Adolescent body image: influencing factors and the clinician's role

The Association of Body Image Perceptions with Behavioral and Health Outcomes among Young Adults

This study was conducted on 5 March 2024, by the Universidad Europea de Madrid. This study aims to explore how body image perceptions influence health behaviors and mental and physical health outcomes among a specific group of 605 young adults aged 20 to 35 engaged in strength training regimes. To measure these perceptions, the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was employed, an advanced tool that assesses multiple dimensions of body image through its subscales, including feelings of physical attractiveness, investment in one's appearance, and satisfaction with different body areas. Participants were segmented into two groups based on a median split of their self-reported body image. The survey assessed a diverse array of variables, including demographic details, physiological data, resistance training routines, and psychological attributes. In this revision, we consistently use the term 'dietary habits' to ensure clear and uniform language when discussing eating patterns. Notable differences were observed in dietary habits and exercise engagement, influenced significantly by body image perceptions. Negative body image was linked to less healthy dietary habits, diminished physical activity, and worse psychological outcomes, such as increased anxiety and depression. Conversely, a positive body image was associated with healthier dietary habits, more frequent physical activity, and better psychological health. The findings suggest that interventions aimed at improving body image could be crucial for enhancing overall health within this specific demographic. Due to the non-representative nature of the study group, conclusions are cautiously presented as applicable only to similar populations engaged in strength training. This study underscores the need for holistic strategies that encourage positive body image to improve both physical and psychological health outcomes in young adults.

Assessment of multidimensional self-concept in the area of physical education: validation of a scale

Introduction

Self-concept is a person's perception of him/herself and how he/she performs in different situations. This aspect must be developed during the formative stages and Physical Education is a fundamental area due to its enormous methodological possibilities.

Aim

Therefore, the aim of this study is to evaluate the factor structure and reliability of an instrument that allows to analyze the multidimensional self-concept of high school students in the context of Physical Education.

Method

The sample consisted of 1,155 secondary school students from public schools in the Autonomous Community of Extremadura, Spain. After the exploratory and confirmatory analyses, a structure composed of 30 items divided into 5 factors was.

Results

This design showed excellent goodness-of-fit indices as well as good internal reliability indicators (Cronbach's Alpha = 0.76 - 0.88).

Conclusion

Therefore, this scale can be considered as a tool to assess the self-concept of high school students in a quick and easy way.

Body dissatisfaction and dieting among Finnish adolescents: a 20-year population-based time-trend study

Body image has an important role in the health and development of adolescents. Body dissatisfaction and dieting can become chronic and continue into adulthood. There is a lack of recent, comprehensive studies on ongoing trends on body dissatisfaction. This study assessed time-trend changes in self-reported body dissatisfaction and dieting among Finnish adolescents at four assessment points. Representative samples of adolescents (N = 6660) aged 13-16 years participated in school-based, cross-sectional studies in 1998 (N = 1458), 2008 (N = 2044), 2014 (N = 1809), and 2018 (N = 1349), respectively. The studies were similar in design, methodology, and geographical recruitment areas. Body dissatisfaction and dieting were assessed with a questionnaire including items derived from the DSM-IV criteria for anorexia and bulimia nervosa. From 1998 to 2018, dieting and fears related to gaining weight decreased among females. Body dissatisfaction reduced among females, and their wishes to become thinner became less prevalent. Consuming large amounts of food at one time consistently decreased among females and males and there were no changes in the rates of willful vomiting. The number of females in the 90th percentile with the most severe symptoms decreased. The results indicate that body dissatisfaction and disturbed dieting improved among females during the 20-year study. Despite these positive developments, the overall level of symptoms among females remained substantial, indicating that females have much higher levels of body dissatisfaction and dieting than males.

