Evaluation and Analysis of Weight Management Awareness and Behaviors Among Iranian Female First-Year University Students: The Mismatch of Perception and Reality

Abstract Background: This study aimed to identify body image perception and weight-control behaviors among female university students. Methods: This cross-sectional study was conducted on female undergraduate students of Shahed University, Tehran, Iran, from September 2023 to February 2024. Sampling was performed using a convenience method, after explaining the objectives and procedures of the study informed written consent was obtained from participants. A self-administered questionnaire was used to assess self-perceived quantitative height and weight, qualitative body mass index (BMI) classification, weight management practices, as well as weight and fitness satisfaction. The height and weight were measured directly, and BMI was calculated. A total of 418 valid responses were collected (estimated participation rate: 89.3%). Data expressed as mean ± standard deviation, frequency, and percentage distribution. Cohen’s d was used to calculate the effect size between perceived and actual BMI across different weight classifications. Additionally, paired t-tests were conducted for within-group comparisons. Results: Based on the findings, only 55% of the participants were of normal weight, 9% were underweight, 24% were overweight, and 12% were obese. Sixty-nine percent of the participants perceived their BMI classification correctly. Contrarily, only 3% perceived their height and weight accurately. Moreover, there was a significant difference between measured and perceived BMI ( P < 0.001). The largest discrepancies between perceived BMI and actual BMI were found in overweight (d = 1.37), lean (d = 1.06), obese (d = 0.82), and normal weight participants (d = 0.69), respectively. On average, participants underestimated their BMI by 1.2 units. Most of them were dissatisfied with their body weight (54.3%) and fitness level (56.2%). However, 51% took no action, while 28% attempted to lose weight, 18% aimed to maintain their weight, and only 3% tried to gain weight. Conclusions: The findings indicate a high prevalence of overweight and obesity among female university students. A misperception of BMI (a tendency to underestimate the actual value) and dissatisfaction with weight status are evident in more than half of them, yet less than half take action to manage their weight. This reveals the need for educational interventions (increasing awareness of weight-related health) and facilitating access to exercise and diet counseling services in university settings to improve health-oriented behaviors.