Although actual obesity is expected to be associated with perceived overweight, some recent studies in adults have suggested that this link may be smaller for Blacks than Whites. It is unknown, however, whether the same trend holds for children or not. This study explored the heterogeneity of the association between actual and perceived obesity in a national sample of American children by race, gender, and their intersection. Health Behavior in School-Aged Children (HBSC), 2009–2010, is a national study of children 17 years or less in the United States. This analysis included a total number of 8860 children, including 6581 (74.28%) White and 2279 (25.72%) Black children. Actual obesity, defined as a body mass index (BMI) greater than 95% of the age- and gender-percentile, was the independent variable. Perceived overweight was the main outcome. We ran linear regression models with and without interaction terms between race, gender, and actual obesity. We also ran race- and gender-specific linear regression models. In the pooled sample, actual obesity was positively associated with perceived overweight. We found an interaction between race and obesity, suggesting stronger association between actual obesity and perceived overweight for White than Black children. Gender or intersection of race and gender did not alter the association between actual obesity and perceived overweight. The link between actual obesity and perceived overweight depends on race of the child. Inaccurately perceived weight may be one of many mechanisms behind the disproportionately higher rate of obesity burden among Black children in the United States. As perceived overweight plays a salient role for weight control behaviors, Black children with obesity may need some help to perceive themselves as obese. Training programs should target Blacks to increase the accuracy of their weight and body size evaluation and perception as an essential step for reducing the burden of obesity among Black children.
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