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Singapore Med J 2009; 50 (3) : 303
O r i g i n a l A r t i c l e
Department of
Nutrition and
Dietetics,
Faculty of Medicine
and Health Sciences,
Universiti Putra
Malaysia,
Serdang 43400,
Malaysia
Khor GL, PhD
Professor
Zalilah MS, PhD
Associate Professor
Phan YY, MSc
Graduate Student
Ang M, MSc
Graduate Student
Department of
Human Development
and Family Study,
Faculty of Human
Ecology
Maznah B, PhD
Associate Professor
Department of
Nutrition and
Dietetics,
Faculty of Allied
Health Sciences,
Universiti
Kebangsaan
Malaysia,
Jalan Raja Muda
Abdul Aziz,
Kuala Lumpur 50300,
Malaysia
Norimah AK, PhD
Associate Professor
Correspondence to:
Prof Khor Geok Lin
Tel: (60) 3 8947 2460
Fax: (60) 3 8947 2460
Email: khorgl@medic.
upm.edu.my
Perceptions of body image among
Malaysian male and female adolescents
Khor G L, Zalilah M S, Phan Y Y, Ang M, Maznah B, Norimah A K
ABSTRACT
Introduction : Body image concerns are common
among adolescents as they undergo rapid physical
growth and body shape changes. Having a distorted
body image is a risk factor for the development of
disordered eating behaviours and eating disorders.
This study was under taken to investigate bod y
image concerns among Malaysian male and female
adolescents aged 11–15 years.
Methods: A total of 2,050 adolescents (1,043 males
and 1,007 females) with a mean age of 13.1 +/− 0.8
years from secondary schools in Kedah and Pulau
Pinang were included in the study. Questionnaires
were used to collect socioeconomic data and body
image indicators.
Re sul ts : The ma jor ity ( 87 pe rc ent ) of the
adolescen ts were concer ne d with their body
shap e. While the majorit y of unde rweight ,
normal weight and overweight male and female
subjec ts per ce ived the ir bod y weight statu s
correctly according to their body mass index
(BMI), a noteworthy proportion in each category
misjudged their body weight. About 35.4 percent
of the males and 20.5 percent of the females in
the underweight category perceived themselves
as having a normal weight, while 29.4 percent and
26.7 percent of the overweight males and females
respectively also perceived that they had a normal
weight. A higher proportion of the females (20
percent) than males (9 percent) with a normal BMI
perceived themselves as fat. Most of the male (78–
83 percent) and female subjects (69–74 percent)
in all the BMI categories desired to be taller than
their current height . An appreciable proportion
of both the males (41.9 percent) and females (38.2
percent) preferred to remain thin, or even to be
thinner (23.7 percent of males and 5.9 percent of
females) . Females had a significantly higher mean
body dissatisfaction score than males, indicating
their preference for a slimmer body shape. More
males (49.1 percent) preferred a larger body size
while more female s (58.3 percent) i deali sed a
smaller body size. Compared to normal weight
and unde rweight subjec ts, overweight male s
and females expressed lower conf idence and
accepta nce levels, as well as expressed greater
preoccupation with and anxiety over their body
weight and shape.
Conclusion: As having a distor ted body image
may lead to negative effects such as unhealthy
eating habits and disordered eating behaviours,
it is recommended that appropriate educational
efforts on body image be incorporated into school
health activities for adolescents.
Keywords: adolescents, body image, eating habits,
school health
Singapore Med J 2009; 50(3): 303-311
INTRODUCTION
While it remains debatable at what age in childhood body
dissatisfaction rst appears, there is no doubt that by
adolescence, the capability to evaluate one’s body and
make comparisons with an ideal is already in place.(1) As
adolescents experience signicant physical changes in their
bodies during puberty, they become increasingly concerned
with their body shape and parts. For example, males tend
to be more concerned with their chest, shoulders and arms,
while females are more concerned with their hips, thighs
and legs.(2) Concerns and a preoccupation with body
weight, shape and size eventually contributes to the process
of developing their individual image.(3) Adolescence is
also a period of “external evaluation by others” – being
concerned with how others perceive their body weight
and shape. Body image may be dened in simple terms
as the way a person perceives or thinks about his body and
how it looks to others. There is increasing pressure during
adolescence for males and females to desire a body shape
that conforms to the “ideal”, i.e. a thin shape for women
and a lean, muscular shape for men.(4) These perceived
ideal body shapes are reinforced by the mass media and
popular cultural icons. Internalisation of body ideals that
are perpetuated by the media can be a strong inuence on
body dissatisfaction, especially among females.(5)
In attempting to achieve their ideal body shape,
Singapore Med J 2009; 50 (3) : 304
adolescents indulge in diet fads and health-compromising
behaviours.(6,7) Those who engage in dieting might
not necessarily be overweight, but may in fact even be
underweight.(3) Such distorted self-perceptions of the
body can lead to inadequate intake of energy and essential
nutrients at an age when demands are high, thereby
jeopardising growth and development. Studies on body
image concentrate on western societies, but there is
increasing attention being paid to body image concerns in
developing countries. In Malaysia, studies that focus on
body image are limited. Females aged 8–9 years have been
found to desire a thinner body size and showed body-size
dissatisfaction.(8) In a study on females aged 13–16 years
by Pon et al, overweight females had higher body image
misrepresentation and tended to skip meals, compared to
those with a normal body weight.(9) As for young adults
aged 19–30 years, Khor et al found signicant correlations
between negative feelings pertaining to the physical self
and uninhibited eating behaviour.(10)
Malaysia typies a country in nutritional transition,
with an increasing overweight problem amidst prevailing
under-nutrition and micronutrient deciency.(11) Public
health authorities, professional societies as well as the mass
media have increasingly directed their attention towards
overweight and obesity issues. As body image has an
important inuence on weight management, this study was
undertaken to investigate perceptions and attitudes toward
body image among male and female adolescents.
