Body Image and its Relation with Body Mass Index among Indian Adolescents

"Change needs to start at home": A reflexive thematic analysis of girl athletes' and coaches' experiences of body image in New Delhi, India

Despite the physical, psychological, and social health benefits of sport participation, multiple barriers keep girls and women on the margins of sport in India. Further, body image concerns are implicated globally as a hindrance to sports engagement among adolescents but are rarely acknowledged in India. Due to a lack of research, the unique restrictions to sport participation faced by girls in India are yet to be understood. Drawing on the Sociocultural Theory of Body Image, this study explored the intersection of body image and sports from the perspectives of Indian athletes and coaches. Twelve athletes (girls aged 11-17 years; football n = 6, netball n = 6) and six coaches (football n = 3, netball n = 3) from New Delhi, India, participated in semi-structured focus groups. Reflexive thematic analysis was used and we formulated three themes: 1) "To Do What We Love, We Must Struggle"; 2) "What Will People Say?"; and 3) "Hold On To Your Power, Be You". The themes provide a nuanced understanding of the experiences of athletes and coaches on and off the playing field. The findings shed light on several individual and systemic factors, such as harassment, societal norms, feelings of empowerment, and internalising appearance ideals, that impact girls' engagement with sport in New Delhi, India. Methods to improve sports engagement, discrepancies between athlete and coach perspectives, and recommendations for sports organisations to combat body image concerns and improve sports uptake among girls in an Indian setting are discussed.

How do adolescents perceive body image and respond to body dissatisfaction?

OBJECTIVES

To assess adolescents' attitudes, satisfaction, and practices regarding their body image across body mass index (BMI) categories.

METHODS

In this cross-sectional survey (2019-2020), we recorded anthropometry of 2,089 girls and boys between 13 and 17 years from semi-urban schools in western India. Multidimensional Body-Self Relations Questionnaire (MBSRQ) was used for multidimensional attitudinal assessment of body image and weight-related variables. The Stunkard scale was used to assess body shape perception.

RESULTS

In higher age categories, boys were more satisfied with their appearance (p=0.012, p linearity=0.001), cared more about grooming (p=0.007, p linearity=0.001), and regarded themselves more physically fit (p=0.003, p linearity 0.030 up to 16 years). Boys with normal BMI were more satisfied with their appearance (p=0.001), fitness (p=0.024), and more alert about symptoms of illness (p<0.000) than others. With increasing BMI, older girls and boys were more preoccupied with their weight and perceived themselves to be heavier (p=0.001). A majority of underweight girls perceived their weight as normal. Students engaged in weight loss practices irrespective of their BMI category. Boys wanted a bigger, and girls a smaller body shape than their current shape. We found body shape dissatisfaction in 66.4 % adolescents, more in boys than in girls (p=0.001).

CONCLUSIONS

Body shape dissatisfaction is quite common among semiurban adolescents, with boys outnumbering girls. BMI, age, and sex are associated with weight perception and attitude toward body image. Unindicated weight loss practices are prevalent.

Adaptation and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) for use in english among adolescents in urban India

Body image concerns are a global issue among adolescents, including in India. These concerns can prevent adolescents from engaging in everyday life activities, impeding social and academic development. However, at present, there are no psychometrically valid measures to assess such impact in the Indian context. This study culturally adapted and validated the Body Image Life Disengagement Questionnaire (BILD-Q) for use in English among adolescents in urban India. A total of 1427 adolescents completed an adapted version of the BILD-Q along with additional measures pertaining to body image. Exploratory factor analysis identified one dimension of body image life disengagement, which provided the best fit. The 9-item one-factor model was further supported by confirmatory factor analysis. The scale demonstrated good internal consistency and test re-test reliability. Further analysis demonstrated that the scale can be used to compare scores between boys and girls without measurement bias. This study presents a culturally adapted version of the BILD-Q, which can be used as a valid and reliable measure to assess the impact of body image concerns on life disengagement among English-speaking adolescents in urban India.

