Body size estimation and other psychosocial risk factors for obesity onset among US adolescents: findings from a longitudinal population level study

Int J Obes (Lond). 2015 Apr;39(4):601-7. doi: 10.1038/ijo.2014.191. Epub 2014 Nov 5.


Background/objective: The purpose of this study was to examine the longitudinal effects of body size over- and underestimation and other psychosocial factors on the risk for onset of overweight (OW) or obesity (OB) 1 year later among US adolescents.

Subjects/methods: Participants with non-missing height and weight were drawn from the first two waves of the National Longitudinal Study of Adolescent to Adult Health (n=13,568). Multinomial logistic regressions were conducted to assess longitudinal risk factors for OW and OB onset, controlling for baseline weight status, age, race/ethnicity, parent education and family structure. Analyses were stratified by sex.

Results: Compared with accurate body size perception, body size overestimation increased the relative risk (RR) of OW onset among women and men (RR=3.34, confidence interval (CI)=2.39-4.68; RR=6.01, CI=4.09-8.83, respectively, P<0.001) in fully adjusted models including body mass index z-scores. Body size underestimation decreased the RR of OW onset among women and men (RR= 0.08, CI=0.03-0.20; RR=0.13, CI=0.06-0.27, respectively) and OB onset (RR=0.05, CI=0.02-0.14; RR=0.19, CI=0.08-0.47, respectively, P<0.001 for all) in fully adjusted models. Dieting, extreme weight loss behaviors and skipping breakfast at Wave 1 increased the risk of OB onset by Wave 2.

Conclusions: Contrary to a common assumption, body size underestimation did not increase, but in fact decreased, the RR for the onset of OW and of OB among adolescents using a prospective longitudinal design. However, body size overestimation predicted onset of OW 1 year later. Body size self-concept and other psychosocial factors have an important role in risk for OW and for OB among both males and females during adolescence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Body Image / psychology
  • Body Mass Index
  • Body Size
  • Depression / epidemiology
  • Depression / psychology*
  • Diet / psychology*
  • Diet, Reducing
  • Female
  • Health Behavior
  • Humans
  • Longitudinal Studies
  • Male
  • Mass Media
  • Obesity / epidemiology
  • Obesity / prevention & control
  • Obesity / psychology*
  • Risk Factors
  • Self Concept*
  • United States / epidemiology