BodyThink program-based body image education improves Korean adolescents' attitudes toward cosmetic surgery: randomized controlled trial

BACKGROUND

The aims of this study were to modify the widely used BodyThink program to suit the circumstances of Korean schools and determine its effects on body esteem, body image, appearance stress, depression, and attitudes toward cosmetic surgery.

METHODS

Participants were 184 third-grade students from two middle schools in Korea, who were randomly assigned to a control or intervention group. Two of the participants dropped out; hence, data from 182 students were analyzed. The control group received the existing curriculum for 4 sessions, and the experimental group was provided with 4 sessions of the revised BodyThink program. Before and after the intervention, all participants completed questionnaires.

RESULTS

In the BodyThink group, improved body image, decreased depression, and positive improvements in attitudes toward cosmetic plastic surgery were observed after the intervention.

DISCUSSION

These results suggest that school health nurses can utilize interventions based on BodyThink program in their curricula to improve the physical and emotional health of adolescents.

TRIAL REGISTRATION

This study has been retrospectively registered with the Clinical Research information Service (CRIS) in Korea on October 5, 2023 (KCT0008839).

Examining health professional perspectives on social media body image movements: A qualitative exploration

There has been a lack of investigation into the understanding of social media body image movements from the healthcare perspective. Health professionals can have a strong influence on how their patients relate to their own bodies, including experiences of weight-based discrimination. This study examined the perspectives of health professionals on body image social media movements and whether they believed they were relevant to their professional practice. This study recruited 30 medical and allied health professionals to participate in semi-structured interviews. Thematic analysis was used to generate common themes across the data. Overall, participants identified benefits associated with body positivity online content, but expressed concerns for the health status of influencers with larger bodies and that overall, the pro-anorexia movement was harmful. Despite having limited understanding and exposure to the body neutrality movement, participants generally preferred it over body positivity. Finally, participants stated that they believed that these movements were relevant to their practice, yet were rarely discussed in consults. These findings suggest there is a lack of body image-based discussions despite the relevance to patient health across multiple domains. This indicates that health professionals may benefit from social media literacy training to support thorough assessment and treatment of their patients.

Children's eating attitudes test (ChEAT): validation and reliability in Turkish children

OBJECTIVES

This study aims to examine the validity and reliability of the children's eating attitudes test (ChEAT) in Turkish children.

METHODS

The participants were 331 children (137 boys and 194 girls, ages 8-15). Data was collected through face-to-face interviews using a questionnaire containing socio-demographic characteristics, the ChEAT, and the children's eating behaviour questionnaire (CEBQ). Exploratory factor analysis (EFA) was performed to determine the factor structure of the Turkish version of the ChEAT. Additionally, the reliability was examined in terms of internal consistency and test-retest reliability. All statistical analyses were performed using Mplus Trial Version and SPSS 11.5 (SPSS, Chicago, IL, USA).

RESULTS

According to the goodness-of-fit statistic, a three-factor solution was appropriate and compatible with clinical considerations. The three factors explained 50.1% of the variance. Cronbach's alpha coefficient was 0.75 for ChEAT-26, 0.67 for "Preoccupation with thinness and food", 0.63 for "Social pressure to eat", and 0.71 for "Dieting". Furthermore, the test-retest reliability was 0.72, 0.62, 0.59, and 0.59 respectively. Statistically significant correlations between the ChEAT and CEBQ were found (p < 0.05). "Preoccupation with thinness and food" was significantly higher in obese children (p < 0.05), while "Social pressure to eat" was lower (p < 0.001). Sex, grade, BMI, parental education in addition to working status affected the ChEAT-26 scores.

CONCLUSIONS

The present study has provided preliminary evidence for the validity and reliability of a Turkish version of the ChEAT.

