International Journal of Health & Allied Sciences

: 2018  |  Volume : 7  |  Issue : 3  |  Page : 145--149

Comparison of body image perception and the actual BMI and correlation with self-esteem and mental health: A cross-sectional study among adolescents

Sudhir Prabhu1, Delma D'Cunha2,  
1 Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
2 Department of Intern, Father Muller Medical College, Mangalore, Karnataka, India

Correspondence Address:
Dr. Delma D'Cunha
Father Muller Medical College, Mangalore, Karnataka


INTRODUCTION: Body image perception refers to an individual's idea about his/her body. Dissatisfaction regarding body image may have a major impact on one's psychological well-being and may be a risk factor for eating disorders. This is generally seen to be more prevalent among growing individuals, namely, adolescents, and this study was conducted to assess the prevalence, find the underlying risk factors, and assess means to manage the conditions effectively to prevent an adverse impact on mental health and well-being. This study was aimed at estimating the prevalence of body image dissatisfaction among adolescents and to make a comparison of these findings among male and female adolescents, and also between the early, middle, and late teens. METHODOLOGY: A total of 309 adolescents (M = 128, F = 181; age range 10–19 years; and mean age = 15.2) were assessed using anthropometric measurements, Body Mass Index calculation, and body image perception questionnaire. This information was correlated with the self-esteem scores of these individuals using Rosenberg's Self-Esteem Questionnaire. RESULTS: Both males and females were found to be equally concerned about their appearance and body shape (51.46% and 48.53%, respectively). Among these, we found that the middle (14–16 years) and late teens (17–19 years) had higher scores of body image dissatisfaction compared to early teens (10–13 years). Majority (62.38%) of the early teens was unconcerned with their body shapes. Not only overweight but also even underweight adolescents had higher body shape dissatisfaction with 64.72% perceiving their body shape wrongly. Mental health and self-esteem scores were shown to have a positive correlation with body dissatisfaction indicating that those who were dissatisfied with their body were more likely to have lower self-esteem (p = 0.036). CONCLUSION: The present study found that majority of the adolescents has body dissatisfaction, which negatively affects their self-esteem.

How to cite this article:
Prabhu S, D'Cunha D. Comparison of body image perception and the actual BMI and correlation with self-esteem and mental health: A cross-sectional study among adolescents.Int J Health Allied Sci 2018;7:145-149

How to cite this URL:
Prabhu S, D'Cunha D. Comparison of body image perception and the actual BMI and correlation with self-esteem and mental health: A cross-sectional study among adolescents. Int J Health Allied Sci [serial online] 2018 [cited 2022 Aug 19 ];7:145-149
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Body image may be defined as a combination of the actual, perceived, and desired size of an individual. The onset of such thoughts begins somewhere in early to mid-teenage years and are commonly seen to affect or at least influence the lifestyle and eating patterns of adolescents. Improper diet, skipping of meals, and consumption of junk food (otherwise known as “empty calories”) lead to both micro- and macro-nutrient deficiencies. In addition, lack of physical activity and outdoor sports, sedentary lifestyles, and binge eating are likely factors contributing to obesity among adolescents.[1] Studies also show that meal types, constituents, and patterns are significantly associated with body dissatisfaction among adolescents.[2] Furthermore, adolescents who perceive themselves as overweight or obese, are also more likely to follow diets for weight reduction compared to those with normal weight.[3]

With strong influences from media, adolescents develop an obsession with their body image; with girls desiring a thin body frame, and guys desiring muscular physiques. In the race to get more attractive, youngsters resolve to unhealthy diets. Failure to reach satisfactory results may lead to depression and lowers the self-esteem in most cases.

All in all, studies that have analyzed body dissatisfaction among adolescents are mainly influenced and explained by pressure to be accepted by peers, pressure from family, and pressure from social media.[4]

Studies have found a positive correlation between body image dissatisfaction among adolescents and an adverse effect on peer relationships due to being subjected to bullying behavior. Adolescents dissatisfied with their bodies due to feeling overweight or obese are found to be more likely to become passive or reactive victims of bullying.[5]

This study was aimed at assessing the prevalence of body image satisfaction/dissatisfaction among adolescents and to evaluate the impact of body image dissatisfaction on mental health and self-esteem.


