Influence of weight perception on the evolution of the body composition of adolescents followed up in an Obesity Consultation

Influence of weight perception on the evolution of the body composition of adolescents followed up in an Obesity Consultation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influence of weight perception on the evolution of the body composition of adolescents followed up in an Obesity Consultation Helena Fonseca, Rita Leiria, António Videira-Silva This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7328065/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Jan, 2026 Read the published version in European Journal of Pediatrics → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose: Obesity is a public health challenge, especially in adolescence, a stage characterized by physiological and behavioral. Although self-image place a significant rule on weight perception, there is no consensus on the impact of self-perceived weight on actual weight development. While some studies suggest that underestimating weight can boost weight gain, others suggest that overestimating is responsible for weight gain. The aim of this study was to analyze the influence of weight perception on the evolution of body composition in adolescents followed in an Adolescent Obesity Consultation. Methods: An exploratory, longitudinal, retrospective study was carried out, analyzing data from 131 adolescents with obesity (BMI Z-Score ≥ 2.0), with valid data from at least two obesity appointments. Results: 44.3% of the participants had a correct perception of their weight evolution; 41.4% perceived an increase, with real weight loss and 7.1% reported having no perception at all of their weight evolution. Lack of perception of weight evolution was associated with an increase in hip circumference (β=1.021; 95%CI: 0.791 to 1.318; R² = 31.6%; p=.012). The correct perception of weight gain, compared to the wrong perception of weight loss, was associated with a greater increase in BMI (respectively, β=5.833; 95%CI: 2.223; 15.304; R² = 67.2%; p<.001; β=.131; 95%CI: 0.003; 0.292; R² = 85%; p<.001). Conclusion: The correct perception of body evolution positively influences body composition in adolescents living with obesity. Adolescents Obesity Body composition Self-perception Body self-image Introduction Obesity is a public health challenge of the 21st century, negatively affecting all organs and systems [ 1 , 2 , 3 ]. Adolescence is a critical period in human development, marked by biological, cognitive, psychological and social transformations and is a period of vulnerability to the development of eating disorders, including obesity. An important component of self-assessment and hetero-assessment of body weight is exposure to the bodies of others [ 4 , 5 ]. As the frequency of obesity has increased, exposure to heavier bodies has become more frequent [ 6 ]. According to the normalization theory, exposure to larger bodies and normalization of increased body weights means that a high percentage of patients diagnosed with obesity, according to their BMI, do not identify themselves as such [ 7 ]. The transtheoretical model for change indicates that awareness of a condition is necessary for its management and treatment [ 8 ]. Because a large proportion of individuals with obesity do not identify themselves as such, there is a barrier to their control. In this sense, a series of three studies followed the evolution of body weight in a group of obese adults. It was found that, over the course of 5 to 20 years of follow-up, self-identification as having obesity, whether correct or incorrect, was associated with its actual increase [ 9 ]. The inconsistency found in the literature on this issue, as well as the lack of evidence in adolescents, highlights the need for more studies on this subject. Methods Objective The aim of this study was to analyze the influence of weight perception on the evolution of body composition in adolescents with obesity, followed in an Obesity Consultation. Study design This exploratory study was designed as a retrospective longitudinal study, using a non-probabilistic, non-intentional, convenience sampling method. Sample The sample for this study was made up of adolescents between the ages of 12 and 18, who were followed at the Adolescent Obesity in the Clinic Pediatrics Department at the ULSSM, with their first consultation occurring between January 2023 and August 2024. Only participants with valid data on the main variables of interest, in at least two consultations (first time consultation and follow-up), were included in the analysis. Adolescents with intellectual development disorders with impaired comprehension were excluded. Procedure This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculty of Medicine, University of Lisbon (January 30, 2025/No 332/24). The clinical records of each participant were consulted to collect relevant information. After collecting the information, the confidentiality of the data collected was ensured by assigning a random numerical identifier code to each participant. The data collected was recorded in an Excel document, access to which was password-protected. Variables and measuring instruments The clinical interview method was used to obtain the variables needed for the study in question, namely age, ethnicity, nutritional status of the father and mother and time between consultation. In addition, the presence of medical comorbidities was determined. Characterization of obesity, with age at onset and duration of obesity, as well as duration of structured and total weekly physical activity. In order to characterize perceived weight gain, participants were asked whether they perceived weight loss, maintenance or gain, or whether they showed no perception of their weight evolution between the two study periods. For those who were aware of their weight change, they were also asked about their objective weight perception, which is the weight they thought they had at the time. For anthropometric assessment, height and weight were measured, with subsequent calculation of BMI and BMI Z-Score, using the “WHO AnthroPlus” program. Waist circumference and hip circumference were also measured. To characterize body composition, absolute and relative fat and muscle mass were measured using a bioelectrical impedance scale (InBody 230, Seoul, Korea). All anthropometric assessments were carried out by the same researcher. Statistical analysis The data were analyzed using IBM-SPSS software (version 29.0), considering statistical significance for p < .05. The normality of the variables was assessed using the Shapiro-Wilk test and direct observation. To compare quantitative variables between sexes, the t-test (normal distribution) and the Mann-Whitney test (non-normal distribution) were used; for categorical variables, the chi-square test was used. The t-test was also applied to compare participants assessed at two time points with those excluded from the longitudinal analysis, as well as to assess temporal evolution and differences between sexes in anthropometric measurements, body composition, and physical activity. Logistic regressions analyzed the association between subjective perception of weight change and actual changes in measurements. To assess the temporal evolution of these variables according to weight perception (actual or subjective), the ANOVA test was used, followed by the Bonferroni test when significant differences were identified. Results Characterization of the sample The initial sample of this study consisted of 165 participants with valid data at the start, with 83 (50.3%) girls and 82 (49.7%) boys. A statistically significant difference was found between the sexes in the presence of psychopathology, with a lower frequency in girls compared to boys (MD: -16.7%, p = .019). In addition, girls had statistically lower height (MD: -6.1cm, p < .001) and weight (MD: -8.0 Kg, p = .007) than boys (Table 1 ). The BMI Z-Score was statistically lower in girls than in boys (MD: -0.24, p = .003). Waist circumference was also statistically significant lower in girls than in boys (MD: -7.7 cm, p < .001) (Table 1 ). Relative fat mass was statistically higher in girls than in boys (MD: 3.3%, p = .007). Absolute and relative muscle mass were significantly lower in girls compared to