Self-perception of weight and physical fitness, body image perception, control weight behaviors and eating behaviors in adolescents

Abstract

Introduction:
self-perception of weight and physical fitness, aesthetic reasons to diet, self-weighing as a way to feel better and body image perception have been related to a constellation of risks to develop both body image dissatisfaction and eating behavior disturbances, especially among adolescents.

Objectives:
to analyze weight self-perception and self-reported physical fitness, to explore the links between these variables and weight control behaviors, to explore possible relations among weight self-perception, self-reported physical fitness, dieting, self-weighing frequency and body mass index (BMI)/body image and to analyze the relation between all these variables and different eating behaviors.

Methods:
a total of 336 students (mean age of 12.46 ± 2.14; 47.62% females) took part in this study. Different scales were administered (weight self-perception and self-reported physical fitness, dieting, self-weighing frequency, body image perception, eating behaviors) and height and weight were measured in order to obtain the BMI.

Results:
mean BMI was 20.18 ± 3.58 and 41.14% of participants had overweight/obesity. Among those who perceived themselves as overweight, 76.92% were girls. More than 70% of participants reported average or good physical fitness and more boys reported good or excellent physical fitness. Almost 60% of participants who planned to diet for aesthetic reasons were girls, and girls more than boys self-weighed to feel better. BMI was significantly correlated with body image dissatisfaction/restrictive eating.

Conclusions:
there are clear links between weight self-perception, body image, dieting, self-weighing and eating behaviors at an age which might be considered as a starting point to eating behavior disturbances.

Full text

Nutrición
Hospitalaria
Trabajo Original Valoración nutricional
ISSN (electrónico): 1699-5198 - ISSN (papel): 0212-1611 - CODEN NUHOEQ S.V.R. 318
Correspondence:
Ignacio Jáuregui-Lobera. Universidad Pablo de Olavide.
Ctra. de Utrera, 1. 41013 Sevilla, Spain
e-mail: ignacio-ja@telefonica.net
Jáuregui-Lobera I, Iglesias Conde A, Sánchez Rodríguez J, Arispon Cid J, Andrades Ramírez C, Herrero
Martín G, Bolaños-Ríos P. Self-perception of weight and physical fitness, body image perception, control
weight behaviors and eating behaviors in adolescents. Nutr Hosp 2018;35(5):1115-1123
DOI: http://dx.doi.org/10.20960/nh.1726
Self-perception of weight and physical fitness, body image perception, control weight
behaviors and eating behaviors in adolescents
Autopercepción del peso y forma física, percepción de la imagen corporal y conductas de control de
peso y alimentarias en adolescentes
Ignacio Jáuregui-Lobera1, Amalia Iglesias Conde2, Josefa Sánchez Rodríguez3, Juan Arispon Cid4, Cristina Andrades Ramírez5, Griselda Herrero Martín1
and Patricia Bolaños-Ríos3
1Universidad Pablo de Olavide. Sevilla, Spain. 2Nutritionist. Private Clinic. Sevilla, Spain. 3Instituto de Ciencias de la Conducta. Sevilla, Spain. 4Psychologist. Private Clinic.
Sevilla, Spain. 5Norte Salud Nutrición. Sevilla, Spain
Palabras clave:
Percepción del peso.
Percepción del estado
de forma física. Dieta.
Pesarse. Trastornos
alimentarios.
Adolescencia.
Resumen
Introducción: la autopercepción del peso y de la forma física, razones estéticas para hacer dieta, pesarse como método para sentirse mejor
y la percepción de la imagen corporal se han relacionado con una constelación de riesgos para desarrollar tanto insatisfacción corporal como
alteraciones alimentarias, especialmente en adolescentes.
Objetivos: analizar la autopercepción del peso y de la forma física, explorar los vínculos entre estas variable y conductas de control de peso,
explorar posibles relaciones entre la autopercepción del peso y de la forma física, realización de dietas, frecuencia con la que se pesan los
adolescentes e índice de masa corporal (IMC)/imagen corporal, así como la relación de todo ello con diferentes conductas alimentarias.
Resultados: el IMC medio fue de 20,18 ± 3,58 y el 41,14% de los participantes presentaba sobrepeso/obesidad. Entre quienes se percibían
con sobrepeso, el 76,92% eran chicas. Más del 70% de los participantes decían estar en una buena forma física o en la media y eran más los
chicos los que decían estar en buena o excelente forma física. Casi el 60% de los participantes que planeaban hacer dieta por razones estéticas
eran chicas y ellas más que los chicos se pesaban para sentirse mejor. El IMC correlacionó significativamente con la subescala imagen corporal/
ingesta restrictiva.
Conclusiones: existen claros vínculos entre autopercepción ponderal, imagen corporal, realización de dietas, pesarse y conductas alimentarias
en una edad que podría considerarse como un punto de partida para la presentación de alteraciones alimentarias.
Key words:
Weight
misperception.
Self-reported
physical fitness.
Diet. Self-weighing.
Eating disorders.
Adolescence.
Abstract
Introduction: self-perception of weight and physical fitness, aesthetic reasons to diet, self-weighing as a way to feel better and body image
perception have been related to a constellation of risks to develop both body image dissatisfaction and eating behavior disturbances, especially
among adolescents.
Objectives: to analyze weight self-perception and self-reported physical fitness, to explore the links between these variables and weight control
behaviors, to explore possible relations among weight self-perception, self-reported physical fitness, dieting, self-weighing frequency and body
mass index (BMI)/body image and to analyze the relation between all these variables and different eating behaviors.
Methods: a total of 336 students (mean age of 12.46 ± 2.14; 47.62% females) took part in this study. Different scales were administered
(weight self-perception and self-reported physical fitness, dieting, self-weighing frequency, body image perception, eating behaviors) and height
and weight were measured in order to obtain the BMI.
Results: mean BMI was 20.18 ± 3.58 and 41.14% of participants had overweight/obesity. Among those who perceived themselves as overweight,
76.92% were girls. More than 70% of participants reported average or good physical fitness and more boys reported good or excellent physical
fitness. Almost 60% of participants who planned to diet for aesthetic reasons were girls, and girls more than boys self-weighed to feel better.
BMI was significantly correlated with body image dissatisfaction/restrictive eating.
Conclusions: there are clear links between weight self-perception, body image, dieting, self-weighing and eating behaviors at an age which
might be considered as a starting point to eating behavior disturbances.
Received: 15/12/2017 • Accepted: 04/03/2018
©Copyright 2018 SENPE y ©Arán Ediciones S.L. Este es un artículo Open Access bajo la licencia CC BY-NC-SA (http://creativecommons.org/licenses/by-nc-sa/4.0/).

