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Health perception, obesity risk awareness and eating behavior in adolescents


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Unhealthy eating behaviors and physical inactivity among adolescents are common (1, 2).  Among adolescents, the main cause of overweight is wrong eating habits (1, 3). The factors affecting eating behavior are the physical, developmental, and social changes that occur during adolescence (4). Research related to adolescent obesity have focused on individual characteristics and the environmental influences on eating behaviors (3, 5). The emotional eating behavior and external eating behavior may play a significant role in the development of obesity (6). Several studies have shown positive associations between emotional eating and overweight for adolescent girls (7, 8).

Awareness about causes and consequences of obesity are the keys to combatting obesity (9, 10). Also, understanding obesity risk perception is important when developing health strategies to combat this epidemic. There is very little information literature on the awareness of obesity, its health risks and risk factors among adolescents (11). It can be said that studies on the awareness about the risk factors and health risks of obesity among adolescents are scarce. Identification of adolescents' knowledge of the consequences of obesity will guide the planning of adolescents' training and the fight against obesity.

Aim: The purpose of this study was to determine the relationship between health perceptions, obesity risk awareness and eating behaviors in adolescents.


This is a cross-sectional study of high school students in the center of a city located in the west of Turkey. The sample size was determined to be at least 173 according to the prevalence of obesity in the study area; this study was completed with 579 adolescents. Stratified and simple random sampling methods were used in the selection of the high schools, classes, and students.

Data Collection

The researchers made an appointment with the school administration before reporting to the school on the appointed day. Explanations were given to the student group in the class determined by the simple random method. The adolescents filled out the questionnaires by self-report method. The Dutch Eating Behavior Questionnaire (DEBQ) consists of three sub-scales and 33 items evaluating the emotional eating behaviors, external eating behaviors, and restrained eating behaviors. The items in the questionnaire are evaluated with 5-point likert scale (12).

The Perception of Health Scale is a five-point likert-type scale consisting of 15 items and four sub-factors (control center, self-awareness, precision and importance of health). The lowest score that may be obtained from the scale is 15 and the highest score is 75 (13).

Ethical Considerations

The study was conducted according to the guidelines laid down in the Declaration of Helsinki. Official permission was obtained from the institutional review board of Aydın Province National Education Directorate in order to conduct this study. All participants and their parents were informed about the study and gave verbal informed consent before enrollment. 


Of the 579 adolescents, 56.5% (n=327) were male, the mean age was 15±0.59 years and average body mass index was 20.43±3.20 kg / m2. While 11.6% of the adolescents (n=67) were overweight or obese. The mean score of health perception of the adolescents in the study group was 52.34±7.59. We examined the associations between participants’ some characteristics such as obesity risk perception, obesity risk awareness, BKI percentile and eating behaviors scores. Emotional eating behavior score (p=0.007) and external eating behavior score (p=0.001) of the adolescents who perceived themselves as having the risk of developing obesity were found to be higher than the group not perceiving any risk. Although emotional eating behavior score and external eating behavior score of those who were aware of some health problems caused by obesity were higher than those who were not aware of the health problems related to the obesity, this difference was not statistically significant (p>0.05). According to BMI percentile, it was found that emotional eating behavior score of the underweight adolescents was significantly lower than the adolescents in the other group (p<0.001). It was also observed that as the BMI percentile increased in the adolescents, emotional eating behavior score increased. Similarly, there was a statistically significant difference among the restrained eating behavior scores of underweight, normal and overweight or obese groups (p=0.014). Further analysis revealed that this was due to the difference between the overweight / obese group and the underweight group. In other words, restrained eating behavior score of the overweight/obese adolescents was lower than the restrained eating behavior score of the underweight adolescents.

It was found that there was a very weak relationship between the health perception scores of the participants and emotional eating behavior score (p=0.003) and restrained eating behavior score (p=0.029), and there was also a weak relationship between the health perception scores and external eating behavior score (p<0.001) (Table-1).


The adolescents with better health perception are less affected by the environment and they impose limitations on food selection. Overweight and obese adolescents tend to eat more depending on the emotional influences and environmental factors. Awareness of personal obesity risk as well as the causes of obesity and health risks of obesity do not positively affect the eating behaviors of the adolescents.  

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