Body image perception, eating disorder behavior, self-esteem and quality of life: a cross-sectional study among female medical students

BACKGROUND

Eating disorders are strongly associated with body image concerns. Eating disorders tend to significantly impact the current and future health and quality of life of affected persons, their caregivers, and society. As body image is based on a social construct of ideal body image, it is essential to evaluate it in its cultural context.

METHODS

The current study explored the relationship among body image perception, perceived stress, eating disorder behaviour and quality of life among female medical students (n = 777). Measurements included Body Shape Questionnaire, Body Image Quality of Life Inventory, Eating Attitudes Test-26 and Rosenberg Self-Esteem Scale. Multivariate analysis was conducted.

RESULTS

There was a significant correlation between eating disorder behaviour and perceived body shape, body image, quality of life and self-esteem among our study participants. We also found eating disorder status was significantly associated with BMI, perceived body shape, quality of life and self-esteem.

CONCLUSIONS

This is of clinical implication to female medical students and healthcare professionals to engage early in primary and secondary prevention of eating pathologies. Increasing awareness of these facts among female students can help identify at-risk students and help them seek timely medical help.

Adaptation and Validation of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) for Use in English among Adolescents in Urban India

Eating pathology is increasingly common among Indian adolescents. However, brief validated measures of disordered eating in Indian contexts are scarce. This study adapted and validated a culturally appropriate English language version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) among 385 adolescents (mean age = 13.42 years; 47.3% girls) in urban India. Confirmatory factor analysis indicated that a two-factor eight-item solution had an acceptable fit to the data across gender: an 'Eating Concerns and Restraint' subscale and a 'Weight and Shape Concerns' subscale. Further, the questionnaire can be utilised as both a unidimensional and multidimensional tool. This allows for the computation of a total score on the primary factor of 'Child Eating Pathology', as well as the two subscales. Internal consistency of the 'Weight and Shape Concerns' subscale (α = 0.825) and 'Eating Concerns and Restraint' subscale (α = 0.649) was satisfactory. Concurrent validity was established through medium significant correlations with measures of body image and broader mental health. The results support the use of the ChEDE-Q for assessing disordered eating among urban Indian adolescents, thus providing the research community and practitioners with a measure to investigate the nature and scale of disordered eating among adolescents in India.

Evaluating a body image school-based intervention in India: A randomized controlled trial

Body dissatisfaction is highly prevalent among adolescents in low- and middle- income countries, including in India. However, evidence-based interventions are lacking. This study evaluated the efficacy of a school-based mixed-gender body image intervention among adolescents in India. A randomized controlled trial was conducted among 568 (43 % girls) Year 7 students (aged 11-14; 94 % aged 12-13) in six schools in Delhi. Each school was randomly allocated to receive five 45-minute intervention sessions delivered by trained psychologists or a wait-list control condition. The primary outcome of body image and related secondary outcomes were assessed at pre-intervention, post-intervention, and 3-month follow-up. Intention-to-treat linear mixed models analyses showed improvements in body image relative to the control group at post-intervention and 3-month follow-up. Significant improvements were identified at post-intervention for internalization, life disengagement, disordered eating, self-esteem, and negative affect, with effects maintained in nearly all outcomes (girls only - internalization, boys only - life disengagement) at 3-month follow-up. This study presents the first mixed-gender school-based body image intervention in India, which was efficacious in improving urban adolescents' body image, disordered eating, and related outcomes.

Confirmatory factor analysis and psychometric properties of the Persian version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) in women with polycystic ovary syndrome

PURPOSE

Body image is a multidimensional and complex psychological construct. Since the Multidimensional Body Self-Relation Questionnaire-Appearance Scale (MBSRQ-AS) is a questionnaire that measures body image as a multidimensional construct. This study aimed to translate and evaluate the psychometric properties of the Persian version of MBSRQ-AS.

