More Overweight Adolescents Think They Are Just Fine: Generational Shift in Body Weight Perceptions Among Adolescents in the U.S.

Introduction As obesity prevalence has increased, adolescents' self-perceived body weight might have shifted accordingly. This study aims to investigate the generational shift in adolescents' perception of their body weight. Methods We used data from adolescents aged 12-16 years who participated in the National Health and Nutrition Examination Survey in 1988-1994 (early, n=1,720) or 2007-2012 (recent, n=2,518). Self-perceived weight status was assessed by face-to-face interviews, and BMI z-scores were calculated using directly measured weight and height with the 2000 CDC Growth Charts as the reference. The analysis was conducted in 2013. Results The median BMI z-score of self-perceived overweight adolescents increased from 1.32 (95% CI=1.18, 1.46) among adolescents interviewed early to 1.82 (1.74, 1.90) among adolescents interviewed recently. After adjusting for age, race/ethnicity, sex, and family income, the probability of self-perceiving as "overweight" declined by 29% for overweight/obese adolescents interviewed recently (probability ratio [PR]=0.71 [0.62, 0.82]) compared with adolescents with the same z-scores but interviewed early. The declining tendency of accurately self-perceiving as overweight was most pronounced among whites (PR=0.64 [0.48, 0.85]), and least among blacks (PR=0.76 [0.58, 0.99]). Both boys and girls interviewed recently were significantly less likely to accurately self-perceive as overweight (PR=0.70 [0.56, 0.89] and 0.73 [0.61, 0.87], respectively) compared with their counterparts who were interviewed early. Conclusions Fewer overweight/obese adolescents self-perceived as such in the 2007-2012 survey compared with the 1988-1994 survey. The declining tendency among overweight or obese adolescents may be indicative of a generational shift in body weight perceptions.