Discordance between perceived body size and actual body size and psychological wellbeing in adolescence: Evidence from the multi-ethnic DASH longitudinal study

Abstract

Objective: To examine the influence of discordance between perceived bodyweight and actual weight on psychological well-being among a multi-ethnic cohort of British adolescents. Design and Methods: Multivariate multilevel models were used to examine the association between psycho-logical well-being, measured by the total difficulty score (TDS) from Goodman's Strengths and difficulty Questionnaire, (higher scores correspond with greater difficulties) and discordance among 3228 adolescents in 49 London schools in the determinants of adolescent social well-being and health longitudinal (DASH) study. Self-perception of bodyweight, measured anthropometry and psychosocial factors were collected at 11-13 years and again at 14-16 years. Results: Forty per cent of adolescents had a discordant perception of weight (ie underestimated or overestimated actual weight), with girls being more likely than boys to be discordant (p < 0.05). Discordance was related to age, ethnicity, gender, family life and racism. Among those who measured overweight/obese, more Black Caribbean's (11.9%, 95% CI 9.7, 14.6) and Black Africans (10.5%, 95% CI, 8.5, 12.8) than White British (6.9%, 95% CI 5.40, 8.81) reported normal weight. Compared with concordance (accurate perception of weight), discordance was associated with higher TDS at 14-16 years, (+0.56, 95% CI 0.25, 0.87, p = 0.01), independent of all confounders. Increase in discordant perceptions between 11-13 years and 14-16 years was also associated with increasing TDS (+0.23, 95% CI 0.10, 0.46, p = 0.04), which attenuated on adjustment for racism. These effects did not vary by ethnicity. Conclusion: Misperception of weight is common and associated with worse psychological well-being in adolescence. Interventions that engage with the underlying determinants of discordance, such as racism and target families with young children could have profound benefits.