Associations between body image changes and modifiable behavioral variables among university students in the context of COVID-19 pandemic

Abstract

Although previous studies have already examined pandemic-era behavior changes, there are still unanswered questions related to complex and sensitive topics such as body image, that can be answered by exploratory contextual analysis. The aim of this study was to evaluate changes in body image and explore its associations with modifiable behavioral variables among university students in the context of COVID-19 pandemic, controlling by sex and age. This cross-sectional study assessed body image perception both retrospectively (before the pandemic) and during the pandemic, as well as behavioral factors, in a sample of 252 university students of both sexes (77.4% female), aged 25.22±6.73 years. The Body Silhouette Scale measured the difference between participants perceived current and desired body image. Walking time, sedentary behaviour, and diet changes were considered modifiable behaviours and were assessed using a specific question about walking time, the short-form of the International Physical Activity Questionnaire (IPAQ-short) and a specific question about diet, respectively. Including those who became dissatisfied during the pandemic, 77.4% of the sample reported dissatisfaction with their body image. Sedentary behaviour and diet changes were significantly associated with body image changes. Low levels of sedentary behaviour reduced the odds of remaining dissatisfied by approximately 53% (OR = 0.47; 95% CI: 0.23-0.94; p = 0.03), while diet changes reduced the odds of becoming dissatisfied by 82% (OR = 0.18; 95% CI: 0.06-0.51; p < 0.01) to 83% (OR=0.17; 95% CI: 0.06-0.49; p < 0.001), and the odds of remaining dissatisfied by 69% (OR = 0.31; 95% CI: 0.15-0.64; p < 0.01) to 70% (OR = 0.30; 95% CI: 0.15-0.60; p < 0.001). Lower sitting time and diet changes acted as positive associated factors among university students during pandemic, with diet changes showing a strong association.

Background

Body image can be understood as a projection of one’s own body, based on what has been constructed about physical appearance in relation to socially influenced behaviors^1,2. Satisfaction with one’s body can be influenced by several factors, such as age, sex, physical activity or diet^3,4, with the degree of satisfaction or dissatisfaction being able to vary constantly. In this sense, considering the full complexity of changes that university life brings to young adults⁵, this group is believed to be more exposed to body image dissatisfaction.

Additionally, the literature has reported high levels of mental health problems and low self-esteem among university students worldwide^6–11, including those in Brazil^12–14. University students have also shown low levels of physical activity and increased sedentary behavior^15,16. These factors together can contribute to a more negative perception of body image, particularly when associated with social isolation, as experienced during the COVID-19 pandemic.

As of 16th March, 2025, the pandemic has affected around 778 million people and caused 7.1 million deaths globally, with 10% of these occurring in Brazil¹⁷. During the outbreak, in 2020, social isolation was adopted to contain the spread of the virus^18,19, which led to an increased physical inactivity, sedentary behavior^15,20, and tendency toward inadequate lifestyles, including unhealthy or unbalance diets²¹. This was particularly evident among university students, who experienced concentration difficulties during remote learning, concerns about the progress of their courses²² and increased sleepiness²³. On the other hand, the pandemic positively influenced university students’ behaviours, with some studies reporting improvements in physical activity engagement²⁴, and increased consumption of healthy foods, such as fruits and vegetables²⁵.

A study²⁶ conducted with university students during the COVID-19 pandemic explored the relationship between physical activity and symptoms depression and anxiety, taking into account the potential mediating roles of body image and body mass index (BMI) among Chinese university students. The only significant association observed was between physical activity and anxiety, mediated by body image²⁶. Although not directly examining body image as a mediator, other studies have highlighted the impact of COVID-19 related restrictions on eating behaviors. For example, a longitudinal investigation²⁷ involving 22,374 adults in the United Kington identified five distinct trajectories of eating behaviours over time. These trajectories reflected heterogeneous patterns, with participants showing no change, increased eating, or decreased eating behaviors. While profiles characterized by increased and decreased eating were associated with depression and stress, respectively, most participants (64%) reported no changes in eating behaviors during the pandemic²⁷.

Another study²⁸ conducted in the UK found that negative changes in eating behaviors were associated with sex, emotional eating, and anxiety, whereas positive changes were linked to participants’ adaptive coping strategies during the COVID-19 pandemic. Higher levels of pre-lockdown emotional or uncontrolled eating associated with higher BMI or a history of unhealthy lifestyle were found to mediate more maladaptive coping strategies related to eating behaviors²⁸.