boys (DM: -8.8 kg, p < .001; DM: -2.1%, p = .003) (Table 1 ). There were no statistically significant differences between the sexes in the other variables studied. The characterization of the participants at the start of the study is shown in Table 1 . The participants assessed at two points in time and the participants excluded from the longitudinal analysis did not show statistically significant differences, as shown in Table 2 . [insert Tables 1 and 2 here ] Temporal evolution and differences between sexes in anthropometric values, body composition and physical activity Between the first and second assessment moments, there was a statistically significant increase in both girls (∆1.0 cm, p < .001) and boys (∆2.2 cm, p < .001), with a statistical difference between the sexes (MD: 1.26 cm, 95%CI -1.96 to -0.57, p < .001) (Table 3 ). The BMI Z-Score showed a statistically significant reduction in both girls (∆ -0.14 cm, p = .002) and boys (∆ -0.29 cm, p = .011), with no statistical difference between the sexes. There was a statistically significant reduction in relative fat mass in boys (∆ -2.3%, p = .012), with no statistical significance between the sexes (Table 3 ). The other variables showed no statistically significant changes or differences, as shown in Table 3 . [insert Table 3 here ] Perceived weight change The participants' perceived weight change is shown in Table 4 . Eight participants (7.1%) had no perception of their weight evolution, while eight participants (7.1%) also had a perception of weight maintenance. 53 participants (47.3%) perceived an increase in weight and 43 participants (38.4%) perceived a decrease in weight. There was no statistically significant difference between sexes in terms of perceived weight gain (Table 4 ) 46 participants (44.3%) correctly perceived their weight gain, with four participants (3.9%) correctly perceiving weight loss and 42 participants (40.4%) correctly perceiving weight gain. 58 participants (55.8%) had an incorrect perception of their evolution, with 43 (41.4%) having an incorrect perception of weight gain and 15 (14.4%) an incorrect perception of weight loss, with no statistically significant differences between the sexes (Table 4 ). [insert Table 4 here ] Relationship between perception of weight gain and variation in anthropometric measurements and physical activity Table 5 shows multiple regression models with the association between subjective perception of weight change (gain, loss or no perception) and variation in anthropometric measurements and physical activity, with only the statistically significant variables represented. Lack of perception of weight gain was associated with a significant increase in hip circumference (β = 1.021; 95%CI: 0.791 to 1.318; R² = 31.6%; p = .012). Perceived weight loss was associated with an actual increase in BMI (β = .395; 95%CI: 0.231; 0.678; R² = 40.1%; p < .001) and a longer duration of structured physical activity (β = .994; 95%CI: 0.989; 1.000; R² = 50%; p < .001). It was also found that the perception of weight gain was associated with a significant increase in BMI (β = 2.274; 95%CI: 1.425; 3.629; R² = 31.6%; p < .001) (Table 5 ). With regard to the perception versus reality of weight gain, participants who correctly perceived weight gain showed a strong association with a real increase in BMI (β = 5.833; 95%CI: 2.223; 15.304; R² = 67.2%; p < .001). The same was true in the participants with an erroneous perception of real weight loss (β = .131; 95%CI: 0.003; 0.292; R² = 85%, p < .001) (Table 5 ). [insert Table 5 here ] Differences in the evolution of anthropometric values, body composition and physical activity, according to the perception of ponderal evolution Between the groups with no perception of ponderal evolution and those with a perception of ponderal loss, there was a ponderal reduction, with a statistical difference between the groups (DM: 0.9Kg, p = .020). The groups with perceived weight loss and perceived weight gain also showed statistically significant differences in weight gain (DM: 6.2Kg, p < .001). Between the groups with perceived weight loss and perceived weight gain, there were also statistically significant differences in BMI variation (∆0.82 Kg/m², p < .001) (Table 6 ). The BMI Z-Score decreased with a statistical difference between the groups with no perception and those with a perception of weight gain (MD: 0.98, p = .002). Meanwhile, absolute fat mass showed a statistically significant difference between the groups with perceived weight loss and perceived weight gain (MD: 5.1 Kg, p = .011) (Table 6 ). [insert Table 6 here ] Differences in the time evolution of anthropometric values, body composition and physical activity, according to perceived versus actual weight evolution With regard to body weight, there was a statistically significant difference between the groups with a correct perception of weight loss and weight gain (DM: 7.1 Kg, p = .001), between the groups with correct and incorrect perception of weight gain (MD: 9.7 Kg, p < .001), as well as between the groups with incorrect perception of weight gain and weight loss (MD: 7.3 Kg, p < .001) (Table 7 ). BMI variations and the BMI Z-score showed statistically significant differences between the groups with correct and incorrect perception of weight gain (DM ∆Weight: 3.25 Kg/m², p < .001; DM ∆BMI: 0.45, p < .001). In addition, there were also statistical differences in BMI (DM: 2.61 Kg/m², p < .001) and BMI Z-score (DM: 0.42, p < .001) between the groups with a misperception of weight gain and weight loss (Table 7 ). As for the change in fat mass (absolute and relative), there were statistically significant differences between the groups with a correct perception of weight gain and those with a wrong perception of weight gain (DM: 8.0 Kg, p < .001) (Table 7 ). [insert Table 7 here ] Discussion Obesity is one of the biggest challenges of the 21st century [ 11 ], with adolescence being a critical period in the development of this condition, partly associated with the numerous physiological and behavioral changes. In addition, at this age self-image has a marked relevance, a variable that can influence the course of this pathology [ 12 , 13 ]. There is no consensus in the literature about how body self-image and self-perception can influence weight development in adolescents with obesity. With this in mind, the aim of this study was to investigate the influence of weight perception on the evolution of body composition in adolescents followed up in an obesity consultation. 92.8% of the participants showed a perception of weight evolution, revealing that the majority of adolescents with obesity are aware of their body evolution, which may represent a positive starting point for therapeutic adherence. In fact, the literature indicates that the subjective perception of body evolution is a relevant predictor of behavioral change [ 14 ]. However, the study data revealed that perception alone is not enough. In fact, its accuracy is crucial if it is to translate into adaptive behavior. In terms of perceived versus actual weight gain, there was a high rate of incorrect perception of weight gain, with 55.8% of adolescents incorrectly perceiving their weight gain. This high percentage confirms that the perception of weight gain in adolescents with obesity is often distorted, even when they are under clinical supervision [ 15 ]. This incongruity can compromise the effects of educational and behavioral interventions. In addition, the high prevalence (41.4%) of participants with an incorrect perception of weight gain has potential clinical implications and may indicate hypersensitivity to body image [ 16 ], and is associated with a greater risk of restrictive or inappropriate eating behaviours [ 17 ]. Finally, it can also induce demotivation, hindering the continuity of the therapeutic plan. The incorrect perception of weight loss (14.4%) can lead to an increased risk of obesity in the long term, since the incorrect belief of weight loss can lead to a reduction in physical activity or less careful food intake. The literature argues that adolescents with an incorrect perception of weight loss are less likely to initiate or maintain behaviors of change, making it necessary to intervene in this type of cognitive error [ 18 ]. On the other hand, the correct