Internalisation of stereotyped body appearance standards and body dissatisfaction in adolescent boys: Moderating role of sports participation

The aim of this study was to test the moderating role of sport participation in the mediation model of media pressures, internalisation of appearance ideals and body dissatisfaction in adolescent boys. Five hundred and seventy adolescent boys (mean age 17.2 ± 0.45; range 15-19 years) participated in the cross-sectional study. Adolescents completed a questionnaire consisting of measures of attitudes towards sociocultural pressures on appearance, body dissatisfaction and sport participation (participation in achievement sport, leisure exercising and non-participation in any sports). Sports participation moderated the associations between the internalisation of stereotyped appearance ideals and body dissatisfaction. In athletes, the effect of internalisation of thin body ideals on body dissatisfaction was not significant, while the effect of internalisation of muscular/athletic body ideals was negative. In leisure exercisers, the effect of internalisation of muscular body ideals on body dissatisfaction was not significant, yet internalisation of thin body ideals had a significant effect on body dissatisfaction. The strongest associations between appearance ideals internalisation and body dissatisfaction were found in adolescent boys who reported no participation in sports. Sports participation might be an effective tool in decreasing the negative effect of internalisation of stereotyped appearance ideals on adolescent boys' body image.

Body Image and Physical Activity and the Diet of Polish Youth Aged 15-18

Adolescence is a crucial stage in the biological, psychological, and social development of humans. During this period, perceptions of one's body and behaviors are formed. The aim of the study was to investigate body image (BI) and its relationship with physical activity and selected eating habits in adolescents. The study included 312 people (102 girls (32.69%) and 210 boys (67.31%)) aged 15-18. As many as 40% of the girls and 27% of the boys reported feeling dissatisfied with their body mass. BI was negatively perceived by the adolescents, with girls being more critical than boys. Lack of acceptance of one's body mass negatively affects overall BI in girls, and only the functional aspects in boys. Negative perception of body mass in girls does not motivate them to increase physical activity but rather causes them to adopt dietary restrictions.

Prediction of body fat increase from food addiction scale in school-aged children and adolescents: A longitudinal cross-lagged study

Objective

Food addiction (FA) is associated with a higher body mass index z-score (BMIZ) in children and adolescents; however, whether these two aspects evolve interdependently remains unknown. This study aimed to address this question using a cross-lagged study.

Methods

Weight status, including BMIZ, fat content (FC), and visceral fat level (VFL), was determined in 880 children and adolescents (mean age = 14.02 years [range = 8.83-17.52 years]) at two-time points with an interval of 6 months. FA was characterized using the Chinese version of the dimensional Yale Food Addiction Scale for Children 2.0. Furthermore, FC and VFL were measured using direct segmental multi-frequency bioelectrical impedance analysis at each time point.

Results

Higher FA was associated with increased BMIZ, FC, and VFL (P < 0.05). FA at T0 could predict increased FC at T1 (P < 0.05). The characteristics of females, primary students, and living in urban areas may aggravate the adverse effect of FA on weight status over time and age, particularly the increased VFL in participants aged > 14 years.

Conclusion

Children and adolescents with a high FA level were at risk for weight gain attributed to increased FC, and the adverse effect could be aggravated with time and age. Novel FA-targeting interventions may help mitigate the risk of getting obesity.

Body Image Dissatisfaction and Aggressive Behavior Among Chinese Children at Different Pubdertal Stages: A Path Analysis

Background

Body image dissatisfaction and aggressive behavior have become important public health problem in children and adolescents, and body image dissatisfaction may increase the occurrence of aggressive behavior. The aim of this study was to explore the correlation between body image dissatisfaction and aggressive behavior among Chinese children in different developmental stages.

Methods

The stratified cluster sampling method was used to effectively survey 518 children aged 8–15 years. The Body Shape Questionnaire and the Buss-Warren Aggressive Questionnaire scale were used to measure body image dissatisfaction and aggressive behavior. Pubertal development stages were divided into three stages according to Tanner criteria.

