Journal List > J Korean Acad Community Health Nurs > v.29(4) > 1110663

J Korean Acad Community Health Nurs. 2018 Dec;29(4):476-487. Korean.
Published online Dec 26, 2018.
© 2019 Korean Academy of Community Health Nursing
Multilevel Analysis of Factors associated with Subjective Weight Perception among Normal Body Weight Adolescents based on the 2017 Korean Youth's Risk Behavior Survey (KYRBS)
Eun Ha Joeng,1 and In Sook Lee2
1Doctoral Student, College of Nursing, Seoul National University, Seoul, School Health Teacher, Munhyeon Middle School, Seoul, Korea.
2Professor, College of Nursing, Seoul National University, Seoul, Korea.

Corresponding author: Lee, In Sook. College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8828, Fax: +82-2-765-4103, Email:
Received Apr 25, 2018; Revised Sep 18, 2018; Accepted Oct 07, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The present study is focused on understanding weight perception related with individual- and school-level multifactorial origins, underestimated and overestimated respectively, in normal body weight adolescents.


Using the 2017 Korea Youth Risk Behavior Web-based Survey data of 45,902 students from 799 secondary schools, a multilevel multinomial logistic regression analysis was performed where adolescents (level1) were nested within schools (level 2).


At the school level, the average school body mass index (BMI, kg/m2) and physical education were associated with weight perception among both boys and girls. In boys, geographic areas were associated with weight underestimation. At the individual level, perceived economic status, weekly allowance, BMI (kg/m2), smartphone usage time (hrs/day) and perceived stress were associated with weight perception among both boys and girls. Age, paternal education, academic achievement and alcohol use were associated with weight perception among girls, while part-time job and physical activity were associated with weight perception among boys.


Our findings underscore the importance of individual- and school-level environments in developing correct weight perception and have implications for school health education to establish healthy lifestyle behaviors for all adolescents.

