“Am I really fat/thin?!” Self-perceived body image and correlation with nutritional status among medical students in Central Gujarat

ABSTRACT

Introduction:

Adolescence is a crucial part of life characterised by rapid body changes that can be influenced by perceptions and misinformation regarding their body image. Body image is usually associated with self-esteem and self-worth. Therefore, it is important to address this issue at this transitional time. This study aims to understand the perception of body image and its correlation with nutritional status among first-year medical students.

Methods:

A cross-sectional study was conducted among first-year medical students enrolled in the MBBS curriculum. Data related to perception of body image were collected through a self-administered, pre-tested questionnaire. Height and weight were taken by the principal investigator at the time of data collection and body mass index (BMI) was calculated according to Asian criteria for BMI. Kappa statistics were used for the agreement between self-perceived body image and BMI.

Results:

A total of 234 out of the 250 students enrolled in the first year gave consent for the study. The median (interquartile range [IQR]) age of the students was 18 (17–19) years and 72% were male students. One-fourth of the students were dissatisfied with their weight (26.9%) followed by height (25%). The Kappa statistics for agreement between BMI and self-perception about body weight was 0.373 (95% confidence interval [CI], standard error (SE) of Kappa = 0.048), showing poor agreement.

Conclusion:

One-fourth of the students were dissatisfied with their physical appearance. The agreement between perceived body weight and nutritional status was poor (64.53%).

Introduction

India has 253 million adolescents in the age group 10–19 years, which is the largest in the world. They are susceptible to several preventable and treatable health problems, and one of them is nutritional disorders like malnutrition, anaemia, and overweight.[1,2] This phase is an intricate chapter in the book of human development, where the canvas of physical and psychological health undergoes profound transformations. This transformative phase is characterised by rapid changes in the body, which, in turn, exert a significant influence on an individual’s perception of themselves. Central to this transformation is the concept of body image, a critical element in shaping an adolescent’s emotional attitude, perception, and belief regarding their physique.[3]

Body image is a multifaceted construct that encompasses an individual’s perception, thoughts, and feelings about their own body, and it goes beyond just what they see in the mirror.[4] It is a complex interplay between self-esteem, self-worth, and physical appearance. During adolescence, as the body experiences unprecedented growth and alteration, the relationship between one’s body and their self-concept becomes increasingly complex. While attempting to strike a delicate balance between cultural expectations, self-identity, and self-acceptance, adolescents frequently find themselves in a tangle of emotions. A negative body image is consistently connected to obesity and a lack of physical activity, according to research,[5] and it also serves as a key factor in the emergence of eating disorders among adolescents.[3] Negative body image can also serve as the reason for the development of mental disorders like anxiety and depression.[6]

One of the interesting aspects of this journey through adolescence is the link between body mass index (BMI) and body weight perception. BMI, a numerical representation of an individual’s body mass relative to their height, serves as a rudimentary tool for gauging physical health.[7] However, as research has shown, the connection between BMI and an adolescent’s perception of their weight is far from straightforward.[8] Despite the seemingly objective nature of BMI, adolescents frequently struggle to perceive their weight accurately.[8] This could be attributed to the fact that the most commonly perceived body image notion for boys is to have a ‘muscular body’ and for girls is to have a ‘thin and slim body’ or ‘zero figure’. This is increased due to increase in exposure to social media in adolescence.[9]

This article delves into the intricate dynamics of body image perception during adolescence, exploring the factors that influence it and the consequences it holds for physical and psychological well-being. It unravels the complex relationship between BMI and an adolescent’s perception of their weight, shedding light on why this connection often remains tenuous. Gaining a deeper understanding of these intricacies can be useful as the world is facing the double burden of malnutrition, overweight, and underweight. Physicians are seeing more cases of lifestyle disease in adolescents as well as mental issues related to overweight and obesity.

Methodology

A cross-sectional study was conducted among first-year students of MBBS. They were included in the study after obtaining their written consent. The administrative permission was obtained from the dean. A total of 250 students were enrolled in the first-year batch. Ethical clearance was obtained from the Institutional Ethical Committee. Out of the total, 234 students gave their consent to participate in the study.