METHODS
This cross-sectional study was part of a nationwide
project on nutrition, physical activity and body image of
Malaysian adolescents. Four universities collaborated
on this study, with each covering a specic geographical
region for logistical convenience. This report focuses on
ndings obtained from subjects in the states of Penang
and Kedah in Peninsular Malaysia. A total of 185 schools
that fullled the inclusion criteria, i.e. public schools
which are coeducational, multiracial, non-religious and
non-residential, were identied. Thus, the subjects were
chosen from the mainstream educational system and not
from special types of schools. Schools were located in big
and small town areas. All students aged between 11 and 16
years in each school were enlisted with the cooperation of
the teachers. Students were excluded from the study if they
had diet-related illnesses (such as diabetes mellitus and food
allergies), heart problems and/or physical disabilities.
A total of 6,555 students were measured for body weight
(TANITA weighing scale HD-309, Japan) and height (SECA
Body Meter 208, Germany). Body mass index (BMI) was
computed and the students were classied as underweight,
normal weight or overweight according to the WHO’s cut-
off points for males and females.(12) Within each of the
six BMI-by-gender categories, approximately 350 students
were randomly selected, with an equal number of males
and females. A nal sample of 2,050 students gave their
consent to participate in the study, and all were included.
The subjects were asked to complete a questionnaire that
consisted of the following components:
(1) Body shape concerns consisting of questions on their
reasons for concern, role models and sources of
advice.
(2) Body weight perceptions on whether they are very
thin to very fat as perceived by the self and others.
(Questions on the above two components were developed
based on several focus group discussions held prior to the
commencement of this study.)
(3) Body shape perceptions, using a gure-rating scale
adapted from Stunkard et al.(13) Subjects were
asked to select the body shape that they perceived
as ideal, healthy, attractive and closest to their
current body shape. They were also asked to identify
the body shape of the opposite gender that they
perceived as attractive. Each gure was given a score
ranging from zero for the thinnest shape to 26.0 for
the largest figure. Body size dissatisfaction was
Characteristics No. (%) of subjects
Gender
Male 1,043 (50.9)
Female 1,007 (49.1)
Age (years)
12–13 1,415 (69.0)
14–15 635 (31.0)
Mean and standard deviation 13.1 ± 0.8
Ethnicity
Malay 1,218 (59.4)
Chinese 562 (27.4)
Indian 270 (13.2)
Parental educational attainment
Father (n = 1,992)*
None 40 (2.0)
Primary (≤ 6 years) 541 (27.2)
Secondary (7–11 years) 1,179 (59.2)
College/university 232 (11.7)
Mother (n = 1,993)*
None 89 (4.5)
Primary (≤ 6 years) 703 (35.3)
Secondary (7–11 years) 1,058 (53.1)
College/university 143 (7.2)
Household income (RM per month)† (n = 1,819)*
< 1,000 1,393 (76.6)
1,000–3,000 303 (16.7)
> 3,000 123 (6.7)
* Data is not available for all the subjects. Total no. of subjects
= 2,050.
† RM3.40 = USD1.00 (exchange rate at the time of the study).
Table 1. Demographics of the study subjects.
Singapore Med J 2009; 50 (3) : 305
calculated as the difference between the perceived
current and ideal body shapes. While a score of
zero showed body satisfaction, a negative score
indicated a desire to be thinner, and a positive score
showed a preference for a bigger body size.
(4) Attitudes towards body image (28 items) using a
ve-point scale ranging from “denitely disagree” to
“definitely agree”, adapted from the Multidimen-
sional Body Self Relations Questionnaire (MBS
RQ).(14) There are nine subscales of the instrument
that reflect attitudes towards body weight and
shape: parental (four items) and peers’ (four items)
acceptance of body shape, importance of body
shape (two items), body shape confidence (two
items) and satisfaction (three items), comparison
of body shape with others (three items), body weight
satisfaction (two items) and anxiety (four items)
and preoccupation with body weight and shape
(four items) (Appendix 1). The internal consistency
of the 28 items used in this study was 0.77 with α
Cronbach’s values for the nine subscales in the range
of 0.48–0.85.
