Being overweight — or simply believing they are overweight — might predispose some U.S. teens to suicide attempts, according to a new study.

The study looked at more than 14,000 high school students to determine the relationship between body mass index (BMI) and suicide attempts, as well as the relationship between believing one is overweight — whether true or not —and suicide attempts.

“Our findings show that both perceived and actual overweight increase risk for suicide attempt,” said lead study author Monica Swahn, Ph.D. That association was as strong for boys as for girls, contrary to what the researchers had originally expected.

Teens who believed they were overweight were at greater risk for suicide attempts compared to those who did not believe they were overweight. Similarly, teens with a BMI that indicated they were indeed overweight were more likely to be at risk for suicide attempts. Those who perceived themselves as overweight and who actually had BMIs that put them into the “overweight” or “obese” category also were at greater risk.

“This is a major concern since more and more children and youth are becoming overweight and obese,” said Swahn, an associate dean for research at the College of Health and Human Sciences and an associate professor in the Institute of Public Health at Georgia State University.

Hatim Omar, M.D., chief of the Division of Adolescent Medicine at the University of Kentucky, said his own experience has led him to believe that perceived obesity does increase both depression and suicide risk. “Teens are vulnerable because of their development and any actual or perceived changes in their lives, including weight issues, can potentially increase the risk of depression or suicide,” he said.

Understanding these associations can help in the development of appropriate strategies for suicide prevention, the authors said. “We cannot only focus prevention strategies on those who are overweight and who are concerned about their weight,” Swahn said, “but we also need to include youth who feel that they are overweight even though they may not be.”

“Youth feel very pressured to fit in and to fit certain limited ideals of beauty,” Swahn said.

“This study adds another wake-up call to providers, parents, teachers and society about the need for screening for depression and suicide risk in all teens, with special attention to teens with perceived or actual obesity,” Omar said.