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

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.