This study was a cross-sectional, community-based descriptive study. A total of 309 adolescents (10–19 years of age) of Dakshina Kannada district were included in the study. Adolescents belonging to the age group of 10–19 years were included in the study. Adolescents with preexisting structural or psychiatric disorders were excluded from the study. The purpose of this study was explained and written consent obtained from the participants before enrolling them in the study. Ethical clearance was obtained from the Institutional Ethics committee of Father Muller Institution, Mangalore.

A pretested and prevalidated questionnaire was used for obtaining sociodemographic details.

The nine-figure silhouette body image rating scale developed by Stunkard et al.[6] was used for assessing body image dissatisfaction. Silhouettes ranging from very thin to very obese were presented to the participants who were asked to choose two silhouettes; one which they perceived as closest to his/her body size and another silhouette representing his/her desired size. Discrepancies were noted and analyzed based on their Body Mass Index (BMI) values (weight in kg/height in meter).[2]

Rosenberg's self-esteem scale [7] was then used to assess self-esteem among these individuals and correlate the findings. The scale consists of 10 items, each measured on a four-point Likert scale ranging from “strongly disagree (1)” to “strongly agree (4)” for positive points and reverse scored from “strongly disagree (4)” to “strongly agree (1)” for negative points. Association of self-esteem and body satisfaction was done, with higher scores indicating higher self-esteem. Data were entered into Microsoft excel sheet and analyzed using SPSS 23 software (IBM Corp., Armonk, NY). Descriptive statistics such as frequency, percentages, and inferential statistics such as the Chi-square tests were used.


Anthropometric measurements of height and weight correlated positively with age among all 309 study participants [Table 1]. In boys, mean height of 131.5 cm and mean weight of 28 kg at 10 years to mean height of 181 cm and mean weight of 62 kg at 19 years.{Table 1}

Similarly, in girls, mean height of 133 cm and mean weight of 27.5 kg at 10 years to a mean height and weight of 160 cm and 53 kg at 19 years, respectively.

Majority of the adolescents 279 (90.2%), irrespective of BMI, or gender were concerned with their body shape as shown in [Table 2]. Among the age groups, the early teens (10–13 years) were the least concerned about their image compared to the older teens who formed a majority of the dissatisfied lot (78.66%).{Table 2}

The gender perception about body shape problems differed in that females preferred a thinner built and shape, whereas males desired a heavier and more muscular body.

Reasons cited for desiring a different body shape were mainly to look good (58.15%), to gain approval from the opposite sex (15.06%), to have more friends (14.22%) to be more popular (8.78%) and to be healthy (3.76%) as shown in [Table 2].

A total of 99 teens, i.e., nearly one-third (32%) of the study participants did not have a role model for body shape. Among those that did, males chose sportspersons as their role model, whereas females chose movie stars.

As shown in [Table 3], female adolescents negatively perceived themselves as being fatter, whereas most of the males positively perceived themselves as having a larger body frame. Contrastingly, females preferred a smaller size than their current body shape as ideal, but males chose a bigger frame as more attractive.{Table 3}

In spite of both males and females showing body dissatisfaction, the rates were higher among female adolescents as shown in [Table 3].

Among early teens, body dissatisfaction was found to be minimal. Both male and female adolescents seemed to be less concerned with their physical appearance with only 41 of 109 early teens (37.61%) expressing body dissatisfaction. Among these, a larger number (28 of 41, i.e., 68.29%) desired a larger frame which is a positive sign of healthy growth and development.

Among female adolescents between the ages of 14 and 16, equal numbers were found for those desiring a thinner image and those satisfied with their current shape (50% and 42.3%, respectively) with the remaining 7.69% desiring larger frames.

Among the male adolescents, majority (65.21%) desired a bigger, heavier frame.

The statistics for late teens showed clear-cut interests in that a majority of males (73.46%) wanted a heavier, more muscular physique, whereas females wanted thinner, more delicate body frames (67.9%).

