Weight Perception and Weight-control Intention among Youth in the COMPASS Study

Objectives: Youth weight perceptions and the association with weight-control intentions were explored by sex and body mass index (BMI). Methods: Cross-sectional analyses (frequency, chi-square, multiple logistic regression) were conducted among 44,861 grade 9-12 students in Year 2(Y₂:2013-2014) of the COMPASS study, adjusting for sex and race/ethnicity. Results: Overall, weight underestimations were more common than overestimations, although there were differences by sex and race/ethnicity. Boys were relatively more likely to underestimate their weight status, and girls were more likely to overestimate. Compared to youth with normal-weight BMIs, students with overweight BMIs were more inclined to underestimate their weight, and those with BMIs in the obese range had higher odds of accurately perceiving their weight. Regardless of BMI, youth with overweight perceptions were more likely to report trying to lose weight than those who perceived their weight to be "about right," whereas youth with underweight perceptions tended to report efforts to gain weight. Conclusions: While youth with overweight BMIs did not necessarily perceive their weight as such, accurate perceptions were more likely once BMI reached the obese range. Results suggest weight perception is a more useful predictor of weight-control intentions than self-reported weight status among youth.