perception of weight gain can lead to greater involvement and adherence to goals and therapeutic plan, as long as there is adequate monitoring [ 19 ]. However, the low rate of correct perception of weight loss (3.9%) reveals a high discrepancy between reality and awareness of progress. Finally, the data presented showed no statistically significant difference between sexes in the perception of weight gain, although the literature shows different sexual patterns [ 20 ]. In fact, the homogeneity of results between the sexes can be explained by the presence of obesity in the participants, which can reduce subjectivity in self-assessment [ 21 ]. As for the association between subjective perception of weight change, anthropometric measurements and physical activity, it was found that the group of participants with no perception of body change showed a significant increase in hip circumference, an objective measure of weight change. This finding once again reinforces the idea that many adolescents with obesity do not see themselves as such, and that acquiring competence is a fundamental step in inducing subsequent change [ 9 ]. The group of participants who perceived weight loss was associated with a real increase in BMI, as well as an increase in structured physical activity. Adolescents who perceive a weight gain tend to reinforce healthy habits, particularly physical activity [ 22 ], and this positive perception may be associated with positive reinforcement of healthy lifestyle measures, even if it is associated with an increase in BMI in the short term. The perception of weight gain was associated with a real increase in BMI. In fact, the perception of negative weight gain can be accompanied by feelings of shame, leading to maladaptive eating behaviors and greater sedentary lifestyles [ 23 – 25 ]. The group that had a correct perception of weight gain was associated with a real increase in BMI. In fact, you need to be aware of your condition to change it [ 9 ]. In this case, although in this short period these individuals had worse weight evolution, in the long term, self-awareness and behavioral change are associated with better results [ 26 ]. Finally, the incorrect perception of weight loss was correlated with a significant increase in BMI. In fact, the mistaken feeling of positive weight gain leads to a decrease in the stimulus to change harmful behaviors and may be associated with cognitive illusions or avoidance of discomfort [ 27 ]. As for anthropometric differences according to perceived weight loss, there were statistically significant differences between the group of participants with no perception of weight gain and with a perception of weight gain, as well as between the groups with a perception of weight loss and weight gain. These data support the hypothesis that different groups have unequal health literacy and body image sensitivity, both of which are fundamental for inducing behavioral change [ 9 ]. Finally, as expected, the differences in the evolution of weight were statistically significant between the group with a correct perception of weight loss and weight gain, as well as between the participants with an incorrect and correct perception of weight loss. The evolution of weight, BMI, BMI Z-Score and fat mass (absolute and relative) was significant among the group with the correct perception of weight gain and the wrong perception of weight gain. This may be explained by the fact that adolescents with greater body awareness are more likely to recognize real variations in weight and reinforce positive behaviors. In addition, the group that incorrectly perceived weight gain ended up reducing it, which may show body image disturbances associated with low self-esteem and distortion of weight perception. Conclusion This study emphasizes the importance of accurate body perception in adolescents with obesity, as it significantly influences both their actual weight changes and clinical outcomes. Accurate perception is a key factor in effective prevention and treatment strategies. The authors recommend future research with larger samples and longer follow-ups to better understand its impact on long-term weight trends and chronic health conditions. Abbreviations BMI - Body Mass Index CAML - Centro Académico de Medicina de Lisboa CI - Confidence Interval MD - Mean Difference ULSSM – Unidade Local de Saúde de Santa Maria WHO - World Health Organization Declarations FUNDING/SUPPORT: There is no funding. CONFLICTS OF INTEREST AND SOURCE OF FUNDING : There is no conflict of interest or source of funding. References Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J et al (2009) Body-mass index and cause-specific mortality in 900,000 adults: Collaborative analyses of 57 prospective studies. Lancet 373(9669):1083–1096. https://doi.org/10.1016/S0140-6736(09)60318-4 Preston SH, Vierboom YC, Stokes A (2018) The role of obesity in exceptionally slow US mortality improvement. Proceedings of the National Academy of Sciences, 115(5), 957–961. https://doi.org/10.1073/pnas.1716802115 Rutkowski J, Davis K, Scherer P (2009) Mechanisms of obesity and related pathologies: The macro- and microcirculation of adipose tissue. FEBS J 276(20):5738–5746. https://doi.org/10.1111/j.1742-4658.2009.07303.x Robinson E, Kersbergen I (2017) Overweight or about right? A norm comparison explanation of perceived weight status. Obes Sci Pract 3(1):36–43. https://doi.org/10.1002/osp4.102 Oldham M, Robinson E (2018) Visual body size norms and the under–detection of overweight and obesity. Obes Sci Pract 4(1):29–40. https://doi.org/10.1002/osp4.15 Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL (2018) Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA 319(16):1723–1725. https://doi.org/10.1001/jama.2018.3060 Robinson E (2017) Overweight but unseen: A review of the underestimation of weight status and a visual normalization theory. Obes Rev 18(9):1200–1209. https://doi.org/10.1111/obr.12543 Jackson SE, Johnson F, Croker H, Wardle J (2015) Weight perceptions in a population sample of English adolescents: Cause for celebration or concern? Int J Obes (London) 39(9):1488–1493. https://doi.org/10.1038/ijo.2015.126 Muttarak R (2018) Normalization of plus size and the danger of unseen overweight and obesity in England. Obes (Silver Spring) 26(7):1125–1129. https://doi.org/10.1002/oby.22137 Robinson E, Hunger J, Daly M (2015) Perceived weight status and risk of weight gain across life in US and UK adults. Int J Obes (London) 39(11):1721–1727. https://doi.org/10.1038/ijo.2015.159 NCD Risk Factor Collaboration (2017) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis. Lancet. https://doi.org/10.1016/S0140-6736(17)32129-3 Fonseca H (2002) Compreender os adolescentes: Um desafio para pais e educadores, 6– edn. Editorial Presença, ed.). Lisboa Organização Mundial de Saúde (2001) Global consultation on adolescent friendly health services – A consensus statement, Geneva, 7-9 March 2001. Department of Child and Adolescent Health and Development, Geneva Neumark–Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M (2006) Does body satisfaction matter? Five–year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. J Adolesc Health 39(2):244–251. https://doi.org/10.1016/j.jadohealth.2005.12.001 Maximova K, McGrath JJ, Barnett T, O’Loughlin J, Paradis G, Lambert M (2008) Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents. Int J Obes (London) 32(6):1008–1015. https://doi.org/10.1038/ijo.2008.15 Puhl RM, Latner JD (2007) Stigma, obesity, and the health of the nation's children. Psychol Bull 133(4):557–580. https://doi.org/10.1037/0033-2909.133.4.557 Neumark–Sztainer D, Wall M, Larson NI, Eisenberg ME, Loth K (2011) Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10–year longitudinal study. J Am Diet Assoc 111(7):1004–1011. https://doi.org/10.1016/j.jada.2011.04.012 Quick V, Eisenberg ME, Bucchianeri MM, Neumark–Sztainer D (2013) Perceived weight gain and weight–related behaviors among adolescents. J Adolesc Health 53(4):458–464. https://doi.org/10.1016/j.jadohealth.2013.04.006 Jebeile H, Lister NB, Baur LA, Garnett SP, Paxton SJ (2021) Eating disorder risk in adolescents with obesity. Obes Rev 22(5):e13173. https://doi.org/10.1111/obr.13173 McCabe MP, Ricciardelli LA (2004) Body image dissatisfaction among males across the lifespan: A review of past