1116 I. Jáuregui-Lobera et al.
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INTRODUCTION
Misperception of weight is defined as the discordance between
an individual’s actual weight and the perception of his/her weight
status. Weight perception and misperception might influence the
healthy or unhealthy behaviors people engage in (1). In this regard,
misperception has repeatedly been documented among overweight
and obese adults, and it has been hypothesized that weight misper-
ception among overweight and obese individuals may preclude the
adoption of healthful attitudes and behaviors, perhaps as a result
of lower weight loss motivation. Overweight and obese individuals
who consider their weight healthy, for example, might not try to
lose weight and might be less inclined to eat healthfully and to be
physically active (2). On the other hand, some evidence indicates
that weight misperception among overweight and obese individuals
might be associated with healthful behaviors (e.g., better diet quality,
more physical activity, and less sedentary behavior) (2,3). Perceiv-
ing oneself as overweight-obese is relevant given the association
between that perception and unhealthy weight-control behaviors (1).
It seems that overweight misperception varies according to gender
(among other variables), females tending to perceive themselves as
overweight more than males do, even at the same measured body
mass index (BMI) (4-6). Misperception of overweight-obesity among
adolescents of normal weight might have negative consequences.
The combination of overweight-obesity misperception causing body
dissatisfaction predicts dieting, and dieting is a clear risk factor for
developing different eating disturbances (6). In addition, adolescents
who have been engaged in dieting and other unhealthy weight-control
behaviors have been found to be at risk of weight gain over time (7,8).
Besides the concept of weight misperception, one’s body shape
and/or one’s body image play a relevant role in different behaviors
(9). Both weight misperception and poor body image have nega-
tive psychological and psychosocial effects (e.g., low self-esteem,
anxiety, depression, isolation, discrimination, family conflicts, etc.).
It is well known that people engaged in a process of self-evaluation
(included body checking) comparing themselves to others who they
believe have more desirable sociocultural traits tend to be involved
in behaviors aimed to achieve those desired characteristics (10).
Self-reported physical fitness is another variable to consider as a
starting point to different healthy or unhealthy behaviors. Perceived
physical ability (i.e., the individual’s perception of physical abilities
developed over time as a result of cumulative interactions with the
environment) and perceived physical competence are two goal-ori-
ented self-perception constructs (11). Recently, it has been shown
that body dissatisfaction is a significant mediator of the effect of
BMI on perceived physical activity (12). A large body of research
has aimed to validate the idea that exercise improves body image
through changes in physical fitness (13). However, it has been
suggested that improvements in physical fitness play a minor role
in changing body image, because the effects of physical exercise
and activity on body satisfaction should be mediated by changes in
individuals’ perceptions of their physical fitness and competence.
As a result, it seems that perceptions (weight, physical fitness)
are core constructs to lead to healthy/unhealthy behaviors more
than actual weight or actual physical fitness do.
Healthy or unhealthy behaviors as consequence of different per-
ceptions and their corresponding psychological and psychosocial
effects lead to the concept of emotional eating among other eating
behaviors. Thus, it has been distinguished among restraint eating
(conscious restriction of food intake aimed to control body weight
and/or to promote weight loss), uncontrolled eating (inability to
resist emotional cues, eating as a response to different negative
emotions) and emotional eating (tendency to eat more than usual
due to a loss of control over intake with a subjective feeling of hun-
ger). Other authors have defined external eating as the tendency
to overeat in response to external food-related cues like the sight,
smell, and taste of palatable food, regardless of their physical
need for food (14-16). Moreover, some authors have noted that
different types of bingers and dieters may be found: bingers who
are engaged in restraint-induced binging, and bingers general-
ly disinhibited; dieters who eventually become disinhibited and
overeat, and dieters who maintain the restrictive attitude (17,18).
It has been reported that BMI and negative emotional eating
are highly related whereas positive emotional eating and external
eating loaded onto another factor. In this regard, it is plausible
that even though positive emotions may elicit eating, they do not
necessarily mirror disordered eating. Eating in response to positive
emotions might rather be related to hedonic or external eating
(19,20).
Some models conceptualize eating disturbances as disorders
of affect regulation, considering the impairment in the cognitive
capacity to process and regulate emotions as the primary regu-
latory disturbance (21). According to these models, some eating
behaviors, such as binge eating and compensatory behaviors, as
well as restricted food consumption, are interpreted as respons-
es to cope with intense or relatively undifferentiated emotional
states (22-24). These intense emotional states are usually linked
to self-perceptions (weight, physical fitness, body shape/body
image), especially among adolescents (25-28).
Based on the above-mentioned previous research, the objectives
of this study, focused on preadolescents and adolescents, were: a)
to analyze weight self-perception and self-reported physical fitness;
b) to explore the possible relationship between these variables and
some weight control behaviors (dieting, self-weighing frequency);
to explore possible relations among weight self-perception, self-re-
ported physical fitness, dieting, self-weighing frequency and BMI/
body image; and d) to analyze the relation between all these vari-
ables and different eating behaviors.
METHOD
PARTICIPANTS
The sample comprised 336 students, 160 females (47.62%)
and 176 males (52.38%), with a mean age of 12.46 ± 2.14;
they were all recruited from two public schools in Seville, repre-
senting a middle socio-economic status. The participants have
not any psychiatric history, which was assessed by means of a
brief questionnaire at the time of obtaining the parents’ informed

