Body Weight Misperception and Weight Disorders among Chinese Children and Adolescents: A Latent Class Analysis

Abstract

Body misperception plays an important role in the development of weight and dietary disorders among children and adolescents. A school-based health promotion program (2014–2015) was conducted to promote the school health education and improve the teenagers’ physical health among Chinese children and adolescents. Based on this program, we intended to examine weight status and weight misperception among Chinese children and adolescents and to explore the relationship between weight misperception and lifestyle behaviors. A total of 10 708 Chinese children and adolescents in 3rd and 7th grade from Shandong and Qinghai province participated in the program. The participants’ dietary and activity patterns were clustered by latent class analysis (LCA). Logistic regression analysis was undertaken to explore the relationship between weight perception and demographic factors or dietary and activity patterns. Given the gender-specific difference of children and adolescents, analyses were separately conducted among boys and girls. The total prevalence of weight misperception was 44.50%. Boys, especially those in higher grade and living in wealthier district, were more likely to misperceive body weight. Girls were more likely to overestimate their weight (26.10%) while boys tended to underestimate the weight (28.32%). Three latent dietary and activity patterns including obesogenic pattern, malnourished pattern and healthy pattern were derived. The participants who had weight misperception were more likely to choose unhealthy dietary and exercise activities. The high prevalence of weight misperception was closely related to the unhealthy weight pattern and unhealthy dietary or exercise patterns. Our research found that most children and adolescents failed to perceive their weight correctly and boys tended to underestimate their weight while girls were subjected to overestimation. So, comprehensive intervention programs should focus on improving self-weight awareness, and appropriate guidance should be made to lead the adolescents to more healthy weight pattern.

Keywords

weight perception / children and adolescents / obesity / lifestyle behavior pattern / latent class analysis

References

[1] HoganMJ, StrasburgerVC. Body image, eating disorders, and the media. Adolesc Med State Art Rev, 2008, 19(3): 521-464

[2] McDonaldCM, OlofinI, FlaxmanS, et al.. The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr, 2013, 97(4): 896-901

[3] ParkMH, FalconerC, VinerRM, et al.. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev, 2012, 13(11): 985-1000

[4] ReillyJJ, KellyJ. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes, 2011, 35(7): 891-898

[5] OrganizationWH. Preventing Chronic Diseases, 2005, Geneva, World Health OrganizationA Vital Investment: WHO Global Report

[6] LoWS, HoSY, MakKK, et al.. Weight misperception and psychosocial health in normal weight Chinese adolescents. Int J Pediatr Obes, 2011, 6(2–2): e381-e389

[7] ChisuwaN, O’DeaJA. Body image and eating disorders amongst Japanese adolescents. A review of the literature. Appetite, 2010, 54(1): 5-15

[8] MogreV, MwinlennaPP, OladeleJ. Distorted self-perceived weight status and its associated factors among civil servants in Tamale, Ghana: a cross-sectional study. Arch Public Health, 2013, 71(1): 30

[9] ShirasawaT, OchiaiH, NanriH, et al.. Association between distorted body image and changes in weight status among normal weight preadolescents in Japan: a population-based cohort study. Arch Public Health, 2016, 74: 39

[10] FeltsWM, ParrilloAV, ChenierT, et al.. Adolescents’ perceptions of relative weight and self-reported weight-loss activities: analysis of 1990 YRBS (Youth Risk behavior Survey) national data. J Adolesc Health, 1996, 18(1): 20-26

[11] EdwardsNM, PettingellS, BorowskyIW. Where perception meets reality: self-perception of weight in overweight adolescents. Pediatrics, 2010, 125(3): e452-e458

[12] LeeK, ValeriaB, KochmanC, et al.. Self-assessment of height, weight, and sexual maturation: validity in overweight children and adolescents. J Adolesc Health, 2006, 39(3): 346-352

[13] PichJ, Bibiloni MdelM, PonsA, et al.. Weight self-regulation process in adolescence: The relationship between control weight attitudes, behaviors, and body weight status. Front Nutr, 2015, 2: 14

[14] RawanaJS. The relative importance of body change strategies, weight perception, perceived social support, and self-esteem on adolescent depressive symptoms: longitudinal findings from a national sample. J Psychosom Res, 2013, 75(1): 49-54

[15] KimY, KawachiI. School- and Individual-level Predictors of Weight Status Misperception among Korean Adolescents: A National Online Survey. PloS one, 2016, 11(5): e0154826

[16] MartinMA, FriscoML, MayAL. Gender and race/ethnic differences in inaccurate weight perceptions among U.S. adolescents. Womens Health Issues, 2009, 19(5): 292