literature. J Psychosom Res 56(6):675–685. https://doi.org/10.1016/S0022-3999(03)00129-6 Voelker DK, Reel JJ, Greenleaf C (2015) Weight status and body image perceptions in adolescents: current perspectives. Adolesc Health Med Ther 6:149–158. https://doi.org/10.2147/AHMT.S68344 Neumark–Sztainer D, Bauer KW, Friend S et al (2010) Family weight talk and dieting: Effects on body dissatisfaction and disordered eating in girls. J Adolesc Health 47(3):270–276. https://doi.org/10.1016/j.jadohealth.2010.02.001 Reichenberger J, Smyth JM, Blechert J (2018) Fear of evaluation: Day-to-day correlates. Anxiety Stress Coping 31(2):159–174. https://doi.org/10.1080/10615806.2017.1414354 Leary MR Interpersonal rejection. Oxford University Press. [106] Frayn, M., Knäuper B (2001) (2018). Emotional eating and weight in adults: A review. Current Psychology, 37(4), 924–933 Levinson CA, Rodebaugh TL, White EK et al (2013) Social appearance anxiety, perfectionism, and fear of negative evaluation. Appetite 67:125–133. https://doi.org/10.1016/j.appet.2013.03.013 Delamater AM, Jacobson AM, Anderson B et al (2001) Psychosocial therapies in diabetes. Diabetes Care 24(7):1286–1292. https://doi.org/10.2337/diacare.24.7.1286 Calzo JP, Sonneville KR, Haines J et al (2012) Associations among BMI, body dissatisfaction, and weight concern in adolescents. J Adolesc Health 51(5):517–523. https://doi.org/10.1016/j.jadohealth.2012.02.021 Tables Tables 1 to 7 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx Table 1. Characterization of participants at baseline Table 2. Differences between participants assessed at two points in time and participants excluded from the longitudinal analyses Table 3. Temporal evolution and gender differences in anthropometric values, body composition and physical activity Table 4. Perceived weight evolution Table 5. Multiple regression models using variation in hip circumference, variation in body mass index and variation in structured physical activity as dependent variables Table 6. Differences in the temporal evolution of anthropometric values, body composition and physical activity according to perceived weight gain Table 7. Differences in the temporal evolution of anthropometric values, body composition and physical activity according to perceived versus actual weight gain Cite Share Download PDF Status: Published Journal Publication published 23 Jan, 2026 Read the published version in European Journal of Pediatrics → Version 1 posted Editorial decision: Revision requested 10 Nov, 2025 Reviews received at journal 04 Sep, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviewers invited by journal 11 Aug, 2025 Editor assigned by journal 11 Aug, 2025 Submission checks completed at journal 11 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7328065","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500473115,"identity":"5f831647-2f15-43f7-9fcb-2d9c947739e6","order_by":0,"name":"Helena Fonseca","email":"data:image/png;base64,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","orcid":"","institution":"University of Lisbon, Hospital de Santa Maria","correspondingAuthor":true,"prefix":"","firstName":"Helena","middleName":"","lastName":"Fonseca","suffix":""},{"id":500473116,"identity":"c03d88e1-c46b-4c91-8615-57ba923dcbd2","order_by":1,"name":"Rita Leiria","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Rita","middleName":"","lastName":"Leiria","suffix":""},{"id":500473117,"identity":"d7da8bdc-4342-47b1-9197-e0b9b751d70d","order_by":2,"name":"António Videira-Silva","email":"","orcid":"","institution":"University of Lisbon, Hospital de Santa Maria","correspondingAuthor":false,"prefix":"","firstName":"António","middleName":"","lastName":"Videira-Silva","suffix":""}],"badges":[],"createdAt":"2025-08-08 14:08:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7328065/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7328065/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00431-025-06737-x","type":"published","date":"2026-01-23T15:58:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101153276,"identity":"cff76778-9f53-45fb-a769-f56c49270c00","added_by":"auto","created_at":"2026-01-26 16:14:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":667866,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7328065/v1/e4b1da44-7768-4537-a7cd-a6be42288d58.pdf"},{"id":89391484,"identity":"6c1b07af-3815-4eb2-9dbe-6a854121be08","added_by":"auto","created_at":"2025-08-19 13:08:07","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45875,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Characterization of participants at baseline\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. \u003c/strong\u003eDifferences between participants assessed at two points in time and participants excluded from the longitudinal analyses\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. \u003c/strong\u003eTemporal evolution and gender differences in anthropometric values, body composition and physical activity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. \u003c/strong\u003ePerceived weight evolution\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. \u003c/strong\u003eMultiple regression models using variation in hip circumference, variation in body mass index and variation in structured physical activity as dependent variables\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. \u003c/strong\u003eDifferences in the temporal evolution of anthropometric values, body composition and physical activity according to perceived weight gain\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. \u003c/strong\u003eDifferences in the temporal evolution of anthropometric values, body composition and physical activity according to perceived versus actual weight gain\u003c/p\u003e","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7328065/v1/e80f6a545a00aa42f4a58dbe.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influence of weight perception on the evolution of the body composition of adolescents followed up in an Obesity Consultation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is a public health challenge of the 21st century, negatively affecting all organs and systems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Adolescence is a critical period in human development, marked by biological, cognitive, psychological and social transformations and is a period of vulnerability to the development of eating disorders, including obesity.\u003c/p\u003e\u003cp\u003eAn important component of self-assessment and hetero-assessment of body weight is exposure to the bodies of others [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As the frequency of obesity has increased, exposure to heavier bodies has become more frequent [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to the normalization theory, exposure to larger bodies and normalization of increased body weights means that a high percentage of patients diagnosed with obesity, according to their BMI, do not identify themselves as such [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe transtheoretical model for change indicates that awareness of a condition is necessary for its management and treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Because a large proportion of individuals with obesity do not identify themselves as such, there is a barrier to their control.\u003c/p\u003e\u003cp\u003eIn this sense, a series of three studies followed the evolution of body weight in a group of obese adults. It was found that, over the course of 5 to 20 years of follow-up, self-identification as having obesity, whether correct or incorrect, was associated with its actual increase [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe inconsistency found in the literature on this issue, as well as the lack of evidence in adolescents, highlights the need for more studies on this subject.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe aim of this study was to analyze the influence of weight perception on the evolution of body composition in adolescents with obesity, followed in an Obesity Consultation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThis exploratory study was designed as a retrospective longitudinal study, using a non-probabilistic, non-intentional, convenience sampling method.