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Lower body appreciation in adolescents is associated with higher BMI and unhealthier weight control behaviors, supporting the use of a cognitive behavioral therapy-based health promotion model to improve weight management. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 1, 2026Open Access

Body Appreciation and Weight Control Behaviors in Overweight Adolescents: A Cross-Sectional Study Informing a CBT-Based Health Promotion Model

XWXiaoqiu WuJinhua Academy of Agricultural Sciences QXQunying XuJinhua Academy of Agricultural Sciences ZWZhen WuJinhua Academy of Agricultural Sciences

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Abstract

Background: Overweight and obesity in adolescents have become significant public health issues, with traditional interventions showing limited effectiveness. Cognitive behavioral therapy (CBT) offers a novel approach to adolescent health promotion by altering individuals’ cognitive and behavioral patterns. Objective: This study was designed to construct a health behavior promotion model for overweight adolescents integrating CBT theory and to empirically validate it based on multidimensional behavioral scoring. Methods: A cross-sectional study was conducted among 294 adolescents aged 13– 16 from three secondary schools. Participants were classified into overweight/obese (n = 86) and normal weight (n = 208) groups based on BMI criteria. Data were collected using the Body Appreciation Scale-2, Weight Control Practices Questionnaire, and Comprehensive Lifestyle Assessment Scale. Statistical analyses included independent t-tests, Pearson correlation, structural equation modeling (SEM), and multiple regression. Results: Overweight adolescents scored significantly lower in body appreciation cognition (t = 4.32, p < 0.001) and healthy weight control behaviors (t = 3.87, p < 0.001), and higher in unhealthy weight control behaviors (t = 4.96, p < 0.001). SEM revealed that body appreciation cognition had a direct negative effect on BMI (β = − 0.18, p < 0.01) and an indirect effect through healthy weight control behaviors (β = − 0.12, p < 0.05). The model demonstrated good fit (χ 2 /df = 2.36, CFI = 0.94, RMSEA = 0.06). Conclusion: The findings support the applicability of a CBT-based health behavior promotion model for overweight adolescents. The model, encompassing cognitive restructuring, behavioral activation, self-monitoring, and relapse prevention, provides a theoretical foundation for school- and community-based interventions. Keywords: cognitive behavioral therapy, overweight, adolescents, health behaviors, behavioral intervention

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