Data was analysed using the Statistical Package for
Social Sciences version 12.0 (SPSS Inc, Chicago, IL, USA).
All variables were descriptively presented by gender. Chi-
square test was used for associations between BMI and body
weight perceptions, while t-test and one-way ANOVA were
used for mean score differences in body shape perceptions
by gender as well as body image attitudes according to BMI
status.
RESULTS
The subjects comprised the three main ethnic groups in
Malaysia, and their proportions in the study approximately
reect the ethnic ratio in the general population (Table I).
Two-thirds of the subjects were aged 12.0–13.9 years, and
the overall average age and standard deviation was 13.1 ±
0.8 years. The majority were from families earning a low to
Table II. Distribution of subjects by body mass index and gender.
Body mass index No. (%) of male subjects No. (%) of female subjects Total no. (%)
Underweight 323 (31.0) 220 (21.8) 543 (26.5)
Normal weight 374 (35.9) 435 (43.2) 809 (39.5)
Overweight 346 (33.2) 352 (35.0) 698 (34.0)
Total no. 1,043 (100) 1,007 (100) 2,050 (100)
Table III. Body shape concerns according to gender.
Questions regarding body shape concerns No. (%) of male subjects No. (%) of female subjects Total no. (%) of subjects
Are you concerned with your body shape? (n = 1,038) (n = 1,007) (n = 2,045)
Yes 898 (86.5) 886 (88.0) 1,784 (87.2)
No 140 (13.5) 121 (12.0) 261 (12.8)
Main reasons for concern: (n = 895) (n = 882) (n = 1,777)
To be healthy 661 (73.1) 570 (64.6) 1,231 (71.0)
To gain more self-confidence 134 (15.0) 138 (15.6) 272 (15.3)
To look good 53 (5.9) 153 (17.3) 206 (11.6)
To have more friends 32 (3.2) 12 (1.4) 44 (2.5)
Others 15 (1.7) 9 (1.0) 24 (1.4)
Main source of influence / role model (n = 891) (n = 882) (n = 1,773)
None 294 (33.0) 357 (40.5) 651 (36.7)
Sportsmen/sportswomen 211 (23.7) 31 (3.5) 242 (13.7)
Friends 163 (18.3) 220 (24.9) 283 (16.0)
Artistes/models 72 (8.1) 136 (15.4) 208 (11.7)
Relatives 87 (9.8) 104 (11.8) 191 (10.8)
Teachers 31 (3.5) 14 (1.6) 45 (2.5)
Others 33 (3.7) 20 (2.3) 53 (3.0)
Do you have problems with your body shape? (n = 1,025) (n = 999) (n = 2,024)
Yes 336 (32.8) 456 (45.6) 792 (39.1)
No 689 (67.2) 543 (54.4) 1,232 (60.9)
Do you seek advice? (n = 336) (n = 456) (n = 792)
Yes 248 (73.9) 336 (73.6) 584 (73.7)
No 88 (26.1) 120 (26.4) 208 (26.3)
Sources of advice (n = 248) (n = 336) (n = 584)
Family members only 113 (45.6) 162 (48.1) 276 (47.2)
Friends only 53 (21.5) 55 (16.5) 82 (18.4)
Family members and friends 16 (6.3) 58 (17.3) 70 (13.2)
Professionals 30 (15.2) 13 (3.8) 47 (8.0)
Others 36 (11.4) 48 (14.3) 109 (13.2)
Singapore Med J 2009; 50 (3) : 306
medium income, with most parents having attained at least
a secondary level of education. Based on the BMI status,
about one-quarter of the subjects were underweight, while
another one-third were overweight (Table II). Less than
40% of the students had a normal weight status. There was a
higher percentage of underweight (31.0%) males compared
to females (21.8%). The percentage of overweight students
was similar for males (33.2%) and females (35.0%).
The reason given by the majority of the adolescents
(71.0%) for being concerned with their body shape was “to
be healthy” (Table III). Other reasons given were “to gain
more self-condence” (15.3%) and “to look good” (11.6%).
More of the female (17.3%) than male subjects (5.9%)
attached importance to the latter reason. While more than a
third stated that no specic individual exerted any inuence
on their body shape concerns, a considerable percentage
of the males identied sportsmen (23.7%) and friends
(18.3%) as “idols”, while for the females, friends (24.9%),
artistes/models (15.4%) and relatives (11.8%) were
considered as important sources of inuence. When asked
if they experienced problems with their body shape, more
females (45.6%) than males (32.8%) answered positively.
An encouraging nding is that almost three-quarters of
these subjects said they sought advice for their body shape
problems. Advice was sought from family members only
(45.6% of the males and 48.1% of the females), followed by
friends only (21.5% males and 16.5% females).
The majority of the male subjects in the underweight,
normal weight and overweight BMI categories correctly
perceived themselves as thin, normal or fat, respectively.