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SELF-PERCEPTION OF WEIGHT AND PHYSICAL FITNESS, BODY IMAGE PERCEPTION, CONTROL WEIGHT BEHAVIORS
AND EATING BEHAVIORS IN ADOLESCENTS
consent. None of the participants showed any comprehension
and/or language difficulties. A total of 400 students were invited to
take part in the study. Among them, 37 refused to participate and
there were 27 students whose parents did not return the signed
informed consent. Thus, the response rate was 84%.
INSTRUMENTS AND MEASURES
Weight self-perception and self-reported
physical fitness
Following several previous studies, these measures were
self-reported, so no infographics or any types of guidelines were
used. Participants were classified as “very overweight”, “slightly
overweight”, “about the right weight”, “slightly underweight” or
“very underweight” after responding to the question “How do you
think of yourself in terms of weight?” In addition, participants
were asked about their self-reported physical fitness and they
were classified as perceiving themselves as possessing a “poor”,
“fair”, “average”, “good” or “excellent” physical fitness (27,28).
Dieting
Participants were asked whether or not they were dieting at
the moment (yes/no), the reason or reasons for dieting (aesthetic
reasons, the specific objective of losing weight, other healthy
reasons, others), the origin of the diet (prescribed or self-im-
posed) and the intention to keep on dieting or being about to
do it (yes/no).
Self-weighing frequency
Participants indicated their self-weighing frequency, the possi-
ble responses being: “several times a day”, “once a day”, “several
times a week”, “once a week”, and “occasionally”. Then, partici-
pants were asked about “What is the reason for being weighed?”:
“controlling my weight”, “no fattening”, and “feel better”.
Body image perception
The body silhouettes method was used. This method is based
on self-reporting where participants must choose the silhouette that
most closely resembles the shape of their body. In this study, the nine
Stunkard’s silhouettes were applied (29). Silhouettes numbered 1
represent the thinnest figure and number 9 represents the heaviest.
Body mass index (BMI)
BMI was calculated as the relationship between weight (in kg)
and height squared (in m). Weight and height were taken in indi-
vidual sessions, with the participants in the standing position,
barefoot, and in light garments. A stadiometer Añó-Sayol Atlántida
S13 model was used. Overweight and obesity rates were deter-
mined using the value of BMI-specific percentiles for age and sex
in the reference population (30), considering the cut-off points of
85th and 97th for overweight and obesity, respectively.
Eating behaviors
Different eating behaviors were assessed by means of the
Spanish version of the Three-Factor Eating Questionnaire-R18
(TFEQ-Sp) (31). The questionnaire measures three differ-
ent aspects of eating behavior: a) restrained eating (defined
as conscious restriction of food intake aimed to control body
weight and/or to promote weight loss); b) uncontrolled eating
(the tendency to eat more than usual due to a loss of control
over intake with a subjective feeling of hunger); and c) emotional
eating (inability to resist emotional cues, eating as a response
to different negative emotions). The questionnaire comprises 18
items that are measured on a four-point response scale (defi-
nitely true: 1, mostly true: 2, mostly false: 3, definitely false: 4)
and items scores are summated into subscale scores: a, b and
c. Previous studies have reported that TFEQ-R18 has adequate
internal consistency reliability coefficients for the three sub-
scales, as well as for the whole questionnaire (ranging between
0.74 and 0.87) (14,31). In addition, the Spanish version of the
Eating Behaviors and Body Image Test for Preadolescent Girls
(EBBIT) was used. This instrument was designed to measure
behavioral indicators of dieting and binging and to be put in
practice with preadolescent population trying to avoid some of
the limitations of previous instruments. The content of this ques-
tionnaire permits to be applied in samples of preadolescents and
early years of adolescence. The internal consistency reliability
coefficients of the EBBIT are 0.92 for the BIDRE subscale (body
image dissatisfaction/restrictive eating), 0.82 for the BEB sub-
scale (binge eating behaviors) and 0.90 for the total scale (18).
PROCEDURE
The study was approved by the direction of the Behavioural Sci-
ences Institute (Seville, Spain). After having obtained the schools’
headmasters’ permission, the students’ approval and the parents’
informed consent, participants completed the aforementioned
instruments in group sessions without time limits. A psychologist,
a nutritionist and a teacher supervised the procedure, instructing
the students about how to complete the questionnaires until they
were completely sure about their full understanding of the instruc-
tions. Data collection was developed in a suitable setting so the
attainment of the task could be reached easily. All the participants
volunteered to take part in the study and none of them received
any kind of reward after fulfilling the task. The anthropometric
measures were taken by trained nutritionists with enough expe-
rience with working in these types of studies.

