Table 2.
Literature studies reported in chronological order on body image dissatisfaction, PA, anthropometric profile in adolescents.
| Study Reference -Design- |
Country/Ethnicity | Sex: Number of Subjects |
Age (Years) | BMI (kg/m2) and/or Weight Status |
PA (Tool) |
Body Dissatisfaction | Figure Rating Scale | Main Findings | Study Quality (Score) |
|---|---|---|---|---|---|---|---|---|---|
| Chen and Wang, 2011 [28] -cross-sectional- |
Chicago, USA low-income African Americans |
M + F: 402 (49% F) |
10–14 |
Weight status OW/obesity M: 3 3%; F: 42% M + F: 37% |
Mean values not reported (questions) |
Mean Ideal BI M: 4.19 ± 0.79 F: 4.20 ± 1.05 Body size perception: Among OW and obese adolescents, 69% thought they were OW or obese (boys: 54%; girls: 78%) (only ideal body image (IBI) was assessed) |
8 silhouettes adapted by Stunkard et al. [29]; Stevens et al. [30] |
Girls with smaller IBI were more likely to participate in PA less than 3 days/week. No significant association was found between IBI and PA in males. | 9 |
| Bibiloni et al., 2012 [31] -cross-sectional- |
Balearic Islands |
M: 939 F: 1022 |
12–17 |
Mean BMI by PA behavior M: Sedentary: 22.5 ± 3.8 Active: 21.7 ± 3.8 F: Sedentary: 21.6 ± 4.0 Active: 22.3 ± 3.8 (sedentary cut-off level = 300 min of MVPA per week.) |
PA categories M Inactive: 22% Active: 78% F Inactive: 51% Active: 49% PA practice M Moderate None: 11% Mean duration: 215.1 ± 250.5 min/week Vigorous None: 11% Mean duration: 502.8 ± 401.4 min/week F Moderate None: 13% Mean duration: 169.1 ±165.7 min/week Vigorous None: 28% Mean duration: 354.3 ± 356.2 min/week (IPAQ-A) |
Desire (%) for weight change in sedentary adolescents: M -want to be thinner: 31% -want to remain the same weight: 13% -want to be thicker: 23% F -want to be thinner: 51% -want to remain the same weight: 50% -want to be thicker: 54% |
9 silhouettes developed by Stunkard and Stellar [32] |
Age, sex, and dissatisfaction with body size, in addition to other components, are important factors for PA practice. Association of BI or BID with PA or BMI or weight status not assessed. |
15 |
| Petracci et al., 2013 [33] -cross-sectional- |
Emilia-Romagna region, Italy |
M: 2181 F: 2157 M + F: 4388 |
Mean 13.8 ± 0.4 |
Weight status Not OW: 75% OW: 20% Obese: 5% |
PA practice 44%: <2 h/w 42%: 2–11 h/w 10%: ≥11 h/w (PA measured using only one question: hours per week) |
BID 37% satisfied (FID = 0) 14% want to be larger (FID < 0) 43% want to be thinner (FID > 0) |
9 silhouettes developed by Collins [34] (an incorrect number of figures seems reported: 9 instead of 7) |
62% of the children reported accepting their physical appearance but with a tendency to indicate a heavier self-figure than their ideal one and having an inadequate BI perception relative to their BMI. Association of BI or BID with PA or BMI or weight status not assessed. |
15 |
| Zach et al., 2013 [35] -cross-sectional- |
Israel Jewish, Arab, Bedouin and Druze |
M: 2562 F: 3085 |
Mean M: 15.04 ± 1.68 F: 15.20 ± 1.60 |
Weight status M UW: 5% NW: 74% OW: 13% Obese: 7% F UW: 4% NW: 79% OW: 13% Obese: 4% |
PA level M Inactive: 29% Insufficiently active: 53% Sufficiently active: 18% F Inactive:42% Insufficiently active: 54% Sufficiently active: 5% (PA level by questionnaire: any moderate and/or vigorous level of PA performed for 60 min/day = sufficient; lesser amount = insufficient; no activity or activity less than once/week = inactive. PA intensity by questionnaire: based on the perceived difficulty of exercise as light, moderate and vigorous by the Borg perceived exertion scale) |
Body satisfaction M OK: 77% Too fat: 12% Too thin: 10% F OK: 73% Too fat: 23% Too thin: 4% Satisfaction of body shape and size in OW, obese M OW: 66% Obese: 41% F OW: 47% Obese: 26% Body perception M Very fat: 2%; Fat: 13%; Average: 45%; Thin: 34%; Very thin: 5%. F Very fat: 2%; Fat: 15%; Average: 37%; Thin: 37%; Very thin: 10%. (Body perception by the chosen number of the current figure inside the scale where 1 represents an obese figure and 5 a lean figure. Body satisfaction by questionnaire: I am OK, too fat or too thin) |
5 silhouettes drawn by an artist (not reported) |