(Table IV). Likewise, when asked for their perceptions of
how other people viewed their body weight, more than half
in each BMI category gave the correct answers. However,
there was an appreciable proportion in each category that
seemed to misjudge their own body weight. About 35% in
the underweight category and almost 30% in the overweight
category felt that they had a normal weight. Similarly,
about 25% and 30% in the underweight and overweight
categories, respectively, felt that others thought they had a
normal body weight. In contrast, there were normal weight
male subjects who deemed themselves as thin (21%) or fat
(9%) and also thought that others perceived them as thin
(28%) or fat (13%).
Like the male subjects, the majority of the females in
each BMI category correctly answered the self-perceived
body weight questions. However, a sizeable percentage of
the underweight (20.5%) and overweight (26.7%) females
incorrectly considered themselves as having a normal body
weight (Table IV). There are noticeable differences between
the genders in that a higher percentage of the underweight
males perceived themselves as having a normal weight
(35%) or felt that others thought they had a normal weight
(25%), compared to 21% and 11% among the underweight
females, respectively. In addition, a higher percentage of
Table IV. Perception of body weight by self and others among male and female subjects.
Body weight perception No. (%) underweight* No. (%) normal weight* No. (%) overweight* Total no.
Males
• I feel I am:† (n = 322) (n = 368) (n = 344) (n = 1,034)
Very thin 25 (7.8) 9 (2.4) 0 34 (3.3)
Thin 178 (55.3) 76 (20.7) 2 (0.6) 256 (24.8)
Normal 114 (35.4) 250 (67.9) 101 (29.4) 465 (45.0)
Fat 5 (1.6) 31 (8.4) 226 (65.7) 262 (25.3)
Very fat 0 2 (0.5) 15 (4.4) 17 (1.6)
• Others think I am:‡ (n = 317) (n = 364) (n = 339) (n = 1,020)
Very thin 72 (22.7) 20 (5.5) 0 92 (9.0)
Thin 161 (50.8) 103 (28.3) 5 (1.5) 269 (26.4)
Normal 80 (25.2) 193 (53.0) 103 (30.4) 376 (36.9)
Fat 4 (1.3) 46 (12.6) 193 (56.9) 243 (23.8)
Very fat 0 2 (0.5) 38 (11.2) 40 (3.9)
Females
• I feel I am:§ (n = 219) (n = 431) (n = 348) (n = 998)
Very thin 28 (12.8) 15 (3.5) 0 43 (4.3)
Thin 145 (66.2) 94 (21.8) 4 (1.1) 243 (24.4)
Normal 45 (20.5) 237 (55.0) 93 (26.7) 375 (37.6)
Fat 1 (0.5) 85 (19.7) 221 (63.5) 307 (30.8)
Very fat 0 0 30 (8.6) 30 (3.0)
• Others think I am:¶ (n = 218) (n = 425) (n = 349) (n = 992)
Very thin 82 (37.6) 36 (8.5) 2 (0.6) 120 (12.1)
Thin 112 (51.4) 112 (26.4) 4 (1.1) 228 (23.0)
Normal 22 (10.1) 214 (50.4) 95 (27.2) 331 (33.4)
Fat 2 (0.9) 62 (14.6) 207 (59.3) 271 (27.3)
Very fat 0 1 (0.2) 41 (11.7) 42 (4.2)
* Body mass index classification. Some subjects did not answer all the questions.
†χ2 = 662.98; ‡χ2 = 606.35; §χ2 = 610.25; ¶χ2 = 670.77; df = 8, p < 0.000
Singapore Med J 2009; 50 (3) : 307
normal weight females (20%) than normal weight males
(9%) perceived themselves as fat.
Overall, most (78.3%) of the male subjects expressed
a desire to be taller than their current height, regardless of
BMI status (Table V). As for the desired weight, while
more than half of the underweight males would have liked
to be heavier than their current weight, nearly 42% seemed
to prefer to stay at their current weight (i.e. underweight),
and almost 24% even desired to be lighter. This nding
corresponds with the results in Table IV, where 35.4% of
the underweight males perceived themselves as having a
normal weight, and a few even deemed themselves to be
fat. The majority (69.1%) of the female subjects shared the
same desire as the males in wanting to be taller than their
current height (Table V). Most of the overweight females
(90.6%) desired to be lighter than their present weight. In
contrast, only a small percentage of the underweight female
subjects wished to be heavier (12.2%). A noteworthy
percentage of the underweight females (38.2%) liked their
current thin status, and 5.9% indicated that they wanted to
be even lighter.
Based on Stunkard et al’s gure rating scale,(13) the
male subjects considered a bigger body shape than their
self-perceived current body shape to be healthy, ideal and
attractive (Table VI). In contrast, the females considered a
smaller gure than their current body shape to be ideal and
attractive. Compared to males, females chose signicantly
(p < 0.05) smaller ideal, healthy and attractive body
shapes. Similarly, for an ideal body size perception, the
male subjects chose one that was bigger for females than
the one preferred by the females themselves (10.45 ±
3.11 vs. 8.54 ± 3.00). In contrast, the females appeared to
consider a smaller body size as attractive for males than
the one selected by the males themselves (11.13 ± 3.25 vs.
