R ESEARCH A RTICLE Perception of Overweight Is Associated With Poor Academic Performance in US Adolescents * TODD A. FLORIN, MD a JUSTINE SHULTS, PhD b NICOLAS STETTLER, MD, MSCE c ABSTRACT BACKGROUND: To improve understanding of the mechanisms affecting the relationship between adolescent obesity and poor academic performance, we examined the association of overweight or perceived weight status with academic achievement. METHODS: We performed a cross-sectional study of 14-17-year-olds (N = 11,012) from the nationally representative 2003 Youth Risk Behavior Survey. The main outcome measure was self-reported grades (mostly A, B, C, D, or F). The primary independent variables were medically defined overweight (body mass index [BMI] ≥ 85th percentile), obesity (BMI ≥ 95th percentile), and participants’ perception of their weight status. RESULTS: Medically defined overweight youth were less likely to report higher grades in unadjusted analysis (OR 0.67, 95% CI: 0.60-0.76, p < .001) and after adjustment for demographics, depression, television and video game use, and physical activity (OR 0.83, 95% CI: 0.74-0.94, p = .003). Statistically significant results also were seen with medically defined obese participants. Youth who perceived themselves as overweight were less likely to report higher grades (OR 0.82, 95% CI: 0.73-0.92, p = .001) in unadjusted analysis and after adjustment for the same variables (OR 0.79, 95% CI: 0.68-0.91, p = .002). The perception of overweight was a more significant determinant of academic performance (OR 0.81, 95% CI: 0.69-0.95, p = .012) compared to medically defined obesity (OR 0.90, 95% CI: 0.77-1.05, p = .174). CONCLUSIONS: Perceived overweight status is negatively associated with academic performance, regardless of actual weight status. These findings suggest that perception of overweight may be a mechanism for prior results indicating a negative association of obesity and academic achievements, and have implications for the academic health of these adolescents. Keywords: child and adolescent health; emotional health; health policy; mental; health; obesity; academic achievement. Citation: Florin TA, Shults J, Stettler N. Perception of overweight is associated with poor academic performance in US adolescents. J Sch Health. 2011; 81: 663-670. Received on June 3, 2010 Accepted on November 3, 2010 R esearch has suggested that pediatric obesity is a risk factor for poor health-related quality of life, including self-esteem, depression, and school and social functioning, which includes relationships with peers and teachers, ability to pay attention and complete homework, happiness at school, and absenteeism. 1-3 A limited number of studies suggest that obese children do not perform as well academ- ically as their healthy-weight peers. 4-12 This is of particular concern, as academic achievement during adolescence is important in predicting adult outcomes, a Fellow, (florint@email.chop.edu), Division of Emergency Medicine, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104. b Associate Professor, (jshults@mail.med.upenn.edu), Division of Biostatistics, Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, 610 Blockley Hall, Philadelphia, PA 19104. c Associate Professor, (nstettle@mail.med.upenn.edu), Department of Pediatrics and Epidemiology, Division of Gastroenterology, Hepatology, and Nutrition, North 1559, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. Address correspondence to: Todd A. Florin, Fellow, (florint@email.chop.edu), Division of Emergency Medicine, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA 19104. *Indicates CHES and Nursing continuing education hours are available. Also available at: http://www.ashaweb.org/continuing_education.html such as unemployment, 13 adult obesity, 14,15 and adult cardiac risk profiles. 16 The underlying mechanism and factors affecting the association of obesity and aca- demic performance are unclear. One study found that social context, such as rates of athletic participation and average body mass index (BMI) in the subjects’ school, was a modifier of the association between obe- sity and school performance. 4 Social context has an effect on how adolescents perceive themselves; thus if social context affects the relationship between obe- sity and academic performance, it is possible that if Journal of School Health • November 2011, Vol. 81, No. 11 •  2011, American School Health Association • 663