Weight Perception and Its Impact on Health Behaviors among College Students in Hong Kong: A Cross-Sectional Study

Abstract

Abstract Background Tertiary education is a crucial period during which students develop lifelong habits, including those related to health and wellness. Such students face new stressors and exhibit unhealthy eating behaviors thatmay lead them to become underweight or overweight. Weight misperception is common among young adults but may vary in prevalence by gender and study program. Such misperception may affect a person’s physical and mental health and lead to aggressive weight control behaviors. Therefore, the aim of this study was to examine the factors affecting weight perception and the relationship between weight perception and mental health among college students. Methods This cross-sectional study involved 553 students at two higher education institutions in Hong Kong during 2021 and 2022. Students aged 18 or older were eligible for inclusion. The key variables included gender, body mass index (BMI), study program, weight perception, weight control behaviors, and Depression, Anxiety and Stress Scale-21 Items (DASS-21) scores. Results The mean age of the participants was 19.6 years; 65.5% of the participants were female; and 53.3% were enrolled in a nursing program. First, stronger agreement between the actual weight and perceived weight was observed in men (Kappa = 0.441) than in women (Kappa = 0.303). Women had a significantly greatertendency to incorrectly perceive themselves as overweight than did men(chi-square test, p < .001). Second, similar levels of agreement were observed in health and non-health students (Kappa = 0.331 and 0.343, respectively),but health students were significantly more likely to perceive themselves as underweight (p = .049). Third, women’s use of weight control behaviors, especially vigorous exercise, walking, and a carbohydrate-based diet, tended to be based on weight perception rather than actual weight, whereas such behaviors were not observed in men. Finally, among students with a normal weight, those who perceived themselves as overweight hadsignificantly higher DASS-21 depression (p =.027), anxiety (p =.001), and stress scores (p =.006) than did their counterparts. Conclusion In our sample, an incorrect weight perception was associated with female gender and found to induce unnecessary weight control behaviors and affect mental health among the college students. These findings indicate the need for comprehensive approaches to address weight-related stress and highlight the importance of promoting healthy weight management in future health education programs and policies.