Given this controversial context, in addition to the fact that body image perception may have worsened during the COVID-19 pandemic^29,30, it is important to gain a deeper understanding of the relationship between modifiable behavioral factors and changes in body image through an exploratory contextual analysis based on categorical indicators comparing perceptions before and during the COVID-19 pandemic. Although previous studies have already examined pandemic-era behavior changes, there are still unanswered questions related to complex and sensitive topics such as body image, that can be answered by exploratory contextual analysis. Therefore, the aim of this study was to evaluate changes in body image and explore its associations with modifiable behavioral variables among university students in the context of COVID-19 pandemic, controlling by sex and age. We hypothesize that university students experienced a significant increase in body image dissatisfaction during the pandemic compared to the period before it, and that it was associated with inadequate behaviours related to physical activity, sedentary behaviour, and diet.

Methods

Study design and participants

This cross-sectional study was conducted at a multicampus State University in Bahia, Brazil, during the COVID-19 pandemic (between July and October 2020), when University’s facilities were closed. The study was approved by the local Ethics Committee under n. CAEE 31627020.5.0000.0057, with report n. 4.100.093. All methods were performed in accordance with the Declaration of Helsinki. All participants consented their participation through the informed consent form before they completed the outcomes instruments of this study. Male and female university students older than 18 years old, were recruited through advertisements using University websites and social medias. This study recruited a convenient sample of 252 participants.

Dependent variable (outcome)

The change in body image perception between periods (before and during pandemic) was the outcome of this study. Body image perception was measured using the standard Body Silhouette Scales (Fig. 1), developed for men^31,32 and women³². The male scale has 11 body shape silhouette options while the female scale contains 12. The silhouettes range from an exaggeratedly muscular body (1) to obesity (11/12), with an eutrophic body shape at mid-point. Each participant indicated one of the figures that most represented his/her current perception of the body and the one that best represented his/her ideal body. Each participant indicated their perceptions about current and ideal bodies twice, considering the current pandemic period in 2020 and retrospectively the period before the pandemic. The questions they answered were: (i) Which of the images below best represents your current real body? (ii) Which of the images below best represented your real body before the COVID-19 pandemic? (iii) Which of the images below best represents your current ideal body? (iv) Which of the images below best represented your ideal body before the COVID-19 pandemic?

Fig. 1.

Body Silhouette scales for men³¹ and women³².

In the present study, body image dissatisfaction and satisfaction were defined by the difference in the current and ideal perceptions using the body shape silhouettes. Values different from zero were considered as dissatisfaction, while values equal to zero were considered as satisfaction with body image. Discrepancies between the current and ideal body during the pandemic and between the current and ideal body before the pandemic were analyzed. When comparing perceived current and ideal body silhouettes pre and during the pandemic, the congruence or dissonance in perceptions were classified into four possible categories described in the Table 1.

Table 1.

The four categories of body image changes between periods (before and during pandemic).

Before pandemic	During pandemic	Changes	Categories
Satisfied	Dissatisfied	Was satisfied and became dissatisfied	0
Dissatisfied	Dissatisfied	Was dissatisfied and remained dissatisfied	1
Satisfied	Satisfied	Was satisfied and remained satisfied	2
Dissatisfied	Satisfied	Was dissatisfied and became satisfied	3

Independent variables

The independent variables in this study were walking time (walking for at least 10 min), sedentary behaviour and diet change during the pandemic. Physical activity was estimated by the question “If they walked for at least 10 minutes daily during pandemic”, and the answers dichotomized as ‘Yes’ or ‘No’. Sedentary behavior was estimated by the time in minutes sit during week and weekend days, from the last two questions of the International Physical Activity Questionnaire, short-form (IPAQ-short) [33], and calculated according to the formula [(sitting time in a week day x 5 + sitting time in a weekend day x 2)/7] [34]. A cut-off of 600 minutes/day was assumed to classify those with elevated (> 600 min/day) and non-elevated (≤ 600 min/day) sedentary behavior, based on the median value and consistent with commonly used thresholds in the literature [35,36]. Finally, diet changes were assessed using the question: “Did your diet change during the pandemic?”, with responses dichotomized as “Yes” or “No.” This information was collected as part of the participants’ personal information section at the beginning of the Google Forms questionnaire.

