Body weight perception and body self-esteem in adolescents with overweight or obesity in Costa Rica: challenges for public health policy

ABSTRACT

Objective:

This study estimates the prevalence of weight misperception among Costa Rican adolescents in general and examines its association with body esteem and weight-control behaviors to inform public health policy.

Methods:

The authors analyzed cross-sectional data collected in 2017 from a probabilistic sample of 818 adolescents aged 13–18 years enrolled in public and private secondary schools in urban and rural areas of the province of San José, Costa Rica. Weight and height were measured by trained nutritionists and classified using World Health Organization body mass index (BMI)-for-age standards. Perceived weight status was assessed using culturally appropriate response categories adapted from the Youth Risk Behavior Survey and refined through a pilot study. Body esteem and weight-control behaviors were measured using validated survey instruments.

Results:

Among adolescents with overweight or obesity, 59% underestimated their weight, most commonly perceiving themselves as having an “adequate weight.” Weight underestimation was associated with higher body esteem and lower engagement in weight-control behaviors after adjustment for key sociodemographic characteristics

Conclusion:

By contributing evidence from a Latin American context—where research on adolescent weight perception remains scarce—this study enhances understanding of how excess weight is perceived during adolescence in settings where overweight is highly prevalent and supports public policy approaches that prioritize healthy eating and active living from adolescence.

Adolescent obesity has emerged as one of the most serious threats to global public health, with sustained increases over recent decades (1). Excess weight during adolescence is associated with early cardiometabolic alterations, as well as an increased risk of cardiometabolic disease and the persistence of excess weight into adulthood (2). In Latin America, the situation is particularly concerning (3). In Costa Rica, approximately one in every three adolescents presents with overweight or obesity (4), a prevalence comparable to that observed in countries with a high burden of noncommunicable diseases, such as Chile, Mexico, and the United States (5).

In this context, recognizing one’s own weight is fundamental for making decisions aimed at improving healthy behaviors, increasing physical activity, and adopting preventive practices, as weight perception is closely associated with motivation for weight regulation (6). However, multiple studies indicate that a considerable proportion of adolescents with overweight or obesity perceive themselves as having an “adequate weight,” underestimating their condition (7–11).

In parallel, international evidence suggests that shifts in the population distribution of body weight have contributed to the social normalization of excess weight, understood as the growing perception that overweight and obesity are common and socially accepted, thereby reducing their salience as health risk conditions (12). A systematic review including only high-income countries documented substantial variability in the accuracy of self-perceived weight, underscoring the role of cultural and normative factors (13). This finding is consistent with the notion that weight self-perception is shaped primarily from proximal social referents rather than standardized health parameters (14). However, other factors, including exposure to weight stigma (15, 16), social media influences (17), psychosocial characteristics (18), and broader cultural ideals regarding body size (19), may also contribute to weight misperception.

The psychological dimension is also central. Body self-esteem, understood as the affective appraisal of one’s own body (20), is closely linked to psychological well-being and to health-related behaviors such as physical activity and dietary regulation (21). Lower levels have been associated with depressive symptoms and risky eating behaviors, whereas higher levels may function as a protective resource. Because body self-esteem shapes both the interpretation of one’s own weight and the willingness to engage in health-related behaviors, it is key to understanding how adolescents confront the underestimation of their excess weight. Most available studies have been conducted in the United States, Europe, and Asia (22), with only a few recent studies from Africa (23). Consequently, extrapolation of findings to the Latin American context requires caution, given that cultural factors and body norms may influence how body size and excess weight are interpreted and valued (14).

The aim of this study was to estimate the prevalence of weight misperception among Costa Rican adolescents with overweight or obesity and examine its association with body self-esteem and weight-control behaviors.

METHODS

Study Design and Population

This study used cross-sectional data collected in 2017 from adolescents enrolled in public and private secondary schools located in urban and rural areas of the province of San José, Costa Rica. San José accounts for approximately 30% of the national adolescent population (24), and nearly 80% of Costa Rican adolescents are enrolled in school (25). Sixteen high schools were selected from an official list of all public and private high schools in the province. Students enrolled in grades 7 through 11 at the selected schools were invited to participate. The final analytical sample consisted of 813 adolescents aged 13–18 years.

