The association of body image distortion with weight control behaviors, diet behaviors, physical activity, sadness, and suicidal ideation among Korean high school students: a cross-sectional study

Background: The identification of predictors for body image distortion would be an especially important first step in targeting a vulnerable population and developing a nutrition intervention program. We aimed to investigate the prevalence of body image distortion and the factors associated with body image distortion among Korean high school students. Methods: We selected 20,264 normal weight high school students from the 10(th) Korea Youth Risk Behavior Web-based Survey using nationally representative data in 2014. With multivariate logistic regression, we assessed the association of body image distortion with individual demographic and socio-economic factors, weight control behaviors, and mental health characteristics. Results: The over-estimation group of body weight status, compared with the correct estimation group, was significantly more likely to be a 3(rd) year high school student [adjusted odds ratio (AOR): 1.27, 95 % confidence interval (CI): 1.16-1.39], to be female [AOR: 3.52, 95 % CI: 3.25-3.81], to employ unhealthy weight control behaviors [AOR: 1.54, 95 % CI: 1.37-1.72], and to have a sadness [AOR: 1.25, 95 % CI: 1.16-1.35] and suicidal ideation [AOR: 1.20, 95 % CI: 1.08-1.33]. The under-estimation group, compared with the correct estimation group, was significantly less likely to be female [AOR: 0.23, 95 % CI: 0.21-0.25] and to employ unhealthy weight control behaviors [AOR: 0.50, 95 % CI: 0.43-0.59] but were more likely to have a sadness [AOR: 1.12, 95 % CI: 1.03-1.21] and suicidal ideation [AOR: 1.12, 95 % CI: 1.00-1.25]. Conclusions: Not only the over-estimation but also the under-estimation of body weight is prevalent among high school students in South Korea. Body image distortion was significantly associated with sadness and suicidal ideation.