Results

There was a main correlation path of body image dissatisfaction - hostility - anger - indirect aggression - physical aggression in boys with stage I and stage II and in girls with stage I and stage III. In addition, there were direct paths of hostility - indirect aggression, hostility - verbal aggression, anger - physical aggression, and anger - verbal aggression in boys with stage I; hostility - indirect aggression, hostility - verbal aggression, and anger - physical aggression in boys with stage II and in girls with stage I; and anger - physical aggression, and anger - verbal aggression in girls with stage III.

Conclusion

Body image dissatisfaction might positively correlate with aggression through hostility among Chinese children and adolescents, and their association paths were different in different puberty stages.

Health-related quality of life in Italian children and adolescents with congenital heart diseases

Background

Congenital heart disease (CHD) is the most common congenital anomaly at birth, affecting approximately 1% of live births. In recent decades great medical and surgical advances have significantly increased life expectancy, shifting healthcare professionals' and researchers’ interests in patients' Quality of Life (QoL). The main aims of our study were to evaluate generic and condition-specific QoL in a group of Italian children and adolescents with CHD and their parents and examine the level of agreement and directional disagreement between child/adolescent and parents reports on generic and condition-specific QoL.

Methods

A cross-sectional study was designed with CHD children and adolescents and their parents referred to the Cardiology Department of “Bambino Gesù” Children’s Hospital. The PedsQL scale was used, including generic (PedsQL 4.0) and cardiac-specific modules (PedsQL 3.0) were administered to patients and caregivers. A Kruskal–Wallis test was used to compare generic and cardiac module scores between patients with different ages, CHD diagnoses, and between patients who underwent surgery interventions and/or are currently taking cardiac medications.

Results

498 families were enrolled in this study. On average, patients reported a good level of generic and condition-specific QoL, as well as their mothers and fathers. Children aged between 5–7 years old reported lower generic and cardiac-specific total QoL levels than children aged 8–12 years and adolescents (13–18 years). With regard to the agreement, patient-parent agreement on condition-specific QoL ranged from 25 to 75% while on generic QoL, it ranged from 19 to 76%. The highest percentage of disagreement between parents and children was found in patients aged 5–7 years old, both for condition-specific and generic QoL rates.

Conclusions

Our study contributed to the growing body of knowledge on QoL in CHD, emphasizing the need for these families to receive support from multidisciplinary standardized care, including psychological consultations and support.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02611-y.

Agreement of adolescents’ self-perception of their body image with the analysis on the three-dimensional body image

Abstract Objectives: to verify the agreement among adolescents’ perception of their own body image and the health professionals’ analysis based on three-dimensional body image and the inter-rater agreement. Methods: a cross-sectional study was carried out with 1,662 adolescents, aged 18 to 19 years old, from the 1997/98 birth cohort in São Luís, Maranhão. Self-perception of body image was assessed using the Stunkard’s body image scale. Three nutritionists evaluated the three-dimensional body image obtained by the Photonic Scanner (3D Body Scanner) and classified according to the Stunkard’s scale. The agreement between raters was verified by using weighted Kappa. Results: the analysis of agreement between raters in the general group and when stratified by sexwas considered moderate to good by Kappa. Regarding the intraclass correlation (ICC), good and excellent correlation values were observed both in the general group, males and females. There was a greater perception of overweight by all raters, when compared with the adolescents’ self-assessments. When stratified by sex, examiner 1 had the same perception as male self-assessments, as for females the perception of overweight was more frequent, as well as raters 2 and 3, for both sexes. Conclusion: agreement between raters and self-assessments was considered weak/moderate in Kappa and good/excellent in ICC.

