. 2023 May 8;82(1):104–127. doi: 10.1093/nutrit/nuad044

Table 2.

Summary of included studies on body image perception and dietary habits

Reference	Country (study years)	Sample size (% girls)	Age range^a	Body image perception assessment	Body image categories	Diet assessment	Dietary outcome	Statistical methods	Results
Andrade et al (2020)⁵²	Brazil (2009)	1496 (57.1%)	11–17 (median: 14.3; IQR: 13.1–15.5)	DQ: How do you feel about your weight?	Underestimation, agreed, overestimation	Validated 97 semiquantitative FFQ	14 food groups 4 dietary patterns (cluster analysis)	Kruskal–Wallis test Chi-square test Multinomial logistic regression model Network analysis	BI perception was not associated with any dietary pattern. Overestimation of weight was related to preferential choices of consumption of certain food groups: Roots inversely correlated with oils, processed meat products, and coffee and tea. Vegetables inversely correlated with sweetened beverages
Ben Ayed et al (2019)⁵⁸	Tunisia (2017–2018)	1210 (59.7%)	12–18 (15.6±2.0)	FRS of Stunkard	Underestimation, accurate, overestimation	Eating habits questions	7 DH indicators (skipping breakfast, frequency of eating vegetables, fruit, pasta, soda, fast food, and eating between meals)	Chi-square test Univariant logistic regression model Multivariant logistic regression model	Underestimation of weight was related to having unhealthier DHs (eating between meals, high consumption of pasta and fast food, and low consumption of vegetables and fruit). Overestimation of weight was related to more restrictive dietary behaviors (skipping breakfast, high vegetable, and low fast-food consumption).
Borda Pérez et al (2016)⁵³	Colombia (2014)	262 (38.5%)	10–13 (11.4±1.1)	FRS of Gardner	Negative distortion (real BMI lower than perceived BMI), positive distortion (real BMI higher than perceived BMI), accurate	Krece Plus questionnaire^b	Poor, medium, high adherence to the MedDiet	Odds ratio Chi-square test	BI perception was not associated with DHs.
Buscemi et al (2018)³⁵	Italy (2012–2014)	1643 (46.1%)	11–16 (12.4±0.7)	DQ: Do you think you are underweight, about the right weight, or overweight?	Underestimation, accurate, overestimation	Validated FFQ Kidmed questionnaire	Poor, medium, high adherence to the MedDiet	Logistic regression model	Accurate estimation of weight was related to higher adherence to the MedDiet in adolescents with normal-weight and overweight. Underestimation was associated with lower adherence to the MedDiet in adolescents with normal weight and overweight. Overestimation was related to lower adherence to the MedDiet in adolescents with normal weight.
Cho et al (2012)⁴¹	Korea (2009)	631 (44.7%)	11.57±0.77	Not described (BI was evaluated by adolescents marking their own body shape as ‘very thin’, ‘somewhat thin’, ‘normal’, ‘somewhat overweight’, and ‘very fat’)	Normal perception and overestimation	14-item FFQ	14 food groups	Student t test Chi-square test	BI perception was not associated with DHs.
Edwards et al (2010)⁵⁹	United States (2007)	3687 (42.2%) (adolescents with BMI ≥ 85th percentile)	Not described (9th grade–12th grade)	DQ: How do you describe your weight?	Accurate perception, misperception	DQ: Fruit and vegetable daily intake during the previous 7 days	Eat ≥5 servings of fruit and vegetables per day	Chi-square test Multivariant logistic regression model	Accurate estimation of weight was associated with not meeting the recommended intake of fruit and vegetables.
Hernández Camacho et al (2015)³⁶	Spain (not described)	87 (0.0%)	12–18 (13.5±1.5)	DQ: In relation with your weight, how do you consider your current status? FRS Stunkard	Underestimation, accurate, overestimation	Kidmed questionnaire	DH items from Kidmed questionnaire	Chi-square test	BI perception was associated with fast food and vegetable intake.
Hsu et al (2016)⁴²	Taiwan (2006–2007)	29 313 (48.4%)	10–18 (not described)	BI figures ad hoc	Underestimation, accurate, overestimation	FFQ	5 DH indicators (eating breakfast, fruit and vegetable servings, fried foods, soft drinks, night snacks)	Multivariant logistic regression model	Underestimation of weight was related to skipping breakfast and eating fried foods more frequently.
Jankauskiene and Baceviciene (2019)³⁷	Lithuania (not described)	579 (51.6%)	14–16 (15.0±0.4)	Not described (body weight perception was assessed as the discrepancy between current self-reported body weight and the reported desire to lose or to gain weight)	Underestimation, accurate, overestimation	Validated 11-item FFQ Eating habits questions	11 food groups 2 DH indicators (breakfast, number of meals)	Kruskal–Wallis test	Underestimation in boys was related to a higher consumption of milk products, fats, spreads, oils, and a higher number of meals and frequency of having breakfast. Underestimation in girls was related to higher consumption of sweets.
Lee and Lee (2016)⁴⁵	South Korea (2014)	20 264 (52.3%) (adolescents with normal weight)	12–18 (16.4±0.01)	DQ: What do you think of your body image?	Underestimation, correct estimation, overestimation	Eating habits questions	5 food groups 3 DH indicators (frequency of eating breakfast, lunch, and dinner)	ANOVA Chi-square test	Underestimation was related to a higher consumption of high calorie, low nutrient foods (fast food, soda). Overestimation was related to a lower frequency of having breakfast and dinner, eating fast food, sodas, or milk.