Anthropometric Assessment

A trained nutritionist measured participants’ height to the nearest 0.1 cm using a portable stadiometer and body weight to the nearest 0.1 kg using a calibrated digital scale. Measures were obtained with adolescents barefoot and wearing light clothing. Body mass index (BMI) was calculated as weight (kg) divided by height (m²). Nutritional status was classified using BMI-for-age Z-scores according to World Health Organization standards (26): <−2 SD = underweight; −2 to <+1 SD = healthy weight; +1 to <+2 SD = overweight; ≥+2 SD = obesity. Adolescents with BMI-for-age Z-scores ≥+1 SD were classified as having overweight/obesity.

Perceived Weight Status

Perceived weight status was assessed using the question “How do you perceive your body?,” adapted from the CDC Youth Risk Behavior Survey (27). Response categories were refined through a pilot study involving semistructured cognitive interviews conducted with 100 adolescents (50% girls; aged 13–18 years) from comparable school settings to ensure cultural and semantic appropriateness. During the pilot phase, adolescents consistently identified a clear severity gradient in perceived weight status (“adequate weight,” “slightly overweight,” “very overweight”), with stable interpretation across sex and age groups. Accordingly, perceived weight status in the main study was assessed using five response options: very thin, slightly thin, adequate weight, slightly overweight, and very overweight.

Body Esteem

Body esteem was assessed using the 23-item Body Esteem Scale for Adolescents and Adults (BESAA) (20). The instrument comprises three subscales: appearance (overall feelings about one’s appearance), attribution (perceptions of others’ evaluations of one’s body), and weight (satisfaction with body weight). Items are rated on a 5-point Likert scale (1 = never to 5 = always), and the total score was used for analyses.

Weight-Control Behaviors

Weight-control intentions and behaviors were assessed using items adapted from the CDC Youth Risk Behavior Survey (27). Adolescents were asked: “Which of the following are you currently trying to do about your weight?,” with response options including lose weight, gain weight, stay the same weight, or not trying to do anything. Participants also reported whether they had engaged in behaviors to lose weight or prevent weight-gain during the previous 30 days. The questionnaire assessed the occurrence of weight-control behaviors but did not distinguish between healthy and potentially unhealthy weight-management practices. All weight-control behavior variables were coded dichotomously (yes/no) for analysis.

Sociodemographic Variables

Sociodemographic information—including age, sex, area of residence, parental education, household assets (e.g., internet access, computer ownership, cable television, water heating system), and family structure—was collected through a structured, paper-based questionnaire. Parental education and household asset ownership were used to derive socioeconomic status (SES) following the Costa Rican index for students and secondary schools (28), which is based on the k-means clustering procedure (29).

Ethical Considerations

The study protocol was reviewed and approved by the Bioethics Committee of the Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA) under number IC-2007-01. All adolescents provided written assent, and written informed consent was obtained from their parents or legal guardians. Participation was voluntary, and the confidentiality of all data was strictly maintained throughout the study.

Data Preparation and Statistical Analysis

Prior to analysis, adolescents were classified into analytic categories to construct indicators of body weight perception, accuracy of weight perception, and direction of discrepancy between perceived and objectively measured weight status. Perceived weight status was based on responses to the question “How do you perceive your body?” and categorized into five ordered categories: very underweight, slightly underweight, adequate weight, slightly overweight, and very overweight.

The accuracy of weight perception was determined by comparing perceived weight status and measured BMI-for-age categories and classified as underestimation (perceived weight lower than measured), accurate perception, or overestimation (perceived weight higher than measured).

Descriptive statistics were calculated for all study variables. Group differences in continuous outcomes were examined using t tests or analysis of variance (ANOVA), as appropriate, while associations between categorical variables were assessed using χ² tests. Multivariable linear regression models were fitted to examine associations between weight-perception accuracy and body esteem, as well as weight-control behaviors, adjusting for age, sex, school type, area of residence, and SES. Dichotomous variables (sex, type of school, and area of residence) were dummy-coded using girls, public schools, and rural residence as reference categories (coded as 0).

All analyses were conducted using Jamovi version 2.3.28. Statistical significance was set at p < 0.05.

RESULTS

Table 1 presents the demographic characteristics of the total sample and stratified by BMI-for-age weight-status categories. Most adolescents had a healthy weight (66%), followed by overweight (23%), obesity (10%), and underweight (2%).

TABLE 1. Demographic characteristics of the study sample by BMI-for-age weight status.

