Original article
Body Mass Index and Body Weight Perception as Risk Factors for Internalizing and Externalizing Problem Behavior Among Adolescents

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Abstract

Purpose

To examine the relationship between body mass index (BMI), body weight perception (BWP), and indicators of internalizing and externalizing distress and social, attention and thought problems in a large representative sample of Dutch youth.

Methods

A total of 1826 pupils in the eighth grade of primary education and 5730 students in the first four years of secondary education gave their height and weight to obtain an estimate of their BMI. They reported their evaluation of their body weight and completed Achenbach’s Youth Self-Report (YSR) (1991), which assesses eight types of problem behavior. Data were analyzed in a multivariate framework with BMI and BWP as predictors and the YSR scores on different kinds of problem behavior as dependent variables, controlling for background characteristics.

Results

Both BMI and BWP are associated with internalizing and externalizing problem behavior, and social, attention and thought problems. Multivariate tests show that BWP is more closely linked to problem behavior than BMI. Adolescents who were either underweight or overweight but considered themselves in good shape had no more problems than the group with normal BMI and BWP ‘good’. The perception of being ‘too thin’ and particularly the perception of being ‘too heavy’ best predict problem behavior in both male and female adolescents. Overweight youngsters with an adequate perception of their weight have less somatic complaints than their normal-weight peers who perceive themselves as too heavy, but they show higher withdrawnness, social problems, and anxiety/depression.

Conclusions

Adolescent girls are more dissatisfied with their weight than boys; however, the relationship between weight perception and problem behavior is the same for both genders.

Section snippets

Sample

A sample of 1826 pupils in the eighth grade of primary education and 5730 pupils in the first four years of secondary education (a total of 7556 students) completed the questionnaires. This sample from the Health Behavior in School-aged Children (HBSC) study is representative for the Dutch population of school children aged 11–16 years. Detailed descriptions of the sampling procedure can be found in [33].

Data collection

All data were collected with questionnaires, which were distributed in classes and

Descriptive results

Table 1 shows BMI and BWP scores and the correspondence between these two scores by Gender and Age. In the 11–16-year-old age category, 5.8% of both Dutch boys and girls are underweight, whereas 10.1% of the boys and 8.3% of the girls are overweight. During adolescence, the percentage of both underweight boys and girls decreases from approximately 6% at age 11 to 4.5% and 3.4%, respectively, at age 16. The proportion of overweight girls drops in early adolescence from 10.2% to around 6.4%, then

Discussion

Havighurst [1] classified the acquisition of a positive body image as one of the central developmental tasks of adolescence. In a cultural climate fostering both obesity with the availability of an abundance of high-calorie food and ideals of leanness and muscularity supported by media coverage of high-status role models, increasing numbers of adolescents are confronted with demands on their body shape that are hard to meet.

We studied a large, representative sample of Dutch young people, aged

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