Body image perception is the subjective representation each person has of their own body, and it may depart considerably from actual body size. The gap between the perceived figure and the ideal one is a well-known source of dissatisfaction in adolescence and a recognized risk factor for disordered eating. Most evidence on adolescent body dissatisfaction is cross-sectional, so it remains unclear how this perception evolves as the body changes.

This video abstract summarizes a three-year longitudinal study of 209 Italian early adolescents (121 boys, 88 girls; mean age 11.33 ± 0.38 years at enrolment), assessed annually from 2020 to 2023. Stature and weight were measured directly and also self-reported; body image perception and dissatisfaction were assessed in individual interviews using a silhouette scale.

Although anthropometric traits changed significantly over the three years, weight status prevalence, body image perception, and dissatisfaction remained substantially stable. Dissatisfaction was similar in both genders but increased significantly with body mass index. Self-reported measurements proved unreliable, with only weak-to-moderate agreement between perceived and measured weight status: underweight participants tended to feel heavier than they were, and those with excess weight lighter. Compared with pre-pandemic regional data, both underweight and excess weight were more frequent, excess weight especially among girls.

These findings indicate that gendered aesthetic ideals are already established by age eleven and that self-perception is not reliable enough to replace direct measurement in school health screening. They support school actions promoting healthy lifestyles and a positive body image from early adolescence, and point to the need for silhouette scales able to distinguish muscularity from adiposity specifically for adolescents.