Demographic variables	Total n = 813	Underweight n = 13 (2%)	Healthy weight n = 535 (66%)	Overweight n = 186 (23%)	Obese n = 79 (10%)
Age (Mean ± SD)	15.03 ± 1.70	15.62 ± 1.94	15.07 ± 1.72	15.01 ± 1.67	14.76 ± 1.59
Sex
Girls (%)	63.47	15.38	65.42	65.59	53.16
Boys (%)	36.53	84.62	34.58	34.41	46.84
Area
Urban (%)	50.31	38.46	50.84	49.46	50.63
Rural (%)	49.69	61.54	49.16	50.54	49.69
SES
Low (%)	32.35	15.38	34.95	25.27	34.18
Middle (%)	39.36	53.85	37.20	45.16	37.97
High (%)	28.29	30.77	27.85	29.57	27.85
Type of school
Public (%)	85.52	84.62	84.18	87.57	89.87
Private (%)	14.48	15.38	15.82	12.43	10.13

Source: Original table for this article.

Note: SD = standard deviation; SES = socioeconomic status.

Participants ranged in age from 13 to 18 years, with a mean age of 15 years [standard deviation (SD) = 1.70]. No statistically significant differences in age were observed across BMI-for-age categories [F(3, 809) = 1.29, p = 0.275]. Girls comprised 63% of the total sample. The distribution of BMI-for-age weight status differed significantly by sex (χ² = 8.32, n = 813, df = 2, p = 0.016); specifically, girls were underrepresented in the underweight and obesity categories, whereas boys were underrepresented in the healthy-weight and overweight categories. Students were evenly distributed across urban and rural areas, SES categories, and school type. No significant differences were found in BMI-for-age weight status by area of residence (χ² = 0.85, p = 0.838), SES (χ² = 8.38, p = 0.212), or school type (χ² = 2.61, p = 0.455) (Table 1).

Table 2 presents the distribution of adolescents’ perceived weight status according to their objectively measured BMI-for-age category. Panel A evaluates the accuracy of body weight perception relative to objective BMI-for-age classification, whereas Panel B describes how adolescents label their body weight using specific weight-status descriptors.

TABLE 2. Accuracy of body weight perception and perceived weight-status categories by BMI-for-age classification.

A. Accuracy of body weight perception based on the comparison between the measured BMI-for-age weight status and adolescents’ self-reported body weight perception
BMI-for-age weight status	Underestimation		Accurate		Overestimation
Underweight	0%		84%		16%
Healthy weight	30%		60%		10%
Overweight	47%		48%		5%
Obesity	82%		18%		0%
Total	38%		53%		9%
B. Adolescents’ self-reported body weight perception based on the answers to question “How do you perceive your body?”
BMI-for-age weight status	Very thin	Slightly thin	Adequate weight	Slightly overweight	Very overweight
Underweight	46%	38%	8%	8%	0%
Healthy weight	7%	23%	60%	10%	1%
Overweight	0%	1%	46%	48%	5%
Obesity	0%	0%	13%	69%	18%
Total	6%	16%	51%	24%	3%

Source: Original table for this article.

Note: Data show row percentages. Contingency analysis results for Panel A: χ² = 368.90, n = 813, df = 12, p < 0.001. Contingency analysis results for Panel B: χ² = 97.46, n = 813, df = 6, p < 0.001. BMI = body mass index.

Panel A shows that in the total sample, 53% of students accurately perceived their weight status, 38% underestimated it, and 9% overestimated it. However, when examined across BMI-for-age categories, the accuracy of weight-status perception was unevenly distributed (χ² = 97.46, n = 813, df = 6, p < 0.001). Most adolescents with underweight accurately perceived their weight status (84%), while the remaining 16% overestimated it. Among students with a healthy weight, 60% accurately perceived their weight status, whereas 30% underestimated it and 10% overestimated it. Among adolescents with overweight, fewer than half accurately perceived their weight status (48%); a similar proportion underestimated it (47%), and a small proportion overestimated it (5%). Finally, among adolescents with obesity, only 18% accurately perceived their weight status, while the remaining 82% underestimated it. Overall, the prevalence of weight-status underestimation increased progressively with higher BMI-for-age categories.

To further characterize how these inaccuracies were expressed, Panel B describes adolescents’ self-reported body weight perception across BMI-for-age categories. Most adolescents with underweight described themselves using one of the two underweight categories (84%; very underweight: 46%, slightly underweight: 38%). Among students with a healthy weight, the majority perceived themselves as having an adequate weight (60%). Slightly more than half of overweight students (53%) described themselves as overweight, predominantly as slightly overweight (48%), while a smaller proportion classified themselves as very overweight (5%). Among adolescents with obesity, 69% classified themselves as slightly overweight and 18% as very overweight. Contingency analyses indicated a statistically significant association between adolescents’ perceived weight status and their objectively measured weight status (χ² = 368.90, n = 813, df = 12, p < 0.001).