Keywords: Adolescent; Weight Perception; Multilevel analysis


Table 1
Cross Tabulation of Weight Perception and Gender among Normal BMI Adolescents (N=45,902)
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Table 2
Weight Perception by Individual- and School-level Characteristics (N=45,902)
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Table 3
Estimates of Variance and ICC for Random Effect on Null Model
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Table 4
Multilevel Analysis: Factors associated with Weight Perception (N=45,902)
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1. Korean Academy of Child and Adolescent Psychiatry. Adolescent psychiatry. Seoul: Sigmapress; 2012. pp. 720.
2. Kim YG, Yoo SH, Lee MH, Kim JH. In: The study on the current status of Korean children's and young people's rights VI-The youth's and children's rights indicator system of 2016-. Research Report. Sejong: National Youth Polcy Institute; 2016 Dec.
Report No.: 16-R11-2.
3. Statistics Korea. 2016 Social survey: Worries of the youths (Main Response, 13~18 years old)[Internet]. Daejeon: Statistics Korea; 2017 [cited 2018 February 14].
4. Lee JY, Yoo JA. Influence of body shape perception on self-esteem among normal-weight middle school students in South Korea: The mediating effect of body shape satisfaction and gender differences. Studies on Korean Youth 2015;26(4):267–297. [doi: 10.14816/sky.2015.26.4.267]
5. Korea Centers for Disease Control and Prevention. Statistics from the thirteenth Korea youth risk behavior web-based survey [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2017 [cited 2018 February 14].
6. Kwon EJ, Chu JE, Nah EH. Secular trends and characteristics of weight status misperception among Korean children and adolescents: Based on school health examination data in 2009~2015. The Journal of the Korean Public Health Association 2017;43(4):73–85.
7. Kim HC, Kim MR. Effect of self-esteem, body image and external factors of body type on dieting behavior of high school students. Journal of Korean Home Economics Education Association 2010;22(4):65–75.
8. Kim MH, Yun YH, Choi MK, Kim EY. A study on body image recognition and dietary habits of middle school students in the Chungnam area. The Korean Journal of Food and Nutrition 2012;25(2):338–347.
9. Chung MY, Kim SH. Prevalence and factors affecting body shape misperception among Korean adult women. Korean Journal Women Health Nursing 2016;22(3):162–169. [doi: 10.4069/kjwhn.2016.22.3.162]
10. Lim HJ, Wang Y. Body weight misperception patterns and their association with health-related factors among adolescents in South Korea. Obesity 2013;21(12):2596–2603. [doi: 10.1002/oby.20361]
11. Fan M, Jin Y, Khubchandani J. Overweight misperception among adolescents in the United State. Journal of Pediatric Nursing 2014;29(6):536–546. [doi: 10.1016/j.pedn.2014.07.009]
12. Maximova K, McGrath JJ, Barnett T, O'Loughlin J, Paradis G, Lambert G. Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents. International Journal of Obesity 2008;32(6):1008–1015. [doi: 10.1038/ijo.2008.15]
13. Kim YR, Jang HS, An MR. Emotional stress, dietary attitude, and nutrient intake according to BMI and sex of middle school students in Daegu, Kyungpook. Journal of the Research Institute of Curriculum Instruction 2011;15(3):633–655.
14. Shin A, Nam CM. Weight perception and its association with socio-demographic and health-related factors among Korean adolescents. BMC Public Health 2015;15(1):1292–1300. [doi: 10.1186/s12889-015-2624-2]
15. Xie B, Chou CP, Spruijt-Metz D, Reynolds K, Clark F, Palmer PH, et al. Weight perception and weight-related sociocultural and behavioral factors in Chinese adolescents. Preventive Medicine 2006;42(3):229–234. [doi: 10.1016/j.ypmed.2005.12.013]
16. Jeon BH. Relationship among physical and social characteristics and subjective body perception. Journal of the Korean Society for Wellness 2015;10(1):149–157.
17. Kim SH, So WY. Prevalence and sociodemographic trends of weight misperception in Korean adolescents. BioMed Central Public Health 2014;14(1):452–460. [doi: 10.1186/1471-2458-14-452]
18. Kim YG, Kim BS, Won CW, Choi HR, Kim SY, Kim H. The association between recognition of weight and health behavior of Korean adolescents: The Korea youth risk behavior webbased survey, 2014. Korean Journal of Family Practice 2017;7(3):322–329. [doi: 10.21215/kjfp.2017.7.3.322]
19. Sarafrazi N, Hughes JP, Borrud L, Burt V, Paulose-Ram R. In: Perception of weight status in U.S. children and adolescents aged 8-15years, 2005-2012. NCHS Data Brief. Hyattsville, MD: National Center for Health Statistics; 2014 Jul.
Report No.: 158.
20. Lee EM. Association between body shape perception and stress, depression, suicidal ideation. Journal of the Korean Data Analysis Society 2017;19(6):3331–3343.
21. Jung MR, Jeong E. Convergence factors influencing body image in adolescents. Journal of Digital Convergence 2017;15(8):265–275. [doi: 10.14400/JDC.2017.15.8.267]
22. Ene M, Leighton EA, Blue GL. Multilevel models for categorical data using SAS® PROC GLIMMIX: The basics [Internet]. North Carolina: SAS Institute Inc; 2015 [2018 February 14].
23. Ali MM, Amialchuk A, Renna F. Social network and weight misperception among adolescents. Southern Economic Association 2011;77(4):827–842. [doi: 10.4284/0038-4038-77.4.827]
24. Patte KA, Laxer RE, Qian W, Leatherdale ST. An analysis of weight perception and physical activity and dietary behaviours among youth in the COMPASS study. SSM - Population Health 2016;2:841–849. [doi: 10.1016/j.ssmph.2016.10.016]
25. Song KH, Kang HS. Analysis of the direction and features of Health Education curriculum under the 2015 revised curriculum. Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology 2016;6(4):329–339. [doi: 10.14257/ajmahs.2016.04.42]
26. Lee JH, Heo TY. A Study of effect on the smoking status using multilevel logistic model. Korean Journal of Applied Statistics 2014;27(1):89–102. [doi: 10.5351/kjas.2014.27.1.089]
27. Kang HJ. In: Korean adolescents body weight perception and weight change effort by the socioeconomic positions [master's thesis]. [Seoul]: Seoul National University; 2010. pp. 101.
28. Bordo S. In: Park OBUnbearable Weight. California: The University of California Press; 2003.
29. Murnen SK. Gender and body images. In: Cash TF, Smolak L, editors. Body image: A handbook of science, practice, and prevention. 2nd ed. New York: The Guilford Press; 2011. pp. 173-179.