Results from a Chinese nationwide survey indicate that the prevalence of childhood overweight/obesity nearly tripled from 6.5% to 16.8% from 2000-2011, but children’s perception of being fat remained at 2%. The findings are published in Obesity.

The study also found that 49% of children underestimated their weight status at the start of the study. Children who perceived themselves as being fat at the start of the study had a higher increase in BMI over time than those with an average body image. Boys, young children, and rural children had higher BMI increases than their counterparts. Over time, a thin body silhouette became more desirable.

The study analyzed data on 4,605 children aged 6-17 years at baseline.

“Resolving negative body image among children could bring great self-motivation toward a healthy lifestyle,” said lead author Dr. Jungwon Min, of Ball State University.