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STATISTICAL ANALYSES
Data are expressed as means ± standard deviations. To study
gender differences and others based on categorical variables, the
proportions (percentages) were considered, the analysis being
done by means of χ2. An analysis of variance (ANOVA) was con-
ducted to study differences with respect to the different variables
included in the study, after having applied the Kolmogorov-Smirn-
off test in order to analyze whether the data fitted a normal distri-
bution. The software used for the analyses was “R”, version 3.3.2
(2016-10-31), “Sincere Pumpkin Patch” (Copyright 2016, The R
Foundation for Statistical Computing Platform: x86_64-apple-dar-
win13.4.0 -64-bit-).
RESULTS
The sample comprised 336 students, 160 females (47.62%)
and 176 males (52.38%), with a mean age of 12.46 ± 2.14.
With respect to BMI, the mean was 20.18 ± 3.58. Considering
the value of BMI-specific percentiles for age and sex, 57.65%
of participants had normal weight, 14.41% had overweight and
26.73%, obesity. Thus, overweight + obesity (BMI ≥ 85th percen-
tile) was 41.14%.
Considering weight self-perception, 66.02% of participants
perceived themselves as normal weighted, 19.09% as overweight
and 4.21% as obese. This way the perceived total overweight was
23.30%. No significant gender differences with respect to weight
self-perception were found (χ2 = 8.04; p = 0.09). Overall weight
misperception was 44.77%. Among those participants who had
overweight, 69.23% misperceived their weight, mainly consid-
ering that they had normal weight (62.82%). In case of obese
participants, 88.63% misperceived their weight, 84.09% of them
perceiving themselves as normal weight or slightly overweight.
While 49.68% of boys misperceived their weight, in the case of
girls that percentage was 39.58%. Nevertheless, among those
who perceived themselves as very overweight, 76.92% were girls.
On the contrary, among those who perceived themselves as very
or slightly underweight, 62.5% and 60% respectively were boys.
Respecting self-reported physical fitness, most of participants
reported an average (34.57%) or good (38.27%) physical fit-
ness; poor (2.47%), fair (13.9%) and excellent (10.80%) were
the reported physical fitness of the rest. Considering gender differ-
ences, while 57.40% of men reported good and excellent physical
fitness, in case of women that percentage was 40.52%. On the
contrary, 28.40% of men reported average physical fitness while
this percentage was 41.83% for women (χ2 = 14.59; p < 0.01).
Most participants who considered to have average, good or
excellent physical fitness reported to be about the right weight
(66.79%). When the reported physical fitness was poor or fair,
there were more participants who perceived themselves as slightly
or very overweight (55.32%). Bearing in mind the actual weight,
we found similar results. Figure 1 represents the participants who
considered their physical fitness as average, good or excellent and
Figure 1.
Actual weight, weight self-perception and self-reported physical fitness (average, good, excellent).

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AND EATING BEHAVIORS IN ADOLESCENTS
the corresponding percentages related to weight self-perception
and actual weight (classified as normal, overweight or obesity).
Among boys, considering not weight perception but actual weight,
good and excellent physical fitness was reported by 72.27%,
42.10% and 25.92% of participants at normal weight, overweight
and obesity, respectively. In case of girls, these percentages were
45.34%, 38.63% and 16.66%.
With respect to dieting, 18.73% of participants were dieting at the
moment, and 29% planned to diet in the future. Among those who
planned to diet, 30.95% gave aesthetic reasons to do it, 57.14% of
them being girls. Considering self-weighing frequency, the following
percentages were obtained: several times a day (2.15%), once a
day (3.38%), several times a week (5.54%), once a week (20.31%),
and occasionally (66.77%). Only 1.85% of participants never self-
weighed. The main reason to self-weighing was “controlling my
weight” (67.71%), followed by “no fattening” (17.01%) and “feel
better” (12.15%). There were no significant gender differences
with respect to dieting and self-weighing frequency. Nevertheless,
57.14% of those who self-weighted to “feel better” were girls.
Body image perception was assessed by means of the body
silhouettes method. Table I shows the results by sex with mention
to the BMI linked (approximately) to each silhouette.
Bearing in mind the silhouettes which correspond to normal BMI
(2-4), more girls (60.51%) than boys (51.42%) chose silhouettes
3-4. Overall, no gender differences with respect to body image
perception were observed (Fig. 2).
Taking into account actual BMI and body perception, among
those who chose silhouettes 2, 3 and 4 (these silhouettes are
usually associated to normal BMI), 1.25% had moderate denu-
trition, 12.5% were overweight and 2.5% were obese in case
of silhouette 2; with respect to silhouette 3, 0.95% had severe
denutrition, 30.48% were overweight and 2.86% were obese;
finally, in the case of silhouette 4, 35.90% were overweight
and 20.51% were obese. As a result, when participants iden-
tify their body image with silhouette number 2, 16.25% was
misperceiving their weight; when participants chose silhouette
number 3, the percentage of misperception was 34.29; and,
finally, considering the silhouette number 4 the percentage of
misperception was 56.41.
With respect to physical fitness, among those who identified
themselves with silhouettes 2-4, self-reported physical fitness
was “average”, “good” or “excellent” in 89.01%. When partici-
pants chose silhouette number 1, that percentage was 85.71%.
Finally, the percentage was 56.86% when participants identified
themselves with silhouettes 5-9. It must be noted that poor phys-
Figure 2.
Silhouettes chosen by boys and girls.
Table I. Body image perception by sex
Silhouettes
123456789
Boys 5 42 53 37 24 10 3 0 1
Girls 10 39 52 43 10 2 1 0 0
BMI 17 19 19 23 25 27 29 31 33
χ2 = 13.50; p < 0.05.