14.21 ± 3.77). Female subjects expressed a signicantly
higher level of body dissatisfaction (2.30 ± 4.95) compared
to the males (−0.29 ± 5.57). While a signicantly higher
percentage (p < 0.05) of female subjects idealised a smaller
body size (58.3%), a higher percentage of the male subjects
(49.1%) desired a larger body size.
Overweight male subjects expressed signicantly
lower parental but higher peer acceptance for their body
shapes compared to those who had a normal weight or were
underweight (p < 0.05) (Table VII). Overweight males
also had signicantly less condence and satisfaction with
their body shapes and weight, compared to those with a
normal weight. In addition, they experienced signicantly
higher levels of anxiety and preoccupation with body
weight and shape. Compared to normal weight subjects,
underweight male subjects also expressed signicantly
greater preoccupation with body weight and shape. Like
their male counterparts, overweight female subjects
also expressed signicantly lower parental and peer
acceptance of their body shapes compared to the normal
weight and underweight adolescents (Table VII). They
tended to make signicantly more comparisons of their
body shape with others, showed greater body weight and
shape dissatisfaction and had higher levels of anxiety and
preoccupation with their body weight and shape. A nding
of concern is that, not only the overweight females but
Table V. Desired height and weight among male and female subjects according to BMI.
Desired height and weight No. (%) underweight* No. (%) normal weight* No. (%) overweight* Total no.
Males
• I want my height to be:† (n = 323) (n = 371) (n = 344) (n = 1,038)
Shorter 4 (1.2) 4 (1.1) 8 (2.3) 16 (1.5)
Status quo 66 (20.4) 67 (18.1) 49 (14.2) 182 (17.5)
Taller 253 (78.3) 300 (80.9) 287 (83.4) 840 (80.9)
• I want my weight to be:‡ (n = 322) (n = 371) (n = 344) (n = 1,037)
Lighter 22 (23.7) 88 (23.7) 264 (76.7) 374 (36.1)
Status quo 135 (41.9) 181 (48.8) 65 (18.9) 381 (36.7)
Heavier 165 (51.2) 102 (27.5) 15 (4.4) 282 (27.2)
Females
• I want my height to be:§ (n = 220) (n = 434) (n = 351) (n = 1,005)
Shorter 5 (2.3) 12 (2.8) 4 (1.1) 21 (2.1)
Status quo 63 (28.6) 122 (28.1) 87 (24.8) 272 (27.1)
Taller 152 (69.1) 300 (69.1) 260 (74.1) 712 (70.9)
• I want my weight to be:¶ (n = 220) (n = 35) (n = 351) (n = 1,006)
Lighter 13 (5.9) 206 (47.4) 318 (90.6) 537 (53.4)
Status quo 84 (38.2) 167 (38.4) 24 (6.8) 275 (27.3)
Heavier 123 (12.2) 62 (14.3) 9 (2.6) 194 (19.3)
* Body mass index classification. Some subjects did not answer all the questions.
†χ2 = 6.35, df = 4, not significant
‡χ2 = 431.08, df = 4, p < 0.000
§χ2 = 4.32, df = 4, not significant
¶χ2 = 479.41, df = 4, p < 0.000
Singapore Med J 2009; 50 (3) : 308
also the normal weight females were signicantly more
dissatised with and anxious over their body weight and
shape when compared to all normal weight subjects.
DISCUSSION
The majority of both male and female adolescents were
concerned with their body shape. This nding is consistent
with other studies, which have also found adolescents to
be concerned and preoccupied with their body image.(6,7,15)
While both male and female adolescents in this study
expressed concerns about body image, more females
stated that they encountered body shape problems. Being
overweight in adolescence appears to be an important factor
associated with body image problems. Both males and
females experienced signicantly higher levels of anxiety
and preoccupation with body weight and shape, compared
to the normal weight subjects. While the overweight males
said they experienced lower parental acceptance of their
body shape, overweight females also expressed lower peer
acceptance of their body shape.
The majority of the adolescents selected “to be healthy”
as the reason for their body shape concerns. About one
Body shape Male Female
Mean ± SD Median Mean ± SD Median
Current body shape 13.92 ± 5.60 13.00 10.85 ± 5.67† 10.40
Ideal body shape 14.21 ± 3.77 14.20 8.54 ± 3.00† 7.80
Healthy body shape 15.97 ± 4.38 15.60 11.54 ± 4.29† 10.40
Attractive body shape 14.75 ± 4.00 15.60 8.49 ± 3.35† 7.80
Attractive body shape 10.45 ± 3.11 10.40 11.13 ± 3.25† 10.40
of the opposite sex
Body dissatisfaction −0.29 ± 5.57 0.00 2.30 ± 4.95† 2.60
Score of −26.0 to −1 509 (49.1) 312 (31.0)
(desired a bigger body size)‡
Score of 0 (satisfied with 100 (9.7) 108 (10.7)
current body size)‡
Score of +1 to +26 427 (41.2) 587 (58.3)
(desired a thinner body size)‡
* The modified Figure Rating Scale of Stunkard et al(13) is shown in Fig. 1.