The data were collected through a self-administered, pre-tested questionnaire. The questionnaire contained details related to how they perceived their body image and body image satisfaction. The questionnaire also had other details like age, weight and height. During the time of data collection, the name of the student was not asked to encourage honest answers. The weight and height were measured by the principal investigator and team. The measurements were taken by investigators in a confidential place so that students did not feel embarrassed, taking care of gender sensitivity.

BMI was calculated according to Asian criteria for BMI.[10] According to the Asian cut-off, a BMI less than 18.5 indicates ‘underweight’, a BMI ranging from 18.5 to 22.9 indicates ‘normal weight’, a range of 23–24.9 indicates ‘overweight’ and index of 25 and above is considered as ‘obese’.[10]

The data were entered in a password-protected MS Excel and analysed using Epi-info 7 software. The perception of students related to their body image was described as frequency and percentage. The quantitative variables like age, weight, height and BMI were checked for the normalcy of data, and if a normal distribution was found, it was described as mean and standard deviation (SD); if a non-normal distribution was found, it was described as median and IQR. The correlation between self-perceived body image and nutritional status was calculated using Kappa statistics. Kappa statistics were calculated using an online tool.[11] The result of kappa was interpreted as Kappa <0: no agreement; Kappa between 0.00 and 0.20: slight agreement; Kappa between 0.21 and 0.40: fair agreement; Kappa between 0.41 and 0.60: moderate agreement; Kappa between 0.61 and 0.80: substantial agreement; and Kappa between 0.81 and 1.00: almost perfect agreement.[12]

Results

A total of 234 out of the 250 students enrolled in the first year gave consent for the study. The median (IQR) age of the students was 18 (17–19) years. Out of the total, 169 (72%) were male students. Nearly one-fourth of the male and female students were dissatisfied with their weight (P = 0.74) and physical appearance, while in the case of height, 24 (37%) of the female students and 35 (21%) of the male students were not satisfied (P < 0.01). Table 1 shows the perceptions of the students regarding their body weight, height and overall perception regarding their physical appearance. A total of 58 (25%) students were dissatisfied with their physical appearance [Table 1]. The major reason for the dissatisfaction was the weight of the students. The other reasons include excessive body hair, length of the hair, size of the chest, and colour of the skin, eyes and hair [Figure 1]. Figure 1 shows the main reasons for dissatisfaction among the students. Among 58 dissatisfied students, nearly 22 (37%) had consulted the doctor for their dissatisfaction, and 24 (48%) were taking various kinds of nutritional supplements for weight gain, weight loss and clear skin.

Table 1.

Perceptions of the students regarding weight, body height and physical appearance

Variables	Male (n=169)	Female (n=65)	P
Satisfaction with weight
Satisfied	122 (72.1%)	49 (75.3%)	0.74
Dissatisfied	47 (27.8%)	16 (24.6%)
Satisfaction with body height
Satisfied	134 (79.2%)	41 (63.0%)	0.01
Dissatisfied	35 (20.7%)	24 (36.9%)
Satisfaction with physical appearance
Satisfied	126 (74.5%)	50 (76.9%)	0.83
Dissatisfied	43 (25.4%)	15 (23.0%)

Figure 1.

Reasons for dissatisfaction with physical appearance

The majority (78%) of them perceived themselves as normal, although only 49% were classified as normal according to BMI. The remaining 21% were underweight, 17% were overweight and 3% were obese. The Kappa statistics for agreement between BMI and self-perception about body weight is 0.373 (95% CI, SE of Kappa = 0.048), which shows poor agreement. The agreement between self-perceived body image and BMI is shown in Table 2 and the graphical presentation of self-perceived body image and categorization of BMI is shown in Figure 2.

Table 2.

Correlation with BMI and perceived body image

Self-perceived body image	BMI			Total
	Underweight	Normal	Overweight + obese
Skinny	20	3	0	23
Normal	40	107	36	183
Overweight + obese	1	3	24	28
	61	113	60	234

Kappa=0.373 (95% CI, SE of Kappa=0.048) Number of observed agreements=151 (64.53%) Number of agreements by chance=101.5 (43.40%) Kappa shows poor agreement

Figure 2.

