Background
Although 32.0% of high school girls who completed the 2015 U.S. Youth Risk Behavior Survey were actually overweight or obese, 60.6% reported trying to lose weight [
1]. Consistent with this finding, Duchesne and colleagues [
2] noted that as high as 63.5% of adolescent girls experience poor body image. One factor contributing to poor body image is that girls learn from their families, friends, and other sources, such as the media, that thinness is desirable [
3]. Of concern is that girls’ negative perceptions of their body weight, shape, or size places them at high risk for low self-esteem, decreased self-worth, poor self-concept, and negative affect [
4] or an eating disorder [
5,
6]. In contrast, a positive body image may protect against the development of various mental health conditions, such as depression [
7].
Body image is widely referred to as the personal internal view or representation [
8] or self-evaluation of outer physical appearance [
9]. This multi-dimensional construct is often assessed by measures of body satisfaction or esteem and weight satisfaction [
9]. Body satisfaction is usually measured in adolescents by asking them to rate their level of satisfaction with aspects of their body, such as height, weight, shape, waist, build, face, and specific body parts [
5,
10‐
13]. Body esteem is relatively similar to body satisfaction, but reflects the level of agreement with positive versus negative aspects related to one’s body (e.g., being proud of one’s body) [
9]. Weight satisfaction, commonly referred to as body image discrepancy, is easily measured and defined as the difference between self-perceived current or actual and ideal body size [
9,
14,
15]. Body image discrepancy is identified as one possible reason underlying body dissatisfaction among adolescents [
14]. Because girls have more body image concerns than boys [
13], understanding factors uniquely related to girls’ body image discrepancy may be important for developing targeted interventions to address body-related issues and prevent adverse health-related sequelae in this population [
3,
16].
A few studies were found that examined relationships between demographic factors, such as socioeconomic status (SES) and body image. Some indicated that adolescents of higher SES had greater body image discrepancy than those of middle or lower SES [
17], whereas other noted that lower SES was related to greater body image discrepancy [
18] and more unhealthy weight control behaviors [
19]. In contrast, Story and colleagues [
20] reported that higher SES was related to greater weight satisfaction and lower unhealthy weight control behaviors. Others noted that higher SES was associated with eating disorders [
21] or showed no relationship between SES and disordered eating attitudes or behaviors [
22]. Interestingly, O’Dea [
23] found no differences between Australian adolescent girls of low and middle-high SES regarding body image; but, in a later study, O’Dea and Caputi [
24] noted girls of low SES were more likely to report being “too thin,” as compared to their middle-high SES counterparts [
24]. The ambiguous findings indicate a need for continued research.
Findings concerning race or ethnicity and body image were also equivocal. Some researchers noted no racial or ethnic differences in body dissatisfaction among girls [
18,
25]. In contrast, others found that Asian and Hispanic girls had the highest levels of body dissatisfaction with African American girls being less likely to express body dissatisfaction than White girls [
5,
10]. In another study, White 5th grade students had lower body image discrepancy than Latino 5th graders with neither group differing from African Americans who were in the same academic grade [
15,
26]. In addition, the 5th graders’ body image discrepancy was significantly and positively associated with their body mass index (BMI) [
26]. Due to the limited number of studies examining the relationship between BMI (especially when objectively measured) and body image in large samples [
27] of racially and ethnically diverse girls, consensus indicating that those who are overweight or obese experience greater body image discrepancy or satisfaction/dissatisfaction than those who have a healthy weight has not yet been reached [
28]. No studies were found that specifically examined the relationship between girls’ body image discrepancy or satisfaction/dissatisfaction and percent body fat.
Besides demographics, certain behaviors may be related to body image. Schneider and colleagues [
18] reported that more time spent watching television (TV) daily was related to a higher level of body dissatisfaction among adolescent girls, whereas Añez and colleagues [
29] found no association. Interestingly, in the latter study, adolescent girls’ greater number of hours of computer use for leisure was related to higher body dissatisfaction, but a higher number of hours using the computer for homework was associated with lower body dissatisfaction. The researchers hypothesized that web-based surfing or social networking during leisure time may have exposed the girls to information about the thin-beauty ideal, which is promoted extensively yet unattainable for most. Girls’ internalization of the thin-beauty ideal may have resulted in negative body image perceptions [
29]. Although this contention is plausible, without information about the type of material viewed in the media, interpreting any findings is difficult.
