Cross-sectional associations between weight-related health behaviors and weight misperception among U.S. adolescents with overweight/obesity

BACKGROUND: Weight misperception occurs when there is a discrepancy between one’s actual and perceived weight status. Among adolescents with overweight/obesity, many believe that correcting weight misperception is imperative to inspire weight-related behavior change. However, past research has shown that adolescents with overweight/obesity who misperceive their weight status gain less weight over time compared to accurate perceivers. Therefore, our objective was to examine possible mechanisms underlying this relationship. Specifically, we examined the association between weight misperception and engagement in weight-related health behaviors among adolescents with overweight/obesity. METHODS: Self-reported data from the 2015 National Youth Risk Behavior Survey was used in analyses restricted to participants with overweight/obesity (n = 4383). Using multivariate logistic models correcting for sex, race/ethnicity, and grade in school, we examined the cross-sectional associations between weight misperception and engagement in weight-related health behaviors, specifically related to dietary intake, physical activity, and sleep. RESULTS: Adolescents with overweight/obesity who misperceived their weight status were more likely to drink 100% fruit juice two or more times per day (OR = 1.53, 95% CI: 1.20, 1.94), eat vegetables two or more times per day (OR = 1.29, 95% CI: 1.07, 1.57), be physically active for 1 hour or more per day for at least 5 days in the week prior (OR = 1.40, 95% CI: 1.15, 1.72), be on a sports team in the last year (OR = 1.55, 95% CI: 1.21, 1.97), sleep an average of at least 8 hours per school night (OR = 1.40, 95% CI: 1.15, 1.72), and less likely to be trying to lose weight (OR = 0.17, 95% CI: 0.15, 0.20). Misperceivers were more likely to consume breakfast every morning in the week prior and to drink a sports drink at least once per day, though these results were not statistically significant. We observed no difference in fruit intake, soda intake, or TV viewing between weight misperceivers and accurate perceivers. CONCLUSIONS: Overall, weight misperception among adolescents with overweight/obesity was associated with a number of beneficial weight-related health behaviors. Engagement in these healthy weight-related behaviors may explain some of the protective effect of weight misperception on weight gain over time. TRIAL REGISTRATION: Not applicable.