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Indian Pediatr 2017;54:1025-1028 |
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Body Image and its
Relation with Body Mass Index among Indian Adolescents
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Vaishali R Deshmukh and #Aditi
A Kulkarni
From Departments of Pediatrics and #Research,
Deenanath Mangeshkar Hospital and Research Centre, Pune, India.
Correspondence to: Dr Vaishali R Deshmukh, Department
of Pediatrics, Deenanath Mangeshkar Hospital and Research Centre,
Erandawane, Pune 411004, India.
Email: [email protected]
Received: November 08, 2016;
Initial review: February 22, 2017;
Accepted: July 27, 2017.
Published online: August 24, 2017.
PII:S097475591600086
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Objective: To evaluate association of body mass index with
perception and attitude towards bodyweight, shape and body image among
adolescents. Methods: This cross-sectional study was done on 1811
adolescents. Attitude towards body image was assessed by using a
self-administered Multidimensional Body-Self Relations
Questionnaire. Perceived body shape was measured using the Stunkard
scale. Results: Adolescents showed significant difference
(P<0.005) in perceptions and behaviors related to appearance,
fitness, health, body areas and weight across various body mass index
and socioeconomic categories. Girls articulated significantly higher (P<0.005)
body dissatisfaction than boys. Conclusions: Attitudes and
perceptions towards body image differ with sex, body mass index and
socioeconomic class.
Keywords: Adolescents, Body image, Body mass index.
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B
ody image is the way a person perceives or thinks
about his/her body and how it looks to others. It can be divided into
perceptual and attitudinal body image. A person is said to be suffering
from poor body image when he/she focuses on the negative or imaginary
negative aspects related to own body or its competence to the total
exclusion of positive aspects [1]. A study on factors of body image in
Japanese and Vietnamese adolescents concluded that girls from both
Vietnam and Japan prefer a thinner body image than healthy body image
but Japanese girls desire a smaller ideal size than Vietnamese girls do.
Besides, Vietnamese boys desire more muscular body than Japanese boys
[2]. This signifies that there are sociocultural differences in body
image perception among various groups of adolescents. This highlights
the need to study body image concerns in adolescents from various
sociocultural backgrounds, as not many such studies have been done on
Indian adolescents [3-5]. Besides, majority of studies focused only on
female adolescents and college-going population [6]. In this study, we
evaluated association of body mass index (BMI) with perception and
attitude towards body weight, shape and body image among adolescents.
Methods
This cross-sectional study was conducted during
academic year 2015-2016 in Pune, India. The study procedures were
approved by the Ethics Committee of our institute. All the schools in
the city of Pune were enlisted. Convenient sampling was used for
selection of schools. Data were collected after permission from school
authorities. The socioeconomic variables were considered to be
associated to type of school attended and fee structure of school. BMI
was categorized according to revised Indian Academy of Pediatrics (IAP)
cut-off points [7]. Perceived body shape was measured using the Stunkard
scale, which consists of silhouette drawings [8]. The difference between
current body shape and ideal body shape was used to determine the level
of dissatisfaction with body image. Participant’s attitude towards body
image was assessed by using a self-administered Multidimensional
Body-Self Relations Questionnaire (MBSRQ) [9]. There are 69 items in
this measure, which are broken down into subscales: the first three
special multi item subscales are the revised Body-Self Relations
Questionnaire subscales, the Body Areas Satisfaction Scale and the
weight attitude scales. An interpretation for each subscale is based on
high and low scores. The questionnaire was translated into Marathi
language according to universal translation method and tested for
internal consistency. Internal consistency of the MBSRQ was obtained
using Cronbach’s Alpha, ( a=0.781)
indicating reliability of questionnaire. Statistical analyses were
performed with Statistical Package for the Social Sciences version 20.0
(SPSS, Inc., Chicago, IL, USA).
Results
A total of 1811 participants (956 boys) of age group
13-16 years (mean (SD) 13.9 (0.63) years) from different schools were
included.
There was a significant association (P<0.005)
between attitude towards body image and BMI among boys and girls.
Significant difference (P<0.005) was found in mean score of sub
scales of MBSRQ such as appearance, fitness, body areas satisfaction and
overweight preoccupation according to BMI categories among boys; whereas
among girls, this difference was noted in subscales of appearance,
health, body area satisfaction and overweight preoccupation (Table
I).
