Children’s self-body weight perception and dietary behavior under multiple influences: a social ecological perspective

Based on the socio‑ecological theoretical framework, this study aimed to explore the relationships among the self‑body weight perception (BWP), self-weight loss intentions, and dietary behaviors in children with obesity, and to examine the roles of parents’ BWP of the children and physician-diagnosed overweight in these relationships. Using data from the 2007–2020 National Health and Nutrition Examination Survey, children with obesity aged 8–15 years were selected as study subjects. Logistic regression was applied to analyze factors influencing the accurate self-BWP and self-weight loss intentions. Principal component analysis (PCA) was used to extract dietary patterns. Multivariate analyses were conducted to explore the effects of self-BWP, self-weight loss intentions, parents’ BWP of the children, and physician-diagnosed overweight on dietary patterns and self‑reported weight loss frequency. A total of 1,101 children with obesity were included. Age, female, physician-diagnosed overweight, accurate parents’ BWP of the children, and self-weight loss intentions were independent factors for accurate self‑BWP ( p < 0.05). Physician-diagnosed overweight and accurate self‑BWP were key factors in motivating weight loss intention. At the dietary behavior level, self- weight loss intention served as a necessary condition for translating accurate self‑BWP into healthier dietary patterns (reflected in lower inclination toward high‑sugar and high‑energy dietary patterns), and parents’ BWP of the children influenced this translation process. However, neither accurate self‑ BWP, self -weight loss intention, nor dietary patterns were associated with weight loss frequency ( p > 0.05). Accurate self‑BWP is a prerequisite for self‑weight loss intention. Parents’ BWP of children and physician-diagnosed overweight can effectively promote the formation of accurate self‑BWP and self‑weight loss intention, and influence immediate dietary choices, leading to perception‑driven behavioral changes. However, they do not ensure long‑term adherence to weight‑loss behaviors, indicating a dissociation between intention and behavior. Future intervention strategies should, on the basis of stimulating intention, strengthen systematic support for the skills and environments needed to sustain behavioral changes. Not applicable.