Perception or Reality of Body Weight: Which Matters the Most to Adolescents' Emotional Well-being?

We systematically examined recent publications to weigh the relative contribution of directly measured and perceived body weight on the status of emotional well-being, and to determine whether the relationship between measured body weight and emotional well-being is mediated or confounded by perceived body weight among adolescents (11-18 year old). A total of 61 papers met inclusion criteria and were included for review. Approximately, half of the studies suggested a relationship between emotional statuses and directly measured body weight; whereas, the other half did not. The presence of a relationship primarily depended on how perceived body weight was controlled for. Results were converging for studies that included both measured and perceived body weight. Irrespective of directly measured body weight, perceived weight was significantly associated with emotional health. Perceived overweight was a predominant concern among girls; whereas, perceived underweight and overweight were equally worrisome to boys. The findings also suggest a bidirectional relationship between body weight and poor emotional health. Perceived overweight predicted depressive symptoms in longitudinal studies. Meanwhile, low self-esteem aggravated the onset of obesity, and depressive symptom exacerbates an excessive increase in body weight. Programs to correct normative misperceptions and reduce stigma exposure may improve emotional well-being and ultimately lead to more effective prevention of both obesity and emotional disturbances among adolescents.