A large percentage of OW/obese and more than half of UW adolescents were satisfied with their body shape and size. As a result, the likelihood of motivating self-satisfied people to change is very low. As for PA, thin girls (UW based on BMI) were the least active among girls, while the least active male groups were the extremes: thin boys (UW) and fat boys (OW) or those who perceived themselves as fat. Probably this pattern was due to the reason that they perceived their appearance as satisfactory and PA as a tool for weight reduction. According to regression analyses, BMI, sex, and age accounted for 30% of the variance in participants’ body perception; BMI, sex, and age accounted for 22% of body satisfaction variance, and PA was not related to either body perception or body satisfaction. PA as a variable does not explain the BI of Israeli adolescents. | 13 |
| Cheah et al., 2014 [36] -cross-sectional- |
Malaysia | M: 49 F: 96 |
13–15 |
Nutritional status M Thinness and below: 4% NW: 63% OW: 14% Obese: 18% F Thinness and below: 3% NW: 73% OW: 16% Obese: 8% |
Mean PA M: 6699.67 ± 3605.46 step/day F: 6022.55 ± 2775.66 step/day M + F: 6251.37 ± 3085.31 step/day (Pedometer clipped at the waist for 1 week) |
Body size discrepancy score M: 0.96 ± 0.89 F: 1.29 ± 0.82 M + F: 1.18 ± 0.89 (Body size discrepancy score = difference between perceived current body size and perceived ideal body size) |
9 silhouettes developed by Thompson and Gray [37] |
The study found low PA and OW/obesity in nearly one-third of the respondents. The mean steps per day were lower than international standards for both genders. Girls were more aware of their bodies and concerned about their appearance while performing PA. Association of BI or BID with PA or BMI or weight status not assessed. | 12 |
| Schuster et al., 2014 [38] -longitudinal- |
3 USA communities (Birmingham, AL, Houston, TX, and Los Angeles County, CA) |
M: 1958 F: 2003 M + F: 3961 |
Mean Survey 1: 11.1 ± 0.5 Survey 2: 16.1 ± 0.5 |
Weight status Survey 1 UW: 1% NW: 53% OW: 19% Obese: 26% Survey 2 UW: 2% NW: 60% OW: 18% Obese: 20% |
3.8 ± 2.0 days past week (PA measured as the number of days in the past 7 in which the child was engaged in vigorous exercise for ≥20 min) |
BID 5% much heavier than ideal 29% somewhat heavier than ideal 50% same as ideal 15% thinner than ideal (BID: “Much heavier” indicates those whose self-image was >2 levels heavier than their ideal BI, “somewhat heavier” indicates those whose self-image was 1 level heavier than ideal, and “thinner” indicates those whose self-image was thinner than ideal) |
7 silhouettes developed by Collins [34] |
BID was related to the BMI category: obese and OW students were more likely than NW students to identify as being much heavier or somewhat heavier than ideal. Students were less likely to become obese if they performed more vigorous exercise. Association of BI or BID with PA not assessed. |
14 |
| Chongwatpol and Gates, 2016 [39] -cross-sectional- |
Bangkok Metropolitan Region, Thailand | M: 1026 (700 in Single-sex schools; 326 in Mixed-sex schools) F: 1056 (497 in Single-sex schools; 559 in Mixed-sex schools) |
15–18 |
Mean BMI by type of school M 21.5 ± 0.2 (Single-sex schools) 21.0 ± 0.3 (Mixed-sex schools) F 20.1 ± 0.2 (Single-sex schools) 20.9 ± 0.2 (Mixed-sex schools) Weight status M Very UW: 2% UW: 10% NW: 67% OW: 14% Obese: 8% F Very UW: 1% UW: 6% NW: 81% OW: 8% Obese: 4% |
Mean PA score M + F: 2.2 ± 0.6 PA score by type of school M 2.3 ± 0.02 (Single-sex schools) 2.6 ± 0.04 (Mixed-sex schools) F 2.1 ± 0.03 (Single-sex schools) 2.1 ± 0.03 (Mixed-sex schools) (PAQ-A modified according to Janz et al. [40]: the total PA score is an average of eight items with a score of 1 indicating low PA and 5 high PA) |
Mean BID by type of school M 1.16 ± 0.03 (Single-sex schools) 1.02 ± 0.04 (Mixed-sex schools) F 1.18 ± 0.04 (Single-sex schools) 1.11 ± 0.04 (Mixed-sex schools) The mean female desired body shape: 3.14 ± 0.82. No BD in 18% of females and 21% of males. Desire for a thinner figure in two-thirds of girls and 44% of the boys. Desire for a bigger figure in 35% of males. |
9 silhouettes developed by Stunkard et al. [29] |