METHODS

This methodological study was conducted on 251 women with polycystic ovary syndrome referring to polyclinics of hospitals that were covered by Iran University of Medical Sciences, with age ranging from 18 to 46 years old (M = 27.35; SD = 6.32). The mean body mass index (BMI) was 25.59 kg/m² (SD = 4.9). A forward-backward translation procedure was applied. Then face and content validity was inducted.

RESULTS

Face and content validity of the Persian MBSRQ-AS was established. Confirmatory factor analyses showed good fit indices for the five-factor structure (appearance evaluation, appearance orientation, body areas satisfaction, overweight preoccupation, and self-classified weight). The internal consistency (Cronbach's alpha ranged from 0.71 to 0.85) and test-retest reliability by calculating the intraclass correlation coefficient ranged from 0.75 to 0.91 was adequate.

CONCLUSION

This study confirms the factor structure of the MBSRQ-AS. The Persian version of MBSRQ-AS has acceptable psychometric properties.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Adaptation and validation of the Internalisation-General subscale of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) in English among urban Indian adolescents

Few studies have validated body image related measures in Asian countries, including in India, thus stunting research progress. To provide a robust method of assessing internalisation of cultural appearance ideals, the purpose of this study was to validate a culturally appropriate English version of the Internalisation-General subscale from the Sociocultural Attitudes Towards Attitudes Questionnaire-3 among a school sample of 1,432 urban Indian adolescents (Mage = 12.9 years; 44 % girls). Exploratory factor analyses revealed a one-factor solution for both girls and boys. Analyses indicated a six-item scale for girls and a four-item scale for boys; both of which were verified by confirmatory factor analysis. Cronbach's alpha was high for both female (.88) and male scales (.87), and convergent validity was confirmed via significant correlations with measures of body esteem and disordered eating. Using the items which were common in both the male and female versions of the scale, confirmatory factor analysis supported a psychometrically sound model that was gender invariant, and thus can be used to assess and compare both genders. Overall, results support the reliability and validity of the Internalisation-General subscale among English-speaking urban Indian adolescents.

The Relationship between Body Appreciation and Self-Esteem and Associated Factors among Omani University Students: An Online Cross-Sectional Survey

BACKGROUND

Given the rapid pace of globalization and the fact that the Sultanate of Oman is experiencing a significant impact of social media on specifying appearance norms among youth in the country, research into positive body images and self-esteem among young individuals has become a national priority. Whilst body image has been well studied across cultures, both positive body image and the relationship between positive body image and self-esteem among Omani youth have been neglected. The aim of the study was to investigate the relationship between positive body image and self-esteem and associated sociodemographic factors among Omani university students based on gender.

METHODS

This cross-sectional study used an online survey consisting of the two questionnaires that are Body Appreciation Scale-2 and Rosenberg's Self-Esteem Scale. A total of 237 students were recruited from Sultan Qaboos University's different colleges.

RESULTS

The results indicated that positive body image has a significant relationship with an individual's self-esteem (β = 0.122, t = 2.197, p=0.038), Cumulative Grade Point Average (cGPA) (β = 0.140, t = 2.306, p=0.022), body mass index (BMI) (β = -0.414, t = -6.930, p < 0.001), monthly household income (β = -0.129, t = 2.467, p=0.029), and the number of social media accounts (≥2, β = -0.132, t = -2.232, p=0.027). In addition, an individual's self-esteem was significantly associated with an individual's cGPA (β = 0.231, t = 3.592, p < 0.001) and mothers' educational level (β = -0.130, t = -2.065, p=0.040) besides body appreciation (β = 0.160, t = 2.491, p=0.013).

CONCLUSIONS

The findings of this study shed light on the current status of positive body image among university students of Oman. In light of the new knowledge, we propose health interventions that include strategies such as involvement of family, to maintain and/or promote positive body image perceptions among young individuals and subsequently promote healthy appreciation of the physical appearance and self-esteem.

