Weight perception and weight-related sociocultural and behavioral factors in Chinese adolescents Bin Xie a, ⁎ , Chih-Ping Chou b , Donna Spruijt-Metz b , Kim Reynolds b , Florence Clark c , Paula H. Palmer b , Peggy Gallaher b , Ping Sun b , Qian Guo b , C. Anderson Johnson b a Hamovitch Research Center, School of Social Work, University of Southern California, 669 West 34th Street, MRF102U, Los Angeles, CA 90089-0411, USA b Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, CA 91803, USA c Department of Occupational Science and Occupational Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA Abstract Background. Rapid economic development accompanied by imported Western media, advertising, fashion, and lifestyle in mainland China has resulted in shifts in cultural beliefs and beauty ideals in adolescents. The present study focused on understanding relationships among weight perception and weight-related sociocultural and behavioral factors in Chinese adolescents. Methods. Data collected in 2002 from 6863 middle and high school students and their parents from four large cities in mainland China were used. Weight status was determined by measured weight and height. Weight perception, media exposure, attitudes, and health behaviors were assessed by a structured questionnaire survey. Results. Boys were more likely to describe themselves as either too thin or relatively thin than girls (37.32% vs. 18.79%), while girls more often considered themselves either relatively heavy or too heavy than boys (50.83% vs. 26.54%). Girls who were actually normal or underweight were more likely than boys to describe themselves as either relatively heavy or very heavy (41.6% vs. 11.6%), while boys who were actually normal or overweight were more likely than girls to believe themselves as underweight (30.9% vs. 15.7%). Girls who were frequently exposed to media from Japan, Korea, Hong Kong, and Taiwan, and placed high value on their physical appearance, were more likely to be dissatisfied with their body weight, which in turn were more likely to restrict consumption of certain foods, smoke cigarettes, and drink alcohol. Similar results were not observed in boys. Conclusions. Weight dissatisfaction was prevalent in Chinese adolescents and was significantly related to media exposure, attitudes towards physical appearance, and adoption of certain health-risk behaviors in girls. Our findings underscore the importance of sociocultural influences in shaping realistic body image and have implications for prevention and early intervention for establishing health behavioral practices during adolescence. © 2006 Elsevier Inc. All rights reserved. Keywords: Weight perception; Chinese adolescents; Sociocultural factors; Health behaviors Introduction The economic transitions in China have been linked to shifts in cultural beliefs and beauty ideals among adolescents living in metropolitan areas with pervasive exposure to imported Western media (Lee and Lee, 1999). Mass media provides the major channel of information on the Western ideal body weight norms, which may be internalized by adolescents (Russell, 1992; Ogden and Mundray, 1996; Field et al., 1999; Labre, 2002; Borzekowski and Bayer, 2005; Wiseman et al., 2005). This shift may be exacerbated by other sociocultural factors including pressures from peers, relatives, parents, and other social environmental factors, and play an important role for adolescents in setting their own weight standards, even if these standards are considered unhealthy or unrealistic (Dawson, 1988; Felts et al., 1996). A growing body of evidence in Western societies suggested that weight perception and body image concerns may vary according to gender, pubertal status, and actual weight status or BMI, and may be related to social pressure, attitudes, and norms of ideal body size and physical attractiveness. Excessive weight concerns and distortion of Preventive Medicine xx (2006) xxx – xxx + model YPMED-01891; No. of pages: 6; 4C: www.elsevier.com/locate/ypmed ⁎ Corresponding author. Fax: +1 213 821 2237. E-mail address: bxie@usc.edu (B. Xie). 0091-7435/$ - see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2005.12.013 ARTICLE IN PRESS