More than 80% of adolescents reported being dissatisfied with their current body shape. Overall BID, when measured as an absolute value, was similar in male and female Thai adolescents but the majority of girls wanted to be thinner, while boys wanted to be either smaller or bigger. Among risk factors, lower socioeconomic status, higher BMI, and lower PA were found to be associated with higher body dissatisfaction explaining 20% of its variation. Participants from single-sex schools reported higher body dissatisfaction than those from mixed schools. In general, Thai adolescents reported a low PA. | 12 |
| Coelho et al., 2016 [41] -cross-sectional- |
Portugal | M: 284 F:245 M + F: 529 |
10–18 Mean 13.32 ± 1.59 |
Weight status: M + F NW: 77% OW: 18% Obese: 4% |
Sports activity 52% 0–1 day/week 24% 2–3 days/week 24% ≥4 days/week (question about frequency of sports activities expressed as day/week) |
M: 44% satisfied 16% want to be larger 40% want to be thinner F: 39% satisfied 11% want to be larger 50% want to be thinner Dissatisfaction by weight status: NW: 50% satisfied; 16% want to be larger; 34% want to be thinner. OW: 18% satisfied; 4% want to be larger; 78% want to be thinner. Obese: 4% satisfied; 96% want to be thinner. |
7 silhouettes developed by Collins [34] |
A significant association was found between obesity and body dissatisfaction: obese and OW adolescents were more dissatisfied with their BI (96% and 78%, respectively) and wished to be thinner. Of the NW group, only 49.8% were satisfied with their BI. Obesity and four or more days per week of sports activities (OR = 0.52; IC95%: 0.32–0.84) were associated with BID. Sports activity was the only variable acting as a preventive factor for BID. |
11 |
| Rinaldo et al., 2016 [42] -repeated measures (after 12 weeks of training)- |
Ferrara, Emilia-Romagna region, Italy | M: 36 soccer players |
Age category: 10 years (The authors had also examined another group in the age category of 9 years) |
Survey 1 Mean BMI: 19.4 ± 2.9 Weight status UW: 3% NW: 58% OW/obese: 39% Survey 2 Mean BMI: 19.6 ± 3.1 Weight status UW: 6% NW:56% OW/obese: 39% |
4 h/week of soccer (question about the amount of soccer training) |
Mean BID Survey 1: FID: 0.5 ± 1.1 Survey 2: FID: 0.2 ± 1.0 |
7 silhouettes developed by Collins [34] |
The 10-year-old soccer players showed greater anthropometric changes and lower BID after 12 weeks of training than the nine-year-old boys. Boys aged 10 reported a general improvement in BI satisfaction after the training. Association of BI or BID with BMI or weight status not assessed. |
11 |
| Shaban et al., 2016 [43] -cross-sectional- |
All six governorates in the State of Kuwait | F: 169 | 10–14 |
Weight status UW/NW: 39% OW: 17% Obese: 44% (Three BMI categories were constructed based on the percentiles: UW/NW: < 85th OW: 85th–94th Obese: ≥ 95th) |
Perceived PA (yes) by BMI UW/NW: 80% OW: 56% Obese: 64% (Perceived PA was measured with a single question, “Do you consider yourself to be physically active?” with the answer: yes or no) |
BI satisfaction by BMI UW/normal:68% OW: 30% Obese: 12% (Using 9 figures, the image was assigned to one of four categories: images 1, 2, and 3 = UW, images 4 and 5 = NW, images 6 and 7 = OW, and images 8 and 9 = obesity) |
9 silhouettes developed by Stunkard et al. [29] |
The level of engagement in perceived PA was not significantly associated with BID. In this study, 50% of the girls classified as obese (32%) regarded themselves as being NW. Obesity was not found to be associated with sedentary activities. | 9 |
| Michels and Amenyah, 2017 [44] -cross-sectional- |
Accra, Ghana Akan 46% Ga-Adangme 25% |
M + F: 370 (48% males) |
11–18 Mean 15.5 ± 1.8 |
Mean BMI z-score: 0.09 ± 1.20 Weight status UW: 5% NW: 76% OW/obese: 19% |
Mean MVPA 323.9 ±160.3 min/day (IPAQ to compute the total time for MVPA per day in a typical week) |
Mean discrepancy based on silhouettes −0.3 ± 1.2 Self-Report dissatisfaction Body too thin: 42% Body satisfactory: 40% Body too heavy: 18% |
9 silhouettes developed by Stunkard et al. [29] |
