Relationships between Body Weight Perception, Body Mass Index, and Food Choices in Southern California Adolescents
Authors: Gaylis Jaclyn B. , Levy Susan S. , Hong Mee Yong 
Published: November 2023

Body weight perception is gaining recognition as a powerful determinant of nutritional habits and weight management practices among adolescents. The purpose of this cross‐sectional study design was to examine the relationships between body weight perception, Body Mass Index (BMI) and food choices among Southern Californian teenagers. Nutritional intake, height and weight for the calculation of BMI, and demographic information were assessed using a modified validated questionnaire measure for the 1,212 Southern California teenager participants. Chi‐square tests and t‐tests examined the relationships between demographic variables and outcome variables of interest.Average BMI percentile was higher in males than females (p < 0.001). A significant gender relationship was found on body weight perception (thin, fit and overweight). More females perceived themselves as overweight and had tried to control their weight, where as more males tried to gain weight or never tried to control their weight (p < 0.001). However, both males and females reported concerns about controlling their weight for improved appearance. A significant relationship was found between BMI category and body weight perception. Of those adolescents in the healthy BMI category, 52.7% perceived themselves to be fit and 23.5% perceived themselves as overweight (p < 0.001). A greater number of overweight/obese BMI adolescents (62.3%) reported having tried to lose weight and 35.1% of those within the healthy BMI category reported attempting to lose weight (p < 0.001).A higher number of adolescents who perceived themselves to be thin consumed hamburgers (13.1%) and regular soda (22.9%) on a daily basis, compared to those adolescents who considered themselves overweight and who consumed fewer hamburgers (7.5%) and regular sodas (14.6%) (p < 0.001). Adolescents who perceived themselves as fit and overweight had daily consumption of salad more frequently than those who perceived themselves as thin (p < 0.01). Similarly, those who perceived themselves as fit and overweight had greater daily consumption of vegetables than those who considered themselves thin (p < 0.003). Of the adolescents who perceived themselves as thin, 57.6% had the most daily consumption of junk food compared to those who considered themselves to be fit (49.1%) or overweight (48.8%) (p < 0.004). Interestingly, results showed that adolescents who perceived themselves to be thin tend to consume unhealthier foods such as hamburgers and regular soda, where those who perceived themselves as fit and overweight made healthier food choices by eating more salad and vegetables.The complex relationship between weight perception and body image is important because of its influence on adolescents' health behaviors. The results of this study validate that having a correct perception of weight is critical to the success of education and behavior intervention programs for both overweight and normal‐weight adolescents. In order to create long lasting program effects on actual weight improvements and healthy lifestyles, efforts to educate children and adolescents regarding body weight perception and healthy behaviors such as physical activity and health eating habits are needed.
Demographic Data

Males (n=446)
Females (n=766)

Age (y)†
16.0±1.5
16.0±1.5

Weight (kg)†
70.1±15.9
58.1±11.6

Height (m)†
173.4±10.4
162.2±8.9

BMI (kg/m2)†*
23.2±4.4
22.1±4.0

BMI%†*
65.8±26.3
60.0±25.7

BMI% by Body Weight Perception†*

Thin
45.6±26.0
36.2±22.0

Fit
64.7±23.8
55.7±22.7

Overweight
83.8±18.2
75.8±19.3

Ethnicity (%)

Caucasian
41.4
43.3

Black
7.2
6.3

Hispanic
32.0
33.0

Asian
10.8
10.2

Other
8.6
7.2

measures expressed as mean±standard deviation
indicates statistical significance between males and females using non‐paired t‐tests (p < .05)

BMI, Body Weight Perception and Weight Control by Gender

Male (%)
Female (%)
P‐value*

BMI Category

Healthy
67.5
78.7
P < .001

Overweight/Obese
32.5
21.3

Body Weight Perception

Thin
20.1
18.3
P < .001

Fit
53.8
42.4

Overweight
26.0
39.3

Control Weight

Try to Lose
24.0
50.4
P < .001

Try to Gain
19.2
3.9

Maintain
15.3
24.1

Never tried
41.6
21.6

Reason for Weight Control

Health concern
4.8
5.0
P < .01

Improve health
24.6
24.7

Look Better
52.2
61.3

Other
18.4
8.9

indicates statistical significance between males and females using Chi‐squared tests (χ2 test) (p < .05).
BMI category: percentile categorization: healthy = BMI percentile 5–84.9%, Overweight/Obese = BMI percentile ≥ 85%.

