NCHS Data Brief ■ No. 158 ■ July 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Perception of Weight Status in U.S. Children and Adolescents 

Aged 8–15 Years, 2005–2012

Neda Sarafrazi, Ph.D.; Jeffery P. Hughes, M.P.H.; Lori Borrud, Ph.D.; Vicki Burt, Sc.M., R.N.; 

and Ryne Paulose-Ram, Ph.D., M.A.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

2005–2012

• About 30% of children and 

adolescents aged 8–15 years in 

the United States misperceive 

their weight status. Weight 

status misperception is more 

common among boys (32.3%) 

than girls (28.0%).

• About one-third of MexicanAmerican (34.0%) and 

non-Hispanic black (34.4%) 

children and adolescents 

misperceive their weight status 

compared with non-Hispanic 

white children and adolescents 

(27.7%).

• Approximately 81% of 

overweight boys and 71% of 

overweight girls believe they 

are about the right weight.

• Nearly 48% of obese boys 

and 36% of obese girls consider 

themselves to be about the right 

weight.

Childhood obesity is a major public health problem associated with many 

adverse health outcomes in adulthood (1). During 2011–2012, nearly 17% of 

children and adolescents were obese (2). Weight status misperception occurs 

when the child’s perception of their weight status differs from their actual 

weight status based on measured height and weight. Accurate weight status 

self-perception has been linked to appropriate weight control behaviors in 

youth. The National Health and Nutrition Examination Survey (NHANES) 

data for children and adolescents aged 8–15 years offers an opportunity to 

examine weight perception status in this age group.

Keywords: weight perception • youth • overweight • obesity

Are there differences in weight status misperception 

between children and adolescents by sex and age?

During 2005–2012, 30.2% of children and adolescents misperceived their 

weight status. Overall, weight status misperception was more common among 

Figure 1. Weight status misperception among children and adolescents aged 8–15 years, by sex 

and age: United States, 2005–2012

1

Significantly different from girls, p < 0.05. 2

Significantly different from adolescents, p < 0.01. 3

Significantly different from adolescents, p < 0.05. 

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db158_table.pdf#1.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2012. Percent

0

10

20

30

40 All Boys Girls

All ages 8–11 years 12–15 years

30.2

1

32.3

28.0

2

33.1

3

34.9

3

31.2

27.4

29.7

25.0
NCHS Data Brief ■ No. 158 ■ July 2014

■  2  ■

boys (32.3%) than girls (28.0%).

About 33% of children aged 8–11 years and about 27% of adolescents aged 12–15 years 

misperceived their weight status. Weight status misperception was significantly higher among 

children compared with adolescents (p < 0.05). This was true for both boys and girls (Figure 1).

Are there differences in weight status misperception among children and 

adolescents by race and Hispanic origin?

The prevalence of weight status misperception was lowest among non-Hispanic white (27.7%) 

children and adolescents compared with non-Hispanic black (34.4%) and Mexican-American 

(34.0%) children and adolescents. This was true for both boys and girls (p < 0.05) (Figure 2).

Figure 2. Weight status misperception among children and adolescents aged 8–15 years, by race and Hispanic origin: 

United States, 2005–2012

1

Significantly different from non-Hispanic black youth, p < 0.01.

2

Significantly different from Mexican-American youth, p < 0.01.

3

Significantly different from Mexican-American youth, p < 0.05.

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db158_table.pdf#2.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2012. Percent

0

10

20

30

40 Non-Hispanic white Non-Hispanic black Mexican American

All Boys Girls

1,227.7

34.4 34.0

36.0 36.9

1,325.7

32.7

31.2 1,229.7
NCHS Data Brief ■ No. 158 ■ July 2014

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Are there differences in weight status misperception among children and 

adolescents by sex and body mass index?

Weight status misperception varies by body mass index: 87.4% of normal weight youth, 76.0% of 

overweight youth, and 41.9% of obese youth considered themselves to be about the right weight 

(Figure 3). 