TABLE I Attitude Towards Body Image Among Boys (N=956) and Girls (N=855) According to BMI Category
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Attitude scales of MBSRQ |
BMI category |
P value |
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Underweight |
Normal weight |
Overweight and Obese |
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Boys |
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Appearance evaluation |
3.41 (0.5) |
3.49 (0.59) |
3.33 (0.68) |
0.003 |
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Appearance orientation |
3.52 (0.59) |
3.43 (0.64) |
3.39 (0.67) |
0.321 |
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Fitness evaluation |
3.61 (0.88) |
3.88 (0.82) |
3.79 (0.79) |
0.035 |
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Fitness orientation |
3.67 (0.56) |
3.87 (0.58) |
3.80 (0.63) |
0.033 |
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Health orientation |
3.39 (0.49) |
3.51 (0.55) |
3.48 (0.55) |
0.262 |
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Health evaluation |
3.33 (0.65) |
3.46 (0.63) |
3.36 (0.61) |
0.06 |
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Illness orientation |
3.44 (0.71) |
3.30 (0.85) |
3.31 (0.74) |
0.43 |
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Body areas satisfaction scale |
3.51 (0.81) |
3.92 (0.69) |
3.70 (0.74) |
0.001 |
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Overweight preoccupation |
2.36 (0.78) |
2.37 (0.89) |
2.79 (0.91) |
0.001 |
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Girls |
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Appearance evaluation |
3.10 (0.58) |
3.34 (0.57) |
3.18 (0.62) |
0.001 |
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Appearance orientation |
3.69 (0.55) |
3.62 (0.59) |
3.69 (0.65) |
0.32 |
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Fitness evaluation |
3.47 (0.8) |
3.73 (0.8) |
3.67 (0.75) |
0.06 |
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Fitness orientation |
3.60 (0.48) |
3.77 (0.57) |
3.73 (0.54) |
0.09 |
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Health orientation |
3.43 (0.44) |
3.53 (0.54) |
3.54 (0.53) |
0.47 |
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Health evaluation |
3.30 (0.60) |
3.48 (0.62) |
3.33 (0.63) |
0.004 |
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Illness orientation |
3.53 (0.74) |
3.56 (0.88) |
3.46 (0.88) |
0.36 |
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Body areas satisfaction scale |
3.59 (0.56) |
3.81 (0.63) |
3.50 (0.62) |
0.001 |
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Overweight preoccupation |
2.51 (0.90) |
2.60 (0.95) |
3.21 (0.91) |
0.001 |
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All values in mean (SD); BMI: body mass index, MBSRQ:
multidimensional body self relations questionnaire. |
Significant association (P<0.05) was observed
about self and others’ perception of body weight and BMI categories for
boys and girls as well as for both the socioeconomic class. (Web
Tables I and II). There was noticeable difference in the
perception of body weight between the genders with 40% of overweight
boys considering themselves as having normal weight compared to girls
from the same class.
We observed statistical significant (P<0.05)
difference among boys and girls of both the socioeconomic classes
regarding perception of current body shape, ideal body shape and body
dissatisfaction. Compared to boys, girls chose significantly (P<0.05)
smaller ideal body shapes and articulated a significantly higher level
of body dissatisfaction (Table II).
TABLE II Perception of Body Shape in Adolescents (N=1811)
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Body Shape |
Boys |
Girls |
P value |
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High Socioeconomic Class |
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Current body shape |
4.44 (1.30) |
3.64 (1.20) |
<0.001 |
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Ideal body shape |
4.62 (0.66) |
3.32 (0.79) |
<0.001 |
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Body dissatisfaction |
-0.19 (1.33) |
0.31 (1.12) |
<0.001 |
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Low Socioeconomic Class |
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Current body shape |
4.32 (1.34) |
3.67 (1.19) |
<0.001 |
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Ideal body shape |
4.59(0.98) |
3.62 (0.89) |
<0.001 |
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Body dissatisfaction |
-0.27 (1.31) |
0.27 (1.11) |
<0.001 |
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Body dissatisfaction = current body shape - ideal body shape.
Based on the Modified Figure Rating Scale of Stunkard. All
values in mean (SD). |
Discussion
In this cross-sectional study, we found significant
body image concerns in Indian adolescents in both boys and girls across
socioeconomic classes. Body shape dissatisfaction was more in girls.
Boys preferred a larger figure while girls chose a smaller figure than
their current body shape as ideal. Higher number of girls misperceived
their body weight. As compared to normal weight adolescents, under
weight and overweight/obese boys and girls were unhappy with size and
appearance of several body areas. These adolescents also showed fat
anxiety, weight vigilance, dieting and eating restraint. Significant
association was found between various BMI categories and attitude
towards appearance.
Our study had limitation of being focused only on
urban children from a single city. We did not include children from
early or late adolescence. We could not assess specific entities like
breast size or penile length. Unlike our study, most other studies were
on girls or late adolescence age (>16 yrs), and focused on perception of
body shape rather than attitude.
In our study, we used BMI as an objective marker of
the adolescent’s overall bodyweight against the subjective evaluation by
the adolescent of his/her own bodyweight. A few studies found that
compared to males, females tend to be more dissatisfied with their body
image during puberty phase [10-12]. Similar to our results, literature
shows higher number of girls misperceiving their body weight [13,14].
The body weight misperception may lead to body image dissatisfaction,
eating disorders and unhealthy diet practices among adolescents.
Self-esteem plays a big role in how a person perceives his/her own body.