Despite this overall correspondence, systematic biases in body weight perception were evident, particularly among adolescents with excess weight. Nearly half of overweight students (46%) perceived themselves as having an adequate weight, and a small proportion (1%) perceived themselves as slightly underweight. Similarly, 13% of students with obesity perceived their weight as adequate. Overall, 59% of adolescents with excess weight perceived themselves as having an adequate weight, indicating a systematic tendency toward weight underestimation.

Table 3 summarizes the results of the multiple regression analyses examining body esteem and weight-control behaviors as outcome variables. All models were adjusted for age, sex, type of school, area of residence, and SES. The regression model for body esteem was statistically significant [F(8, 799) = 9.70, p < 0.001], explaining approximately 9% of the variance in body esteem scores. After adjustment for covariates, the accuracy of body weight perception was a significant predictor of body esteem. Adolescents who accurately perceived their weight reported significantly higher body esteem scores than those who underestimated their weight, whereas adolescents who overestimated their weight reported the lowest body esteem scores among all groups. These graded differences across accuracy categories are illustrated in Figure 1. Among the covariates, sex was also significantly associated with body esteem, with boys reporting lower body esteem scores than girls. No significant associations were observed for age, school type, area of residence, or SES.

TABLE 3. Results of the multiple regression analyses for body esteem and weight-control behaviors.

Body esteem							Weight-control behaviors
Predictor	B	EE	95% CI	t	p	b	B	EE	95% CI	t	p	b
Intercept	3.4102	0.2366	2.9458–3.8745	14.4153	<0.00001	—	–0.2899	0.3201	–0.9184–0.3385	–0.9057	0.36539	—
Age	0.0024	0.0149	–0.0270–0.0317	0.1573	0.87501	0.0054	0.0591	0.0202	0.0194–0.0988	2.9219	0.00358	0.1028
Sex
Boy–Girl	–0.1577	0.0524	–0.2605 to –0.0548	–3.0089	0.00270	–0.2125	0.2392	0.0709	0.1001–0.3784	3.3748	0.00077	0.2442
School type
Public–Private	0.0025	0.0821	–0.1587–0.1636	0.0301	0.97596	0.0033	0.1382	0.1111	–0.0798–0.3562	1.2442	0.21381	0.1411
Area of residence
Rural–Urban	–0.0303	0.0537	–0.1358–0.0751	–0.5649	0.57229	–0.0409	0.0308	0.0727	–0.1120–0.1736	0.4238	0.67185	0.0315
Socioeconomic status
Low–Middle	–0.0198	0.0601	–0.1378–0.0982	–0.3293	0.74201	–0.0267	0.0656	0.0813	–0.0939–0.2250	0.8068	0.42005	0.0669
Low–High	–0.0830	0.0727	–0.2258–0.0598	–1.1414	0.25406	–0.1119	0.2028	0.0985	0.0095–0.3961	2.0592	0.03980	0.2070
Weight-perception accuracy
Underestimation– Consistent	0.1320	0.0533	–0.7981 to –0.4191	2.4746	0.01355	0.1779	–0.1168	0.0723	0.0442–0.5556	–1.6161	0.10646	–0.1192
Underestimation– Overestimation	–0.6086	0.0965	0.0273–0.2367	–6.3039	<0.00001	–0.8201	0.2999	0.1303	–0.2586–0.0251	2.3020	0.02159	0.3062

Source: Original table for this article.

Note: 95% CI : 95% confidence interval.

FIGURE 1. Body esteem and weight-control behaviors across categories of body weight perception accuracy.

Source: Original figure for this article.

The regression model predicting weight-control behaviors was also statistically significant [F(8, 792) = 5.23, p < 0.001], accounting for approximately 5% of the variance in reported behaviors. Accuracy of body weight perception remained a significant predictor of weight-control behaviors after covariate adjustment. Adolescents who overestimated their weight reported the highest frequency of weight-control behaviors, followed by adolescents that underestimate their weight, whereas those who accurately perceived their weight reported the lowest frequency (Figure 1). The difference between adolescents who overestimated and those who underestimated their weight was statistically significant after adjustment for covariates (Table 3). Regarding covariates, sex and high SES were positively associated with weight-control behaviors, whereas age, school type, and area of residence were not significantly related to the outcome.