1120 I. Jáuregui-Lobera et al.
[Nutr Hosp 2018;35(5):1115-1123]
ical fitness was considered by 0.78% when participants chose
silhouettes 2-4 and 11.76% in case of silhouettes 5-9. Nobody
referred poor physical fitness in case of silhouette number 1.
Due to the fact that silhouette number 8 has not been chosen
and number 9 only was chosen by one participant, these two
silhouettes have been removed from figure 3.
Means of eating behaviors as measured by means of TFEQ-Sp
and EBBIT are shown in table II. It must be noted that the original
purpose of the EBBIT was to test the hypothesis that young girls
at risk of eating disorders may exhibit problems in several areas.
Nevertheless, there are no psychometric reasons not to use this
instrument in boys so for this work it was applied.
Considering different nutritional states (severe denutrition [SD],
moderate denutrition [MD], normal weight [NW], overweight [OW],
obesity [OB]), there were no significant differences with respect
to restrained eating, emotional eating, uncontrolled eating and
binge eating behaviors. Significant differences were found in case
of body image dissatisfaction/restrictive eating (BIDRE) subscale
(p < 0.0001). Tukey mean-differences test revealed that scores
were higher in overweight/obesity than in normal weight (p <
0.0001) and scores were also higher in obesity than in overweight
(p < 0.0001) (Fig. 4).
Correlational analyses between scores on eating behaviors and
BMI revealed a unique significant correlation between BIDRE and
BMI (r = 0.47; p < 0.0001; 95% CI = 0.38-0.55), the rest being
not significant. With respect to different subscales of EBBIT and
TFEQ-Sp, BEB correlated negative a significantly with restrained
eating (r = -0.23; p < 0.0.1), uncontrolled eating (r = -0.18;
p < 0.01) and emotional eating (r = -0.32; p < 0.01). No signif-
icant correlations were found between BIDRE and uncontrolled
eating and restrained eating. BIDRE correlated positively with
emotional eating (r = 0.19; p < 0.05).
DISCUSSION
Weight misperception may be associated to healthful or
unhealthy behaviors (1-3). Misperception of overweight or obesi-
Figure 3.
Distribution of self-reported physical fitness by silhouettes.
Table II. Means of TFEQ-Sp and EBBIT
by sex
Boys Girls p
TFEQ-Sp
Restrained eating 14.31 15.51 < 0.05
Emotional eating 8.16 9.55 < 0.001
Uncontrolled eating 24.54 26.2 < 0.05
EBBIT
BIDRE 15.24 16.76 0.322
BEB 7.87 6.59 0.123
EBBIT: Eating Behaviors and Body Image Test; TFEQ-Sp: Three-Factor Eating
Questionnaire-R18, Spanish version; BIDRE: body image dissatisfaction/
restrictive eating; BEB: binge eating behaviors.