BMI and self-perceived body image

Discussion

Adolescence is a time of intense development, marked by profound changes in one’s body. Body image, as a multidimensional construct, plays a pivotal role in shaping an individual’s self-esteem and self-worth. The reasons for body image dissatisfaction among the students were diverse, with weight being the primary concern. This aligns with previous studies that have shown a strong connection between body weight and body image perception.[5] Despite the importance of self-perceived body image for psychological and general health, few studies have investigated the agreement between different measurements of self-perceived body image and nutritional status according to BMI, especially in adolescents from developing countries.[13,14]

This study explores the relationship between self-perceived body image and nutritional status among first-year medical students. Our findings reveal that body image dissatisfaction is a prevalent issue, affecting both male and female students within the cohort. Our research demonstrates that approximately one in four male students reported dissatisfaction with their weight. Similar outcomes were observed among female students, indicating that weight concerns are not gender-specific within this age group. This finding underscores the universal nature of body image challenges faced by adolescents, irrespective of gender. These findings are supplemented by a systemic review done by Martini MCS et al.,[15] which reveals that dissatisfaction related to weight is present in adolescents of both genders. Conversely, while one in five male students expressed dissatisfaction with their height, a significant gender disparity was evident, with every third female student reporting the same concern. The main reason for the dissatisfaction can be attributed to the societal belief that females should have thin bodies and males should have muscular bodies.[16] As adolescents are considered to be in a transformational phase, they will try to modify according to societal norms. Social media and other platforms, which are easily available nowadays strengthen these types of unrealistic expectations.[17] It is important to address this issue as this can lead to unhealthy dietary practices,[18] which can further affect the growth and development of adolescents.

Notably, one in four students in the cohort expressed dissatisfaction with their overall physical appearance, underscoring the widespread prevalence of body image concerns among first-year medical students, irrespective of gender. Additional reasons for dissatisfaction among adolescents encompass excessive body hair, hair length, chest size, and variations in skin, eye, and hair coloration. The dissatisfaction is mainly attributed to peer pressure, societal reforms for males and females, and social media.[19,20]

One of the key findings of this study was the poor agreement between self-perceived body image and BMI. While the majority of students perceived themselves as ‘normal’, only 59% of them fell within the ‘normal weight’ category according to BMI calculations. In a Brazilian study focusing on adolescents, it was discovered that boys had a notably higher tendency to overestimate their current weight status, while girls were more inclined to underestimate it.[8] Conversely, a separate investigation involving 6,863 Chinese adolescents in middle and high school settings found that girls, more frequently than boys, perceived themselves as heavier.[21] Kappa statistics showed poor agreement between self-perceived body weight and nutritional status, suggesting a lack of concordance between the two. Similar findings were present in a study done by Moitra M et al.[13] which showed poor agreement between perceived body weight and BMI. This discrepancy underscores the complexity of body image perception, as it does not always align with objective measures of physical health. A study showed that adolescents with body image dissatisfaction were more likely to have positive screenings for common mental disorders like depression, anxiety, and eating disorders.[9]

The prevalence of body image dissatisfaction among first-year medical students calls for heightened awareness and support within educational institutions. Recognising that a quarter of the cohort struggles with their self-perceived body image underscores the need for comprehensive interventions and resources that address these concerns.

Future research could delve deeper into the factors influencing body image dissatisfaction, including societal pressures, peer comparisons, and media influences. Additionally, exploring the long-term effects of body image dissatisfaction on the well-being and professional development of medical students could provide valuable insights into the broader implications of these findings. A similar study among adolescents from other educational institutions could be undertaken.

As this study was conducted among medical students only, generalisation of the findings is not possible. This was the main limitation of this study.

Conclusion

One-fourth of the students were dissatisfied with their physical appearance. The main reason for their dissatisfaction was body weight (26.9%) followed by height (25.2%). The agreement between perceived body weight and nutritional status was poor (64.53%).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest to declare.