Factors Related to Weight Perception Accuracy among Obese Children and Adolescents at-Risk for Cardiovascular Disease

Background: Pediatric obesity has become a public health epidemic, but many overweight and obese children consider their weight normal. While having overweight or obese peers and family members further reduces the likelihood of children correctly self-identifying as overweight or obese, accurate identification of current body weight status is necessary in order to initiate behavior change and reduce risk of cardiovascular disease.

Objective: The objective of this study was to explore factors related to children’s and adolescents’ perceptions of current body weight status.
Design and Participants: This cross-sectional study included data from 117 obese children and adolescents (n=76 female, 41 male) ages 4-17 years, attending the Medical University of South Carolina’s Heart Health Program.

Results: Thirty-seven percent of the sample accurately categorized their weight status; accuracy did not differ by race. Older children (>11.9 y) were more likely to accurately perceive their weight than younger children (p=0.02), and older girls were more likely to be accurate than older boys (p=0.03). Relatively larger children were also more likely to accurately perceive their weight (p=0.01). Logistic regression analyses revealed that after controlling for BMI-for-age percentile, older girls had a 1.4 times higher likelihood of accurately perceiving their weight status compared to all other children (p=0.12 for the gender-by-age interaction).

Conclusions: In a cohort of obese children and adolescents at-risk for cardiovascular disease, boys and younger girls were less likely to correctly identify their current body weight status. An individualized, family-centered approach should be taken during clinic visits to address children’s weight status, and patient education should be focused on encouraging gradual behavior change strategies in order to improve self-efficacy, preserve health-related quality of life, and reduce cardiovascular disease risk in this population.

Keywords: obesity, weight perception, overweight, children, adolescent, cardiovascular disease risk.