Background
Concerns with body weight and physical appearance are prevalent among adolescents [
1,
2] and are part of the larger phenomenon of body image perceptions, which relate to how individuals feel about their bodies [
3]. Poor body image is often correlated with increasing body weight [
4‐
6] and is linked to adverse outcomes such as psychological problems (including depression and low esteem) [
4], perceived negative physical and mental health [
7,
8] and a higher likelihood of poor dieting and eating disorders, which may be sustained in adulthood [
9]. Poor body image is also a potential mediator of the relationship between obesity and psychological distress [
4]. While eating disorders generally tend to decline during the transition to early adulthood, poor body image remains a problem for a substantial segment of the adult population [
10].
There is a large body of evidence addressing the differences in weight, weight perceptions, satisfaction with weight and their links with perceived appearance and attractiveness across ethnic groups in multiethnic populations like those in the USA (e.g. [
11‐
19]) or the UK [
20]. While most studies reported cross-sectional differences for specific age groups, some longitudinal studies were identified that addressed changes over time within predefined age ranges (e.g. [
21‐
26]). However, the genesis of these differences and their development across the age spectrum remain insufficiently understood. Large variations in individuals’ weight and weight perceptions occur throughout the life course and are shaped by multiple factors. Newborns of different ethnic backgrounds can differ in their birthweight, based on genetic and phenotypical parental differences [
27,
28]. Parental and children’s own behaviors join to influence weight and weight perceptions in early childhood and kindergarten years. During the school years, interactions with peers and comparisons with peers may become the dominating reference system for children’s evaluations of their weight and their weight perceptions. Children’s media consumption also increases during this period and can contribute to perceptions of weight, appearance and attractiveness [
29]. However, the age at which perceptions become stable or change is understudied.
In this study, our goal was to examine ethnic, sex and age differences in body satisfaction and perceptions of physical appearance versus body mass index (BMI) among a nationally representative sample of U.S. youth aged 11 to 17 years. The original study oversampled ethnic minorities, so we had a sufficient sample size to examine these relationships among Non-Hispanic Whites, African-American and Hispanic youth separately. We hypothesized that a) while body satisfaction and perceptions of physical appearance can be already established before the bottom end of the here studied age range, there will be substantial changes thereafter (conceptualized as differences by age), b) females will display stronger age effects, c) there will be particularly strong age effects among Non-Hispanic Whites.
Discussion
We analyzed a representative sample of U.S. schoolchildren with respect to body satisfaction and perceived appearance. All three assessed ethnic groups displayed distinct characteristics. For Non-Hispanic Whites and Hispanics, perceptions of body appearance were similar for both genders and across the age spectrum, but African-American youths differed substantially from both other groups. African-American youths had much better perceived body appearance at the youngest age. Perceived appearance remained high in African-American girls over the age range, but dropped dramatically in African-American boys. There was also a non-negligible drop in positive perceived appearance among Non-Hispanic White and Hispanic girls towards the end of the analyzed age spectrum (older adolescence). Only Non-Hispanic White girls exhibited an increase in the proportion considering themselves too fat; the proportion doubled between 11 and 15 years of age. (In this age group BMI scores also increased among Non-Hispanic White girls.) Conversely, perceptions of weight remained stable for all other groups. Non-Hispanic White and Hispanic boys had similar perceptions of body weight in relation to their BMI, compared to African-American boys, who were less likely to perceive themselves as too fat at higher BMI percentiles. Girls in all three ethnic groups considered themselves as being too fat at substantially lower age- and gender-specific percentiles of BMI than boys. However, there was a substantial difference across all three ethnic groups, with Non-Hispanic White girls substantially more likely to perceive themselves too fat at a given BMI percentile, followed by Hispanics and African-American.
The perceived positive appearance in African-American boys was exceptionally high at young ages (60% considered themselves being very good looking), but the dramatic drop between 11 to 17 years of age is nevertheless troubling. A longitudinal study in Finland found that perceptions regarding appearance are increasingly fixed with age and more stable in boys than girls [
35], thus underscoring the importance of the unusual process occurring in African-American boys. The drop in perceived positive appearance in African-American boys may be associated with increasing environmental awareness, which develops during adolescence and may partially account for the decrease in self-perception [
36]. McCabe and Ricciardelli [
37] report that, as boys get older, “they become more aware of the sociocultural ideal for males, and they recognize that there is pressure to strive not only for a larger body, but also for a body that demonstrates muscular strength and tone” (p.676). This could be especially true for African-American boys since research shows that they are at greater risk for weight-related concerns and behaviors, as compared to Non-Hispanic Whites [
38]. Paradoxically, the excessive weight-related concerns among this group could stem from the disconnect between the larger ideal body sizes that they strive for [
39] and their perception that they are not big enough.
African-American girls showed high self-perception at the age of 11, and sustained it across all of the ages studied. In contrast, there was a substantial loss of positive self-perception among Non-Hispanic White and Hispanic girls towards the end of the studied age spectrum. There is evidence that the negative relationship between BMI and perceived physical appearance is greater in Non-Hispanic White girls ages 9 to 14, compared to African American girls [
6]. There is also research indicating that body sizes presented in the media differ by ethnicity and thus media can influence perceived appearance across ethnic groups in different intensity [
40]. Therefore, the observed effects among girls could be either linked to the increase of BMI or to the increased exposure to the media.
