Background and Objective: The aim of this study was to assess the relationships of self-perceived weight with having more metabolic syndrome (MetS) components and the MetS score regardless of body mass index (BMI)-based weight category. Methods: Utilizing data from the Korea National Health and Nutrition Examination Survey 2014 to 2019, weight categories according to BMI and self-perception (underweight, normal weight, or overweight), MetS components defined by the International Diabetes Federation for adolescents, the MetS score, and confounding factors were evaluated in 1441 female adolescents and 1646 male adolescents aged 10 to 18 years. A complex samples general linear model and ordinal regression were used to analyze those relationships. Results: The odds of having more MetS components were 1.67 (95% confidence interval, CI: 1.38-2.03) in adolescents who self-perceived as overweight than in those who self-perceived as normal weight after controlling for sociodemographic and health-related factors and BMI-based weight categories. Compared with adolescents who accurately self-perceived as normal weight (reference group), the odds were 1.48 (95% CI: 1.19-1.84) in those with normal weight, but self-perceived as overweight; 2.90 (95% CI: 1.69-4.98) in those who were overweight, but self-perceived as normal weight; and 9.38 (95% CI: 7.52-11.71) in those who accurately self-perceived as overweight. In relation to the MetS score, similar findings were observed. The combined weight categories had significant interactions with sex and age groups (10-12 years vs. 13-18 years) in those relationships. Conclusions: Regardless of actual weight status, adolescents' self-perceived weight may be a crucial consideration when determining whether or not MetS components may be present.
Keywords: adolescent; age; metabolic syndrome; sex; weight perception.