[17] ParkE. Overestimation and underestimation: adolescents’ weight perception in comparison to BMI-based weight status and how it varies across socio-demographic factors. J Sch Health, 2011, 81(2): 57-64

[18] ShirasawaT, OchiaiH, NanriH, et al.. The relationship between distorted body image and lifestyle among Japanese adolescents: a population-based study. Arch Public Health, 2015, 73(1): 32

[19] ShiZ, LienN, Nirmal KumarB, et al.. Perceptions of weight and associated factors of adolescents in Jiangsu Province, China. Public Health Nutr, 2007, 10(3): 298-305

[20] LimH, WangY. Body weight misperception patterns and their association with health-related factors among adolescents in South Korea. Obesity, 2013, 21(12): 2596-2603

[21] HaY, ChoiE, SeoY, et al.. Relationships among subjective social status, weight perception, weight control behaviors, and weight status in adolescents: findings from the 2009 Korea Youth Risk Behaviors Web-Based Survey. J Sch Health, 2013, 83(4): 273-280

[22] ChenX, WangY. Is ideal body image related to obesity and lifestyle behaviors in African American adolescents?. Child Care Health Dev, 2012, 38(2): 219-228

[23] PetracciE, CavriniG. The effect of weight status, lifestyle, and body image perception on health-related quality of life in children: a quantile approach. Qual Life Res, 2013, 22(9): 2607-2615

[24] PatnodeCD, LytleLA, EricksonDJ, et al.. Physical activity and sedentary activity patterns among children and adolescents: a latent class analysis approach. J Phys Act Health, 2011, 8(4): 457-467

[25] de OnisM, OnyangoAW, BorghiE, et al.. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ, 2007, 85(9): 660-667

[26] MenschikD, AhmedS, AlexanderMH, et al.. Adolescent physical activities as predictors of young adult weight. Arch Pediatr Adolesc Med, 2008, 162(1): 29-33

[27] StrasburgerVC, HoganMJ, MulliganDA, et al.. Children, Adolescents, and the Media. Pediatrics, 2013, 132(5): 958-961

[28] LandisKGJr.. The measurement of observer agreement for categorical data. Biometrics, 1977, 33: 159-174

[29] HagenaarsJA, McCutcheonAL. Applied latent class analysis, 2002, New York, Cambridge University Press

[30] PatnodeCD, LytleLA, EricksonDJ, et al.. Physical activity and sedentary activity patterns among children and adolescents: a latent class analysis approach. J Phys Act Health, 2011, 8(4): 457-467

[31] XieB, ChouCP, Spruijt-MetzD, et al.. Weight perception, academic performance, and psychological factors in Chinese adolescents. J Phys Act Health, 2006, 30(2): 115-124

[32] XieB, ChouCP, Spruijt-MetzD, et al.. Longitudinal analysis of weight perception and psychological factors in Chinese adolescents. Am J Health Behav, 2011, 35(1): 92-104

[33] LanzaST, CollinsLM, LemmonDR, et al.. PROC LCA: A SAS Procedure for Latent Class Analysis. Struct Equ Modeling, 2007, 14(4): 671-694

[34] SmolakL. Body image in children and adolescents: where do we go from here?. Body Image, 2004, 1(1): 15-28

[35] Avila, C. Media’s portrayal of the “ideal image” with emphasis on the “thin ideal” and its effects on women’s body image. Diss, 2015.

[36] CaladoM, LameirasM, SepulvedaAR, et al.. The association between exposure to mass media and body dissatisfaction among Spanish adolescents. Womens Health Issues, 2011, 21(5): 390-399

[37] McLeanSA, PaxtonSJ, WertheimEH. Does Media Literacy Mitigate Risk for Reduced Body Satisfaction Following Exposure to Thin-Ideal Media?. J Youth Adolesc, 2016, 45(8): 1678-1695

[38] HelfertS, WarschburgerP. A prospective study on the impact of peer and parental pressure on body dissatisfaction in adolescent girls and boys. Body Image, 2011, 8(2): 101-109

[39] GondoliDM, CorningAF, SalafiaEH, et al.. Heterosocial involvement, peer pressure for thinness, and body dissatisfaction among young adolescent girls. Body Image, 2011, 8(2): 143-148

[40] LabreMP. Adolescent boys and the muscular male body ideal. J Youth Adolesc, 2002, 30(4): 233-242

[41] RobinsonE, KersbergenI. Overweight or about right? A norm comparison explanation of perceived weight status. Obes Sci Pract, 2017, 3(1): 36-43

[42] ShirasawaT, OchiaiH, NanriH, et al.. The relationship between distorted body image and lifestyle among Japanese adolescents: a population-based study. Arch Public Health, 2015, 73(1): 32