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ty among adolescents at normal weight is a clear risk factor for
eating behavior disturbances. The sequence weight mispercep-
tion, body dissatisfaction and dieting is prone to develop negative
eating attitudes and finally high risk for different pathologies, eat-
ing disorders being the most relevant among adolescents (6-8).
It has been reported that females tend to perceive themselves
as overweight more than males do (4-6). In the current study,
despite no general differences were found considering the weight
self-perception scale, it must be noted that among the participants
who considered to be very overweight, 76.92% were girls. On
the contrary, among those who perceived themselves as very or
slightly underweight, 62.5% and 60% respectively were boys.
These results are similar to others previously found in a similar
study with a sample of adolescents with a mean age of 16.22,
so a bit older (28). Other studies have reported that females tend
to perceive themselves as overweight more than men usually do
(4-6). Generally, the identification with larger silhouettes (e.g.,
from 2 to 4) increases the percentage of weight misperception.
Body dissatisfaction has been considered as a mediator on the
effect of BMI on perceived physical activity (12), and body image
is improved by changes in physical fitness (13). Recently, it has
been shown that body dissatisfaction is a significant mediator of
the effect of BMI on perceived physical activity (12). A large body
of research has aimed to validate the idea that exercise improves
body image through changes in physical fitness (13). However,
Martin and Lichtenberger have suggested that improvements
in physical fitness play a minor role in changing body image,
because the effects of physical exercise and activity on body satis-
faction should be mediated by changes in individuals’ perceptions
of their physical fitness and competence (15). This study shows
that most participants reported an average or good physical fit-
ness (72.84%). Again, some gender differences appeared since
57.40% of boys reported good and excellent physical fitness, this
percentage being 40.52% in case of girls. This difference has
been reported previously (28). In view of our results, boys tend to
have a better perception of their physical fitness than girls, this
result appearing at normal weight, overweight and obesity.
A worse self-reported physical fitness (regardless of actual
weight) and a tendency to perceive themselves as overweight
could lead girls to higher risk of developing body dissatisfaction.
In addition, it must be noted that almost 31% of participants
who planned to diet in the future had aesthetic reasons to do
it, 57.14% of them being girls. The main reason for self-weigh-
ing was “controlling my weight”, but when the reason was “feel
better”, almost 58% of participants were girls. In this regard, a
worse self-reported physical fitness, a worse weight perception,
aesthetic reasons for planning to diet in the future and considering
self-weighing as a way to feel better could yield a constellation of
risks to develop both body image dissatisfaction and eating behav-
ior disturbances. In fact, a previous study has reported that dieting
for aesthetic reasons, weight misperception, worse self-reported
physical fitness and the fact of being female perform a high-risk
group of developing eating disorders (28).
Healthy or unhealthy behaviors as a consequence of different
perceptions and their corresponding psychological and psycho-
social effects lead to the concept of emotional eating, among
other eating behaviors. Thus, it has been distinguished among
restraint eating (conscious restriction of food intake aimed to
control body weight and/or to promote weight loss), uncontrolled
eating (inability to resist emotional cues, eating as a response
to different negative emotions) and emotional eating (tendency
to eat more than usual due to a loss of control over intake with
a subjective feeling of hunger) (14). Other authors have defined
external eating as the tendency to overeat in response to external
food-related cues like the sight, smell, and taste of palatable food,
regardless of their physical need for food (15,16). Moreover, some
authors have noted that different types of bingers and dieters may
be found: bingers who are engaged in restraint-induced binging,
and bingers generally disinhibited; dieters who eventually become
disinhibited and overeat, and dieters who maintain the restrictive
attitude (17,18). Also, in the field of eating behaviors, the concept
of dietary restraint is relevant, highlighting the regulation of food
intake in order to control weight and body shape (32). That control
based on restrictions may cause consequent overeating episodes
and eating disorders, and overweight and obesity at long-term
(14). Along with dietary restraint, other eating behaviors have been
described such as loss of control over intake and overeating as a
consequence of emotional distress (33).
It has been reported that BMI and negative emotional eating
are highly related whereas positive emotional eating and external
eating loaded onto another factor. In this regard, it is plausible
that even though positive emotions may elicit eating, they do not
necessarily mirror disordered eating. Eating in response to positive
emotions might rather be related to hedonic or external eating
(19,20).
Some models conceptualize eating disturbances as disorders
of affect regulation, considering the impairment in the cognitive
capacity to process and regulate emotions as the primary regulatory
disturbance (21). According to these models, some eating behav-
Figure 4.
Differences in BIDRE scores considering several nutritional states (SD: severe
denutrition; MD: moderate denutrition; NW: normal weight; OW: overweight; OB:
obesity).