Preoperative nutritional evaluation of patients with hepatic alveolar echinococcosis

OBJECTIVE

This study is aimed at determining the preoperative nutritional status of patients with hepatic alveolar echinococcosis (HAE), and subsequently establish a concise and reasonable nutritional evaluation indicator. The established evaluation method could be used for clinical preoperative risk assessment and prediction of post-operation recovery.

METHODS

The basic patient information on height, body weight, BMI and hepatic encephalopathy of 93 HAE patients were examined. Subsequently, abdominal ultrasonography, blood coagulation and liver function tests were done on the patients. Liver function was assessed using the Child-Pugh improved grading method while nutritional status was evaluated using the European Nutrition Risk Screening 2002 (NRS 2002) method. Additional parameters including hospitalization time, the hemoglobin (HGB) level on the 3rd day after the operation, and the number of postoperative complications of HAE patients were also recorded.

RESULTS

The NRS 2002 score was negatively correlated with body weight, body mass index (BMI)and albumin (ALB) (P<0.01), and positively correlated with the transverse and longitudinal diameters of the lesions (P<0.01). A worse grading of liver function was associated with a low ALB and a high NRS 2002 score (P<0.01). Results of the NRS 2002 score indicate that the hospitalization time of the normal nutrition group was significantly shorter than that of the malnourished group (P < 0.05). The HGB level of the control group on the 3rd day after the operation was significantly higher than that of the malnourished group (P < 0.05), and the number of postoperative complications was lower than that of malnutrition group (P < 0.05).

CONCLUSION

Malnutrition is common in HAE patients. The nutritional status of HAE patients is related to many clinical factors, such as Child-Pugh classification of liver function, size of the lesion, and ALB among others. Although both BMI and ALB can be used as primary screening indicators for malnutrition in HAE patients, NRS 2002 is more reliable and prudent in judging malnutrition in HAE patients. Therefore, BMI and ALB are more suitable for preoperative risk assessment and prediction of postoperative recovery.

Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research

PURPOSE OF REVIEW

Misperception of children's weight status is prevalent among parents and children themselves and may impact parents' and children's health behaviors. This study was conducted in order to provide a descriptive systematic review of research on factors influencing parents' and children's misperceptions of children's weight status published in the past 5 years.

RECENT FINDINGS

Factors studied most often in relation to parents' and children's misperception included children's weight status, gender, and age, as well as parents' weight status, parental education levels and socioeconomic status, and ethnicity. Most determinants that were found to have a significant influence on misperception in parents also did in children. The literature on misperception of children's weight status is extensive. Most determinants assessed in included studies were known determinants of childhood obesity. Further research should be directed toward better understanding the impact of weight status perception (whether it is accurate or not) on health behaviors and weight gain over time.

Dimensional structure, psychometric properties, and sex invariance of a Bahasa Malaysia (Malay) translation of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) in Malaysian Malay adults

The 34-item Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) is a widely-used measure of multidimensional body image. Here, we examined the psychometric properties of a Bahasa Malaysia (Malay) translation of the MBSRQ-AS. A sample of 629 Malaysian Malays (women n = 315) completed the MBSRQ-AS, as well as measures of body appreciation, psychological well-being, perceptions of appearance ideals, and internalisation of appearance ideals. Exploratory factor analysis indicated that the MBSRQ-AS items reduced to four dimensions, although one factor had less-than-adequate internal consistency. Omitting this factor resulted in a 23-item 3-factor solution, which we tested for fit using confirmatory factor analysis (CFA) alongside the parent 5-factor model. CFA indicated that both models had good fit on some indices, but less-than-ideal fit on other indices, with the 3-factor model showing comparatively better fit. Multi-group CFA indicated that it was not possible to achieve scalar invariance across sex, but internal consistency coefficients were adequate. Evidence of construct validity, as assessed through correlations between MBSRQ-AS scores and additional measures, was mixed. We discuss reasons that complicate interpretation of the dimensionality of MBSRQ-AS scores in this and previous studies, and call for further research on this issue.