† Significantly different (p < 0.05) between male and female adolescents.
‡ Data is expressed as no. (%).
Body dissatisfaction = current body size – ideal body size.
Table VI. Perception of body shape based on the modified Figure Rating Scale of Stunkard et al.*
Fig. 1 Selection of body shape according to gender, based on the modified figure rating scale of Stunkard et al. (1983).
Singapore Med J 2009; 50 (3) : 309
quarter of the male adolescents chose sportsmen as their
role models for body shape, presumably because sportsmen
are perceived as healthy and muscular. Past studies found
that male adolescents tend to select large and muscular
gures as their ideal body shape.(16) In comparison, the
female adolescents were more likely to select slim singers
and actresses as their role models, indicating that the
females tend to have a preference for slim body shapes.
Such ndings are not unexpected and have been reported
previously among adolescents in western countries.(17,18)
Females tend to be more appearance-orientated and less
tness-oriented than males.
In this study, BMI is used as an objective indicator of
the adolescent’s overall body weight against the subjective
assessment by the adolescent of his own body weight. A
major limitation in the use of the BMI is that it does not
differentiate between muscle and fat mass. Thus, a muscular
subject, such as a body builder, may have a similar BMI to
an obese person. However, this is not a signicant factor
in the context of this study on adolescent students. While
the majority of the subjects in the underweight, normal
weight and overweight BMI categories correctly perceived
themselves as thin, normal or fat, respectively, a smaller
proportion of the females among the underweight subjects
perceived themselves as having a normal weight (20.5%),
compared to the males (35.4%). This is in contrast to other
studies, that found that more females judged themselves
to be of average weight or fat when they were, in fact,
underweight.(1,4) In this study, two-thirds of the subjects
were 12–13 years of age, and by this age, a considerable
proportion of the females would have attained menarche
and experienced body shape changes. Thus, one would
have expected the females to be as aware as, if not more
so than, the males on issues of body image. More studies
should be conducted to obtain a better understanding of
gender differences in body image development among
Malaysian adolescents.
In relation to the desire for an ideal body shape, the
male adolescents selected a larger gure than their current
body shape as ideal, healthy and attractive, while the
females chose a smaller gure than their current body shape
as ideal and attractive. Thus, while the males preferred a
stronger and more muscular body shape, the females
showed a preference for a slim body shape; this is consistent
with the ndings of several other studies.(19-21) The female
ideal is to be thin with slim lower body parts while the male
ideal is to gain weight to achieve a V-shaped body and
additional muscles.(4,22) A preoccupation with body image is
especially acute during puberty.(23) Compared to their male
counterparts, females tend to be more dissatised with their
body image throughout puberty.(24,25) The dissatisfaction
in females may arise from an increase in body fat, which
is in conict with the pursuit of a thin ideal.(26) In contrast,
puberty is associated with an increase in lean body mass for
males, and this muscle gain may contribute to males being
generally more satised with their physical appearance.(27)
In relation to differing perceptions of the ideal body
shape, females and males tend to pursue opposite strategies
in shaping their physical looks. While females who are not
satised with their body are more likely to adopt strategies
in order to lose weight, male adolescents are more likely
to pursue strategies to increase their body weight and
muscle mass.(28,29) In this study, family members, followed
by friends, were found to be the main sources of advice
concerning body shape problems. It is an encouraging
nding that Malaysian adolescents can look to their families
for support regarding a sensitive matter such as body weight
and shape. Several other studies have also reported the
Subscales for attitude Underweight Normal weight Overweight Total
Males Females Males Females Males Females Males Females
(n = 322) (n = 218) (n = 366) (n = 430) (n = 342) (n = 347) (n = 1,030) (n = 995)
Parental acceptance 9.8 ± 3.9a 9.7 ± 3.7a 9.4 ± 4.1b 9.1 ± 3.7b 10.7 ± 4.4a,b 11.6 ± 4.4a,b 9.9 ± 4.2 10.1 ± 4.1
Peer acceptance 9.0 ± 3.0a 8.8 ± 3.0a 9.1 ± 3.2b 8.5 ± 3.2b 8.0 ± 3.6a,b 10.0 ± 3.6a,b 9.1 ± 3.4 9.1 ± 3.4
Importance of body shape 10.0 ± 2.9 9.7 ± 2.7a,c 9.7 ± 2.9 10.3 ± 2.9b,c 9.8 ± 2.8 10.6 ± 2.8a,b 9.8 ± 2.9 10.3 ± 2.8
Comparison of body shape 10.0 ± 2.9 9.7 ± 2.7a 9.7 ± 2.9 10.3 ± 2.9b 9.8 ± 2.8 10.6 ± 2.8a,b 9.8 ± 2.9 10.3 ± 2.8
Body shape confidence 6.0 ± 1.8a 6.5 ± 1.7a 5.9 ± 1.7b 6.5 ± 1.6b 6.3 ± 1.8a,b 7.1 ± 1.7a,b 6.1 ± 1.8 6.7 ± 1.7
Body shape satisfaction 9.0 ± 2.5a 8.8 ± 2.3a 9.3 ± 2.3b 8.2 ± 2.3b 7.7 ± 2.6a,b 6.9 ± 2.4a,b 8.7 ± 2.6 7.9 ± 2.4
Body weight satisfaction 5.9 ± 1.7 5.5 ± 1.6a 6.1 ± 1.6b 5.5 ± 1.7a 5.7 ± 1.6b 5.2 ± 1.5b 5.9 ± 1.6 5.4 ± 1.6
Body weight and shape anxiety 12.8 ± 3.3a 12.8 ± 3.0a,c 12.4 ± 3.3b 14.1 ± 3.4b,c 13.9 ± 3.5a,b 14.9 ± 3.4a,b 12.9 ± 3.4 14.1 ± 3.4
Body weight and shape preoccupation 13.5 ± 4.0a,c 12.7 ± 3.8a 12.1 ± 4.0b,c 12.6 ± 3.8b 15.3 ± 3.8a,b 16.3 ± 3.3a,b 13.5 ± 4.2 13.9 ± 4.0
Data is expressed as mean± standard deviation.