1122 I. Jáuregui-Lobera et al.
[Nutr Hosp 2018;35(5):1115-1123]
iors, such as binge eating and compensatory behaviors, as well as
restricted food consumption, are interpreted as responses to cope
with intense or relatively undifferentiated emotional states (22-24).
These intense emotional states are usually linked to self-perceptions
(weight, physical fitness, body shape/body image), especially among
adolescents (25-28). Thereby, it has been reported that people with
higher weight and those who perceive themselves as overweight
usually show higher scores on cognitive restriction (31). In fact, the
link between higher BMI and higher scores on cognitive restriction
has been reported previously (34,35). In the current study we have
not found any significant differences with respect to restrained eat-
ing, emotional eating, uncontrolled eating and binge eating behav-
iors when the actual weight has been considered. In this regard, as
other studies have shown, cognitive dietary restraint is not consis-
tently linked to body weight-adiposity (29). Nevertheless, scores on
body image dissatisfaction/restrictive eating (BIDRE subscale) were
different with regards to actual weight (normal weight, overweight
and obesity). The fact that the difference is showed in this subscale
but not in the BEB subscale indicates that it is possible to maintain
a tendency to restrictive attitudes without binge eating behaviors in
both obese and overweight participants. With respect to the asso-
ciation, the correlation between BIDRE and BMI was 0.47. In fact,
BIDRE and BEB suggest that these two factors might be considered
as independent dimensions (18).
Another point to discuss refers to the instruments which aim to
assess eating behaviors. Thus, BEB correlated negative a signifi-
cantly with restrained eating, uncontrolled eating, and emotional
eating. This result seems to indicate that binge eating behavior,
restrained eating, uncontrolled eating and emotional eating are
different constructs despite having possible shared elements. In
addition, no significant correlations were found between BIDRE
and uncontrolled eating and restrained eating. It seems that when
there is a component linked to body image (e.g., BIDRE), correla-
tions with uncontrolled and restrained eating are not significant
but this changes with respect to emotional eating, in this case
existing a positive correlation. In this regard, body image dissatis-
faction could lead to eating disturbances through emotional more
than restrained eating.
This study adds some new results to others previously pub-
lished in the same field (25-28,32). Comparing to these others,
we have studied a sample with the lowest age range which per-
mits to study possible links between weight self-perception, body
image (and related variables such as dieting or self-weighing)
and eating behaviors in a stage of life which could be recognized,
to some extent, as a starting point to develop eating disorders.
Some conclusions emerge from the results. First, the majority of
participants who perceive themselves as obese are girls and the
majority of participants who perceive themselves as underweight
are boys. Second, boys tend to perceive themselves with a better
physical fitness than girls. Third, more girls than boys plan to
diet in the future for aesthetic reasons. Fourth, when the reason
to self-weighing is feel better, more girls than boys are involved.
Finally, BMI is significant and positively correlated to BIDRE. When
body image dissatisfaction is controlled for analysis, then BMI
correlates with emotional eating.
In view of these results, it would be interesting to study in depth
the reasons that lead girls to overestimate their weight and, on
the contrary, underestimate it in case of boys.
The current study has some limitations. Different variables are
self-reported at an age which could reflect doubts about reliabil-
ity. Nevertheless, previous studies have followed a similar way
to assess some information. Despite that EBBIT was designed
for young girls at risk for eating disorders, after analyzing the
content of the test no psychometric reasons have been found to
avoid that instrument in the current study. Body dissatisfaction has
not been assessed by means of a specific instrument apart from
the BIDRE subscale of the EBBIT. The body silhouettes method is
based on self-reporting where participants must choose the sil-
houette that most closely resembles the shape of their body. Then,
it is possible to analyze differences with respect to self-reported
weight or actual weight as well as others measures. In this study,
we emphasized some self-reported measures more than body
image dissatisfaction scores as usually are measured by several
questionnaires. Finally, precocious puberty is a risk factor clearly
related to the onset of that puberty. Secondary sexual character-
istics may lead to affective and psychosocial adaptive problems,
which also lead to behavior disorders and a negative body image.
Pubertal timing is a potentially significant factor when assessing
psychopathological symptoms. Pubertal timing refers to the timing
when pubertal development occurs in relation to peers, i.e., it
relates to whether an adolescent is ahead of peers in pubertal
development (early pubertal timing), in line with peers (on-time) or
behind peers in pubertal development (late pubertal timing). In this
regard, not having applied the pubertal stage categorization (e.g.,
by means of Tanner stages) is a limitation to take into account in
future similar studies (36).
REFERENCES
1. Pash KE, Klein EG, Laska MN, Velázquez CE, Moe SG, Lytle LA. Weight mis-
perception and health risk behaviors among early adolescents. Am J Health
Behav 2011;35:797-806. DOI: 10.5993/AJHB.35.6.15
2. Duncan DT, Wolin KY, Scharoun-Lee M, Ding EL, Warner ET, Bennett GG. Does
perception equal reality? Weight misperception in relation to weight-related
attitudes and behaviors among overweight and obese US adults. Int J Behav
Nutr Phys Act 2011;22:8-20. DOI: 10.1186/1479-5868-8-20.
3. Lynch E, Liu K, Wei GS, Spring B, Kiefe C, Greenland P. The relation between
body size perception and change in body mass index over 13 years: the
Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J
Epidemiol 2009;169:857-66. DOI: 10.1093/aje/kwn412.
4. Kilpatrick M, Ohannessian C, Bartholomew JB. Adolescent weight mana-
gement and perceptions: an analysis of the National Longitudinal Study of
Adolescent Health. J Sch Health 1999;69:148-52. DOI: 10.1111/j.1746-
1561.1999.tb04173.x.
5. Hazzard VM, Hahn SL, Sonneville KR. Weight misperception and disordered
weight control behaviors among U.S. high school students with overweight
and obesity: associations and trends, 1999-2013. Eat Behav 2017;26:189-
95. DOI: 10.1016/j.eatbeh.2017.07.001
6. Pritchard ME, King SL, Czajka-Narins DM. Adolescent body mass indices and
self-perception. Adolescence 1997;32:863-80.
7. Bašková M, Holubčíková J, Baška T. Body-image dissatisfaction and wei-
ght-control behaviour in Slovak adolescents. Cent Eur J Public Health
2017;25(3):216-21.
8. Ter Bogt TF, Van Dorsselaer SA, Monshouwer K, Verdurmen JE, Engels RC,
Vollebergh WA. Body mass index and body weight perception as risk factors