Several studies have suggested that increased physical activity (PA) participation is associated with a more positive body image among adolescent girls. Unfortunately, findings were limited in that PA participation was either self-reported by the girls [
29,
30] or based only on whether girls participated in sports [
18] or dance [
31,
32]. Altıntaş and colleagues [
33] found that self-reported PA was not correlated with body image satisfaction among adolescent girls. No study was found that included an objective measure of girls’ PA.
Three studies including adolescents were found that examined body image and cardiovascular (CV) fitness. In the single cross-sectional study, increased fitness was associated with a more positive body image among 8- to 16-year-olds [
28]. In the remaining two, both of which were randomized controlled trials with overweight and obese adolescents, body image improved following participation in the PA intervention offered in each study [
34,
35]. Whether these findings apply to girls is unknown because results were not presented separately for each sex in any of the three studies.
To address some ambiguous findings noted in the literature regarding this area of research, the aims of this study were to: 1) examine demographic (e.g., age, grade, ethnicity, race, and enrollment in the free or reduced-price lunch program) differences in body image discrepancy; and 2) determine the association of body image discrepancy with weight status, percent body fat, PA, sedentary behavior, and CV fitness among young adolescent girls in the U.S. This study makes an important contribution by including a large sample of girls of minority status and objective measures of their height and weight, percent body fat, PA, and CV fitness.
Discussion
Overall, we found that 67.5% of the 10- to 15-year-old girls chose smaller ideal body images than their selected current/actual figure. Other studies listed the following specific percentages of girls who wished they were smaller or thinner than their current/actual body image: 73.0% (
n = 106) of 14- to 17-year-olds in Germany [
18], 48.7% (
n = 178) of 12- to 15-year-olds in South Korea [
50], 58.6% (
n = 188) of 11- to 15-year-olds in South Africa [
51], and 32.8% (
n = 79) of 12- to 15-year-olds in the U.S [
50]. The high percentage noted in this study, as well some of the others, underscores an urgent need to address the problem.
With regard to race, the finding that Black girls perceived less body image discrepancy or lower body dissatisfaction than White girls is consistent with results from previous research [
5,
10,
13]. In one study involving girls, identifying as being Black in high school predicted a lower increase in body dissatisfaction post-high school 5 years later. The researchers conducting the latter study explained that a large ideal body size may be consistent with the natural shape of Black girls as they progress through high school and beyond. Consequently, the departure from the ideal body shape is likely to be less, resulting in more protection against rising body dissatisfaction [
12]. Health professionals may need to consider racial differences when counseling Black girls on the benefits of certain healthy behaviors, such as PA, because focusing on how engagement in them can assist with attaining or maintaining a healthy weight may hold less relevance for this group than for White girls who experience higher body image discrepancy. Discussing perceived benefits of PA specifically identified by Black girls, such as the behavior helps with “staying in shape,” may be a more fruitful approach for promoting positive behavior change [
52].
Consistent with findings of Kelly et al. [
10] and Monteiro et al. [
32], SES was not correlated with either body satisfaction or dissatisfaction among adolescent girls, respectively. However, other researchers reported that lower SES among girls of high school age correlated with greater body dissatisfaction [
12] and body discrepancy [
18]. Paxton et al. [
12] suggested that low self-esteem among high school girls of low SES, possibly resulting from a reduced ability to afford fashionable clothing, may negatively impact girls’ view of their bodies. In this study, the girls had not yet reached high school and a high percentage were of low SES, both of which may have contributed to the unexpected results.
