Cross-national time trends in adolescent body weight perception and the explanatory role of overweight/obesity prevalence

ABSTRACT

Introduction

Body weight perception (BWP) is associated with health behaviors. Current evidence points to an increase over time in both actual and perceived weight status among adolescents, however there is limited evidence on time trends in BWP in cross-national samples of adolescents. Therefore, the aims of this study were to examine time trends in BWP between 2002 and 2018 among adolescents from 41 countries and regions, including gender and country differences and to explore the role of changes over time in country-level overweight/obesity prevalence in these trends.

Methods

Data were used from five cycles (2002, 2006, 2010, 2014, 2018) of the repeated cross-sectional Health Behavior in School-Aged Children (HBSC) study (n = 746,121; mean±standard deviation age 13.7 ± 1.6 years, 51.0% girls). Multilevel logistic models estimated cross-national linear time trends in adolescent BWP (correct perception, underestimation, or overestimation), adjusted for gender, age, and family affluence. Next, we tested whether country-level changes over time overweight/obesity prevalence could explain these trends in BWP among adolescents.

Results

Correct weight perception increased over time among girls, while it decreased among boys. Underestimation of weight status increased, and overestimation of weight status decreased over time among both genders, with stronger trends for girls. Furthermore, country differences in trends in both BWP and overweight/obesity were found. Changes over time in country-level overweight/obesity prevalence could not explain these trends.

Conclusion

The linear increase over time in correct weight perception and the decrease in overestimation may have a positive effect on unhealthy weight reduction behaviors among adolescents. However, the increase in underestimation could signal a need for interventions to strengthen correct weight perception among adolescents. Several implications for policy and practice are discussed.

KEYWORDS:

• Body weight congruence
• weight perception
• overweight
• obesity
• adolescents
• trends

Acknowledgments

Health Behaviour in School-aged Children is an international study carried out in collaboration with World Health Organization Regional Office for Europe. The International Coordinator was Jo Inchley (University of Glasgow) for the 2018 survey and Candace Currie (Glasgow Caledonian University) for the 2002 to 2014 surveys. The Data Bank Manager was Professor Oddrun Samdal (University of Bergen). The survey data included in this study were conducted by the following principal investigators in the 41 countries: Armenia (Sergey Sargsyan and Marina Melkumova), Austria (Rosemarie Felder-Puig), Flemish Belgium (Katrijn Delaruelle and Maxim Dierckens), French Belgium (Katia Castetbon), Canada (William Pickett and Wendy Craig), Croatia (Ivana Pavic Simetin), Czech Republic (Michal Kalman), Denmark (Katrine Rich Madsen), England (Fiona Brooks and Sally Kendal), Estonia (Leila Oja and Jaanika Piksööt), Finland (Leena Paakkari and Nelli Lyyra), France (Emmanuelle Godeau and Mariane Sentenac), Germany (Matthias Richter), Greece (Anastasios Fotiou and Anna Kokkevi), Greenland (Birgit Niclasen), Hungary (Ágnes Németh), Iceland (Arsaell M. Arnarsson), Ireland (Saoirse Nic Gabhainn), Italy (Alessio Vieno), Latvia (Iveta Pudule), Lithuania (Kastytis Smigelskas), Luxembourg (Andreas Heinz and Bechara Georges Ziadé), Macedonia (Lina Kostarova Unkovska), Malta (Charmaine Gauci, Paula Vassallo and Michelle Deguara), the Netherlands (Gonneke Stevens and Saskia van Dorsselaer), Norway (Oddrun Samdal), Poland (Agnieszka Malkowska-Szkutnik and Anna Dzielska), Portugal (Tania Gaspar), Romania (Adriana Baban), Russia (Alexander Komov and Anna Matochkina), Scotland (Jo Inchley), Slovakia (Andrea Madarasova Geckova), Slovenia (Helena Jeriček Klanšček), Spain (Carmen Moreno and Francisco Rivera), Sweden (Petra Löfstedt), Switzerland (Marina Delgrande-Jordan), Ukraine (Daryna Pavlova), the United States of America (Mary Overpeck and Roland Iannotti), and Wales (Chris Roberts). For details on the HBSC survey visit www.hbsc.org.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings are available from the HBSC Data Management Centre at https://www.uib.no/en/hbscdata/113290/open-access.

Additional information

Funding

Anne-Siri Fismen is a postdoctoral fellow in the CO-CREATE project, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No. 774210.