LAUSR

OBJECTIVE The relationships between childhood weight self-misperception and obesity-related factors particularly health markers have not been extensively discussed. This study aims to examine the associations between weight self-misperception and obesity-related knowledge, attitudes, lifestyles and cardio-metabolic markers among Chinese pediatric population. DESIGN Cross-sectional study. SETTING Data sourced from a national survey in Chinese seven provinces in 2013. PARTICIPANTS Children and adolescents aged 5-19 years. RESULTS Of the total 14079 participants, there were 14.5% and 2.2% participants over-estimated and under-perceived their weight, respectively. Multi-variable logistic regression was applied to calculate odds ratio (OR) and 95% confidence interval (95% Cl) of obesity-related behaviors and cardio-metabolic markers by actual and perceived weight status. Individuals who perceived themselves as overweight/obese were more likely to have prolonged screen time, insufficient dairy intake, and over sugar-sweetened beverages consumption (all P<0.05), regardless of their weight. Furthermore, actual overweight/obese individuals had higher odds of abnormal cardio-metabolic markers, but a smaller magnitude of association was found among weight under-estimators. Among non-overweight/obese individuals, weight over-estimation was positively associated with abdominal obesity (OR: 10.49, 95% CI: 7.45, 14.76), elevated blood pressure (OR: 1.30, 95% CI: 1.12, 1.51), and dyslipidemia (OR: 1.43, 95% CI: 1.29, 1.58). CONCLUSIONS Weight over-perception was more prevalent than under-estimation, particularly in girls. Weight over-estimators tended to master better knowledge but behave more unhealthily, both weight over-perception and actual overweight/obesity status were associated with poorer cardio-metabolic markers. Future obesity intervention programs should additionally pay attention to the population with inaccurate estimation of weight who were easily overlooked.