Lim and Wang (2013)⁴⁷	South Korea (2009)	72 399 (47.3%)	12–18 (not described)	DQ: How do you describe your weight?	Underestimation, accurate, overestimation	8 eating habits questions	8 DH indicators (frequency of having breakfast, eating fruits, vegetables, milk, sugar sweetened beverages, fast foods)	Chi-square test Logistic regression model	Underestimation of weight was related to unhealthier DHs (higher fast food and unhealthy snacks daily consumption and breakfast skipping). Overestimation of weight was related to consuming less sugar sweetened beverages daily.
Marques et al (2018)³⁸	Portugal (2014)	3693 (53.4%)	14–17 (14.7±1.1)	DQ: Do you think your body is…?	Perceived underweight, perceived normal weight, perceived overweight	DQ: Describe your eating habits; do you eat well? 6-item eating practice score	Realistic negative (reported bad eating practice and eating habits), underestimators (reported good eating practice, but bad eating habits), overestimators (reported bad eating practice, but good eating habits), realistic positive (reported good eating practice and eating habits)	Chi-square test Logistic regression model	Normal weight perception was related to being realistic positive about diet.
Mikkilä et al (2002)³⁹	Finland (1996–1997)	60 252 (50.7%)	14–16 (not described)	DQ: What do you think about your body weight?	Dissatisfaction, satisfaction^c	Validated 15-item FFQ 2 eating habits questions	3 dietary patterns (factor analysis): Fast food (hamburgers and hot dogs, meat pasties, pizza, soft drinks sweetened with sugar, crisps, chips, and sweets), Healthy food (fruits and berries, rye bread, fresh vegetables, salad, and yoghurt), and Traditional food (coffee, sweet buns, and sausages)	Logistic regression models	Dissatisfaction was related to less frequently following the Fast food (girls and boys) and the Healthy food (boys) dietary patterns.
Niswah et al (2021)⁴⁸	Indonesia (2017)	2144 (48%) (adolescents with overweight and obesity)	12–18 (not described)	Adapted and validated FRS (not specified) Adapted Body Shape Questionnaire	Thin, normal, overweight/obese	Qualitative FFQ Eating habits questions	5 DH indicators (frequency of snacks, fast food, ready-to-eat meals, sweetened beverages, and fruits)	Chi-square test Cox regression models	Accurate perception in girls was related to a lower consumption of high-caloric snacks. BI perception was not associated with DHs in boys.
Oellingrath et al (2015)⁴⁰	Norway (2010)	469 (50.5%)	12–13 (12.7±0.3)	DQ: How do you consider your current status?	Perceived underweight, perceived accurate, perceived overweight	Modified validated 69-item FFQ (reported by parents)	4 dietary patterns (PCA): Junk/convenience (high energy processed fast foods, refined grains, cakes and sweets), Varied Norwegian (fruits and vegetables, brown bread, fish, water and regular breakfast and lunch, close to official nutritional advice), Snacking (sugar-rich snack items and drinks, low intakes of vegetables and brown bread, low frequency of breakfast and dinner and high frequency of eating between meals), and Dieting (foods and drinks often associated with weight control, like artificially sweetened drinks and other ‘light’products)	Multivariant logistic regression model	Underweight perception in boys was related to unhealthier DHs (Junk/Convenience dietary pattern).
Shirasawa et al (2015)⁵¹	Japan (2005–2009)	1731 (48.9%)	12–13 (mean ± sd both boys and girls: 12.3±0.4)	DQ: Do you think you are very thin, thin, normal weight, heavy, or very heavy?	Underestimation, accurate, overestimation	DQ: Snacking after dinner and skipping breakfast	2 DH indicators (snacking after dinner, skipping breakfast)	Logistic regression model	Overestimation in girls was related to higher consumption of snacks after dinner.
Tilles-Tirkkonen et al (2015)³³	Finland (2012–2013)	887 (52.0%)	10–17 (not described)	Not described (BI was evaluated from adolescents’ perceptions of their body on a five-point scale ranging from ‘too fat’, through ‘somewhat fat’, ‘appropriate size’, and ‘somewhat thin’ to ‘too thin’)	Somewhat fat or too fat, appropriate size, and somewhat thin or too thin	Eating habits questions	Balanced and imbalanced school lunch eaters	Chi-square test Logistic regression model	Appropriate perception was related to having a healthier diet (balanced school lunch eaters).
Xie et al (2006)⁴³	China (2002)	6863 (51.7%)	14.8±1.7	DQ: What do you think about your body shape?	Perceived underweight, perceived overweight, misperceived (underweight or overweight)	5 questions from adapted the US YRBSS questionnaire	5 DH indicators (frequency of eating vegetables, fruit and fruit juice, meat or poultry, milk and dairy products, and snack foods)	Logistic regression model	Overweight perception in girls was related to higher consumption of fruit and snacks and lower consumption of milk and dairy products. Underweight perception in girls was related to lower consumption of vegetables and fruit and higher consumption of milk and dairy products. Underweight perception in boys was related to higher consumption of snacks.

Age y.o. (mean ± sd) unless otherwise specified.

The Krece Plus questionnaire was defined but the Kidmed questionnaire was used.

This article misclassified BI perception as satisfaction.

BI, body image; BMI, body mass index; DH, dietary habit; DQ, direct question; FFQ, food-frequency questionnaire; FRS, figure rating scale; IQR, interquartile range; MedDiet, Mediterranean diet; YRBSS, Youth Risk Behavior Survey.