Body Weight Perception and Weight Control by Ethnicity (%)

Caucasian
Black
Hispanic
Asian
P‐value*

BMI Category

Healthy
78.4
68.8
70.6
77.8
P < .001

Overweight/Obese
21.6
31.3
29.4
22.2

Body Weight Perception

Thin
21.7
20.0
17.3
17.7
P < .001

Fit
51.5
52.5
39.5
46.8

Overweight
26.8
27.5
43.1
35.5

Weight Control

Try to Lose
37.8
31.1
49.3
37.1
P < .05

Try to Gain
9.8
11.5
6.5
12.4

Maintain
21.0
23.0
21.0
20.6

Never tried
31.5
34.4
23.2
29.9

Reason for Weight Control

Health concern
4.6
6.9
6.2
4.2
NS

Improve health
25.2
22.4
22.4
27.4

Look Better
56.8
58.6
61.8
54.7

Other
13.4
12.1
9.7
13.7

indicates statistical significance between ethnicities using Chi‐squared tests (χ2 test) (p < .05).
BMI category: percentile categorization: healthy = BMI percentile 5–84.9%, Overweight/Obese = BMI percentile ≥ 85%. NS: not significant.

Body Weight Perception and Weight Control by BMI

Healthy BMI (%)
Overweight/Obese BMI (%)
P‐value*

Body Weight Perception

Thin
23.8
4.9
P < .001

Fit
52.7
28.9

Overweight
23.5
66.2

Control Weight

Try to Lose
35.1
62.3
P < .001

Try to Gain
11.3
1.8

Maintain
23.1
14.5

Never tried
30.5
21.5

Reason for Weight Control

Health concern
4.8
5.5
NS

Improve health
24.0
26.7

Look Better
58.5
58.1

Other
12.7
9.7

indicates statistical significance between healthy and overweight/obese using Chi‐squared tests (χ2 test) (p < .05).
BMI category: percentile categorization: healthy = BMI percentile 5–84.9%, Overweight/Obese = BMI percentile ≥ 85%. NS: not significant.

Body Weight Perception by PA

PA meeting (%)
PA not meeting (%)
P‐value*

BMI Category

Healthy
74.7
74.4
NS

Overweight/Obese
25.3
25.6

Body Weight Perception

Thin
15.1
21.1
P < .001

Fit
57.5
38.7

Overweight
27.4
40.2

Control Weight

Lose
38.0
44.1
P < .05

Gain
12.0
7.0

Maintain
20.9
21.2

Never tried
29.1
27.7

Reason for Weight Control

Health concern
5.3
4.1
P < .001

Improve health
27.3
21.7

Look Better
51.1
65.0

Other
16.3
9.2

indicates statistical significance between body weight perception groups using Chi‐squared tests (χ2 test) (p < .05).
PA: physical activity. BMI category: percentile categorization: healthy = BMI percentile 5–84.9%, Overweight/Obese = BMI percentile ≥ 85%. PA meeting: ≥ 420 min/wk. PA not meeting: < 420 min/wk. NS: not significant.

Dietary Intake by Body Weight Perception

Daily (%)
Weekly (%)
Monthly (%)
Yearly (%)
P‐value*

Hamburger

Thin
13.1
45.5
35.1
6.3
P < .05

Fit
8.3
43.2
38.9
9.6

Overweight
7.5
38.6
38.6
15.3

Regular Soda

Thin
22.9
42.5
16.8
17.8
P < .001

Fit
17.0
33.8
22.2
27.0

Overweight
14.6
33.4
17.8
34.2

Salad

Thin
11.5
55.0
18.3
15.1
P < .05

Fit
23.0
53.5
13.9
9.6

Overweight
20.9
53.6
15.5
10.0

Vegetables

Thin
27.9
59.4
9.1
3.7
P < .05

Fit
38.1
55.1
5.7
1.1

Overweight
36.1
56.7
5.5
1.7

Junk Food

Thin
57.6
40.6
13
0.4
P < .05

Fit
49.1
48.5
1.6
0.7

Overweight
48.8
46.3
4.5
0.5

indicates statistical significance between body weight perceptions using Chi‐squared tests (χ2 test) (p < .05).
Vegetables include: salad, dark‐yellow vegetables (carrots/paprika/etc), cruciferous vegetables (broccoli, cauliflower, turnip root/cabbage), other vegetables (onion/garlic/cucumber/zucchini/etc), corn/green beans, and tomatoes. Junk Food includes: hamburger, cookies/cake, salted snacks, pizza/cheese dishes, ice cream, sweets (sugar, honey, candy, chocolates), and regular sodas.

Dietary Intake by Weight Control

Daily (%)
Weekly (%)
Monthly (%)
Yearly (%)
P‐value*

Regular Soda

Try to Lose
14.4
27.6
21.8
36.2
P < .001

Try to Gain
17.9
40.5
16.7
25.0

Maintain
17.8
35.6
15.3
31.2

Never tried
15.6
44.5
19.8
20.2

Salad

Try to Lose
49.0
43.7
30.8
32.6
P < .002

Try to Gain
3.5
8.8
13.8
12.8

Maintain
22.7
20.6
26.9
16.3

Never tried
24.7
26.9
28.5
38.4

indicates statistical significance between weight control methods using Chi‐squared tests (χ2 test) (p < .05)