DISCUSSION

The aim of this study was to estimate the prevalence of weight misperception among Costa Rican adolescents in Costa Rica in general and to examine its association with body self-esteem and weight-control behaviors. The finding that 59% of adolescents with overweight or obesity underestimate their body weight, perceiving themselves as having an “adequate weight,” is particularly noteworthy. This pattern aligns with international evidence showing higher levels of inaccurate weight perception in contexts where excess weight is highly prevalent (12, 30), suggesting a process of social normalization of higher body weight. Because perceived weight status was assessed using adolescents’ everyday understanding of weight-related terms rather than clinical criteria, discrepancies between perceived and measured weight status likely reflect true perceptual misalignment rather than limitations of the measurement approach. These findings should also be interpreted within the broader Latin American context, where overweight and obesity are highly prevalent. In settings where excess weight has become increasingly common, shifting body weight norms may contribute to patterns of weight misperception similar to those observed in Costa Rica.

Visual normalization theory posits that repeated exposure to individuals with excess weight can shift perceptions of what constitutes an adequate body weight, promoting judgments grounded in local social norms rather than clinical standards (12, 31). Such exposure may recalibrate perceptual reference points, increasing the likelihood that higher body weights are perceived as normal (12, 32). This process may be particularly relevant in Costa Rica, where 70.7% of adults have excess weight (33), making higher body weights a common visual referent and potentially reducing recognition of excess weight as a health concern. Such normalization processes operate not only at the population level but also within family contexts, further increasing the likelihood that adolescents underestimate their own weight status. Consistent with this interpretation, adolescents whose mothers or fathers have excess weight are more likely to underestimate their own weight (31, 34). Although visual normalization theory provides a useful explanatory framework, weight misperception is unlikely to be explained by this mechanism alone. Peer norms, social media influences, exposure to weight stigma, broader cultural ideals regarding body size, and individual psychosocial characteristics may also contribute (15–19, 35).

Likewise, social comparison theory (36) suggests that adolescents evaluate their bodies relative to peers; when excess weight is common, such comparisons may promote more favorable body evaluations.

The psychological implications of weight underestimation also warrant consideration. In this study, adolescents who underestimated their weight reported higher levels of body self-esteem, which is consistent with self-discrepancy theory (37). According to this framework, recognizing oneself as having excess weight increases the discrepancy between the “actual self” and the “ideal self,” which can generate emotional distress. Thus, weight underestimation may operate as a form of emotional regulation based on cognitive avoidance (38), temporarily reducing the tension associated with this self-discrepancy and attenuating negative body-related affect (39). These findings are consistent with the possibility that weight underestimation functions as a short-term psychological buffer, lowering immediate emotional discomfort linked to acknowledging excess weight during adolescence. However, given the cross-sectional nature of the study, the directionality of this association cannot be established.

During adolescence, heightened emotional reactivity and ongoing prefrontal maturation may favor benign interpretations of one’s own weight in the short term (40), potentially influencing how adolescents recognize and respond to excess weight. However, longitudinal studies are needed to clarify temporal relationships.

This perceptual pattern also has relevant behavioral consequences. One possible interpretation is that adolescents who do not recognize their excess weight may perceive less need to engage in weight-control behaviors. By reducing the discrepancy between the actual and ideal self (37), weight underestimation may attenuate emotional distress and reduce the perceived urgency to modify health-related behaviors. This interpretation is consistent with the lower frequency of weight-control behaviors observed among adolescents who underestimated their weight. However, the association between weight underestimation and weight-control behaviors should be interpreted cautiously because the questionnaire did not distinguish between healthy and potentially unhealthy weight-management practices. Furthermore, because the study is cross-sectional, the directionality of this association cannot be established, and alternative explanations, including reverse causality, cannot be excluded.

From a public health perspective, weight underestimation should not be interpreted as a protective factor. Risk perception is a central determinant in classic behavior-change models, such as the health belief model (41) and protection motivation theory (42), in which recognizing a health risk constitutes a necessary step for generating an intention to change behavior.

Some studies have reported that adolescents who do not recognize their excess weight present certain favorable indicators related to weight-control behaviors (7–9) or psychological well-being (11, 43), whereas those who accurately identify their excess weight exhibit higher levels of mental distress and fewer psychological protective factors (7, 10, 43). However, this evidence should be interpreted with caution due to methodological limitations. Many studies rely on cross-sectional designs, which preclude the exclusion of reverse causality (44), a particularly relevant concern during adolescence, when depressive symptoms may shape weight perception rather than result from it (45). Residual confounding caused by unmeasured psychosocial factors (e.g., bullying, family support, baseline self-esteem) and a reliance on self-reported anthropometrics or figure-drawing scales not validated for adolescents may further compromise the validity of these associations (46, 47). Therefore, conclusions suggesting that weight underestimation is psychologically protective, or that accurate weight recognition is detrimental to adolescents’ mental health, should be interpreted with caution.