Aligned with the findings of this study, accumulating research indicates that higher BMI is associated with lower body satisfaction [
13,
33], a more negative body image [
30], and greater discrepancy between their current/actual and ideal body image [
25] with obese girls being the least likely to report high body satisfaction [
10]. For both junior high and high school girls, BMI emerged as a significant positive predictor of body dissatisfaction 5 years later when the girls were in high school and post-high school, respectively [
12]. In efforts to promote positive body-related perceptions among adolescent girls, BMI remains an important factor to consider [
53]. Based on findings that overweight adolescent girls having very low body satisfaction had a nearly three unit greater increase in BMI over a 10-year period than those with high body satisfaction, Loth and colleagues [
11] suggested that health professionals working with overweight adolescent girls should direct some effort toward promoting a positive body image.
In this study, negative correlations with body image discrepancy were very low for MVPA and moderate for CV fitness, but associations were not significant any more after adjusting for demographics and percent body fat. These suppressions effects may imply that percent body fat has a direct relationship with body image discrepancy, while PA and CV fitness have an indirect effect with body image discrepancy via percent body fat. The underlying causes for the suppression effects warrant further investigation. Therefore, assisting girls to attain and sustain a healthy weight remains critical for helping them to achieve and maintain a positive body image. The high negative correlation between CV fitness and percent body fat indicates that interventions to promote a positive body image among girls may need to include strategies to increase PA as a means to improve their CV fitness, thereby reducing their percent body fat. Evidence has supported that the increased muscle tone, strength, physical competence or fitness, and reduced body size, occurring from increased PA can help to improve body image perceptions [
54,
55]. Burgess, Grogan, and Burwitz [
31] found that participation in 6 weeks of aerobic dance significantly reduced adolescent girls’ body dissatisfaction. In another study, the BMI of girls who were not involved in dance practice was positively correlated with body dissatisfaction; however, for those practicing dance, the same significant relationship did not occur [
32]. According to Kelly [
10], girls with high body satisfaction are more likely to report exercising and being fit than those with low body satisfaction. Although PA and CV fitness may have a positive effect on adolescent girls’ body image, one challenge that needs to be overcome is that adolescent girls who are overweight or obese, especially those who have body-related concerns, are likely to avoid attaining PA [
3] at an intensity sufficient enough to improve their CV fitness.
This study’s findings showing no relationship between self-reported screen time and body image discrepancy are different from those of Schneider et al. [
18] and Añez et al. [
29] who found that time spent watching TV [
18] and leisure time computer use [
29] were associated with a more negative body image, respectively. Añez and colleagues [
29] hypothesized that girls’ exposure to the thin-beauty ideal during leisure-time computer use might negatively affect their body image perception [
29]. Based on this contention, the null findings in this study may have resulted from no-to-minimal exposure or limited influence from any exposure to the thin-beauty ideal during the girls’ leisure screen time due to the girls being younger than those in the other two studies.
Strengths and limitations
This study had strengths and limitations. Strengths included a large sample of girls of minority status. A second strength was the use of objective measures to estimate BMI, PA, percent body fat, and CV fitness. Limitations included the self-reported screen time and cross-sectional design, the latter of which prevented the determination of causality or differentiation of a precursor from a consequence of body image discrepancy. The omission of a measure of body distortion or other scales measuring body satisfaction/dissatisfaction limited the comprehensiveness of the study. Limitations were also related to the use of a figural drawing scale to assess body image. As noted by Gardner and Brown [
56], use of a limited number of response choices in figural drawing scales may not be sufficient for representing a near-continuous variable. In addition, test-retest reliability may be inflated among adolescents because the vast majority of their responses are usually selected from a small subset of the scale. Moreover, representations of the human form may be unrealistic or inappropriate for certain racial or ethnic groups. Finally, a biased response may result when figures are presented in ascending sizes from left to right and not in a random order. Due to the existing suppression effects, careful consideration is needed when interpreting the pairwise correlations between body image discrepancy and other study variables.
Acknowledgements
The authors appreciate the support received from school administrators, nurses, teachers, and other staff. We want to acknowledge Kelly Bourne, Project Manager, for her tireless effort to manage the study. We are also grateful to Michigan State University undergraduate and graduate nursing and kinesiology students who assisted us in various ways. Lastly, we thank the young female participants and their parents/guardians for their interest.