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. 2025 Mar 31;25(1):1210.
doi: 10.1186/s12889-025-22219-z.

Perceived body size across sex and weight categories and its association with body size dissatisfaction: a cross-sectional study among early primary school children in Norway

Tove L Drilen  1   2 , Trine T Eik-Nes  3   4 , Ellen M I Ersfjord  5   6 , Christian A Klöckner  7   6 , Rønnaug A Ødegård  8   6
Affiliations

Perceived body size across sex and weight categories and its association with body size dissatisfaction: a cross-sectional study among early primary school children in Norway

Tove L Drilen et al. BMC Public Health. .

Abstract

Background: Inaccurate perceptions of body size, known as body size misperception (BSM), may be linked to body size dissatisfaction (BSD) and unhealthy eating behaviours. However, these associations remain inconclusive and not fully understood in young children. This study aimed to investigate the prevalence of BSM across sex and weight categories and to further assess the association between BSM and BSD in 8-to 9-year-old children.

Methods: This cross-sectional study of 209 primary school children (51% boys) from central Norway was performed during the national height and weight screening program in third grade. Researcher-assisted questionnaires and Stunkard's figure rating scales adapted for children were used to assess two dimensions of body image: BSM (perceived-actual body size) and BSD (perceived-ideal body size). The agreement between children's ideal and actual body size was also evaluated (actual-ideal body size). Associations between BSM and BSD were examined by multinomial logistic regression, adjusting for sex, Body Mass Index (BMI), socioeconomic status, ethnicity, and residence.

Results: BSM was frequently observed (81%), with most children overestimating their body size (67%). Boys tended to overestimate their body size more frequently (75% vs. 59%, p = 0.014) and indicated a larger mean ideal body size than girls (silhouette fig. 4.2 [95% CI 4.0, 4.5] vs. 3.9 [95% CI 3.7, 4.1], p = 0.012). According to BMI, overestimation was common among children with underweight (100%) and average weight (78%), whereas underestimation of body size was prevalent among children with overweight/obesity (59%). Although 23% desired at least one body size figure smaller or larger than their perceived size, interpreted as BSD, no difference was observed between mean perceived and mean ideal body size (silhouette fig. 4.1 in both groups). No significant association was found between BSM and BSD, for either underestimation (OR 1.32 [95% CI 0.33, 5.32]) or overestimation (OR 0.99 [95% CI 0.38, 2.58]) of body size.

Conclusions: Boys and girls from all weight categories frequently misperceived their body size toward their ideal body size, with overestimation of underweight and average weight status and underestimation of overweight status being most frequently reported. No association was found between BSM and BSD, however, the long-term health consequences of BSM should be further elucidated.

Keywords: Body image; Body size dissatisfaction; Body size misperception; Boys; Children; Overweight; Public health.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and was approved in 2021 by the Regional Committees for Medical and Health Research Ethics of Mid-Norway (no. 244609). Informed consent was obtained from both parents and legal guardians of all children below 16 years of age, and informed assent was collected from all the children. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
BMI cut-offs used to estimate actual body size for 8–9-year-old boys and girls. The body silhouette figures are used with permission from Dr Tiggemann
Fig. 2
Fig. 2
Distribution of body size misperception (BSM), body size dissatisfaction (BSD), and the discrepancy scores between actual and ideal body size
See this image and copyright information in PMC

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