\u003c/p\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eThe sample for this study was made up of adolescents between the ages of 12 and 18, who were followed at the Adolescent Obesity in the Clinic Pediatrics Department at the ULSSM, with their first consultation occurring between January 2023 and August 2024. Only participants with valid data on the main variables of interest, in at least two consultations (first time consultation and follow-up), were included in the analysis. Adolescents with intellectual development disorders with impaired comprehension were excluded.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculty of Medicine, University of Lisbon (January 30, 2025/No 332/24).\u003c/p\u003e\u003cp\u003eThe clinical records of each participant were consulted to collect relevant information. After collecting the information, the confidentiality of the data collected was ensured by assigning a random numerical identifier code to each participant.\u003c/p\u003e\u003cp\u003eThe data collected was recorded in an Excel document, access to which was password-protected.\u003c/p\u003e\n\u003ch3\u003eVariables and measuring instruments\u003c/h3\u003e\n\u003cp\u003eThe clinical interview method was used to obtain the variables needed for the study in question, namely age, ethnicity, nutritional status of the father and mother and time between consultation. In addition, the presence of medical comorbidities was determined. Characterization of obesity, with age at onset and duration of obesity, as well as duration of structured and total weekly physical activity.\u003c/p\u003e\u003cp\u003eIn order to characterize perceived weight gain, participants were asked whether they perceived weight loss, maintenance or gain, or whether they showed no perception of their weight evolution between the two study periods. For those who were aware of their weight change, they were also asked about their objective weight perception, which is the weight they thought they had at the time.\u003c/p\u003e\u003cp\u003eFor anthropometric assessment, height and weight were measured, with subsequent calculation of BMI and BMI Z-Score, using the \u0026ldquo;WHO AnthroPlus\u0026rdquo; program. Waist circumference and hip circumference were also measured. To characterize body composition, absolute and relative fat and muscle mass were measured using a bioelectrical impedance scale (InBody 230, Seoul, Korea).\u003c/p\u003e\u003cp\u003eAll anthropometric assessments were carried out by the same researcher.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed using IBM-SPSS software (version 29.0), considering statistical significance for p\u0026thinsp;\u0026lt;\u0026thinsp;.05. The normality of the variables was assessed using the Shapiro-Wilk test and direct observation. To compare quantitative variables between sexes, the t-test (normal distribution) and the Mann-Whitney test (non-normal distribution) were used; for categorical variables, the chi-square test was used. The t-test was also applied to compare participants assessed at two time points with those excluded from the longitudinal analysis, as well as to assess temporal evolution and differences between sexes in anthropometric measurements, body composition, and physical activity. Logistic regressions analyzed the association between subjective perception of weight change and actual changes in measurements. To assess the temporal evolution of these variables according to weight perception (actual or subjective), the ANOVA test was used, followed by the Bonferroni test when significant differences were identified.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eCharacterization of the sample\u003c/h2\u003e\u003cp\u003eThe initial sample of this study consisted of 165 participants with valid data at the start, with 83 (50.3%) girls and 82 (49.7%) boys. A statistically significant difference was found between the sexes in the presence of psychopathology, with a lower frequency in girls compared to boys (MD: -16.7%, p\u0026thinsp;=\u0026thinsp;.019). In addition, girls had statistically lower height (MD: -6.1cm, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and weight (MD: -8.0 Kg, p\u0026thinsp;=\u0026thinsp;.007) than boys (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe BMI Z-Score was statistically lower in girls than in boys (MD: -0.24, p\u0026thinsp;=\u0026thinsp;.003). Waist circumference was also statistically significant lower in girls than in boys (MD: -7.7 cm, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRelative fat mass was statistically higher in girls than in boys (MD: 3.3%, p\u0026thinsp;=\u0026thinsp;.007). Absolute and relative muscle mass were significantly lower in girls compared to boys (DM: -8.8 kg, p\u0026thinsp;\u0026lt;\u0026thinsp;.001; DM: -2.1%, p\u0026thinsp;=\u0026thinsp;.003) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere were no statistically significant differences between the sexes in the other variables studied. The characterization of the participants at the start of the study is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe participants assessed at two points in time and the participants excluded from the longitudinal analysis did not show statistically significant differences, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cem\u003e[insert\u003c/em\u003e Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eTemporal evolution and differences between sexes in anthropometric values, body composition and physical activity\u003c/h2\u003e\u003cp\u003eBetween the first and second assessment moments, there was a statistically significant increase in both girls (∆1.0 cm, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and boys (∆2.2 cm, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with a statistical difference between the sexes (MD: 1.26 cm, 95%CI -1.96 to -0.57, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe BMI Z-Score showed a statistically significant reduction in both girls (∆ -0.14 cm, p\u0026thinsp;=\u0026thinsp;.002) and boys (∆ -0.29 cm, p\u0026thinsp;=\u0026thinsp;.011), with no statistical difference between the sexes. There was a statistically significant reduction in relative fat mass in boys (∆ -2.3%, p\u0026thinsp;=\u0026thinsp;.012), with no statistical significance between the sexes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe other variables showed no statistically significant changes or differences, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cem\u003e[insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e here\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePerceived weight change\u003c/h2\u003e\u003cp\u003eThe participants' perceived weight change is shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Eight participants (7.1%) had no perception of their weight evolution, while eight participants (7.1%) also had a perception of weight maintenance. 53 participants (47.3%) perceived an increase in weight and 43 participants (38.4%) perceived a decrease in weight. There was no statistically significant difference between sexes in terms of perceived weight gain (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e46 participants (44.3%) correctly perceived their weight gain, with four participants (3.9%) correctly perceiving weight loss and 42 participants (40.4%) correctly perceiving weight gain. 58 participants (55.8%) had an incorrect perception of their evolution, with 43 (41.4%) having an incorrect perception of weight gain and 15 (14.4%) an incorrect perception of weight loss, with no statistically significant differences between the sexes (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e here\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eRelationship between perception of weight gain and variation in anthropometric measurements and physical activity\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows multiple regression models with the association between subjective perception of weight change (gain, loss or no perception) and variation in anthropometric measurements and physical activity, with only the statistically significant variables represented.\u003c/p\u003e\u003cp\u003eLack of perception of weight gain was associated with a significant increase in hip circumference (β\u0026thinsp;=\u0026thinsp;1.021; 95%CI: 0.791 to 1.318; R\u0026sup2; = 31.6%; p\u0026thinsp;=\u0026thinsp;.012). Perceived weight loss was associated with an actual increase in BMI (β\u0026thinsp;=\u0026thinsp;.395; 95%CI: 0.231; 0.678; R\u0026sup2; = 40.