Co-variables

Given that sex and age are commonly considered risk factors in epidemiological studies [37–39], we included sex (female/male) and age (≤ 23 years/>23 years), dichotomized according to the median value, as co-variables of this study. Accordingly, sex and age were incorporated into the base model of the multilevel multinomial regression analyses and used as adjustment factors in all regression models. These data were collected as part of the participants’ personal information section at the beginning of the Google Forms questionnaire. For sex, participants selected either “female” or “male”, and for age, they entered their age in years; we then dichotomized this variable later.

Statistical analyses

Initially, participants were characterized using descriptive statistics. Bivariate and multivariate multinomial logistic regression analyses were conducted to estimate the associations between body image changes and modifiable behavioral factors, in addition to sex and age. The associations were estimated using odds ratio (OR) and the 95% confidence intervals (95%CI). Four multinomial logistic regression models were used to estimate the associations between body image changes and modifiable behavioural variables among university students. In Model 1, we tested the association between body image changes and walking for at least 10 min during the pandemic, adjusted for age and sex. In Model 2, we examined the association between body image changes and sedentary behaviour, also adjusted for age and sex. In Model 3, we tested the association between body image changes and diet changes during the pandemic, again adjusted for age and sex. Finally, given the strength of diet changes as a predictor of body image changes, in Model 4 we tested the association between body image changes and diet changes during the pandemic, adjusted for age, sex, walking for at least 10 min during the pandemic, and sedentary behaviour. ORs with 95% CI were estimated for all four categories of body image changes across the four models, using the category ‘was satisfied and remained satisfied’ as the reference group for the regression analyses. The significance level was set at p < 0.05 and all analyses were performed in Statistical Program for the Social Sciences (SPSS), version 29.0.

Results

The sample was mostly female (77.4%) and young adults (25.22 ± 6.73 years). The mean age between female (25.13 ± 6.19) and male (25.53 ± 8.35) was not statistically different (p = 0.74). The characterization of participants is described in the Table 2.

Table 2.

Characterization of participants.

Variables	n	%
Sex Female Male	195 57	77.4 22.6
Age ≤ 23 years > 23 years	146 106	57.9 42.1
Pandemic changed diet Yes No Non-respondents	170 80 02	67.5 31.7 0.8
Walking at least for 10 min during pandemic No Yes	154 98	61.1 38.9
Sedentary behaviour Elevated Non-elevated	129 123	51.2 48.8

Sedentary behavior was calculated using the formula [(sitting time in a week day x 5 + sitting time in a weekend day x 2)/7]³⁴. A cut-off of 600 min/day (based on the median value) classified elevated (> 600 min/day) and non-elevated (≤ 600 min/day) sedentary behavior.

The proportion of body image changes in the context of pandemic is showed in Fig. 2. Although the majority of participants remained dissatisfied with their body image in the context of pandemic (63.1%), 14.3% became dissatisfied, while only 5.2% became satisfied.

Fig. 2.

Proportion of body image changes between periods (before and during pandemic).

The bivariate multinominal regression analyses (Table 3) showed a significant association between becoming dissatisfied with body image and diet changes during pandemic (OR = 5.45; 95% CI: 1.96–15.09; p < 0.01). Significant associations were also observed between remaining dissatisfied with body image and both diet changes (OR = 3.23; 95% CI: 1.62–6.43; p < 0.001) and sedentary behaviour (OR = 2.16; 95% CI: 1.08–4.32; p = 0.02).

Table 3.

Bivariate multinomial regression analyses of the association between body image changes and modifiable behavioral variables.

