In this analysis, we explored weight perception among young people in Canada and how it related to engagement in overt risk-taking. A priori we hypothesized that males and females would experience such perceptions and their potential effects differently. Consistent with expectations (Liu et al., 2019), females were more likely to report feeling that their body was “too fat”, while males were more likely to report that their body was “too thin”. Females who perceived their body to be “too fat” were significantly more likely to smoke, use cannabis or alcohol, engage in physical fighting, and engage in high levels of overt risk-taking. In contrast, males more often felt that their body was “too thin”, and these perceptions were generally associated with lower levels of engagement in overt risk-taking both measured in composite and in terms of individual behaviours.

Our findings can be framed in the context of coping theory (Stallman, 2021). As adolescents deal with the perceived stigma and internalized feelings associated with alternate weight perception, they may resort to risk-taking behaviours to cope (Stallman, 2021). Risk-taking can relieve the distress that they may be facing through several mechanisms. First, it may serve as a “rite of passage” into a social group, leading to a feeling of group acceptance, despite their perception of incongruence with societal body ideals (Pound & Campbell, 2015). Substance use is also recognized as a coping mechanism that some adolescents lean towards when dealing with negative emotions, like those brought on by alternate weight perception (Sharma & Morrow, 2016). This is consistent with our results, which show that females who perceive themselves as “too fat” have higher likelihoods of engagement with alcohol, cannabis, and tobacco products, both alone and in combination. Furthermore, some risk-taking behaviours can allow adolescents to cope by directly addressing the perceived issues with their body. For example, the nicotine which is found in many tobacco products is an appetite suppressant and has been previously identified as a weight-control tactic among females (White, 2012).

Such theories might be further interpreted with consideration of the influence of biological sex. For example, females may be especially prone to perceiving social approval from peers when they engage in risk-taking behaviours. In addition, females who report alternate weight perception are known to perceive disapproval from family and community based on their bodies; hence, further adult disapproval with respect to their risk-taking may be of less concern to them (Nishida et al., 2019). Among males with alternate weight perception, the opposite trend occurs where the avoidance of risk-taking becomes more characteristic. Existing cognitive models suggest that males with alternate weight perception may be too embarrassed or shy to engage in social activities (i.e., risk-taking) as their constant self-evaluation stops them from defying societal norms (Swami et al., 2021). In contrast, males who report feeling “about right” exert confidence in complying with societal ideals, and in turn engage in more socially oriented risk-taking (Swami et al., 2021).

Our findings are highly aligned with existing studies conducted in other contexts. Of 50 such studies reviewed during development of this study, most focused only on females and considered risk-taking behaviours in isolation. Past investigations have shown that females with alternate weight perception are prone to binge drinking (Raffoul et al., 2018b) and that current smoking behaviour is more likely among adolescents who perceive themselves as overweight, with higher effect sizes in females (Yoon and Bernell, 2016).

Major study strengths include the grounding of this analysis in theory, and use of a large and nationally representative sample. We considered the possible effect of sex in our analysis, whereas most existing studies focus exclusively on the experiences of females. Limitations of our study also warrant comment. First, our analysis involves a cross-sectional design which limits the ability to make causal inferences. Second, our analyses were also restricted to available indicators of risk-taking from a traditional general health survey. We acknowledge that other, more contemporary expressions of risk-taking do exist (Vente et al., 2020), which could lead to some misclassification of study outcomes. Third, the variable used in the 2018 HBSC provides a limited view of sex and gender and forced us to consider our questions with a view to the influence of biological sex only. This could have led to misclassification of at-risk groups. Furthermore, due to privacy issues, only those participants who self-identified as males or females could be included in sex-stratified analyses. Young people who do not identify as male or female may experience differential outcomes of weight perception (Kennis et al., 2022), so their omission is unfortunate but necessary. Fourth, sample size concerns among several racial and ethnic groups in the stratified data resulted in the need to amalgamate minority groups together into one category. We recognize that there are likely between-group differences in weight perception among minority groups, and though measuring these differences was not possible in this study, we encourage this as an aim for future works. Finally, stigma related to different body types may also contribute to misclassification (Brewis et al., 2016), as such stigmatization can lead to distress, impacting mental and physical health, and in some cases exacerbating health challenges to a greater level than the excess weight itself (Brewis et al., 2016). This stigma is not accounted for in the current analysis.

These findings have several important implications for prevention and clinical practice. To address such an important contemporary health issue, one must begin with the young people themselves, trying to change their attitudes, beliefs, how they think about their body, and what behaviours they subsequently choose to engage in (Morrongiello & Lasenby-Lessard, 2007). Interventions commonly consider weight perception and overt risk-taking as separate issues, yet there may be value in considering them together as common factors and experiences. Cluster-based risk-taking interventions have previously been demonstrated as more efficacious (Hale et al., 2014), and would likely be even more so if novel risk factors such as alternate weight perception are considered. Furthermore, our finding that males and females are differently affected by weight perception, and likely have different coping experiences, should be considered. Congruent with our finding that females with alternate weight perception are more likely to partake in risk-taking behaviours, which is often a group activity, females are also more prone to social influence and peer pressure (Dir et al., 2017). Therefore, programs that focus on social skills training, coping skills, and small group–based therapies are most beneficial in mitigating female substance use (Dir et al., 2017). Adding a cognitive behavioural therapy component (Lewis-Smith et al., 2019) to such programs to encourage development of positive self-image and confidence has the potential to create more efficacious programming that also addresses alternate weight perception as a risk factor (Jarry and Cash, 2011). As our finding among males suggested a null or even protective relationship between alternate weight perception and risk-taking behaviours, this paradoxical finding shows the need to consider sex when designing interventions based upon these identified correlations. Finally, in-depth research is required into the perceptions and behaviour of young people who identify as non-binary, as their experiences may be unique.