Body mass index and body weight perception as risk factors for internalizing and externalizing problem behavior among adolescents.

Purpose: To examine the relationship between body mass index (BMI), body weight perception (BWP), and indicators of internalizing and externalizing distress and social, attention and thought problems in a large representative sample of Dutch youth.

Methods: A total of 1826 pupils in the eighth grade of primary education and 5730 students in the first four years of secondary education gave their height and weight to obtain an estimate of their BMI. They reported their evaluation of their body weight and completed Achenbach's Youth Self-Report (YSR) (1991), which assesses eight types of problem behavior. Data were analyzed in a multivariate framework with BMI and BWP as predictors and the YSR scores on different kinds of problem behavior as dependent variables, controlling for background characteristics.

Results: Both BMI and BWP are associated with internalizing and externalizing problem behavior, and social, attention and thought problems. Multivariate tests show that BWP is more closely linked to problem behavior than BMI. Adolescents who were either underweight or overweight but considered themselves in good shape had no more problems than the group with normal BMI and BWP 'good'. The perception of being 'too thin' and particularly the perception of being 'too heavy' best predict problem behavior in both male and female adolescents. Overweight youngsters with an adequate perception of their weight have less somatic complaints than their normal-weight peers who perceive themselves as too heavy, but they show higher withdrawnness, social problems, and anxiety/depression.

Conclusions: Adolescent girls are more dissatisfied with their weight than boys; however, the relationship between weight perception and problem behavior is the same for both genders.