School- and Individual-level Predictors of Weight Status Misperception Among Korean Adolescents: A National Online Survey

Background: Growing body of literature has reported that weight status estimation pattern, including accurate-, under-, and overestimation, was associated with weight related behaviors and weight change among adolescents and young adults. However, there have been a few studies investigating the potential role of school contexts in shaping adolescents' weight status estimation pattern among Korea adolescents.

Objective: The aim of the present study was to investigate the association between weight status misperception patterns and factors at individual-, family-, and school-level, simultaneously, and whether there was significant between schools variation in the distribution of each weight status misperception pattern, underestimation and overestimation respectively, among Korean adolescents aged 12-18 years.

Method: Data from the Eighth Korea Youth Risk Behavior Web-based Survey (KYRBS), 2012, a nationally representative online survey of 72,228 students (boys = 37,229, girls = 34,999) from a total of 797 middle and high schools were used. Sex stratified multilevel random intercept multinomial logistic models where adolescents (level 1) were nested within schools (level 2) were performed.

Results: At the school level, attending a school with higher average BMI (kg/m2) was positively associated with weight status underestimation, and inversely associated with weight status overestimation among boys and girls. Single-sex schooling was positively associated with weight status underestimation among girls. At the family level, higher household income (high/middle versus low) was inversely associated with both weight status under- and overestimation among boys and girls. Higher maternal education (equal to or more than college graduate versus equal to or less than high school graduate) was positively associated with weight status overestimation among boys, and living with both parents (compared to not living with both parents) was inversely associated with weight status underestimation among girls. At the individual level, high academic achievement (compared to low) was positively associated with weight status underestimation among boys and girls.

Conclusions: While further research with prospective designs and objectively measured anthropometric information is needed, school environmental factors such as sex composition and school average BMI, as well as, family contexts such as socioeconomic status need to be considered when developing and implementing obesity prevention programs.