Variables	Body image changes
	Was satisfied and became dissatisfied			Was dissatisfied and remained dissatisfied			Was dissatisfied and became satisfied
	OR	IC95%	p-value	OR	IC95%	p-value	OR	IC95%	p-value
Age ≤ 23 years > 23 years	0.55 1	0.22–1.35	0.19	1.08 1	0.54–2.13	0.81	0.80 1	0.23–2.80	0.73
Sex Female Male	1.37 1	0.40–4.64	0.60	0.58 1	0.25–1.34	0.20	----------	----------	-
Pandemic changed diet Yes No	5.45 1	1.96–15.09	< 0.01	3.23 1	1.62–6.43	< 0.001	2.96 1	0.79–11.08	0.10
Walking at least for 10 min. during pandemic No Yes	1.66 1	0.66–4.15	0.27	1.45 1	0.73–2.85	0.28	0.52 1	0.14–1.84	0.31
Sedentary behaviour Elevated Non-elevated	2.18 1	0.89–5.37	0.08	2.16 1	1.08–4.32	0.02	1.09 1	0.30–3.91	0.89

Was satisfied and remained satisfied is the reference category.

The parameter sex for “was dissatisfied and became satisfied” is set to zero because it is redundant.

Sedentary behavior was calculated using the formula [(sitting time in a week day x 5 + sitting time in a weekend day x 2)/7]³⁴. A cut-off of 600 min/day (based on the median value) classified elevated (> 600 min/day) and non-elevated (≤ 600 min/day) sedentary behavior.

The multivariate multinomial regression analyses are showed in the Table 4. Significant associations were observed in Model 2 between sedentary behaviour and lower likelihood of remaining dissatisfied with body image (OR = 0.47; 95% CI: 0.23–0.94; p = 0.03). In Model 3, diet changes during pandemic were significantly associated with lower likelihood of becoming dissatisfied (OR = 0.17; 95% CI: 0.06–0.49; p < 0.001), and of remaining dissatisfied (OR = 0.30; 95% CI: 0.15–0.60; p < 0.001). Finally, in Model 4, diet changes remained significantly associated with body image changes, particularly by reducing the likelihood of becoming dissatisfied (OR = 0.18; 95% CI: 0.06–0.51; p < 0.01) and of remaining dissatisfied (OR = 0.31; 95% CI: 0.15–0.64; p < 0.01). None of the four models showed a significant association with positive changes in body image, such as becoming satisfied after previously being dissatisfied.

Table 4.

Multivariate multinomial regression analyses of the association between body image changes and modifiable behavioral variables.

Models	Body image changes	OR	IC95%	p-value
1	Was satisfied and became dissatisfied	0.58	0.22–1.50	0.26
	Was dissatisfied and remained dissatisfied	0.59	0.29–1.19	0.14
	Was dissatisfied and became satisfied	2.37	0.65–8.57	0.18
2	Was satisfied and became dissatisfied	0.42	0.17–1.06	0.06
	Was dissatisfied and remained dissatisfied	0.47	0.23–0.94	0.03
	Was dissatisfied and became satisfied	0.85	0.23–3.08	0.81
3	Was satisfied and became dissatisfied	0.17	0.06–0.49	< 0.001
	Was dissatisfied and remained dissatisfied	0.30	0.15–0.60	< 0.001
	Was dissatisfied and became satisfied	0.34	0.09–1.30	0.11
4	Was satisfied and became dissatisfied	0.18	0.06–0.51	< 0.01
	Was dissatisfied and remained dissatisfied	0.31	0.15–0.64	< 0.01
	Was dissatisfied and became satisfied	0.36	0.09–1.36	0.13

“Was satisfied and remained satisfied” is the reference category.

Model 1: Association between body image changes and walking for at least 10 minutes during pandemic (Yes or No), adjusted for age (≤23 years or >23 years) and sex (Female or Male);

Model 2: Association between body image changes and sedentary behaviour, adjusted for age (≤23 years or >23 years) and sex (Female or Male);

Model 3: Association between body image changes and diet changed during pandemic (Yes or No), adjusted for age (≤23 years or >23 years) and sex (Female or Male);

Model 4: Association between body image changes and diet changed during pandemic (Yes or No), adjusted for age (≤23 years or >23 years), sex (Female or Male); walking for at least 10 minutes during pandemic (Yes or No) and sedentary behaviour.

Discussion

The aim of this study was to evaluate changes in body image and explore its associations with modifiable behavioral variables among university students in the context of COVID-19 pandemic, controlling by sex and age. We observed a high proportion of body image dissatisfaction among the university students, especially during the pandemic. Furthermore, significant associations were found between body image dissatisfaction and modifiable behavioral variables.

