Weight status misperception and its association with socio-demographic, lifestyle, and mental health-related factors among school adolescents in Malaysia: a nationwide cross-sectional study
Abstract
Background: Weight status misperception is an emerging public health concern among adolescents and may adversely affect their physical health, weight management behaviors, and psychosocial well-being. This study examined the prevalence of weight status misperception among school-going adolescents in Malaysia and identified socio-demographic, lifestyle, and mental health-related factors associated with weight status underestimation and overestimation.
Methods: Data were derived from the 2022 National Health and Morbidity Survey (NHMS): Adolescent Health Survey, a nationwide cross-sectional school-based survey. A total of 33,523 adolescents aged 13–17 years from 239 randomly selected secondary schools completed self-administered Global School-based Student Health Survey (GSHS) questionnaires and underwent anthropometric assessments. Actual weight status was classified using WHO body mass index (BMI)-for-age criteria and compared with self-perceived weight. Weighted Cohen’s kappa test assessed agreement between measured BMI and perceived weight status. Multinomial logistic regression analysis was performed to identify factors associated with weight status underestimation and overestimation.
Results: Overall, 47.9% of adolescents misperceived their own weight status, with 30.8% underestimated and 17.1% overestimated their weight status, while 52.1% had an accurate perception. Agreement between actual and perceived weight status was moderate (κ = 0.466, p < 0.001). Adolescents aged 13 years (aOR 2.10, 95% CI: 1.89–2.33), ever/current drug users (aOR 1.22, 95% CI: 1.07–1.39), and those who frequently consumed soft drinks (aOR 1.10, 95% CI: 1.02–1.18) and fast food (aOR 1.23, 95% CI: 1.11–1.37) were more likely to underestimate their weight. Overestimation was significantly associated with female gender (aOR 1.95, 95% CI: 1.75–2.16), inadequate fruit intake (aOR 1.16, 95% CI: 1.07–1.25), frequent fast food consumption (aOR 1.23, 95% CI: 1.08–1.40), loneliness (aOR 1.16, 95% CI: 1.02–1.32), depression (aOR 1.39, 95% CI: 1.23–1.57), and suicidal ideation (aOR 1.16, 95% CI: 1.03–1.32).
Conclusion: Nearly half of Malaysian adolescents misperceived their weight status. Weight status misperception was associated with a complex interplay of socio-demographic, lifestyle, and mental health factors, highlighting the need for integrated school-based interventions that promote accurate body weight perception, healthy lifestyle practices, and mental health support.
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BibTeX
@article{chan2026weight,
title = {{Weight status misperception and its association with socio-demographic, lifestyle, and mental health-related factors among school adolescents in Malaysia: a nationwide cross-sectional study}},
author = {Ying Ying Chan and Norhafizah Sahril and Hamizatul Akmal Abd Hamid and Mohamad Aznuddin Abd Razak and Azli Baharudin and Chee Cheong Kee and Zamtira Seman and Kuang Kuay Lim and Mohd Azahadi Omar and Noor Ani Ahmad},
journal = {BMC Public Health},
year = {2026},
month = nov,
doi = {10.1186/s12889-026-30243-w},
url = {https://link.springer.com/article/10.1186/s12889-026-30243-w},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Weight status misperception and its association with socio-demographic, lifestyle, and mental health-related factors among school adolescents in Malaysia: a nationwide cross-sectional study
AU - Ying Ying Chan
AU - Norhafizah Sahril
AU - Hamizatul Akmal Abd Hamid
AU - Mohamad Aznuddin Abd Razak
AU - Azli Baharudin
AU - Chee Cheong Kee
AU - Zamtira Seman
AU - Kuang Kuay Lim
AU - Mohd Azahadi Omar
AU - Noor Ani Ahmad
PY - 2026
DA - 2026/11/04
JO - BMC Public Health
DO - 10.1186/s12889-026-30243-w
UR - https://link.springer.com/article/10.1186/s12889-026-30243-w
AB - Background: Weight status misperception is an emerging public health concern among adolescents and may adversely affect their physical health, weight management behaviors, and psychosocial well-being. This study examined the prevalence of weight status misperception among school-going adolescents in Malaysia and identified socio-demographic, lifestyle, and mental health-related factors associated with weight status underestimation and overestimation. Methods: Data were derived from the 2022 National Health and Morbidity Survey (NHMS): Adolescent Health Survey, a nationwide cross-sectional school-based survey. A total of 33,523 adolescents aged 13–17 years from 239 randomly selected secondary schools completed self-administered Global School-based Student Health Survey (GSHS) questionnaires and underwent anthropometric assessments. Actual weight status was classified using WHO body mass index (BMI)-for-age criteria and compared with self-perceived weight. Weighted Cohen’s kappa test assessed agreement between measured BMI and perceived weight status. Multinomial logistic regression analysis was performed to identify factors associated with weight status underestimation and overestimation. Results: Overall, 47.9% of adolescents misperceived their own weight status, with 30.8% underestimated and 17.1% overestimated their weight status, while 52.1% had an accurate perception. Agreement between actual and perceived weight status was moderate (κ = 0.466, p < 0.001). Adolescents aged 13 years (aOR 2.10, 95% CI: 1.89–2.33), ever/current drug users (aOR 1.22, 95% CI: 1.07–1.39), and those who frequently consumed soft drinks (aOR 1.10, 95% CI: 1.02–1.18) and fast food (aOR 1.23, 95% CI: 1.11–1.37) were more likely to underestimate their weight. Overestimation was significantly associated with female gender (aOR 1.95, 95% CI: 1.75–2.16), inadequate fruit intake (aOR 1.16, 95% CI: 1.07–1.25), frequent fast food consumption (aOR 1.23, 95% CI: 1.08–1.40), loneliness (aOR 1.16, 95% CI: 1.02–1.32), depression (aOR 1.39, 95% CI: 1.23–1.57), and suicidal ideation (aOR 1.16, 95% CI: 1.03–1.32). Conclusion: Nearly half of Malaysian adolescents misperceived their weight status. Weight status misperception was associated with a complex interplay of socio-demographic, lifestyle, and mental health factors, highlighting the need for integrated school-based interventions that promote accurate body weight perception, healthy lifestyle practices, and mental health support.
SN - 1471-2458
ER -