Body image dissatisfaction and associated factors in adolescents

DOI: 10.1590/1413-81232020257.27452018 Giulia Xavier de Carvalho (https://orcid.org/0000-0001-7002-4479) 1 Ana Paula Nogueira Nunes (https://orcid.org/0000-0002-1825-6990) 2 Claudia Leite Moraes (https://orcid.org/0000-0002-3223-1634) 3 Gloria Valeria da Veiga (https://orcid.org/0000-0002-7985-0213) 1 1 Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Cidade Universitária. 21941-902 Rio de Janeiro RJ Brasil. 2 Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina MG Brasil. 3 Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil. Abstract This study aimed to examine the factors associated with body dissatisfaction in adolescents. This is a cross-sectional study with students from two public and four private schools in the metropolitan region of Rio de Janeiro. Body dissatisfaction was evaluated using the Body Silhouette Scale, by the difference between the image they perceive as their current image and the one they would like to have. The association was assessed by hierarchical logistic regression multinomial model, by estimating odds ratios (OR) and 95% confidence intervals (95%CI). Among the 1,019 adolescents evaluated (13-19 years), 75% showed body dissatisfaction, 41.4% wishing for a smaller silhouette and 33.7% wishing for larger silhouettes. The wish for a smaller silhouette was more significant in girls, overweight adolescents, those with an unsatisfactory meal pattern, and with higher waist circumference. Adolescents that had been exposed to teasing due to their body shape increased the probability of wishing for both smaller and larger silhouettes. Strategies are required for a more positive perception of body image, especially for girls and for overweight adolescents, which provide guidance on adequate meal consumption and prevent exposure to peer teasing, valuing coexistence and well-being in the face of existing bodily differences. Key words Body image, Adolescents, Overweight free themes Body image dissatisfaction and associated factors in adolescents 2769 Carvalho GX et al. 2770 Introduction Body image is part of the mechanism of personal identity that has a multidimensional construction1. In contemporary Western society, it is common to observe many people trying to fit the ideal beauty standards, generating dissatisfaction with body image when not successful2. Such dissatisfaction is more evident in adolescents because they are more vulnerable to pressures imposed by society, family, friends and the media to reach the perfect body as a way of obtaining acceptance and social success3. In the search for the aesthetic ideals imposed, many adolescents resort to very restrictive diets, exaggerated physical exercise, the use of diuretics and laxatives, anabolics, as well as the search for unnecessary aesthetic plastic surgeries4. Such behaviors may be in the genesis of eating disorders such as anorexia nervosa, bulimia and binge eating, which can severely compromise the health of young people. Dissatisfaction with body image has been related to some demographic factors such as being adolescent and female5, psychosocial, such as being involved with exposure to bullying6, related to lifestyle habits, such as physical inactivity, and irregular dietary practices7-9, and nutritional status, such as being overweight5,10. However, the interrelation between these factors requires that they are analyzed in a multidimensional context and from a hierarchical perspective that allows the identification of those who associate with the outcome independently. Therefore, this study intends to evaluate the level of body dissatisfaction in adolescents and identify higher risk subgroups, based on the analysis of possible associated factors. Such research may be useful to subsidize the discussion about the problem and implement strategies that promote a more positive body image among adolescents, thus avoiding adverse health effects caused by such dissatisfaction. Methods Evaluated population Data from adolescents enrolled in the 1st year of high school were analyzed in two public schools and four private schools in the metropolitan region of Rio de Janeiro in 2010, which were part of the baseline of the Longitudinal Study on Adolescent Nutritional Assessment (ELANA). The exclusion criteria of the main study were being physically disabled, thus preventing anthropometric evaluation, pregnant adolescents and those who were undergoing some drug treatment for weight control. In total, 1,131 eligible participants were identified for the study. Of these, 92 did not participate because they did not submit authorization from their parents or guardians (17), because they refused to participate (66) or because they were absent on the day of data collection (9). Specifically, for this study, 20 adolescents who did not present data related to self-perceived body image were excluded, totaling 1,019 adolescents to be analyzed, corresponding to a response rate of 90%. Data collection and study variables Data was collected between February and August 2010 by a properly trained team, with the authorization of parents or guardians and following the students’ assent. Information was collected from self-completed questionnaires to investigate outcome variable (body dissatisfaction) and exposure variables: demographic (gender, age, skin color/ethnicity), socioeconomic status (economic class, household head schooling and school type), psychosocial (exposure to teasing), lifestyle (meal pattern, tobacco use, current experimentation and consumption of alcohol, physical activity and sedentary behavior), anthropometric and body composition variables (body mass index and body fat percentage). The Body Silhouettes Scale adapted for adolescents11 was applied to evaluate perceived body image. It consists of nine silhouettes for girls and nine for boys, ranging from the figure corresponding to the extreme thinness (nº1) to obesity (nº 9)12. The scale was accompanied by the following questions: 1. Check the figure you think you look the most; 2. Mark the picture you would most like to appear with. The variable “body dissatisfaction” was defined by the difference between the score corresponding to the silhouette that the adolescents thought was their current one (question 1) and what they would like to look like (question 2), which can range from -8 to +8. The negative score indicated a desire to have larger silhouettes and the positive score showed the desire to have smaller silhouettes. Skin color/ethnicity information was obtained by self-evaluation. The adolescents were questioned about how they classified themselves and could choose the same options investigated 2771 consumption of the three meals) to 1 (up to 3 to 6 times a week in, at most, one of the three meals), as per the criterion proposed by Estima et al.16. Experimentation in alcohol consumption and current consumpt (...truncated)