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and a longer duration of structured physical activity (β\u0026thinsp;=\u0026thinsp;.994; 95%CI: 0.989; 1.000; R\u0026sup2; = 50%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001). It was also found that the perception of weight gain was associated with a significant increase in BMI (β\u0026thinsp;=\u0026thinsp;2.274; 95%CI: 1.425; 3.629; R\u0026sup2; = 31.6%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWith regard to the perception versus reality of weight gain, participants who correctly perceived weight gain showed a strong association with a real increase in BMI (β\u0026thinsp;=\u0026thinsp;5.833; 95%CI: 2.223; 15.304; R\u0026sup2; = 67.2%; p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The same was true in the participants with an erroneous perception of real weight loss (β\u0026thinsp;=\u0026thinsp;.131; 95%CI: 0.003; 0.292; R\u0026sup2; = 85%, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e here\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDifferences in the evolution of anthropometric values, body composition and physical activity, according to the perception of ponderal evolution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBetween the groups with no perception of ponderal evolution and those with a perception of ponderal loss, there was a ponderal reduction, with a statistical difference between the groups (DM: 0.9Kg, p\u0026thinsp;=\u0026thinsp;.020). The groups with perceived weight loss and perceived weight gain also showed statistically significant differences in weight gain (DM: 6.2Kg, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Between the groups with perceived weight loss and perceived weight gain, there were also statistically significant differences in BMI variation (∆0.82 Kg/m\u0026sup2;, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe BMI Z-Score decreased with a statistical difference between the groups with no perception and those with a perception of weight gain (MD: 0.98, p\u0026thinsp;=\u0026thinsp;.002). Meanwhile, absolute fat mass showed a statistically significant difference between the groups with perceived weight loss and perceived weight gain (MD: 5.1 Kg, p\u0026thinsp;=\u0026thinsp;.011) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e here\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDifferences in the time evolution of anthropometric values, body composition and physical activity, according to perceived versus actual weight evolution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWith regard to body weight, there was a statistically significant difference between the groups with a correct perception of weight loss and weight gain (DM: 7.1 Kg, p\u0026thinsp;=\u0026thinsp;.001), between the groups with correct and incorrect perception of weight gain (MD: 9.7 Kg, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), as well as between the groups with incorrect perception of weight gain and weight loss (MD: 7.3 Kg, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBMI variations and the BMI Z-score showed statistically significant differences between the groups with correct and incorrect perception of weight gain (DM ∆Weight: 3.25 Kg/m\u0026sup2;, p\u0026thinsp;\u0026lt;\u0026thinsp;.001; DM ∆BMI: 0.45, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). In addition, there were also statistical differences in BMI (DM: 2.61 Kg/m\u0026sup2;, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and BMI Z-score (DM: 0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) between the groups with a misperception of weight gain and weight loss (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs for the change in fat mass (absolute and relative), there were statistically significant differences between the groups with a correct perception of weight gain and those with a wrong perception of weight gain (DM: 8.0 Kg, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e here\u003cem\u003e]\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eObesity is one of the biggest challenges of the 21st century [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], with adolescence being a critical period in the development of this condition, partly associated with the numerous physiological and behavioral changes. In addition, at this age self-image has a marked relevance, a variable that can influence the course of this pathology [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere is no consensus in the literature about how body self-image and self-perception can influence weight development in adolescents with obesity. With this in mind, the aim of this study was to investigate the influence of weight perception on the evolution of body composition in adolescents followed up in an obesity consultation.\u003c/p\u003e\u003cp\u003e92.8% of the participants showed a perception of weight evolution, revealing that the majority of adolescents with obesity are aware of their body evolution, which may represent a positive starting point for therapeutic adherence. In fact, the literature indicates that the subjective perception of body evolution is a relevant predictor of behavioral change [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, the study data revealed that perception alone is not enough. In fact, its accuracy is crucial if it is to translate into adaptive behavior.\u003c/p\u003e\u003cp\u003eIn terms of perceived versus actual weight gain, there was a high rate of incorrect perception of weight gain, with 55.8% of adolescents incorrectly perceiving their weight gain. This high percentage confirms that the perception of weight gain in adolescents with obesity is often distorted, even when they are under clinical supervision [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This incongruity can compromise the effects of educational and behavioral interventions.\u003c/p\u003e\u003cp\u003eIn addition, the high prevalence (41.4%) of participants with an incorrect perception of weight gain has potential clinical implications and may indicate hypersensitivity to body image [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and is associated with a greater risk of restrictive or inappropriate eating behaviours [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Finally, it can also induce demotivation, hindering the continuity of the therapeutic plan.\u003c/p\u003e\u003cp\u003eThe incorrect perception of weight loss (14.4%) can lead to an increased risk of obesity in the long term, since the incorrect belief of weight loss can lead to a reduction in physical activity or less careful food intake. The literature argues that adolescents with an incorrect perception of weight loss are less likely to initiate or maintain behaviors of change, making it necessary to intervene in this type of cognitive error [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn the other hand, the correct perception of weight gain can lead to greater involvement and adherence to goals and therapeutic plan, as long as there is adequate monitoring [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, the low rate of correct perception of weight loss (3.9%) reveals a high discrepancy between reality and awareness of progress.\u003c/p\u003e\u003cp\u003eFinally, the data presented showed no statistically significant difference between sexes in the perception of weight gain, although the literature shows different sexual patterns [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In fact, the homogeneity of results between the sexes can be explained by the presence of obesity in the participants, which can reduce subjectivity in self-assessment [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs for the association between subjective perception of weight change, anthropometric measurements and physical activity, it was found that the group of participants with no perception of body change showed a significant increase in hip circumference, an objective measure of weight change. This finding once again reinforces the idea that many adolescents with obesity do not see themselves as such, and that acquiring competence is a fundamental step in inducing subsequent change [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe group of participants who perceived weight loss was associated with a real increase in BMI, as well as an increase in structured physical activity. Adolescents who perceive a weight gain tend to reinforce healthy habits, particularly physical activity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and this positive perception may be associated with positive reinforcement of healthy lifestyle measures, even if it is associated with an increase in BMI in the short term.