1123
[Nutr Hosp 2018;35(5):1115-1123]
SELF-PERCEPTION OF WEIGHT AND PHYSICAL FITNESS, BODY IMAGE PERCEPTION, CONTROL WEIGHT BEHAVIORS
AND EATING BEHAVIORS IN ADOLESCENTS
for internalizing and externalizing problem behavior among adolescents. J
Adolesc Health 2006;39:27-34. DOI: 10.1016/j.jadohealth.2005.09.007
9. Neumark-Sztainer D. Preventing the broad spectrum of weight-related pro-
blem: working with parents to help teens achieve a healthy weight and a
positive body image. J Nutr Educ Behav 2005;37:S133-40. DOI: 10.1016/
S1499-4046(06)60214-5
10. Stice E, Cameron RP, Killen JD, Hayward C, Taylor C. Naturalistic weight-re-
duction efforts prospectively predict growth in relative weight and onset of
obesity among female adolescents. J Consult Clin Psychol 1999;67:967-74.
DOI: 10.1037/0022-006X.67.6.967
11. Cash TF, Jakatdar TA, Williams EF. The Body Image Quality of Life Inventory:
further validation with college men and females. Body Image 2004;1:279-87.
DOI: 10.1016/S1740-1445(03)00023-8.
12. Festinger LA. A theory of social comparison processes. Hum Relat
1954;7:117-40.
13. Feltz DL, Chow GM, Hepler TJ. Path analysis of self-efficacy and diving performan-
ce revisited. J Sport Exerc Psychol 2008;30:401-11. DOI: 10.1123/jsep.30.3.401
14. Morano M, Colella D, Capranica L. Body image, perceived and actual
physical abilities in normal weight and overweight boys involved
in individual and team sports. J Sports Sci 2011;29:355-62. DOI:
10.1080/02640414.2010.530678
15. Martin KA, Lichtenberger CM. Fitness enhancement and body image change.
In: Cash TF, Pruzinsky T, eds. Body image: a handbook of theory, research, and
clinical practice. New York: Guilford Press; 2002. pp. 414-21.
16. Karlsson J, Persson LO, Sjöström L, Sullivan M. Psychometric properties and
factor structure of the Three-Factor Eating Questionnaire (TFEQ) in obese
men and women. Results from the Swedish Obese Subjects (SOS) study. Int
J Obesity Relat Metab Disord 2000;24:1715-25.
17. Rodin J. Social and immediate environmental influences on food selection.
Int J Obesity 1980;4:364-70.
18. Smith AD, Fildes A, Cooke L, Herle M, Shakeshaft N, Plomin R, et al. Genetic
and environmental influences on food preferences in adolescence. Am J Clin
Nutr 2016;104(2):446-53. DOI: 10.3945/ajcn.116.133983
19. Van Strien T, Schippers GM, Cox WM. On the relationship between emo-
tional and external eating behavior. Addict Behav 1995;20:585-94. DOI:
10.1016/0306-4603(95)00018-8
20. Leigh SJ, Lee F, Morris MJ. Hyperpalatability and the generation of obesity:
roles of environment, stress exposure and individual difference. Curr Obes
Rep 2018 Feb. DOI: 10.1007/s13679-018-0292-0
21. Candy CM, Fee VE. Underlying dimensions and psychometric properties of the
eating behaviours and body image test for preadolescent girls. J Clin Child
Psychol 1998;27:117-27. DOI: 10.1207/s15374424jccp2701_13
22. Jáuregui-Lobera I, Pérez-Lancho C, Gómez-Capitán MJ, Durán E, Garrido
O. Psychometric properties of the Spanish version of the Eating Behaviours
and Body Image Test for preadolescent girls (EBBIT). Eat Weight Disord
2009;14:e22-8.
23. Macht M. Characteristics of eating in anger, fear, sadness and joy. Appetite
1999;33:129-39. DOI: 10.1007/BF03354624
24. Van Strien T, Donker MH, Ouwens MA. Is desire to eat in response to
positive emotions an “obese” eating style: is Kummerspeck for some
people a misnomer? Appetite 2016;100:225-35. DOI: 10.1016/j.
appet.2016.02.035
25. Taylor CB, Altman T. Priorities in prevention research for eating disorders.
Psychopharmacol Bull 1997;33:413-7.
26. Le LK, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders:
a systematic review and meta-analysis. Clin Psychol Rev 2017;53:46-58.
DOI: 10.1016/j.cpr.2017.02.001
27. Austin SB1. Accelerating progress in eating disorders prevention: a call for
policy translation research and training. Eat Disord 2016;24(1):6-19. DOI:
10.1080/10640266.2015.1034056
28. Torres S, Guerra MP, Lencastre L, Roma-Torres A, Brandão I, Queirós C, et
al. Cognitive processing of emotions in anorexia nervosa. Eur Eat Disord Rev
2011;19:100-11. DOI: 10.1002/erv.1046
29. Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register
for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis
1983;60:115-20.
30. Corstorphine E, Mountford V, Tomlinson S, Waller G, Meyer C. Distress tole-
rance in the eating disorders. Eat Behav 2007;8:91-7. DOI: 10.1016/j.eat-
beh.2006.02.003
31. Jáuregui-Lobera I, García-Cruz P, Carbonero-Carreño R, Magallares A,
Ruiz-Prieto I. Psychometric properties of Spanish version of the Three-Factor
Eating Questionnaire-R18 (TFEQ-Sp) and its relationship with some eating-
and body image-related variables. Nutrients 2014;6:5619-35. DOI: 10.3390/
nu6125619
32. Ruiz-Prieto I, Carbonero-Carreño R, Jáuregui-Lobera I. Weight misperception
and physical fitness perception in relation to the physical activity level, dietary
behaviour and psychosocial well-being. Nutr Hosp 2014;31:203-16. DOI:
10.3305/nh.2015.31.1.8119
33. Hernández JD, Rodríguez M, Bolaños-Ríos P, Ruiz-Prieto I, Jáuregui-Lobera I.
Eating habits, excess weight and weight self-perception at school. Nutr Hosp
2015;32:1334-43. DOI: 10.3305/nh.2015.32.3.9351
34. Jáuregui-Lobera I, Bolaños-Ríos P, Santiago-Fernández MJ, Garrido-Casals
O, Sánchez E. Perception of weight and psychological variables in a sample
of Spanish adolescents. Diabetes Metab Syndr Obes 2011;4:245-51. DOI:
10.2147/DMSO.S21009
35. Jáuregui-Lobera I, Ezquerra-Cabrera M, Carbonero-Carreño R, Ruiz-Prieto
I. Weight misperception, self-reported physical fitness, dieting and some
psychological variables as risk factors for eating disorders. Nutrients
2013;5:4486-502. DOI: 10.3390/nu5114486
36. Hernández M, Castellet J, Narvaiza JL, Rincón JM, Ruiz I, Sánchez E, et al.
Curvas y Tablas de Crecimiento. Instituto de investigación sobre crecimiento
y desarrollo. Fundación F. Orbegozo. Madrid: Ediciones Garsi; 1988.