Associations between weight perception, unhealthy weight control behavior, and suicidal ideation and planning among Korean adolescents: A national cross-sectional secondary analysis

Abstract Purpose This study aimed to investigate the associations between weight perception, unhealthy weight control behavior, and suicidal ideation and planning and identify the role of unhealthy weight control behavior as a mediator in these associations among Korean adolescents. Design and methods This national cross-sectional secondary study used data from the 2015–2017 Korea Youth Risk Behavior Web-Based Surveys, with a final sample of 96,285 adolescents who tried to manage their weight in the 30 days prior to the surveys. A multivariate logistic regression was conducted. Results Both adolescent groups who perceived themselves to be underweight or overweight were significantly linked to a greater likelihood of suicidal ideation and planning (COR, 95% CI = 1.249, 1.141–1.367; COR, 95% CI = 1.339, 1.282–1.399) respectively. While adolescents with perceptions of being underweight are associated with suicidal ideation and planning through the suppression effect of unhealthy weight control behavior (Pathway A: OR, 95% CI = 0.628, 0.587–0.671), adolescents with perceptions of being overweight are linked with the same through the mediation effect (Pathway A: OR, 95% CI = 1.195, 1.141–1.251). Conclusions Adolescents with perceptions of being overweight are highly likely to have unhealthy weight control behavior that can be linked to the possibility of suicidal ideation and planning, while adolescents with perceptions of being underweight are comparatively less likely to engage in such behavior. Practice implications It is necessary to identify the status of weight perception among adolescents and closely monitor the unhealthy weight control behavior to prevent suicidal ideation and planning.