Body Image among Girls in Indonesia: Associations with Disordered Eating Behaviors, Life Engagement, Desire for Cosmetic Surgery and Psychosocial Influences

Eating Disorders and Aesthetic Plastic Surgery: A Systematic Review of the Literature

INTRODUCTION

Eating disorders (ED) and plastic surgery are two areas of healthcare that have gained significant attention in recent years. The goal of this review is to provide an overview of the existing literature concerning the interplay between ED and aesthetic surgery, identifying existing questionnaires and providing suggestions for the future research on the psychological aspects of these group of patients.

METHODS

We conducted a systematic review on PubMed. We included studies that examined the type of ED, surgical procedure, outcome measures used, patients' motivations as well as physical and psychological outcomes of individuals with ED seeking or undergoing aesthetic surgery. Three independent reviewers examined each potential study.

RESULTS

Eleven studies met the inclusion criteria. These studies involved 5510 patients, addressing a spectrum of ED such as Anorexia nervosa, Bulimia nervosa, and Binge eating. The primary focus was on body contouring procedures like liposuction, breast surgery, and abdominoplasty. The assessment tools employed in these studies for evaluating ED included the Eating Attitude Test (EAT), Eating Disorder Inventory (EDI), Eating Disturbance Scale (EDS), Sociocultural Attitudes Toward Appearance Questionnaire-Eating Disorder (SATAQ-ED), and the Eating Disorder Examination Questionnaire.

CONCLUSIONS

There is a complex interplay between ED and aesthetic surgery, underscoring the significance of comprehending and dealing with the psychological and sociocultural factors that impact patients in this context. The optimal management for these patients and the most effective tool for plastic surgeons to assess their psychological condition remain unclear. It is, therefore, crucial to standardize the evaluation and approach to this patient subgroup, closely aligned with psychological support, to achieve the best outcomes.

LEVEL OF EVIDENCE III

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Translation and validation of the Body Esteem Scale in Adults and Adolescents among Indonesian adolescents

There is a need for a psychometrically robust body image measure to advance body image scholarship among Indonesian adolescents. This study aimed to validate a Bahasa Indonesia version of the Body Esteem Scale for Adults and Adolescents (BESAA). The measure was forward and back translated from English into Bahasa Indonesia (i.e., primary Indonesian language) and was assessed for comprehension and cultural appropriateness using cognitive interviews and expert reviews. The factor structure, reliability, and validity of the measure was tested with adolescents aged 11-17 years from two districts in Indonesia (N = 650; 51.5 % girls). Exploratory factor analysis identified a suitable 17-item three-factor solution for the BESAA, with Appearance Positive, Appearance Negative, and Weight subscales. This model was confirmed via confirmatory factor analysis and found to be largely invariant across gender and age. Test re-test reliability and internal consistency of the subscales were acceptable. The Bahasa Indonesia version of the BESAA is a psychometrically robust measure suitable for use among Indonesian adolescents. Reasons as to why the factor structure of the BESAA differentiates across cultural contexts are discussed.

Evaluating a school-based body image lesson in Indonesia: A randomised controlled trial

Negative body image is a common public health concern among adolescents, globally. The aim of the current study was to evaluate the effectiveness, implementation fidelity, and acceptability of a single session, school-based universal body image intervention in Indonesia. A total of 1926 adolescents (59.4 % girls) and 12 school guidance counsellors (lesson facilitators) from nine state junior secondary schools in Surabaya, East Java took part in a two-arm open parallel cluster randomised controlled trial. In response to the changing circumstances due to the COVID-19 pandemic, half of the lessons were conducted in person and half were delivered online. Results showed that the lesson did not significantly improve adolescent body image or secondary outcomes relative to the control, though there was no evidence of harm. There were no substantive findings regarding intervention effectiveness by gender. The mode of intervention delivery (online vs. in-person) did not significantly influence the main findings. Implementation fidelity varied widely, and the lesson content and pedagogy were largely acceptable, though there was a strong preference for in-person lesson delivery. Findings have implications for researchers aiming to improve adolescent body image in low- and middle-income countries. Lessons learned can inform future school-based efforts to support adolescent body image.

Social Comparison and Body Image in Teenage Users of the TikTok App

BACKGROUND AND AIM

The TikTok app is one of the video-based social media platforms that is currently trending and commonly used by teenagers. The data about teenage users of the TikTok app are limited. This study aimed to estimate the prevalence of TikTok app use among teenagers in Saudi Arabia and to investigate the association between TikTok app use and the social comparison and the body image of the study population. Further, to explore the potential associations between the social comparison and the body image of the TikTok app users and their different characteristics.

METHODS

This cross-sectional survey study was conducted all over Saudi Arabia. The study included male and female teenagers, aged 12-19 years. The researchers used a structured, self-administered questionnaire to collect data, and it was disseminated using different social media platforms. The social comparison was measured using the questionnaire of the Iowa-Netherlands Comparison Orientation Measure, and the body image was measured using the Measurement of the Body Image Scale. The data were analyzed using the SPSS software version 26 (Chicago, IL: SSPS Inc.). Continuous variables were compared using the Student's t-test, Mann-Whitney U test, or Kruskal-Wallis tests, whereas categorical variables were compared using the Chi-square or Fisher's exact tests as appropriate. Spearman's rank correlation was applied to investigate the association between body image and social comparison scores among TikTok app users and non-users.

RESULTS

This study included 384 Saudi teenagers. Females (n=260) outnumbered males (n=124) (67.7% and 32.3%, respectively), and the mean of their age was 16.3±2.0 years. The researchers found a high prevalence (343/384, 89.3%) of TikTok app use among the studied teenagers. There was a significantly high median of the social comparison score among the TikTok app users (33.0, IQR: 28.0-38.0) compared to the non-users (28.0, IQR: 26.0-34.0), p=0.005. TikTok app users also showed a significantly lower median body image score (64.0, IQR: 54.0-72.0) in comparison to the non-users (67.0, IQR: 58.0-73.0), p=0.037. The correlation between social comparison and body image among teenagers using TikTok showed a negative relationship, but it was not significant (p=0.110). However, a significant negative weak relationship was found between body image and comparison of abilities (rs coefficient=-0.113, p=0.037).

CONCLUSIONS

The findings of the current study indicate a high prevalence of TikTok use among teenagers in Saudi Arabia. The use of TikTok was associated with a high social comparison and a negative body image, with more than half of the users expressing a negative body image. Comparison of abilities was associated with an increased level of body dissatisfaction. These findings emphasize the need for the development and implementation of public health policies and awareness programs to promote body acceptance, especially for young people across the country. Future studies should focus on the long-term impact of TikTok use on psychological health.