Examination of Self-Esteem, Body Image, Eating Attitudes and Cardiorespiratory Performance in Adolescents

Self-esteem, body image and eating attitudes are important characteristics regarding adolescent mental health. In our present work, we aimed to investigate these psychological items in adolescent boys and girls examining gender differences and correlations with the BMI-for-age and cardiorespiratory performance. 374 students (209 girls with an average age of 16.4 ± 1.08 years, and 165 boys with an average age of 16.5 ± 1.03 years) underwent investigation using the Rosenberg self-esteem scale, EAT-26 and BAT questionnaires. The BMI-for-age was calculated with BMI growth charts and the cardiorespiratory performance was measured with the 20 m shuttle run test. Our results showed that adolescent girls scored lower self-esteem and higher values for BAT and each scale of eating behaviors, such as uncontrolled eating, cognitive restraints and emotional eating compared to boys despite the fact, that obesity and overweight were more common among boys. No significant correlation was found between BMI and psychological test results in either boys or girls, however, subjective body shape and gender predicted self-esteem and BAT scores and the cognitive restraints in the eating attitudes. Uncontrolled and emotional eating were primarily influenced by gender, in which BMI played only a weaker role. Cardiorespiratory performance was positively associated with self-esteem and body image among boys, and it had a negative correlation regarding BMI in both genders.

Body Appreciation as a Factor Associated with College Students' Willingness to Receive Future COVID-19 Vaccines

Background: Following the initial manufacture of COVID-19 vaccines, numerous studies have investigated factors that influence people’s vaccination intentions. However, no studies have examined links of vaccination attitudes with body-related attitudes, especially body appreciation. To address this gap in the literature, we conducted this study to disentangle the relationship between college students’ COVID-19 vaccination intentions and body appreciation. Method: A cross-sectional study was conducted among Chinese college students. Participants completed the Body Appreciation Scale-2 (BAS-2) and other questionnaire measures of demographics, intentions to be vaccinated, and attitudes toward COVID-19 vaccination programs. Results: A total of 2058 college students participated in this study. Students who were willing to get COVID-19 vaccines had significantly higher BAS-2 scores than did those who were unwilling to receive a vaccine (3.61 ± 0.84 vs. 3.34 ± 0.92, p < 0.001). A hierarchical multiple logistic regression analysis was performed to test the association between body appreciation and COVID-19 vaccine intentions when controlling for other covariates; elevated BAS-2 scores were associated with greater willingness to receive COVID-19 vaccines (OR = 1.250, 95%CI: 1.112–1.406, p < 0.001), independent of other significant influences. Conclusion: Our study was the first to reveal that body appreciation is a significant factor related to college students’ COVID-19 vaccination intentions. Public health interventions designed to improve people’s body-appreciation levels may help in efforts to promote universal immunization.

The moderating effect of gender on the relationships between obesity, well-being, and stress perception in Korean adolescents

Background

Children and adolescents with obesity are more likely to become adults with obesity. Therefore, obesity prevention in adolescence is essential for eliminating complications associated with obesity, which can affect health throughout the lifespan. This study examined the influences of adolescents’ obesity based on BMI and that of obesity based on adolescents’ perception of their well-being and stress, as well as the moderating effect of gender on these influences.

Methods

Data were analyzed for 61,861 adolescents aged 12–18, who participated in the 2019 Korean Adolescent Health Behavior Survey, an online self-administered questionnaire. Adolescents’ obesity based on perception was based on their self-rating as underweight, healthy weight, or obese. Chi-squared tests were used to determine whether well-being and stress perception were related to obesity based on BMI and obesity based on perception, and a general linear model was used to examine the main and interaction effects of obesity based on BMI, obesity based on perception, and gender on well-being and stress perception.

Results

Obesity based on BMI and obesity based on perception coincided in 58.7% of the sample. However, the degree of obesity was overestimated and underestimated by 19.2 and 24.3% of the sample, respectively. Obesity based on BMI and obesity based on perception varied by gender, age, economic status, and academic achievement. The main effect of obesity based on BMI was not statistically significant on both well-being and stress perception, and only the main effect of obesity based on perception was statistically significant on stress perception. The interaction between obesity based on perception and gender was significant for well-being and stress perception. Herein, males scored higher on well-being and lower on stress perception. However, the association patterns were similar for males and females, with significant differences between underweight, healthy weight, and overweight/obese; however, for only females, there was no difference in well-being scores between underweight and those who perceived themselves as having a healthy weight.