This may explain why some of the normal weight adolescents in our study
were unhappy.
Body shape is quite a sensitive topic in adolescents.
The ideal body shape may differ by gender as well as sociocultural
norms. Most of the studies reported that boys relate to muscular fitness
while girls want thinner and slimmer body [3,5,13]. Tendency of boys to
desire muscular body is related to physical strength, hardness and
power. In our study, boys selected a larger figure than their current
body shape while girls chose a smaller figure than their current body
shape as ideal body shape. This is similar with previously reported
studies [15]. The society considers looks more important in girls where
as other things such as strength matter in boys. As against normal
weight boys and girls, underweight and overweight/obese adolescents were
unhappy with size or appearance of several areas in our study. The
parents and peer influence, media portrayal and cultural invasion have
reinforced this stereotype.
We suggest appropriate interventions such as life
skills education and media literacy to minimize body image issues. In
addition, information regarding normal growth and its variations should
be provided to adolescents. Nationwide research is recommended to
generalise our findings as well as to examine the parents’ and peers’
perception of adolescents’ body image.
Acknowledgements: Dr. Kanade and Dr. Gauri Oka,
biostatisticians, for their valuable guidance. Dr. Thomas Cash, for
allowing us to use their questionnaire (MBSRQ).
Contributors: VRD: conception and design
of the study; VRD, AAK: organized the conduct of the study, supervised
acquisition of data, analyzed the data and reviewed the literature. Both
authors contributed to drafting of the work, approved the final version
of the article, and agree to be accountable for all aspects of the work.
Funding: None; Competing interest: None
stated.
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What This Study Adds?
• Indian adolescents (age 13 to 16 years) have inaccurate
perception of their body weight and shape which varies across
different BMI categories.
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References
1. Johnson F, Wardle J. Dietary restraint, body
dissatisfaction, and psychological distress: A Prospective Analysis. J
Abnorm Psychol. 2005;114:119-25.
2. Sano A, Le DS, Tran MH, Pham HT, Kaneda M, Murai
E, et al. Study on factors of body image in Japanese and
Vietnamese adolescents. J Nutr Sci Vitaminology. (Tokyo) 2008;54:169-75.
3. Singh MM, Ashok L, Binu VS, Parsekar SS, Bhumika
TV. Adolescents and body Image: A cross sectional study. Indian J
Pediatr. 2015;82:1107-11.
4. Waghachavare VB, Quraishi SR, Dhumale GB, Gore AD.
A cross-sectional study of correlation of body image anxiety with social
phobia and their association with depression in the adolescents from a
rural area of Sangli District in India. Int J Prev Med. 2014;5:1626-9.
5. Dixit S, Agarwal G, Singh J, Kant S, Singh N. A
study on consciousness of adolescent girls about their body image.
Indian J Community Med. 2011;36:197-202.
6. Rashmi BM, Patil SS, Angadi MM, Pattankar TP. A
cross-sectional study of the pattern of body image perception among
female students of BBM College in Vijayapur, North Karnataka. J Clin
Diagn Res. 2016;10:LC05-9.
7. Khadilkar V, Yadav S, Agrawal KK, Tamboli S,
Banerjee M, Cherian A, et al. Revised IAP growth charts for
height, weight and body mass index for 5- to 18-year-old Indian
children. Indian Pediatrics. 2015;52:47-55.
8. Bulik CM, Wade TD, Heath AC, Martin NG, Stunkard
AJ, Eaves LJ. Relating body mass index to figural stimuli:
population-based normative data for Caucasians. Int J Obes Relat Metab
Disord. 2001;25:1517-24.
9. Brown TA, Cash TF, Mikulka PJ. Attitudinal
body-image assessment: factor analysis of the Body-Self Relations
Questionnaire. J Pers Assess. 1990;55:135-44.
10. Williams JM, Currie C. Self-esteem and physical
development in early adolescence. J Early Adolesc. 2000;20:129-49.
11. Bahreynian M, Qorbani M, Motlagh ME, Heshmot R,
Ardalan G, Kelishadi R. Association of perceived weight status versus
body mass index on adherence to weight modifying plan among Irarian
children and adolescent: The caspian-IV study. Indian Pediatr.
2015;52:857-63.
12. de Guzman NS, Nishina A. A longitudinal study of
body dissatisfaction and pubertal timing in an ethnically diverse
adolescent sample. Body Image. 2014;11:68-71.
13. Khor GL, Zalilah MS, Phan YY, Ang M, Maznah B,
Norimah AK. Perceptions of body image among Malaysian male and female
adolescents. Singapore Med J. 2009;50:303-11.
14. Kim JH, Lennon SJ. Mass media and self-esteem,
body image, and eating disorder tendencies. Clothing and Textiles
Research Journal. 2007;25:3-23.
15. Wong LM, Say YH. Gender differences in body image
perception among northern malaysian tertiary students. Br J Med Medl
Res. 2013;3:727-47.
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