Influence of Body Weight and Image Perception on the Nutritional Status of 8-19-Year-Olds Attending Schools in Kampala, Uganda

Inaccurate weight perceptions (body image distortion) and body image dissatisfaction among children and adolescents may lead to unhealthy weight control practices, increasing the risk of adult obesity and related health issues. This study aimed to assess weight perception, body image distortion, dissatisfaction, their associated factors, and how these influences affect the nutritional status of children and adolescents attending schools in Kampala District, Uganda. The cross-sectional survey included 1,043 children and adolescents (aged 8–19 years) attending primary and secondary schools in Kampala. Semi-structured questionnaires were used to collect data on self-reported weight perception and preference. Overall, 17.74% of participants underestimated, 67.98% accurately estimated, and 14.28% overestimated their weight status. There was only fair agreement between participants’ actual and perceived weight status, as indicated by a kappa coefficient of 0.21. A significant proportion of participants (32.02%) exhibited body image distortion. The highest levels of dissatisfaction were found among: individuals classified as grade 3 thinness based on BMI, perception, and preference; children aged 10–14 attending primary schools; and females. Normal weight status was the most preferred, while grade 3 thinness was the least preferred weight category. More children (14.46%) than adolescents (9.95%) preferred being obese, and more females (15.29%) than males (8.06%) preferred being thin. Factors such as actual, perceived, and preferred weight status, age, gender, and education level were found to influence weight perception, weight preference, and body image distortion and dissatisfaction. These factors should be considered when designing interventions to prevent and manage childhood and adolescent overweight and obesity.