a,b,c The same superscript denotes a significant difference (p < 0.05) among the underweight, normal weight and overweight categories.
A higher score for each subscale indicates less parental and peer acceptance, greater body shape importance, higher body shape comparison, lower body shape
confidence, higher body shape and body weight satisfaction, more body weight and shape anxiety and preoccupation.
Table VII. Attitudes towards body image among male and female subjects according to BMI category.
Singapore Med J 2009; 50 (3) : 310
important roles played by parents and peers in inuencing
changes in body image among adolescents.(30,31) Mothers
appear to exert greater inuence than fathers on their
children’s body weight and shape development.(32) Such
ndings have implications for promoting positive body
image programmes among adolescents where parents may
be actively involved.
In conclusion, this study found that adolescents
in Malaysia are concerned with their body image. A
signicant proportion of adolescents are not satised
with their body weight, leading to them having a poor
body image. Owing to the negative effects that a distorted
body image can cause, such as unhealthy eating habits or
disordered eating behaviours, the results of the present study
indicate that appropriate education and counselling should
be conducted among adolescents in schools. Separate
intervention programmes for male and female adolescents
are required to address body image concerns, as they have
differing expectations and reactions about their body shape
and size. More studies should be conducted to obtain a
better understanding of gender differences in body image
development among Malaysian children and adolescents.
ACKNOWLEDGEMENTS
The authors express their gratitude to the Ministry of
Science, Technology and Environment, Malaysia for
funding the project (IRPA Grant No.: 06-02-05-9005)
between 2000 and 2005. They are also grateful to the
Ministry of Education, and all the teachers and students
who participated in the study.
REFERENCES
1. Smolak L. Body image in children and adolescents: where do we
go from here? Body Image 2004; 1:15-28.
2. Vander Wal JS, Thelen MH. Eating and body image conce rns
among obese and average-weight children. Addictive Behav
2000; 25:775-8.
3. Emmons L. Predisposing factors differentiating adolescent dieters
and non-dieters. J Am Diet Assoc 1994; 94:725-8,731.
4. McCabe MP, Ricciardelli LA. Body image and strategies to lose
weight and increase muscle among boys and girls. Health Psychol
2003; 22:39-46.
5. Knauss C, Paxton SJ, Alsaker FD. Relationships amongst body
dissatisfaction, internalization of the media body ideal and
perceived pressure from media in adolescent girls and boys. Body
Image 2007; 4:353-60.
6. O’Dea JA, Rawstorne PR. Male adolescents identify their weight
gain practices, reasons for desired weight gain and sources of
weight gain information. J Am Diet Assoc 2001; 92: 306-12.
7. Tiggemann M. The impact of adolescent girls’ life concerns and
leisure activities on body dissatisfaction, disordered eating, and
self-esteem. J Genet Psychol 2001; 162:133-42.
8. Shariff ZM, Yasin ZM. Correlates of Children’s Eating Attitude
Test scores among primary school children. Percept Mot Skills
2005; 100:463-72.
9. Pon LW, M Kandiah, Mohd Nasir MT. Body image perception,
dietary practices and physical activity. Malays J Nutr 2004;
10:131-47.
10. Khor GL, Cobiac L, Skrzypiec G. Gender difference in eating
behavior and social self concept among Malaysian university
students. Malays J Nutr 2002; 8:75-98.
11. Khor GL. Micronutrient status and intervention programs in
Malaysia. Food Nutri Bull 2005; 26:S281-5.
12. World Health Organization. Physical Status: The Use and
Interpretation of Anthropometry. Geneva: World Health
Organization; 1995. Technical series report no. 854.
13. Stunkard AJ, Sorensen T, Schulsinger F. Use of the Danish
Adoption Register for the study of obesity and thinness. Baltimore,
MD: Research Publications - Association for Research in Nervous
and Mental Disease, 1983; 60:115-20.
