Joint Categories of Perceived Stress and Subjective Body-Shape Perception and Health-Related Outcomes Among Adolescents

Background: Perceived stress and subjective body-shape perception may jointly characterize health-related conditions during adolescence. This study examined health-related outcomes across joint categories of perceived stress and subjective body-shape perception and compared perceived stress across combinations of objective and subjective weight status. Methods: This cross-sectional study included 1387 adolescents aged 12–18 years from the 2021–2024 Korea National Health and Nutrition Examination Survey. Survey-weighted multivariable logistic regression was used to examine depressive symptoms, poor self-rated health, and alcohol experience across four joint categories defined by perceived stress and self-perceived body shape, with adjustment for age, sex, household income, and body mass index. Objective weight status and self-perceived body shape were also combined into four categories to compare the odds of high perceived stress. Random Forest and SHapley Additive exPlanations (SHAP) analyses were additionally performed as exploratory cross-sectional classification analyses. Results: Compared with the low-stress, self-perceived non-overweight category, the high-stress, self-perceived overweight category showed higher odds of depressive symptoms (AOR = 15.96; 95% CI, 6.52–39.10), poor self-rated health (AOR = 7.55; 95% CI, 3.22–17.73), and alcohol experience (AOR = 3.04; 95% CI, 1.31–7.07). In the objective–subjective weight-status analysis, adolescents with objective non-overweight and self-perceived overweight showed higher odds of high perceived stress than those with concordant non-overweight status (AOR = 1.90; 95% CI, 1.27–2.86). The exploratory Random Forest model showed modest cross-sectional classification performance (ROC-AUC = 0.615; PR-AUC = 0.438), with depressive symptoms showing the largest SHAP contribution among the displayed features. Conclusions: Health-related outcomes differed across joint categories of perceived stress and self-perceived body-shape perception. Adolescents with objective non-overweight but self-perceived overweight also showed higher odds of high perceived stress than those with concordant non-overweight status. These findings highlight the relevance of considering perceived stress, subjective body-shape perception, and objective weight status together when describing adolescent health-related characteristics.