Unhealthy Weight Change Behaviors and Body Image Perception in Adolescence

Background and Purpose:  Disordered eating affects approximately 13% of girls and 7% of boys nationwide.   The negative health effects of disordered eating are not only a serious public health concern but also potentially life-threatening.  Poor body image perception does not typically result in healthy weight management behaviors, and more research is needed on how specific unhealthy weight change behaviors are related to body image perception.  Unhealthy weight change behaviors increase the risk of future overweight or obesity, which may further complicate the negative health effects of disordered eating.  This study seeks to explore the relationships between unhealthy weight change behaviors and body image perception among a nationwide sample of adolescents.

Methods:  This study examined nationally representative data (n= 13,341) to determine if unhealthy weight change behaviors were related to body image perception.  Data from the 2013 Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS) were utilized.  Body image perception was taken from the question “How do you describe your weight?”, and weight change behaviors were dichotomized as yes or no based on self-reported activity intending to produce weight loss during the past 30 days.  A multinomial logistic regression was conducted to evaluate if fasting, taking diet pills, and vomiting or using laxatives was related to body image perception while controlling for age and gender. 

Results:  Overall among adolescents, 13.3% reported fasting, 5.1% reported taking diet pills, and 4.2% reported vomiting or taking laxatives during the past 30 days to lose weight.  Girls were more likely to feel slightly and very overweight (OR=1.32, 95% CI=1.17-1.48; OR=1.68, 95% CI=1.30-2.16) and less likely to feel slightly and very underweight (OR=.69, 95% CI=.59-.81; OR=.56, 95% CI=.38-.82) compared to those who felt about the right weight.  Those who reported taking diet pills and those who reported vomiting or taking laxatives were more than three times as likely to feel very underweight (OR=3.28, 95% CI=2.09-5.15; OR=3.40, 95% CI=2.24-5.15) compared to those who felt about the right weight.  Adolescents reporting fasting, taking diet pills, and vomiting or taking laxatives were also more likely to report feeling slightly overweight (OR=1.64, 95% CI=1.39-1.94; OR=1.73, 95% CI=1.36-2.20; OR=1.61, 95% CI=1.17-2.22) and very overweight (OR=1.82, 95% CI=1.34-2.48; OR=2.52, 95% CI=1.75-3.62; OR=3.58, 95% CI=2.26-5.68) compared to those who felt about the right weight.    

Conclusions and Implications:  Regardless of high or low weight perception, many adolescents report unhealthy weight change behaviors.  There are startlingly high odds of feeling underweight among adolescents already engaging in unhealthy weight change behaviors.  In addition, unhealthy weight change behaviors were correlated with feeling slightly and very overweight.  Education surrounding healthy diet and activity should be focused on all adolescents, with particular attention to those at extreme ends of spectrum (feeling very underweight and very overweight) as those practicing unhealthy weight change behaviors have the highest odds of falling into these two categories.  There is a critical need to help adolescents feel good about their bodies and develop healthy eating and physical activity patterns.