Considering those who remained dissatisfied in addition to those who became dissatisfied during pandemic, it represents 77.4% of the sample, highlighting the pandemic’s implications, possibly on university students’ body image as well. Although several previous studies [40–42] have reported high rates of body image dissatisfaction among young people, to the best of our knowledge, this is the first study to assess changes between the periods. Our findings show an increase of approximately 14% in the occurrence of body image dissatisfaction during the pandemic, raising the total proportion of participants dissatisfied with their body image to nearly 78%.

While a recent systematic review [43] identified changes in university students’ body image during the pandemic, most of the studies included did not report increases in dissatisfaction [43]. Notably, only one study from the review [43] showed an increase in dissatisfaction, and its sample consisted of Brazilian university students. This finding suggests a stronger negative impact of the pandemic on Brazilians university students, which aligns with the alarming situation faced by the country during the COVID-19 pandemic compared to other parts of the world [44].

Delving deeper into the reasons behind this heightened body image dissatisfaction, our analyses showed that participants with non-elevated sedentary behaviour had 53% lower odds of remaining dissatisfied with their body image, when controlling for sex and age. Elevated sedentary behaviour predicted body image dissatisfaction in at least 67% of the university students, in Minas Gerais, Brazil, before pandemic [45] and represented one of the most concerns during pandemic for Lithuanian university students, who increased their time sitting using computers or smartphones, although it was not associated to body image dissatisfaction [46]. However, the negative role of sedentary behaviour in body image has been consistent in the literature, even when physical activity is not associated to body image dissatisfaction [41,47], as observed in this study.

Given the well-established positive effects of physical activity on physical and mental health [48], our findings revealed no significant association between body image perception and walking time. The lack of significant association between body image and physical activity observed in the present study may be explained by the characteristics of the physical activity measure used. Although physical activity is widely recognized as beneficial to health, the use of a 10-minute cut-off does not capture the total volume of physical activity performed by participants, which may vary substantially across the sample. Future studies should explore the potential relationship between body image and physical activity while considering activity intensity. Examining whether body image dissatisfaction is associated with different levels of physical activity would add value, particularly when controlling for varying intensities, as well as for type and context of physical activity.

Another study also highlighted the complex role of physical activity among university students [48], suggesting that stress may mediate the relationship between physical activity and eating behaviors. This is particularly relevant considering the impact of mood changes on body image dissatisfaction in university students [49]. The pandemic significantly increased mental health issues among university students [15,50–52], potentially exacerbating other health conditions related to modifiable behaviours.

Moreover, our analyses showed that participants perception about their diet changes during the pandemic were associated with an 83% reduction in the odds of becoming dissatisfied, when controlling for sex and age, and an 82% reduction when additionally adjusted for physical activity and sedentary behaviour. Diet changes also reduced the odds of remaining dissatisfied by 70% when controlling for sex and age, and by 69% when accounting for the other predictors as well. Although the negative impacts of the pandemic (e.g. high rates of physical inactivity and poor eating habits) are well known [53–55], being in lockdown may also have encouraged healthier behaviours. In this regard, having more free time during lockdown may have raised awareness about healthy habits, particularly in terms of improving diet choices [56]. However, because the results of this study are based on self-reported dietary changes assessed through a yes/no question, it is not possible to presume that these changes improved participants’ diets. Dietary changes may have represented a coping strategy in response to the complexity of the pandemic. It is also worth noting that the silhouette scale used in this study reflects body types ranging from very muscular to very obese, which is more consistent with current profile of university students. In this sense, given closure of gyms, training centers, and other physical activity facilities, adapting their diet may have been a strategy adopted to at least minimize the risk of increased body image dissatisfaction. Therefore, future investigations should include more detailed questions to determine whether these dietary changes reflected healthier or unhealthier choices.

This situation is further compounded by the fact that, due to the multi-campus structure of the studied university, many students returned to their hometowns, many of which are rural areas characterized by family farming. Being close to their families, presumed more free time, and differences in the eating environment, may have contributed to dietary changes reported.

This finding aligns with existing evidence that eating behaviors were significantly affected during pandemic [57], although the direction of this association remains controversial. The literature suggests that students shifted toward greater consumption of ultra-processed foods and reduced their intake of fresh and healthy foods during pandemic [57,58]. Although the authors did not find body image dissatisfaction during pandemic in Lithuanian university students [46], diet changes played a positive role and participants were able to increase healthy food intake during the lockdown period [46]. Conversely, based on the association found in this present study, it seems more plausible that the participants’ dietary changes were negative or unhealthy as the body image turned for the worse during a COVID-19 pandemic lockdown. Nevertheless, this interpretation should be considered with caution.