Conclusion

The well-being and stress perception are influenced by obesity based on perception rather than obesity based on BMI, and this influence varies according to gender in adolescents.

Testing modified gender-moderated exercise and self-esteem (EXSEM) model of positive body image in adolescents

The most acceptable model explaining the associations between physical exercise and self-esteem is the exercise and self-esteem model (EXSEM). The present cross-sectional study tested the mediating role of body appreciation and physical fitness perception in the associations between physical activity and self-esteem in modified EXSEM. Overall, 1412 Lithuanian adolescents (40.2% were boys, mean age 17.0 (SD = 0.5) years) completed online questionnaires. The study was implemented in 2019 from October to December. Perceived physical fitness and body appreciation mediated the associations in the EXSEM. Physical fitness perception was directly associated with the self-esteem of girls, but not boys. Gender moderated EXSEM associations in body appreciation and perceived physical fitness showed stronger mediation effects for the adolescent girls compared to boys. Increasing physical activity, positive body image and perception of physical fitness might help to foster mental health, especially in girls.

Mental health of people with distorted body weight perception using medicinal remedies: A representative study

We aimed to examine the prevalence of distorted body weight perception (BWP) and the choice of weight control strategies to investigate the associations between the psychological features and the different strategies for controlling body weight. Method: We used a representative nationwide 39-item survey to randomly select 1,000 participants. The extrapolated number (eN) to the whole national population was also reported. Self-BWP, weight control strategies, and obesity-related psychological conditions including anxiety, self-esteem, body satisfaction, obesity-related quality-of-life (QoL), and eating attitudes were assessed. Results: Among men, 39.30% (eN = 5,887,137) underestimated, whereas 24.90% (eN = 3,290,847) of women overestimated their weight. In contrast to 2% (eN = 271,745) of men, 15.20% (eN = 2,012,262) of women sought medical support to control their weight. Men and women who used medical support for weight management and women who overestimated their weight reported the most unfavorable psychological conditions (anxiety, self-esteem, body satisfaction, QoL, and eating attitudes; p < .05). Conclusions: A prevalent burden of psychological problems related to distorted BWP and weight control strategies was revealed. People with distorted BWP and using medical procedures for their weight control could be at a higher risk of psychological disorders. Therefore, body weight-related psychological problems call for urgent public health policies.

Effects of Appearance- and Performance-Enhancing Drugs on Personality Traits

Appearance- and performance-enhancing drugs (APEDs) are commonly used by adolescents and young adults in an effort to improve not only athletic performance but also physical and mental efficiency and sexual appearance. The rationale for using these drugs is grounded in the perceived importance of external appearance, the quest for health and youth, and the urge to boost one's sexual performances. Although APED users tend to be quite moderate overall, some specific subpopulations can display pathological use associated with high-risk behaviors. A wide and diverse range of APEDs is now easily accessible to almost anyone through backdoor online avenues. Common APEDs include anabolic-androgenic steroids, non-steroidal anabolics, anorectics, diuretics and ergo/thermogenics, nootropics or "cognition enhancers," licit and illicit psychostimulants, and finally, sexual enhancers. The use of APEDs appears linked to several psychopathological disorders of unclear prevalence, e.g., body image disorders and eating disorders, perfectionism, but also depression and loneliness. The role of personality traits related to APED use has been investigated in adolescents and young adults, in elite and amateur athletes, and in chemsexers and associated with the above-reported personality traits. The studies herein analyzed show that APED consumption in the general population is quickly growing into a public health concern. It is therefore essential to launch prevention and intervention projects aimed at promoting safe instrumental use of the body, not only in sports disciplines but also among the general population, and to promote psychological aid procedures for people with substance use issues, depression and anxiety, and body image disorders.