\u003c/p\u003e\u003cp\u003eThe perception of weight gain was associated with a real increase in BMI. In fact, the perception of negative weight gain can be accompanied by feelings of shame, leading to maladaptive eating behaviors and greater sedentary lifestyles [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe group that had a correct perception of weight gain was associated with a real increase in BMI. In fact, you need to be aware of your condition to change it [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this case, although in this short period these individuals had worse weight evolution, in the long term, self-awareness and behavioral change are associated with better results [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, the incorrect perception of weight loss was correlated with a significant increase in BMI. In fact, the mistaken feeling of positive weight gain leads to a decrease in the stimulus to change harmful behaviors and may be associated with cognitive illusions or avoidance of discomfort [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs for anthropometric differences according to perceived weight loss, there were statistically significant differences between the group of participants with no perception of weight gain and with a perception of weight gain, as well as between the groups with a perception of weight loss and weight gain. These data support the hypothesis that different groups have unequal health literacy and body image sensitivity, both of which are fundamental for inducing behavioral change [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, as expected, the differences in the evolution of weight were statistically significant between the group with a correct perception of weight loss and weight gain, as well as between the participants with an incorrect and correct perception of weight loss. The evolution of weight, BMI, BMI Z-Score and fat mass (absolute and relative) was significant among the group with the correct perception of weight gain and the wrong perception of weight gain. This may be explained by the fact that adolescents with greater body awareness are more likely to recognize real variations in weight and reinforce positive behaviors. In addition, the group that incorrectly perceived weight gain ended up reducing it, which may show body image disturbances associated with low self-esteem and distortion of weight perception.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasizes the importance of accurate body perception in adolescents with obesity, as it significantly influences both their actual weight changes and clinical outcomes. Accurate perception is a key factor in effective prevention and treatment strategies. The authors recommend future research with larger samples and longer follow-ups to better understand its impact on long-term weight trends and chronic health conditions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI - Body Mass Index\u003c/p\u003e\n\u003cp\u003eCAML - Centro Académico de Medicina de Lisboa\u003c/p\u003e\n\u003cp\u003eCI - Confidence Interval\u003c/p\u003e\n\u003cp\u003eMD - Mean Difference\u003c/p\u003e\n\u003cp\u003eULSSM – Unidade Local de Saúde de Santa Maria\u003c/p\u003e\n\u003cp\u003eWHO - World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFUNDING/SUPPORT:\u0026nbsp;\u003c/strong\u003eThere is no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICTS OF INTEREST AND SOURCE OF FUNDING\u003c/strong\u003e: There is no conflict of interest or source of funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWhitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J et al (2009) Body-mass index and cause-specific mortality in 900,000 adults: Collaborative analyses of 57 prospective studies. Lancet 373(9669):1083\u0026ndash;1096. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(09)60318-4\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(09)60318-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePreston SH, Vierboom YC, Stokes A (2018) The role of obesity in exceptionally slow US mortality improvement. Proceedings of the National Academy of Sciences, 115(5), 957\u0026ndash;961. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1073/pnas.1716802115\u003c/span\u003e\u003cspan address=\"10.1073/pnas.1716802115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRutkowski J, Davis K, Scherer P (2009) Mechanisms of obesity and related pathologies: The macro- and microcirculation of adipose tissue. FEBS J 276(20):5738\u0026ndash;5746. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1742-4658.2009.07303.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1742-4658.2009.07303.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobinson E, Kersbergen I (2017) Overweight or about right? A norm comparison explanation of perceived weight status. Obes Sci Pract 3(1):36\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/osp4.102\u003c/span\u003e\u003cspan address=\"10.1002/osp4.102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOldham M, Robinson E (2018) Visual body size norms and the under\u0026ndash;detection of overweight and obesity. Obes Sci Pract 4(1):29\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/osp4.15\u003c/span\u003e\u003cspan address=\"10.1002/osp4.15\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL (2018) Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007\u0026ndash;2008 to 2015\u0026ndash;2016. JAMA 319(16):1723\u0026ndash;1725. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2018.3060\u003c/span\u003e\u003cspan address=\"10.1001/jama.2018.3060\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobinson E (2017) Overweight but unseen: A review of the underestimation of weight status and a visual normalization theory. Obes Rev 18(9):1200\u0026ndash;1209. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/obr.12543\u003c/span\u003e\u003cspan address=\"10.1111/obr.12543\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJackson SE, Johnson F, Croker H, Wardle J (2015) Weight perceptions in a population sample of English adolescents: Cause for celebration or concern? Int J Obes (London) 39(9):1488\u0026ndash;1493. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/ijo.2015.126\u003c/span\u003e\u003cspan address=\"10.1038/ijo.2015.126\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuttarak R (2018) Normalization of plus size and the danger of unseen overweight and obesity in England. Obes (Silver Spring) 26(7):1125\u0026ndash;1129. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/oby.22137\u003c/span\u003e\u003cspan address=\"10.1002/oby.22137\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobinson E, Hunger J, Daly M (2015) Perceived weight status and risk of weight gain across life in US and UK adults. Int J Obes (London) 39(11):1721\u0026ndash;1727. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/ijo.2015.159\u003c/span\u003e\u003cspan address=\"10.1038/ijo.2015.159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNCD Risk Factor Collaboration (2017) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis. Lancet. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(17)32129-3\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(17)32129-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFonseca H (2002) Compreender os adolescentes: Um desafio para pais e educadores, 6\u0026ndash; edn. Editorial Presen\u0026ccedil;a, ed.). Lisboa\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganiza\u0026ccedil;\u0026atilde;o Mundial de Sa\u0026uacute;de (2001) Global consultation on adolescent friendly health services \u0026ndash; A consensus statement, Geneva, 7-9 March 2001. Department of Child and Adolescent Health and Development, Geneva\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeumark\u0026ndash;Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M (2006) Does body satisfaction matter? Five\u0026ndash;year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. J Adolesc Health 39(2):244\u0026ndash;251. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2005.12.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2005.12.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaximova K, McGrath JJ, Barnett T, O\u0026rsquo;Loughlin J, Paradis G, Lambert M (2008) Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents. Int J Obes (London) 32(6):1008\u0026ndash;1015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/ijo.2008.15\u003c/span\u003e\u003cspan address=\"10.1038/ijo.2008.15\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePuhl RM, Latner JD (2007) Stigma, obesity, and the health of the nation's children. Psychol Bull 133(4):557\u0026ndash;580. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0033-2909.133.4.557\u003c/span\u003e\u003cspan address=\"10.1037/0033-2909.133.4.557\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeumark\u0026ndash;Sztainer D, Wall M, Larson NI, Eisenberg ME, Loth K (2011) Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10\u0026ndash;year longitudinal study. J Am Diet Assoc 111(7):1004\u0026ndash;1011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jada.2011.04.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jada.2011.04.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuick V, Eisenberg ME, Bucchianeri MM, Neumark\u0026ndash;Sztainer D (2013) Perceived weight gain and weight\u0026ndash;related behaviors among adolescents. J Adolesc Health 53(4):458\u0026ndash;464. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2013.04.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2013.04.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJebeile H, Lister NB, Baur LA, Garnett SP, Paxton SJ (2021) Eating disorder risk in adolescents with obesity. Obes Rev 22(5):e13173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/obr.13173\u003c/span\u003e\u003cspan address=\"10.1111/obr.13173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCabe MP, Ricciardelli LA (2004) Body image dissatisfaction among males across the lifespan: A review of past literature. J Psychosom Res 56(6):675\u0026ndash;685. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0022-3999(03)00129-6\u003c/span\u003e\u003cspan address=\"10.1016/S0022-3999(03)00129-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVoelker DK, Reel JJ, Greenleaf C (2015) Weight status and body image perceptions in adolescents: current perspectives. Adolesc Health Med Ther 6:149\u0026ndash;158. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/AHMT.S68344\u003c/span\u003e\u003cspan address=\"10.2147/AHMT.S68344\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeumark\u0026ndash;Sztainer D, Bauer KW, Friend S et al (2010) Family weight talk and dieting: Effects on body dissatisfaction and disordered eating in girls. J Adolesc Health 47(3):270\u0026ndash;276. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2010.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2010.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReichenberger J, Smyth JM, Blechert J (2018) Fear of evaluation: Day-to-day correlates. Anxiety Stress Coping 31(2):159\u0026ndash;174. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/10615806.2017.1414354\u003c/span\u003e\u003cspan address=\"10.1080/10615806.2017.1414354\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeary MR Interpersonal rejection. Oxford University Press. [106] Frayn, M., Kn\u0026auml;uper B (2001) (2018). Emotional eating and weight in adults: A review. Current Psychology, 37(4), 924\u0026ndash;933\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevinson CA, Rodebaugh TL, White EK et al (2013) Social appearance anxiety, perfectionism, and fear of negative evaluation. Appetite 67:125\u0026ndash;133. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.appet.2013.03.013\u003c/span\u003e\u003cspan address=\"10.1016/j.appet.2013.03.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDelamater AM, Jacobson AM, Anderson B et al (2001) Psychosocial therapies in diabetes. Diabetes Care 24(7):1286\u0026ndash;1292. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/diacare.24.7.1286\u003c/span\u003e\u003cspan address=\"10.2337/diacare.24.7.1286\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCalzo JP, Sonneville KR, Haines J et al (2012) Associations among BMI, body dissatisfaction, and weight concern in adolescents. J Adolesc Health 51(5):517\u0026ndash;523. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jadohealth.2012.02.021\u003c/span\u003e\u003cspan address=\"10.1016/j.jadohealth.2012.02.021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 7 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Adolescents, Obesity, Body composition, Self-perception, Body self-image","lastPublishedDoi":"10.21203/rs.3.rs-7328065/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7328065/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: Obesity is a public health challenge, especially in adolescence, a stage characterized by physiological and behavioral. Although self-image place a significant rule on weight perception, there is no consensus on the impact of self-perceived weight on actual weight development. While some studies suggest that underestimating weight can boost weight gain, others suggest that overestimating is responsible for weight gain.\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to analyze the influence of weight perception on the evolution of body composition in adolescents followed in an Adolescent Obesity Consultation.\u003c/p\u003e\n\u003cp\u003eMethods: An exploratory, longitudinal, retrospective study was carried out, analyzing data from 131 adolescents with obesity (BMI Z-Score ≥ 2.0), with valid data from at least two obesity appointments.\u003c/p\u003e\n\u003cp\u003eResults: 44.3% of the participants had a correct perception of their weight evolution; 41.4% perceived an increase, with real weight loss and 7.1% reported having no perception at all of their weight evolution. Lack of perception of weight evolution was associated with an increase in hip circumference (β=1.021; 95%CI: 0.791 to 1.318; R² = 31.6%; p=.012). The correct perception of weight gain, compared to the wrong perception of weight loss, was associated with a greater increase in BMI (respectively, β=5.833; 95%CI: 2.223; 15.304; R² = 67.2%; p\u0026lt;.001; β=.131; 95%CI: 0.003; 0.292; R² = 85%; p\u0026lt;.001).\u003c/p\u003e\n\u003cp\u003eConclusion: The correct perception of body evolution positively influences body composition in adolescents living with obesity.\u003c/p\u003e","manuscriptTitle":"Influence of weight perception on the evolution of the body composition of adolescents followed up in an Obesity Consultation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 13:08:02","doi":"10.21203/rs.3.rs-7328065/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-10T13:37:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-04T19:39:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104181495605200728436807823982943074840","date":"2025-08-14T10:39:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T14:09:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-11T07:17:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-11T07:11:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2025-08-08T13:57:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"6356582f-1831-4d80-9a7a-cf4bf2329ba3","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:12:12+00:00","versionOfRecord":{"articleIdentity":"rs-7328065","link":"https://doi.org/10.1007/s00431-025-06737-x","journal":{"identity":"european-journal-of-pediatrics","isVorOnly":false,"title":"European Journal of Pediatrics"},"publishedOn":"2026-01-23 15:58:33","publishedOnDateReadable":"January 23rd, 2026"},"versionCreatedAt":"2025-08-19 13:08:02","video":"","vorDoi":"10.1007/s00431-025-06737-x","vorDoiUrl":"https://doi.org/10.1007/s00431-025-06737-x","workflowStages":[]},"version":"v1","identity":"rs-7328065","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7328065","identity":"rs-7328065","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}