception have been observed among normal-weight college adults. According to the 2008 National College Health Assessment (NCHA), 28.8% of college females and 39.4% of college males were overweight or obese. However, more females (38.0%) than males (30.8%) described themselves as overweight or obese.8 Non-Hispanic white people are also more likely to report overweight misperception than other racial/ethnic minority groups.8,9