This overall pattern was similar for boys and girls. About 81% of overweight boys and 71% of 

overweight girls believed that they were about the right weight, and about 48% of obese boys and 

36% of obese girls considered themselves to be about the right weight. 

Figure 3. Weight status misperception among children and adolescents aged 8–15 years, by sex and body mass index 

category: United States, 2005–2012

*Estimate does not meet standards of reliability or precision; relative standard error is greater than 30%. 

1

Significant association between BMI categories and weight status misperception, p < 0.001. 2

Significantly different from girls in the same BMI category, p < 0.05.

NOTES: BMI is body mass index. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db158_table.pdf#3. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2012.

Obese

All1

0 20 40 60

Percent

80 100

Too thin About right Overweight 

Obese

Overweight

Normal weight

Underweight 51.5

8.7

1.1 41.9 57.0

0.7 76.0 23.3

87.4 3.9

48.5

Obese2

Overweight2

Normal weight2

Underweight

Boys1

48.2

10.3

*0.6

1.4 47.6 51.0

80.9 18.5

87.0 2.7

51.8

Overweight

Normal weight

Underweight

Girls1

55.8

7.1

*0.9

*0.8 35.6 63.6

71.4 27.7

87.9 5.0

44.2
NCHS Data Brief ■ No. 158 ■ July 2014

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Are there differences in weight status misperception among children and 

adolescents by family income-to-poverty ratio (FIPR)?

Overall, the prevalence of weight status misperception was lowest among children and 

adolescents from higher (350% or more of the FIPR) income (26.3%) families compared with 

those from middle (130%–349% of the FIPR) income (30.7%) or lower (less than 130% of 

the FIPR) income (32.5%) families (Figure 4). A similar decreasing trend in weight status 

misperception with increasing poverty level was seen for girls, but not for boys. 

Figure 4. Weight status misperception among boys and girls aged 8–15 years, by family income-to-poverty ratio: 

United States, 2005–2012

350% or more of 

the FIPR

130%–349% of 

the FIPR

Less than 130% of

the FIPR

1

Significant linear trend, p < 0.01.

NOTES: FIPR is family income-to-poverty ratio. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db158_table.pdf#4.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2012. Percent

0

10

20

30

40

All Boys Girls

32.5

30.7

1

26.3

33.1

28.3

31.5

28.4

1

24.1

33.4
NCHS Data Brief ■ No. 158 ■ July 2014

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Summary

During 2005–2012, approximately 30% of children and adolescents aged 8–15 years, 

corresponding to an estimated 9.1 million children and adolescents in the United States, 

misperceived their weight status. More than 2 million healthy weight children and adolescents 

considered themselves to be too thin or too fat. Weight status misperception was more prevalent 

among overweight boys than girls: Approximately 81% of overweight boys and 71% of 

overweight girls believed that they were about the right weight. 

Weight status misperception varied by sociodemographic characteristics. The prevalence of 

weight status misperception was higher among boys (32.3%) than girls (28.0%) and lowest 

among non-Hispanic white (27.7%) children and adolescents compared with non-Hispanic black 

(34.4%) and Mexican-American (34.0%) children and adolescents. There were also significant 

differences by income level among boys and girls, with weight misperception significantly less 

among higher-income families compared with lower-income families. 

Accurate self-perception of weight status has been linked to appropriate weight control behaviors 

in youth. Understanding the prevalence of weight status misperception among U.S. children and 

adolescents may help inform public health interventions. 

Definitions

Underweight: Children and adolescents with age- and sex-specific body mass index (BMI) less 

than the 5th percentile of the 2000 CDC growth chart were considered underweight (3). BMI was 

calculated as weight in kilograms divided by height in meters squared, rounded to one decimal 

place.

Normal weight: Children and adolescents with age- and sex-specific BMI greater than or equal to 

the 5th and less than the 85th percentile of the 2000 CDC growth chart were considered normal 

weight (3).

