Accuracy of child and adolescent weight perceptions and their relationships to dieting and exercise behaviors: a NHANES study

Objective: Recent public health and media attention on child obesity may have altered accuracy of self-perception of obesity and associated weight control behaviors in children and adolescents. Thus, we examined whether accuracy of weight perceptions were associated with weight loss behaviors.

Methods: We examined children 8 to 15 years old in the National Health and Nutrition Examination Survey (2005-2010) who reported themselves as "overweight/too fat," "about right," or "underweight/too thin." Children reported on efforts to lose weight and engagement in specific weight control behaviors, including how frequently he or she had been on a diet, starved, cut back on eating, skipped meals, or exercised to lose weight. We categorized obesity on the basis of measured body mass index, and we determined the accuracy of weight perceptions. We used chi-square tests to examine age- and sex-based differences in accuracy of perceptions and relationship to weight loss behaviors.

Results: Girls and older children more accurately perceived weight status. Both girls and boys of all ages who perceived themselves as overweight were more likely to engage in weight loss behaviors. Children who were overweight engaged in more weight loss behaviors than healthy weight children perceiving themselves as overweight. Among children who reported themselves as "about right," overweight children engaged in more weight loss behaviors than healthy weight children but less so than those who accurately perceived themselves as being overweight.

Conclusions: The perception of being overweight and actual overweight status are both strongly associated with weight loss behaviors. These findings have important implications for counseling patients who may have inaccurate weight perceptions.