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Evidence in respect of the psychological consequences of child and adolescent obesity is mixed. More studies indicated that mental health appears to be more strongly associated with concern about weight and shape, regardless of body mass index (BMI). Using the data from a national large school-based cohort ( N  = 10 403), we examined the association between obesity, perceived obesity and mental health. There was no relationship between BMI weight status and psychopathological symptoms after adjusting for weight perception and other factors for both genders. More importantly, it was determined that perception of weight as either underweight or overweight was related to higher behavioral symptoms and social adaptation problems. In conclusion, psychological well-being of adolescents is more related to weight perception than BMI is.

Self-reported weight status rather than BMI may be closely related to psychopathological symptoms among Mainland Chinese adolescents