Students may not recognize being overweight or underweight

Using data from National Youth Risk Behavior Surveys conducted during 5 years between 1999 to 2007, investigators examined trends in perceived overweight or underweight among US adolescents in grades 9 through 12. The surveys included measures of self-reported height and weight and perceived weight status.

Overall, 16% of nonoverweight students (body mass index [BMI] <85th percentile for age and sex) perceived themselves as overweight. Among nonoverweight students, female students were about 3 times more likely than their male peers to see themselves as overweight. Among normal-weight males, Hispanic students were most likely to perceive themselves as overweight (9.1%), followed by white students (7.5%) and black students (4.0%). Among nonoverweight females, white students were most likely to perceive themselves as overweight (25.2%), followed by Hispanic students (24.8%) and black students (12.2%). Among all students, the percentage of nonoverweight teens that perceived themselves as overweight decreased from 17.7% in 1999 to 14% in 2007.

As for perceived overweight among overweight students (≥85th percentile for age and sex), the percentage of these teens that recognized themselves as such was 68.5% across all survey years. Overweight females were significantly more likely to perceive themselves as overweight than were overweight males (79.5% vs 60.6%). Among overweight males, whites were most likely to view themselves as overweight (63.8%), whereas Hispanic and black students were less likely to see themselves that way (62.3% and 44.8%, respectively). Among overweight females, perceived overweight was greatest among whites (85.2%), followed by Hispanics (81.0%) and then blacks (64.7%). Trend analyses showed that, overall, the prevalence of overweight students who perceived themselves as overweight has not changed over time except among black males, whose perception of overweight increased from 39.7% in 1999 to 48.1% in 2007 (Foti K, et al. Arch Pediatr Adolesc Med. 2010;164[7]:636-642).

In 2007, the last year studied, nearly one-third of overweight students overall did not recognize their condition. Nearly 52% of overweight black males were unaware. Should we be sending BMI report cards home with the students? Although I hesitate to stigmatize overweight children at school, I can see no way of solving childhood obesity unless its victims acknowledge their condition. -Micahel Burke, MD