Dissatisfaction with body size and ideal body size was not correlated with PA levels in the Ghanaian population. Dissatisfaction with body size in Ghanaians concerned both “too thin” and “too heavy” bodies. | 12 |
| Robbins et al., 2017 [45] -cross-sectional study including secondary analysis of baseline data from a group-randomized controlled Trial- |
Midwestern U.S. Black: 50% White: 27% Hispanic: 14% |
F: 1519 | 10–15 Mean 12.05 ± 1.01 |
Weight status UW: 3% NW: 45% OW: 20% Obese: 32% (UW: BMI-P < 5th NW: 5th to < 85th BMI-P OW: 85th to < 95th BMI-P Obese: ≥ 95th BMI-P) |
PA (min/h) by accelerometer sedentary activity: 39.78 ± 18.30 light PA: 17.84 ± 3.58 moderate PA: 2.09 ± 0.80 vigorous PA:0.74 ± 0.53 Self-reported PA participated in the recommended 60 min of MVPA for 7 days: 9%. engaged in at least 60 min MVPA for 7 days: 7% (accelerometer and self-reported questionnaire to assess PA. Accelerometer cut-points: sedentary activity ≤ 25 counts/15 s; light PA 26–573 counts/15 s; moderate PA 574–1002 counts/15 s, and vigorous PA ≥ 1003 counts/15 s) |
Mean BID 1.10 ± 1.48 (range: from −5 to +7) About 42% had an absolute discrepancy score >1. BID/weight status UW: 0.61 ± 1.99 NW: 0.35 ± 1.30 OW: 1.37 ± 1.07 Obese: 2.04 ± 1.28 Ideal vs. current figure Larger: 11% Similar: 22% Smaller: 67% 72% of white girls vs. 64% of black girls desired a smaller body image (BID: current/actual—ideal rating. Scores range between − 8 and − 1 for girls who want a larger figure and between 1 and 8 for those who prefer a thinner one) |
9 silhouettes developed by Thompson and Gray [37] |
Black girls experienced less BID than white girls. In general, higher BMI values are associated with lower body satisfaction, more negative body image, and a greater discrepancy between current and ideal BI. Negative correlations with BID were very low for MV, indicating that PA had an indirect effect on BID. | 10 |
| Min et al., 2018 [46] -longitudinal: a long-term prospective open-cohort study from the China Health National Survey 2000–2011- (We considered only the cross-sectional study of adolescents surveyed in 2011) |
China | M: 787 F: 749 M + F: 1536 |
12–17 (the authors had also examined another age group in the range 6–11). |
Weight status M UW: 17.3% NW: 62.8% OW: 19.9% F UW: 22.6% NW: 63.8% OW: 13.6% Self-rated BI/actual weight status M Consistent: 40% Underestimates: 54% Overestimates: 5% F Consistent: 45% Underestimates: 49% Overestimates: 6% |
Mean values not reported. (MVPA assessed as min/day spent on six specific sports activities) |
Self-rated BI M Thin: 56% Average: 41% Fat: 3% F Thin: 58% Average: 41% Fat: 1% Desired BI M Thin: 41% Average: 59% Fat: 0.4% F Thin: 52% Average: 47% Fat: 0% Discrepancy between self vs. desired BI M: 65% Consistent; 12% Need to lose weight; 24% Need to gain weight. F: 70% Consistent; 13% Need to lose weight; 17% Need to gain weight. (For adolescents’ self-ratings, the silhouettes were grouped into three levels: thin (silhouettes 1–3), average (silhouettes 4–6), and fat (silhouettes 7–9).) |
9 silhouettes Matching Task for adolescents aged 12–17 (given by the authors in appendix 1 of their article) |
Most of the adolescents perceived themselves as thin, and only 2% considered themselves fat. The least consistency between BI and actual weight (boys: 14%, girls: 5%) occurred in OW adolescents, while UW had the greatest consistency (boys: 72%, girls: 76%). Boys were more likely to desire an average body than girls, which preferred thinner bodies, regardless of their weight status. Boys and girls who needed weight loss were more likely to try dieting and less likely to feel they had enough/lots of PA than others. The discrepancy between BI and desired BI results in significant differences in weight control efforts and insufficient PA awareness in Chinese children. Associations between BI and health behaviors and risk of obesity were found. | 11 |
| Miranda et al., 2018 [47] -cross-sectional- |
Viçosa, Minas Gerais, Brazil | F: 120 | 14–19 Mean 16.5 ± 1.5 |
Weight status: NW:78% OW/obese: 21% Body satisfaction/weight status Eutrophic/low weight: 49% satisfied; 31% dissatisfied. OW/obese: 4% satisfied; 16% dissatisfied. |