With the increase in body dissatisfaction, self-esteem was found to show a significant decline, indicating that those who were dissatisfied with their body were more likely to have lower self-esteem (χ2 = 165.45, df = 2, P = 0.036) as shown in [Table 4].{Table 4}

As shown in [Table 5], among the 161 (52.1%) adolescents involved in outdoor sports or exercise, the average time spent on it daily was 2 h.{Table 5}

The study found that females resorted to dieting (26.5%) while males were more likely to involve themselves in physical activity (38.5%) to achieve their desired body shape as seen in [Table 6].{Table 6}


A study similar to ours by Duchesne et al.[8] evaluated the negative effect of body dissatisfaction on self-esteem in adolescents, which confirmed that a negative discernment of one's body leads to low self-esteem resulting in psychological distress. Another study by Murray et al.[9] investigated the relationship between body satisfaction and psychological constructs of self-esteem, depressive symptoms, and stress in adolescents. Results revealed a significant association between body dissatisfaction and higher levels of stress and lower self-esteem.

In a study using nine female silhouette figures, the associations between body image and BMI were assessed among female students of Kuwait. The results suggested that perceived body image and a desire to be thinner were strongly related to body image dissatisfaction.[10]

Chongwatpol and Gates [11] conducted a study to compare body dissatisfaction, dietary choices, exercise/physical activity, and weight-reduction practices among adolescents. The findings were similar to our study in that females were found to perceive a thinner figure as an ideal than their present figure while similar proportions of their male patients wanted either a thinner or a bigger figure, respectively. In their study, females reported using dietary restrictions and lesser physical activity for reduction, whereas males reported exercise and healthier food choices as their primary methods to reach their desired body shape, which is in agreement with our findings.

Our study found that female adolescents were more dissatisfied compared to their male counterparts. This finding was similar to a cross-sectional study carried out by Cheah et al.[12] to determine the presence of eating disorders and their relationship between BMI and body image dissatisfaction among adolescents in an urban setup. Their study had a higher percentage of obese males than females, and prevalence of eating disorders was found to be higher among males. In spite of this, females were reported as having a higher prevalence of body dissatisfaction compared to males. This is similar to another study conducted by Pinkasavage et al.,[13] where they found that comparison of one's body to other individuals perceived as more attractive is common among adolescents, especially women, and is responsible for body dissatisfaction and disordered eating.

In a similar study by MacNeill and Best [14] body image dissatisfaction and eating disorders were commonly seen in their female patients due to their “thin-ideal” belief which leads to discontent with their body shape. Their study found that even normal or underweight females tend to perceive themselves as overweight.

This may be explained by the fact that adolescents, especially females are exposed to media pressure to be thin, which leads to body dissatisfaction and disordered eating behaviors and unhealthy weight control behaviors than in males.[15]

Pelegrini et al.[16] in their study found that girls wished to reduce the size of their body silhouette, whereas boys wished to increase it. This is in agreement with the findings of our study.

In another study which analyzed body image in different periods of adolescence, the results showed that younger adolescents had higher dissatisfaction than their peers.[17] This was found to be in contrast to the findings of our study, where the younger adolescents were found to be least dissatisfied.

All in all, the findings of our study confirm that body dissatisfaction is particularly prevalent during adolescence and is linked to stress and lowered self-esteem in both females and males.

Although the research correlated body image perception with self-esteem, as a cross-sectional study, it failed to prove a causal link with the psychological health of our study patients. A longitudinal study would be better to find the association between the same and is prospective, it would also help identify the type of psychological comorbidity one is likely to be affected with. Adolescent clinics in hospitals and also adolescent reproductive and sexual health program running as Sneha clinics should also start focusing and addressing adolescent body image concerns and the psychological aspects associated with it which an adolescent can develop.


Depression and low self-esteem are found among a significant proportion of adolescents which may be responsible for various eating disorders, psychological problems, and could be a likely cause for poor performance in schools and colleges.

This study verifies this fact in an Indian rural as well as urban setup. The findings are intended to help bring to light the prevalence of such an issue, and how best to manage adolescents with body dissatisfaction and also to counsel those adolescents with depression or low self-esteem.

Proper regimens to carry out regular exercise and a healthy balanced diet, counseling and psychiatric guidance should be made available at schools and colleges to target this vulnerable population so that the ill influences of media and peer pressure can have a minimal negative impact on the growing mind.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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