Overweight: Children and adolescents with age- and sex-specific BMI greater than or equal to the 

85th and less than the 95th percentile of the 2000 CDC growth chart were considered overweight 

(3).

Obese: Children and adolescents with age- and sex-specific BMI greater than or equal to the 95th 

percentile of the 2000 CDC growth chart were considered obese (3).

Self-perceived weight status: Children were asked the following question by trained interviewers 

at the NHANES mobile examination center: “Do you consider yourself now to be fat or 

overweight, too thin, or about the right weight?”

Weight status misperception: Underweight individuals who considered themselves to be “about 

the right weight” or “overweight” were classified as having a weight status misperception. 

Normal weight individuals who considered themselves to be “overweight” or “underweight” 

were classified as having a weight status misperception. Overweight or obese individuals who 

considered themselves to be “underweight” or “about the right weight” were classified as having 

a weight status misperception. 
NCHS Data Brief ■ No. 158 ■ July 2014

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Family income-to-poverty ratio: Calculated by dividing family income by a poverty measure 

specific for family size. The U.S. Department of Health and Human Services’ poverty guidelines 

were used as the poverty measure to calculate FIPR (4). FIPR accounts for inflation. Income 

eligibility for participation in the Supplemental Nutrition Assistance Program or SNAP is 130% 

of the FIPR (< 130% FIPR) (5). Larger FIPRs indicate greater income.

Data source and methods

Data from NHANES were used for these analyses. NHANES is a cross-sectional survey designed 

to assess the health and nutritional status of the civilian noninstitutionalized U.S. population (6). 

The survey consists of in-home interviews and standardized physical examinations in mobile 

examination centers.

The NHANES sample is selected through a complex, multistage design that includes selection 

of primary sampling units (counties), household segments within the counties, households 

within the segments, and sample persons from selected households. The sample design includes 

oversampling to obtain reliable estimates of health and nutritional measures for population 

subgroups. In 1999, NHANES became a continuous survey. Public-use data files are released in 

2-year cycles.

Survey examination weights, which account for the differential probabilities of selection, 

nonresponse, and noncoverage, were incorporated into the estimation process. The standard errors 

of the percentages were estimated using Taylor series linearization, a method that incorporates 

the sample weights and sample design. Differences between groups were evaluated using a Wald 

chi-square or two-tailed t test, as appropriate, with a p less than 0.05 significance level. Statistical 

analyses were conducted using SAS version 9.3 (SAS Institute Inc., Cary, N.C.) and SUDAAN 

version 10.0.1 (RTI International, Research Triangle Park, N.C.).
NCHS Data Brief ■ No. 158 ■ July 2014

■  7  ■

About the authors

Neda Sarafrazi, Jeffery P. Hughes, Lori Borrud, Vicki Burt, and Ryne Paulose-Ram are with 

CDC’s National Center for Health Statistics, Division of Health and Nutrition Examination 

Surveys.

References

1. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors 

and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study.

J Pediatr 150(1):12–17.e2. 2007.

2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the 

United States, 2011–2012. JAMA 311(8):806–14. 2014.

3. Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: 

Methods and development. National Center for Health Statistics. Vital Health Stat 11(246). 2002.

4. U.S. Department of Health and Human Services. Poverty guidelines, research, and 

measurement. 2012. Available from: http://aspe.hhs.gov/poverty/index.cfm.

5. U.S. Department of Agriculture. Supplemental Nutrition Assistance Program (SNAP): 

Eligibility. Available from: http://www.fns.usda.gov/snap/eligibility.

6. National Center for Health Statistics. 2011–2012 National Health and Nutrition Examination 

Survey. Available from: http://www.cdc.gov/nchs/nhanes/nhanes2011-2012/questexam11_12.htm.
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Suggested citation

Sarafrazi N, Hughes JP, Borrud L, et al. 

Perception of weight status in U.S. children 

and adolescents aged 8–15 years, 2005–

2012. NCHS data brief, no 158. Hyattsville, 

MD: National Center for Health Statistics. 

2014.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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