Adolescent Suicidal Behavior Across the Excess Weight Status Spectrum

The present study examined relative suicidal behavioral risks (ideation, attempts) for overweight, obese, and extremely obese adolescents (vs. healthy weight) and who did/did not accurately perceive themselves as overweight utilizing cross-sectional data from the publicly available Youth Risk Behavior Survey (YRBS). A new variable (weight status/accuracy) was computed that combined actual weight status (based on BMI) with weight perception accuracy. To evaluate the effect of weight status/accuracy on each suicidal risk behavior, logistic regression was performed to calculate odds-ratios and 95% confidence intervals (CI). Potential model covariates included gender, age, race, survey year, and whether they had felt sad/hopeless. Weight perception accuracy increased as the degree of excess weight increased. Relative to healthy weight, being obese or extremely obese (but not overweight) was associated with significantly greater risk for adolescent engagement in suicidal ideation, but was unrelated to suicide attempts. Adolescents in all excess weight categories who were accurate in their weight perception were at significantly greater odds of suicidal ideation, whereas those who were inaccurate of no greater odds of suicidal ideation than healthy weight youth who accurately perceived their weight. Findings regarding suicide attempts varied based on actual weight/weight perception accuracy and race/ethnicity. The present findings are both important and clinically relevant. While widely accepted that there are multiple pathways to suicide, our understanding of adolescent suicidal behavior risks and accordingly, prevention efforts, will be informed by comprehensive prospective studies that should also, from here forward, consider categorization of the entire weight spectrum (e.g., extreme obesity).