Finally, these findings may have implications for the design of public health policies, although the present study did not directly evaluate the effectiveness of alternative intervention approaches. While a more accurate perception of body weight may facilitate risk recognition and motivate informed behavioral change, interventions focused exclusively on weight may increase body dissatisfaction and promote risky eating behaviors (48). Therefore, public policies should balance clear communication about health status with the avoidance of body-centered messages. Health promotion approaches targeting adolescents that emphasize body functionality—that is, what the body can do and enables individuals to do—rather than body weight or physical appearance, may help reduce the influence of aesthetic ideals and support positive body esteem. In turn, such approaches could encourage active lifestyles and healthy eating behaviors without reinforcing aesthetic pressure.

This study has several strengths. First, it provides local evidence on weight underestimation and its psychosocial correlates among adolescents with overweight or obesity in Costa Rica, addressing a critical evidence gap in Latin American settings where empirical data on this topic remain limited. Second, the perceived weight status was assessed using response categories refined through a pilot study with semistructured cognitive interviews, ensuring that the terminology reflected adolescents’ everyday understanding of weight-related concepts and was culturally appropriate. This approach strengthens the content and semantic validity of the measure and allows for meaningful interpretation of discrepancies between perceived and objectively measured weight status. Third, anthropometric measurements were obtained by trained nutritionists using standardized procedures, minimizing measurement error in BMI classification. In addition, the study employed a probabilistic, multistage sampling design and included adolescents from both urban and rural school settings. Finally, the inclusion of multiple sociodemographic covariates—including age, sex, area of residence, and SES—accounts for contextual factors often overlooked in similar studies and enhances the robustness of the observed associations.

Several limitations should be acknowledged. First, the cross-sectional design precludes causal inference regarding the directionality of the associations between weight underestimation, body esteem, and weight-control behaviors, and residual confounding cannot be fully excluded. Second, the analytical sample was restricted to school-enrolled adolescents with overweight or obesity from a single province, which limits the generalizability of the findings to out-of-school youth and adolescents from other regions of the country. Accordingly, caution is warranted when extrapolating these findings to the broader Costa Rican adolescent population. Third, the data were collected in 2017. Changes in social norms, media exposure, health communication, and public awareness regarding obesity may have influenced contemporary patterns of weight perception among adolescents. Nevertheless, overweight and obesity remain highly prevalent in Costa Rica and throughout Latin America, suggesting that the issues examined continue to be relevant for public health. Fourth, the assessment of weight-control behaviors did not distinguish between healthy and potentially unhealthy practices. Consequently, it was not possible to determine whether observed differences reflected greater engagement in health-promoting behaviors or increased use of potentially harmful weight-loss practices. Fifth, weight-control behaviors were self-reported and may have been influenced by social desirability or recall bias. Adolescents may have overreported socially desirable behaviors or underreported behaviors perceived as undesirable, which may have affected the accuracy of the observed associations. Finally, the regression models explained only a modest proportion of the variability in body esteem and weight-control behaviors. Given the multifactorial nature of these outcomes, additional psychological, social, environmental, and contextual factors not included in the present study are likely to have contributed to the remaining variability. Nevertheless, this study provides valuable empirical evidence on weight misperception among adolescents in Latin America, where evidence remains limited, and may inform future research examining its determinants, psychological correlates, and behavioral implications. In conclusion, a substantial proportion of Costa Rican adolescents with overweight or obesity underestimate their weight, a pattern associated with higher body esteem and lower engagement in weight-control behaviors. Using evidence from a Latin American context, this study advances understanding of adolescent weight perception in environments where excess weight is highly prevalent and may help inform public health initiatives that promote healthy eating and active living while recognizing the complex relationships between weight perception, psychological well-being, and health-related behaviors

Data availability statement.

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Disclaimer.

Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH and/or PAHO.

Declaration of Artificial Intelligence (AI) tool use.

OpenAI’s ChatGPT, GPT-5.5 was used solely to assist with English language editing and improve the clarity of the manuscript. The authors reviewed, edited, and verified all AI-assisted revisions; take full responsibility for the final content of the manuscript; and agree with the outputs incorporated into the submitted version.