14. Cash TF. Body Image Assessments: MBSRQ. The
Multidimensional Body Self-Relations Questionnaire Users’
Manual, 2000. Available at: www.body-images.com/assessments/
mbsrq.html. Accessed January 15, 2008.
15. Pesa JA, Syre TR, Jones E. Psychosocial differences associated
with body weight among female adolescents: the importance of
body image. J Adolesc Health 2000; 26:330-7.
16. McCreary DR, Sasse DK. An exploration of the drive for
muscularity in adolescent boys and girls. J Am Coll Health 2000;
48:297-304.
17. Nowark M, Crawford D. Getting the message across: adolescents’
health concerns and views about the importance of food. Aust J
Nutri Diet 1998; 55:3-8.
18. Cash TF, Brown TA. Gender and body images: stereotypes and
realities. Sex Roles 1998; 21:361-73.
19. Epel ES, Spanakos A, Kasl-Godley J, Brownell KD. Body shape
ideals across gender, sexual orientation, socioeconomic status,
race, and age in personal advertisements. Int J Eat Disord 1996;
19:265-73.
20. Murnen SK, Smolak L, Mills JA, Good L. Thin, sexy women
and strong, muscular men: Grade school children’s responses
to objectified images of men and women. Sex Roles 2003;
49:427-37.
21. Ricciardelli LA, McCabe MP. A biopsychosocial model of
disordered eating and the pursuit of muscularity in adolescent
boys. Psychol Bull 2004; 130:179-205.
22. Furnham A, Badmin N, Sneade I. Body image dissatisfaction:
gender differences in eating attitudes, self-esteem and reasons for
exercise. J Psychol 2002; 136:581-96.
23. Wright MR. Body image satisfaction in adolescent girls and boys.
A longitudinal study. J Youth Adolesc 1989; 18:71-83.
24. William JM, Currie C. Self esteem and physical development
in early adolescence: Pubertal timing and body image. J Early
Adolesc 2000; 20:129-49.
25. Brooks-Gunn J, Paikoff R. “Sex is a gamble, kissing is a game”:
Adolescent sexuality, contraception and pregnancy. In: Millstein
SP, Petersen AC, Nightingale EO, eds. Promoting the Health
Behavior of Adolescents: New Directions for the Twenty-rst
Century. New York: Oxford University Press, 1993.
26. Graber JA, Brooks-Gunn J, Paikoff RL, Warren MP. Prediction
of eating problems: An 8-year study of adole scents gi rls. Dev
Psychol 1994; 30:823-34.
27. Gross RT. Patterns of maturation: Their effects on behaviour and
development. In: Levine MD and Satz P, eds. Middle Childhood:
Development and Dysfunction. Baltimore: University Park Press,
1984.
28. Vander Wal JS, Thelen MH. Eating and body image concerns
among obese and average-weight children. Addict Behav 2000;
25:775-8.
29. McCabe MP, Ricciardelli LA, Baneld S. Body image, strategies
to change muscles and weight, and puberty. Do they impact on
positive and negative affect among adolescent boys and girls? Eat
Behav 2001; 2:129-49.
Singapore Med J 2009; 50 (3) : 311
30. Field AE, Camargo CA Jr, Taylor CB, et al. Peer, parent and media
inuences on the development of weight concerns and frequent
dieting among preadolescent and adolescent girls and boys.
Pediatrics 2001; 107:54-60.
31. McCabe MP, Ricciardelli LA. A longitudinal study of body image
and strategies to lose weight and increase muscles among children.
J Appl Dev Psychol 2005; 26:559-77.
32. Lowes J, Tiggemann M. Body dissatisfaction, dieting awareness
and the impact of parental inuence in young children. Br J Health
Psychol 2003; 8:135-47.
APPENDIX 1. Questions on attitudes towards body image adapted from the MBSRQ.(14)
1. Overall, my body shape is not attractive.
2. I feel comfortable when I see my body shape in the mirror.
3. I do not feel comfortable when others look at my body .
4. I avoid social activities because of my body shape.
5. I do not take part in sports because I feel ashamed when friends look at my body.
6. I am proud of my body shape.
7. My body shape is not important to me.
8. I attach importance to comments from others about my body shape.
9. When I see a mirror, I will look at myself in the mirror.
10. I am always comparing my body shape with that of my peers.
11. I always pay attention to my body shape.
12. I feel my mother does not like my body shape now.
13. I feel my father does not like my body shape now.
14. My mother often gives negative comments about my body shape.
15. My father often gives negative comments about my body shape.
16. I feel my mother wants me to change my body shape.
17. I feel my father wants me to change my body shape.
18. My peers said my body shape is not attractive.
19. My peers like to tease my about my body shape.
20. I feel my peers do not like me because of my body shape.
21. I have difficulty making friends because of my unattractive body shape.
22. Whenever I have the opportunity, I weigh myself.
23. I always feel anxious when my body weight increases.
24. I always exercise in order to take care of my body shape.
25. I do not worry when I become fat.
26. I am sensitive to changes in my body weight.
27. I wish to change my body weight.
28. I am not satisfied with my body weight.