Furthermore, it remains unclear whether the dietary change during the pandemic was in fact a health-oriented decision or rather a coping strategy in response to the psychological stress induced by social isolation during that period [59]. A survey conducted in United Kingdom during the pandemic found significant changes in body image and eating behaviours among participants [59]. The study by Robertson et al. [59] suggests that changes in both body image and eating behaviours were mediated by psychological stress, particularly among individuals with a history of eating disorders. Moreover, those with pre-existing eating disorders reported increased preoccupation with food, which in turn intensified concerns about achieving a better body shape [59]. Further studies are needed to fully elucidate these dynamics, as our findings only indicate that behavioral changes occurred during the pandemic and were associated with body image.

Overall, although increased body image dissatisfaction can be attributed to a combination of adverse behaviors adopted by university students during the pandemic, reduced sedentary behaviour, and particularly adopted changes in diet can significantly and consistently protect university students of being dissatisfied with their body image. These findings reinforce the notion that this population represents a high-risk group, underscoring the need for targeted policies and support strategies, particularly from university administrative bodies, to safeguard their physical and mental health.

Strengths and limitations

The limitations of this study should be acknowledged. The main limitation concerns the instruments used to measure the study variables. For example, the decision to analyze body image perception by converting it into categorical changes in (dis)satisfaction represents a significant limitation of this study, as it precluded the quantification of the magnitude of change which would have been highly relevant for understanding body image dynamics in the pandemic context. Future longitudinal studies following these university students should consider analytical approaches that allow the assessment of the magnitude of change in body image perception. Moreover, although the IPAQ-short is a validated and widely used instrument to assess physical activity and sedentary behavior, both variables were self-reported. Furthermore, we did not use moderate and vigorous physical activity from the IPAQ, as changes in these activity levels may have a greater impact on body shape compared to light physical activity. Several responses for moderate and vigorous activities were incomplete, so we decided to focus only on light physical activity to avoid losing statistical power due to a reduced sample size. Additionally, diet change was measured using a single yes/no question, which may have reduced measurement accuracy and limited the strength of inferences about the relationships between variables. The limitation of this question absolutely precludes interpretation if the dietary change was beneficial or adverse.

As a strength of this study, the online administration of the instruments via Google Forms facilitated the recruitment of university students across multiple campuses located in different municipalities throughout the state of Bahia, enabling large-scale data collection during the pandemic. To avoid in-person contact during that period, the use of objective measures, such as accelerometers were not feasible, as they would have introduced additional risks related to potential virus transmission.

Conclusion

Diet and sedentary behaviour were associated with changes in body image perception among university students. Those who spent less time sitting were 53% less likely to remain dissatisfied with their body image, while those who reported diet changes were at least 69% less likely to remain dissatisfied and at least 82% less likely to become dissatisfied with their body image. These findings suggest a positive association of sedentary behaviour, and particularly of diet changes, on body image changes between pre-pandemic and pandemic periods in the present sample of university students. The implementation of specific physical and mental health policies supported by university administrations is recommended. Although our paper does not provide a post-pandemic follow-up, our findings highlight that campus-based health promotion and ongoing psychosocial interventions can offer valuable lessons for future crises, mental health policy, and post-pandemic adaptation.

Author contributions

JLCN was responsible for resources, data curation, conceptualization, methodology, formal analysis, writing – original draft, investigation, project administration, supervision. ISdeC was responsible for data curation, resources, writing – original draft. KAS was responsible for data curation, resources, investigation, conceptualization. CRCdeO was responsible for methodology, writing – review and editing.

Funding

Not applicable.

Data availability

Data are available from the corresponding author Jorge Lopes Cavalcante Neto upon reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the State University of Bahia Institutional Review Board, under n. CAEE 31627020.5.0000.0057, with report n. 4.100.093. All methods were performed in accordance with the Declaration of Helsinki. All participants consented their participation through the informed consent form before they full-fill the outcomes instruments of this study.

Consent for publication

The consent for publication was obtained.

Competing interests

The authors declare no competing interests.