PA level Sedentary/Low PA: 84% Active: 14% Very active: 1% Body satisfaction vs. PA: Active/very active: 4% satisfied; 12% dissatisfied. Sedentary/low PA: 50% satisfied; 34% dissatisfied. (the 24-hour Physical Activity Recall (24 h-PAR)) |
BID Satisfied: 50% Dissatisfied: 50% (29% wishing for a slimmer silhouette and 20% for a thicker silhouette). Body distortion: 51% (26% seeing as bigger; 26% seeing as smaller) (Body satisfaction was present when variation between current and ideal figures was between −1 and +1. When the difference was > +1: desire for a bigger silhouette. When the difference was < −1: desire for a smaller silhouette. Body distortion = difference between the BMI of the silhouette chosen as current and the actual measured BMI) |
15 silhouettes developed by Kakeshita et al. [48] for the adult and validated by Laus et al. [49] |
Nearly half of the sample showed dissatisfaction with their weight and BI. Physically active adolescents had higher BID in comparison with sedentary or inactive girls. Body composition measures (including BMI), along with sedentary behavior and PA level, were found to be correlated with BID in adolescent girls. | 13 |
| Fernández-Bustos et al., 2019 [50] -cross-sectional- |
La Roda, Spain | M: 284 F: 350 M + F: 634 |
12–17 Mean 14.57 ± 1.51 |
Mean BMI M: 22.36 ± 3.93 F: 21.81 ± 3.64 M + F: 22.05 ± 3.78 Weight status M UW: 3% NW: 59% OW: 28% Obese: 9% F UW: 5% NW: 67% OW: 23% Obese: 5% M + F UW: 4% NW: 64% OW: 25% Obese: 7% |
MVPA (min/week) M 281.5 ± 203.2 F 90.5 ± 137.1 M + F 176.0 ± 194.6 PA practice M: 24% inactive; 27% MVPA < 60 min/day; 50% MVPA ≥ 60 min/day. F: 63% inactive; 28% MVPA <60 min/day; 9% MVPA ≥60 min/day. PA type M: 59% non-aesthetic/non-lean; 27% non-aesthetic/lean; 14% aesthetic/lean. F: 36% non-aesthetic/non-lean; 18% non-aesthetic/lean; 46% aesthetic/lean. (IPAQ-SF) |
Mean BID M DDPB: 0.60 ± 2.21 F DDPB: 2.21 ± 2.61 M + F DDPB: 1.49 ± 2.56 (DDPB = Discrepancy Desired—Perceived Body. It is based on: central figure = 0; negative values to figures to its left; positive values to figures to its right.) |
13 silhouettes developed by Gardner et al. [51] adapted for Spanish by Rodríguez et al. [52] |
Sex and BMI are crucial variables for BID in adolescents and PA type was a determinant variable for BI perception for both genders, regardless of BMI. Males showed lower levels of dissatisfaction. The boys showed that MVPA was moderately associated with higher BID and PA participation and organization. In girls, BI concerns were significantly lower among those who practiced non-aesthetic/light sports than among those who practiced aesthetic/light PA or were inactive. The study showed that BID does not depend on the organization or level of competition but on the type of PA practice. | 11 |
| Zaccagni et al., 2019 [53] -cross-sectional- |
Emilia-Romagna region, Italy |
F CRG: 36 CG: 71 (an examined group of younger non-competitive gymnasts was not reported) |
Mean 10.7 ± 1.6 |
Mean BMI CRG: 16.9 ± 1.8 CG: 11.4 ± 0.3 (CRG: competitive rhythmic gymnasts CG: control group) |
13.1 ± 4.9 h/week of training (question about the amount of weekly training for gymnasts) |
Mean BID CRG: FID: 0.4 ± 0.9 FIDSport: 1.1± 1.1 CRG: 45% satisfied (FID = 0); 45% want to be thinner (FID > 0);10% want to be larger (FID < 0). CG 40% satisfied (FID = 0); 50% want to be thinner (FID > 0); 10% want to be larger (FID < 0). (FIDSport: feel figure—ideal figure in the sport) |
7 silhouettes developed by Collins [34] |
Both female athletes and nonathletes desired to have a leaner BI. The ideal BI of competitive girls in gymnastics was found to be thinner, confirming that the ideal figure in sports does not coincide with the ideal figure in daily life. In aesthetic sports, such as rhythmic gymnastics, it is important to assess the “sport” body image dissatisfaction rather than general BID. The practice of rhythmic gymnastics and BMI were negatively correlated with the general ideal figure. | 11 |
| Boraita et al., 2020 [54]; Boraita et al., 2022 [55] -cross-sectional- |
La Rioja, Spain | M: 383 F: 378 M + F:761 |
12–17 Mean 14.51 ± 1.63 |
Mean BMI M: 21.01 ± 3.26 F: 21.02 ± 3.26 Weight status M NW: 72% OW: 20% Obese: 9% F NW:76% OW: 19% Obese: 5% |