In all but Non-Hispanic White girls, proportions of children perceiving themselves as too fat did not differ by age in the studied range (11 to 17 years). In earlier studies, pre-adolescents have been excluded from studies on body image because it was thought that these issues mostly affect adolescents [
41,
42]. However, our findings agree with more recent studies that challenge this perspective and suggest that body image concerns are increasingly affecting pre-adolescents [
43]. The percentage of Non-Hispanic White girls who considered themselves much too fat or a bit too fat increased between 11 and 15 years of age, and then leveled off between 15 and 17 years. This differential effect may be the result of different socio-cultural factors such as the media, peers, and parents [
44]. These results are consistent with findings that African-American and Hispanic females respond differently to Non-Hispanic White media images than their Non-Hispanic White counterparts, and possibly reject the implicit beauty and social pressure to match this “thin” ideal, which Non-Hispanic White girls internalize [
45‐
47]. African-American and Hispanic girls may also perceive that their peers and parents have less weight concerns and larger ideal body sizes compared to their Non-Hispanic White counterparts [
39,
48,
49]. Although further research is needed to explain the stabilization of body perception from 15 to 17 years of age for Non-Hispanic White girls, one possible explanation may be that social comparisons and cultural expectations have already been internalized by age 15 [
36]. Our analysis also demonstrated that the proportion of boys with a perception of being much too fat or a bit too fat did not change with age, which corroborates previous studies that socio-cultural factors perpetuate the muscular body ideal for males [
50].
Early research on body satisfaction problems focused mainly on girls [
51]; recently more attention has been paid to body image among boys [
37,
38,
51]. Our findings indicate that while concerns regarding overweight are more frequent among girls, a substantial proportion of boys also considered their weight as too high. In addition, our findings indicate a higher proportion of boys considered themselves to be too thin. This may be another reflection of the muscular ideal which is more evident in boys [
50]. Similar to women’s internalization of the culturally ideal thin body, men may be susceptible to internalizing a muscular ideal from the media [
52].
Although African-American girls had the highest age- and gender-specific BMI compared to other ethnic groups and African-American boys had substantially higher BMI than Non-Hispanic White boys (and only slightly lower than Hispanic boys), African-American boys and girls were more tolerant than Non-Hispanic Whites and Hispanics regarding the BMI z-score at which they considered themselves too fat. This finding is consistent with a large body of literature indicating different ideals of body attractiveness in African-Americans [
19,
38,
39,
53,
54] and a lower awareness of overweight among African-Americans [
5,
33,
55]. The finding is double-edged: On the one hand, there is substantial evidence that obesity increases multiple health risks; greater weight concerns can support weight loss behavior or the maintenance of a low body weight, thereby subsequently reducing health risks associated with obesity. On the other hand, weight concerns can affect physical and psychological well-being or even misdirect weight-loss strategies [
4,
5,
56]. These findings call for balanced strategies to promote healthy weight perception, with messages framed differently for each ethnic group. While addressing media pressure can be of utmost importance for Non-Hispanic White girls [
40], nutritional and physical activity interventions can be more important for other groups [
15,
57]. For Hispanic adolescents the issue of acculturation was also raised, which additionally complicates the relationship between body perception and appearance [
58,
59] Addressing the links between poor body image and eating disorders might require psychosocial interventions as suggested by the research [
11].
Limitations
This study is based on cross-sectional data, while its main interest is in changes across age. However, it is unlikely that there are cohort effects across such a narrow age range. Despite previous research on the stability of body image perceptions, we do not know how stable these perceptions are within individuals over shorter time periods. While one might think that body weight perceptions do not change from day to day, perceived appearance could be affected by concurrent social interactions. The measures related to perception were subjective per se, but BMI could have been objectively measured. Instead we had to rely on BMI calculated from self reported weight and height. Previous research indicated the self-reported BMI correlates well with measured BMI, in a way which can be sufficient for studies of associations [
60‐
63]. Nevertheless, self-reported BMI may be systematically biased not only for the population, but even more within specific subgroups, but is an adequate measure if no other possibilities exist [
64].
With the exception of the three groups studied, our sample of other ethnic groups was too small for reliable estimates of effects. Furthermore, information about BMI was missing for a substantial fraction of students. While missing information might simply reflect that the child does not know his/her current weight, it could also indicate that he/she is not as occupied with the issue of body weight. Therefore, excluding children with missing self-reported BMI might have resulted in a sample of children more concerned with their weight.
When calculating standardized BMI values we used a common standard for all three ethnic groups and did not ask what respondents considered the reference for their weight. This ignores the fact that the own ethnic group can be the reference for body image and thus individual perceptions of overweight can be based on ethnic-specific standards.
While dichotomizing variables we had to accept some loss of information, but at the same time applying ANOVA would violate assumptions of normal data distribution. We also contrasted the highest values with the remaining values, in this way we focused on the upper end of the spectrum of responses and did not report the findings for those with negative body appearance.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
Conception and design of the study: RTM. Acquisition of the data: RJI; Analysis of the data, RTM; Interpretation of the data RTM, RJI, and TF; Writing of the manuscript, RTM, RJI, TF and VT. All authors gave final approval of the version to be published. All authors read and approved the final manuscript.