The percentage of U.S. adolescents who are overweight has tripled during the past 20 years, from five percent in 1980 to 15 percent by 2000, according to background information in the article. Negative mental health outcomes are the most widespread health consequence associated with overweight and obesity in adolescents. Adolescents, particularly girls, who are overweight are at increased risk for considering suicide and suicide attempts. However, it is unclear whether one's actual weight or one's perception of body weight is a more important risk factor for suicidal behavior.
Danice K. Eaton, Ph.D., from the Centers for Disease Control and Prevention, Atlanta, and colleagues used data from the 2001 Youth Risk Behavior Survey (YRBS) to determine how body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) and perceived weight were associated with thoughts of suicide and suicide attempts in adolescents. Study participants (n = 13,601) were in grades nine through 12 from a national sample of schools. Students were asked whether they would describe their weight as very underweight, slightly underweight, about the right weight, slightly overweight, or very overweight. They were also asked whether they had seriously considered attempting suicide during the past 12 months, and how many times they had actually attempted suicide in the past 12 months.
The researchers found that the prevalence of self-reported suicidal ideation (i.e., seriously considering suicide in the past 12 months) was 14.2 percent for males and 23.6 percent for females, whereas the self-reported prevalence of attempting suicide in the past 12 months was 6.2 percent for males and 11.2 percent for females. When perceived weight was not taken into account, BMI was associated with suicidal ideation, with the odds of suicidal ideation greater among students who were underweight or overweight compared to those of normal weight. However, once perceived weight was taken into account, there no longer was an association between BMI and suicidal ideation but there was an association between perceived weight and suicidal ideation. Compared to students who perceived themselves as about the right weight, those who saw themselves as very underweight, slightly underweight, slightly overweight, or very overweight had a greater likelihood of suicidal thoughts. Similarly, among white and Hispanic students, BMI was associated with suicide attempts when perceived weight was not taken into account, but there was no longer an association between BMI and suicide attempts when perceived weight was taken into account. White students who perceived themselves as very underweight or very overweight were more likely to have attempted suicide compared to those who perceived themselves as about the right weight. Black and Hispanic students who perceived themselves as very underweight were more likely to have attempted suicide compared to those who perceived themselves as about the right weight.
The author's write "Our results suggest that, regardless of actual BMI, students with extreme perceptions of body size are at increased risk for suicide ideation and suicide attempts, though important racial/ethnic differences exist."
(Arch Pediatr Adolesc Med. 2005; 159: 513 – 519. Available post-embargo at www.archpediatrics.com.)
Editorial: When Perception is Reality
In an accompanying editorial, Alain Joffe, M.D., M.P.H., from Johns Hopkins University, Baltimore, discusses the role perception plays in how individuals behave in managing their health.
"In this issue of Archives, Danice Eaton et al examine the role of body mass index (BMI) and perceived weight in relation to suicide ideation and suicide attempts among adolescents," Dr. Joffe writes. "Their results are timely, not only because of the growing epidemic of obesity in our country and its potential impact on the health of young people, but also because it underscores the importance of considering the role perception plays in the health of adolescents."
"As Eaton et al write, we need to know more about how adolescents develop their perceptions of body size. What is the explanation for the fact that almost 72 percent of females in their study had a normal BMI, yet approximately 12 percent and 37 percent considered themselves underweight or overweight, respectively? Do they receive subtle or not so subtle cues from peers and parents?" the editorialist asks. "In one prospective study, girls who read magazines targeted to them at least weekly were more likely to develop an eating disorder over the ensuing 18 months compared to girls who read such magazines less than weekly."
"What are the most effective methods for correcting adolescent misperceptions about various risky behaviors without scaring them needlessly or deterring them from taking health-promoting risks?" Dr. Joffe writes.
(Arch Pediatr Adolesc Med. 2005; 159: 592 – 593. Available post-embargo at www.archpediatrics.com.)
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Journal
Archives of Pediatrics and Adolescent Medicine