Mean PA score M: 2.74 ±0.61 F: 2.46 ± 0.59 PA tertiles by weight status: Low tertile PA: NW 31% OW/obesity 40% Medium tertile PA: NW 35%; OW/obesity 28% High tertile PA: NW 33% OW/obesity 31% (PAQ-A) |
Desire for BMI change M –a lower BMI: 36% –a higher BMI: 23% F –a lower BMI: 50% –a higher BMI: 12% Dissatisfaction vs. PA M + F Low PA dissatisfied: 38%; satisfied: 27%. Medium PA dissatisfied: 33%; satisfied:34%. High PA dissatisfied: 29%; satisfied: 39% |
9 silhouettes developed by Stunkard and Stellar [32] adapted by Marrodàn et al. [56] |
Low engagement in PA was found to be predicted by higher age, female sex, lower to middle SES, environments unfavorable to PA, non-practice of extracurricular sports, and BID. Lower levels of PA were found in students with OW/obesity and dissatisfaction with their BI. In the general sample, no significant correlation was found between PA level and BID in both genders. |
13 16 |
| Tebar et al., 2020 [57] -cross-sectional- |
Presidente Prudente, Brazil | M: 482 F: 592 M + F: 1074 |
10–17 Mean M: 12.9 ± 2.4 F: 13.4 ± 2.3 M + F: 13.1 ± 3.5 |
Mean BMI M: 20.3 ± 4.3 F: 20.5 ± 4.3 |
PA score M: 9.5 ± 2.7 F: 8.8 ± 2.8 (PA was assessed by the Baecke questionnaire. The sum of the scores of three domains indicates the total score of habitual PA with a range from 3 to 15) |
BMI vs. BID Satisfied: 18.7 ± 2.7 kg/m2 Desire to increase: 18.0 ± 3.2 kg/m2 Desire to decrease: 22.5 ± 4.3 kg/m2 PA score vs. BID Satisfied: 9.3 ± 2.7 Desire to increase: 8.9 ± 2.6 Desire to decrease: 9.1 ± 2.7 Dissatisfaction with OW/obesity Satisfied: 13% Desire to increase: 7% Desire to decrease: 47% (BID: difference between the perceived and desired silhouette) |
11 silhouettes developed for children by Kakeshita et al. for the Brazilian Silhouettes’ Scale [48] |
Dissatisfaction with body size was found in 77% of the sample. No significant sex differences were observed in BID. No association between specific PA domains (school, sports, and leisure) and dissatisfaction with body size was found. BID is considered a self-perceived obstacle to PA. Dissatisfaction with body size has been associated with OW, unhealthy eating patterns, and lower levels of PA in Brazilian adolescents. |
15 |
| Miranda et al., 2021 [58] -cross-sectional |
Viçosa, Minas Gerais, Brazil | F: 405 | 14–19 Mean 15.92 ± 1.27 |
Mean BMI = 21.73 |
PA level Inactive: 83% MVPA < 60 min/day: 41.5% (Digiwalker SW 200 Pedometer in a 24 h period. A cut-off value of 11,700 steps to distinguish an active or inactive behavior. The 24 h PA Recall complemented this evaluation) |
BID evaluation Dissatisfied: 51% Body distortion: 53% (Body satisfaction was assessed by the difference between ideal and current silhouettes: satisfaction when the difference is between –1 and +1. Body distortion = difference between the BMI of the silhouette chosen as current and the actual measured BMI) |
15 silhouettes validated by Laus et al. [49] (Although unspecified, these were probably the silhouettes developed by Kakeshita et al. [48] for the adults) |
More than half of the participants were dissatisfied and had a distortion of their BI. Girls with an “inactive and sedentary” latent lifestyle were 1.71 times more likely to feel dissatisfied than those with an active and sedentary or inactive and non-sedentary lifestyle. BI disorders were associated with a decreased amount of MVPA. | 13 |
| Niswah et al., 2021 [59] -cross-sectional- |
Klaten and Lombok Barat districts, Indonesia | M: 1077 F: 1067 |
12–18 |
Nutritional status M Stunting: 19% Thinness: 10% OW/obese: 14% F Stunting: 23% Thinness: 4% OW/obese: 11% (Indicators: Stunting = height-for-age z-score < −2SD thinness = BMI for age z-score < −2 OW/obesity = BMI for age z-score >1 according to 2007 WHO growth |
Compliance with daily recommendations for PA M: 37% F: 35% (PA recommendation (WHO): 12–17 years: at least 60 min of MVPA daily) (7-day activities frequency table to assess the number of days of activity performed and the average duration of the performance of each activity) |
