Objective To compare the psychosocial and weight-related concerns and weight control, eating, and exercise behaviors of overweight and nonoverweight Native American adolescents living on or near reservations.

Study design A cross-sectional survey assessed psychosocial, health, and weight-specific concerns; disordered eating; and health-promoting behaviors.

Study population The study population included 11,868 Native American youth in grades 7 through 12.

Statistical analyses performed Analyses of variance and χ² tests were used to examine associations between weight status and psychosocial and weight-related concerns and behaviors. Stratified analyses were done by gender and by gender and age.

Results Self-reported weights and heights indicated that 25% of the study population was overweight. Overweight youth were twice as likely to report health concerns as nonoverweight youth. Although a high percentage of nonoverweight youth expressed body- or weight-related concerns and reported engaging in disordered eating behaviors, prevalence rates for these concerns were significantly higher among overweight youth. Overweight youth were also somewhat less likely to engage in health-promoting behaviors. In contrast, differences in global psychosocial concerns were minimal.

Applications Overweight Native American youth were concerned about their weight, but did not appear to have major psychosocial concerns associated with being overweight. Interventions aimed at obesity prevention and overall health promotion are essential, given the high prevalence of obesity and of psychosocial and weight-related concerns and behaviors among the study population as a whole. The challenge is to develop culturally appropriate interventions aimed at the promotion of healthful weight control behaviors that will not lead to negative psychosocial consequences.