Background/Objectives: Qualitative child-centered research on pediatric obesity treatment and body image remains limited. This study aimed to explore children’s and adolescents’ experiences with hospital-based obesity treatment and how these experiences relate to body image. Methods: A full-day workshop including three main participatory tasks was conducted in two groups of children (9–13 years) and adolescents (14–18 years), focusing on their experiences with obesity treatment and body image. Data were audiotaped, transcribed verbatim, and analyzed using reflexive thematic analysis. Results: Four main themes emerged, reflecting different aspects of participants’ experiences. The first theme, Talk with me and not my parents, encompassed participants’ desire for greater agency, as children described lacking information and feeling excluded from consultations. The second theme, Experiences of communication with healthcare professionals (HCPs) about obesity, concerned participants’ perceptions of trust, support, and non-judgmental communication, with some adolescents expressing a need for additional psychological support. The third theme, Internalization of lifestyle advice, indicated that healthy diet was viewed as the primary focus of obesity treatment, while physical activity received less attention. The final theme, Perceptions of the body, conveyed mixed experiences with weighing and most participants perceived weight loss as success in treatment and weight gain as failure. The participants shared experiences of weight-based bullying, perceived stigma, and challenges with maintaining a positive body image in a society with stereotypical thin and muscular body ideals. Conclusions: Body image was influenced by HCPs’ emphasis on health and body size, and by their own internalized perceptions, influenced by societal ideals and experiences of stigma.

Background Despite parental concern, few studies have investigated children’s experiences with school-based screening of growth deviations. This study aimed to explore perceptions of height and weight screening and associations with body size dissatisfaction (BSD) among third-grade children aged 8–9 years in central Norway. Methods In a cross-sectional study between November 2021 and April 2022, perceptions of height and weight screening and BSD were assessed individually among 209 children (49% girls) through researcher-assisted interviews. Results Most children indicated satisfaction with the screening by selecting a happy emoji, whereas only 1% indicated dissatisfaction, by selecting an unhappy emoji. However, 23%–30% selected a neutral emoji, indicating either neutrality or a response between satisfaction and dissatisfaction. No difference in the perception of height and weight screening was found between genders or body mass index (BMI). Children with parents from non-Western countries had a higher risk of being less satisfied with the height screening (OR=3.0, 95% CI 1.2 to 7.3) than those from Western origin, and children attending schools with lower socioeconomic status (SES) had increased risk of being less satisfied with both height (OR=5.5, 95% CI 2.2 to 13.5) and weight screening (OR=4.0, 95% CI 1.7 to 9.3), compared with children from schools with medium-high SES. Twenty-three percent reported BSD, in which 14% and 9% desired a thinner or larger body, respectively, independent of gender and BMI. No association was found between BSD and the perception of weighing (OR=1.1, 95% CI 0.6 to 2.4), however, BSD was associated with being more satisfied with height screening (OR=0.3, 95% CI 0.1 to 0.8). Conclusion In the present sample, most children indicated satisfaction with school-based height and weight screening, with no differences between gender or BMI category. However, more children of non-Western origin and from areas with low SES reported less satisfaction with the screening, independent of BSD.

Background: Inaccurate perceptions of body size, known as body size misperception (BSM), may be linked to body size dissatisfaction (BSD) and unhealthy eating behaviours. However, these associations remain inconclusive and not fully understood in young children. This study aimed to investigate the prevalence of BSM across sex and weight categories and to further assess the association between BSM and BSD in 8–to 9-year-old children. Methods: This cross-sectional study of 209 primary school children (51% boys) from central Norway was performed during the national height and weight screening program in third grade. Researcher-assisted questionnaires and Stunkard’s figure rating scales adapted for children were used to assess two dimensions of body image: BSM (perceived-actual body size) and BSD (perceived-ideal body size). The agreement between children's ideal and actual body size was also evaluated (actual-ideal body size). Associations between BSM and BSD were examined by multinomial logistic regression, adjusting for sex, Body Mass Index (BMI), socioeconomic status, ethnicity, and residence. Results: BSM was frequently observed (81%), with most children overestimating their body size (67%). Boys tended to overestimate their body size more frequently (75% vs. 59%, p = 0.014) and indicated a larger mean ideal body size than girls (silhouette fig. 4.2 [95% CI 4.0, 4.5] vs. 3.9 [95% CI 3.7, 4.1], p = 0.012). According to BMI, overestimation was common among children with underweight (100%) and average weight (78%), whereas underestimation of body size was prevalent among children with overweight/obesity (59%). Although 23% desired at least one body size figure smaller or larger than their perceived size, interpreted as BSD, no difference was observed between mean perceived and mean ideal body size (silhouette fig. 4.1 in both groups). No significant association was found between BSM and BSD, for either underestimation (OR 1.32 [95% CI 0.33, 5.32]) or overestimation (OR 0.99 [95% CI 0.38, 2.58]) of body size. Conclusions: Boys and girls from all weight categories frequently misperceived their body size toward their ideal body size, with overestimation of underweight and average weight status and underestimation of overweight status being most frequently reported. No association was found between BSM and BSD, however, the long-term health consequences of BSM should be further elucidated.

Background Misperception of body size may affect children's health, however, associations with body size dissatisfaction among young children remain uncertain. Hence, this study aims to explore body size misperception (BSM) across weight categories and associations with body size dissatisfaction (BSD) in 8-9-year-old Norwegian children.Methods Using researcher-assisted interviews and figure rating scales, children's perceived current and ideal body size figures were assessed and compared with objectively measured body mass index (BMI) to evaluate three body image constructs: 1. body size dissatisfaction (perceived-ideal), 2. body size misperception (perceived-measured) and 3. discrepancy between objectively measured body size and the children's ideals (measured-ideal). The relationship between BSM and BSD was examined by multinomial logistic regression, adjusting for potential confounders (gender, BMI, socioeconomic status, ethnicity, and residency).Results The children's mean perceived body size figure (4.11) resembled their ideal figure (4.06) but was larger than their mean objectively measured figure (3.23). Most participants misperceived their body size, with a tendency to overestimate body size among children categorized as underweight or healthy weight. Children with overweight/obesity perceived their body size most precisely (30%), with higher odds of underestimating their body size (OR 13.17 [95% CI 3.88, 44.77]) compared to children in lower weight categories. No association was found between body size misperception and body size dissatisfaction for either underestimation or overestimation of body size figures.Conclusions Children categorized with underweight or overweight/obesity were likely to perceive a healthy body size figure, whereas the majority of children with healthy weight, overestimated their current body size. Children's perceived body size was in line with their ideal body size figure, but higher than the health professionals' reference categories for healthy weight. The longitudinal impact of body size misperception on children’s health should be further elucidated.