BI perception M Thin: 59% NW: 28% OW/obese: 13% F Thin: 60% NW: 27% OW/obese: 13% BI perception/nutritional status M Thin status: 94% perceived thin; 5% NW; 1% OW/obese. OW/obese status: 6% perceived thin; 24% NW; 70% OW/obese. F Thin status: 92% perceived thin; 7% NW; 1% OW/obese. OW/obese status: 8% perceived thin; 25% NW; 67% OW/obese. |
9 silhouettes from the Figure Ranking Scale (Although unspecified, these are probably the silhouettes developed by Stunkard et al. [29]) |
In Indonesia 1 in 4 adolescents felt pressured to achieve the IBI indicated as thin for girls and muscular for boys. More girls than boys were dissatisfied with their body size and shape and more boys than girls felt neutral or satisfied with their BI. More OW/obese adolescents were reported to be dissatisfied with their BI than their thin counterparts. Despite strong weight-loss intentions, OW adolescent girls who perceived themselves as such did not enhance their eating or PA behaviors. Perceived BI was associated with eating and PA behaviors only in OW/obese girls but not in boys. | 12 |
| Sanchez-Miguel et al., 2021 [60] -cross-sectional- |
Spain | M: 1127 F: 899 M + F: 2026 |
12–14 Mean M: 13.13 ± 0.92 F: 13.06 ± 0.86 |
Mean BMI M: 21.12 ± 3.84 F: 21.06 ± 3.70 M + F: 21.07 ± 3.68 |
PA score M: 2.30± 0.50 F: 2.12 ± 0.47 M + F: 2.21 ± 0.50 (Spanish version of the Physical Activity Questionnaire [61] for Adolescents (PAQ-A)) |
Mean BID M: 2.52 ± 14.80 F: 3.22 ± 14.03 M + F: 2.78 ± 14.38 |
4 figures neutral as to sex, age, and race from the Spanish version of the BIDA questionnaire [62] |
PA was negatively associated with BMI and BID; BMI and BID were positively associated. PA was significantly associated with BID among OW/obese adolescents. No sex differences were found in BID among boys and girls who were OW/obese, and sex-per PA interaction was not significant among these weight status categories. Adolescents, particularly NW boys, with higher levels of PA are less likely to be dissatisfied with their BI. |
14 |
| Toselli et al., 2021 [63] –longitudinal- (survey after one year and after 2 years) |
Emilia-Romagna region, Italy |
M:64 F: 70 M + F: 134 |
Mean Survey 1 M:11.8 ± 0.3 F: 11.9 ± 0.3 |
Mean BMI M Survey 1:19.53 ± 2.89 Survey 2:19.75 ± 2.61 Survey 3:20.29 ± 2.52 F Survey 1 18.85 ± 2.44 Survey 2 19.59 ± 2.46 Survey 3: 20.75 ± 2.65 Weight status M Survey 1: NW: 69%; OW: 27%; Obese: 5%. Survey 2: NW: 76%; OW:24%. Survey 3: NW: 78%; OW:22%. F Survey 1: UW: 1%; NW: 82%; OW:18%; Obese: 1%. Survey 2: UW:1%; NW:86%;OW:13%. Survey 3: NW: 83%; OW:17%. |
Sports practice M Survey 1: 92% Survey 2: 92% Survey 3: 90% F Survey 1: 90% Survey 2: 87% Survey 3: 90% Amount of sports practice (h/week) M Survey 1: 3.74 ± 1.52 Survey 2: 4.53 ± 2.23 Survey 3: 4.85 ± 1.98 F Survey 1: 3.53 ± 2.45 Survey 2: 4.22 ± 2.72 Survey 3: 4.06 ± 2.53 (PA was assessed by questions on sports practice (yes, no) and amount (h/week)) |
Mean BID (FID) M Survey 1: 0.27 ± 1.45 Survey 2: 0.22 ± 0.96 Survey 3: 0.05 ± 0.79 F Survey 1: 0.54 ± 1.26 Survey 2: 0.54 ± 0.79 Survey 3: 0.54 ± 0.88 |
9 silhouettes from the Body Silhouette Chart (Sanchez-Villegas et al.) [64] |
Associations of BI perception with BMI and sex were found. The girls showed a lower incidence of OW and obesity than boys, but girls had a higher dissatisfaction than males. Dissatisfaction and overestimation of one’s weight status increase as BMI increases to a greater extent in females than in males. Association of BI or BID with PA not assessed. |
14 |
| Vaquero-Solis et al., 2021 [65] Sanchez-Miguel et al., 2020 [66] -cross-sectional- |
Spain | M:150 F:153 M + F: 303 |
10–13 Mean 11.74± 0.86 |
Mean BMI M: 18.83 ± 3.27 F: 18.52 ± 2.73 M + F: 18.60 ± 3.00 |
PA score M + F 3.20 ± 0.67 (PAQ-A) |
Mean BID (FID) M: 0.54 ± 1.31 F: 0.51 ± 0.95 M + F: 0.52 ± 1.14 |
9 silhouettes developed by Stunkard et al. [29] |
Significant positive relationships were shown between BMI and BID. Moreover, significant negative relationships were found between BMI and PA. Association of BI or BID with PA not assessed. |
9 10 |
| Lai et al., 2022 [67] -cross-sectional- |
Seremban, Negeri Sembilan, Malaysia Malay 83% |
M:1011 F: 1210 |
12–18 |
Mean BMI 21.17 ± 5.33 Nutritional status M Severe thinness: 2% Thinness: 7% NW:58% OW:16% Obese:17% F Severe thinness: 1% Thinness: 3% NW:64% OW:18% Obese:13% |
PA level M Low: 48% Moderate/high: 52%. F Low: 65%. Moderate/high: 35%. M + F Low: 57% Moderate/high: 43%, (PAQ-C) |
Mean BID M DS: 0.18 ± 1.20 F DS: 0.71 ± 1.35 M + F DS: 0.46 ± 1.31 (Discrepancy score (DS) in body size satisfaction = current − ideal) |
9 silhouettes developed by Thompson and Gray [37] |
OW and obese participants had significantly higher body discrepancy scores than their NW or thin counterparts. A third of the OW/obese participants underestimated their weight status, more than one-third were unaware that they were OW, and 83% of OW/obese perceived themselves to be smaller. Low levels of PA and body dissatisfaction were significant predictors of OW and obesity. | 13 |
| Leppänen et al., 2022 [68] -cross-sectional- |
Helsinki, Turku, Espoo, Oulu, Jyväskylä, Tampere, Kuopio, Finland |
M: 4980 F: 5516 M + F: 10,496 |
9–12 Mean M: 11.2 ± 0.84 F: 11.1 ± 0.85 |
Nutritional status M Thin: 9% NW: 75% OW/obese: 15% F Thin: 13% NW: 72% OW/obese: 15% |
PA level M Low: 32% Moderate: 30% High: 38% F Low: 41% Moderate: 31% High: 27% (Based on a questionnaire: PA ≤ 5 h/week (low level); PA = 6–8 h/week (moderate level); PA ≥ 9 h/week (high level).) |
BID categories M -wishing for a smaller body: 27% -satisfied: 63% -wishing for a bigger body: 10% F -wishing for a smaller body: 32% -satisfied: 59% -wishing for a bigger body: 9% (Three groups based on the difference between the wanted and current BI (wishing for a smaller body, satisfied, wishing for a bigger body)) |
7 silhouettes developed by Collins [34] |
BI was associated with both BMI and PA. Girls had higher odds of wishing for a different body in comparison with boys. Having an NW or a high level of PA was associated with higher BI satisfaction. Adolescents with low and moderate PA levels had lower odds of wishing for a bigger body than adolescents with high PA levels. PA level modified the associations between BMI and BI, especially in thin adolescents and more in girls than in boys. | 14 |
| Song et al., 2022 [69] -cross-sectional from the China Health National Survey 2015- |
China from rural (34%) and urban (66%) areas | M: 729 F: 640 M + F: 1369 |
6–17 Mean M: 10.38 ± 3.18 F: 10.37 ± 3.06 M + F: 10.37± 3.12 |
Mean BMI M: 18.08 ± 3.39 F: 17.61 ± 3.20 M + F: 17.86 ± 3.31 Weight status M: UW: 7% NW: 64% OW/obese:29% F UW:9% NW: 66% OW/obese:20% Actual vs. self-perceptive weight status M UW: 42% perceived UW; 53% perceived NW; 2% perceived OW/obese. NW: 17% perceived UW; 78% perceived NW; 5% perceived OW/obese. OW/obese: 7% perceived UW; 61% perceived NW; 32% perceived OW/obese. F UW: 43% perceived UW; 55% perceived NW; 2% perceived OW/obese. NW: 14% perceived UW; 76% perceived NW; 9% perceived OW/obese. OW/obese: 8% perceived UW; 71% perceived NW; 21% perceived OW/obese. |
PA practice M No: 59% Regular: 40% F No: 63% Regular: 36% M + F No: 61% Regular: 38% (Information on PA (no, regularly) through CHNS (2015) questionnaires) |
BID M Satisfied: 40% Desire to be heavier: 36% Desire to be thinner: 23% F Satisfied: 41% Desire to be heavier: 33% Desire to be thinner: 26% (BID= present body FRS score—ideal body FRS score. Desire to be thinner: BID score ≥ 1; desire to be heavier: BID score ≤ −1; satisfaction: BID score = 0.) |
9 silhouettes developed by Stunkard et al. [29] |
About two-fifths of the total sample had a misperception of their weight status, and more than half of the total sample was dissatisfied with their BI. Boys tend to underestimate their weight status, while girls are more likely to overestimate it. In particular, females would be more sensitive to their weight status and BI due to external and internal pressures than males. Only the association between body perception and behaviors of dietary weight management was assessed. | 14 |
Note: M: males; F: females; MVPA: moderate/vigorous physical activity; UW: underweight; NW: normal weight or healthy weight; OW: overweight; BI= body image; IBI: ideal body image; BID: body image dissatisfaction; FRS: figure rating scale; FID: feel minus ideal discrepancy. Underlined and italicized text indicates data calculated by us.