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Body size ideals, beliefs and dissatisfaction in Ghanaian adolescents: socio-demographic
determinants and intercorrelations.
Sophia Doyo Amenyah1, MSc; Nathalie Michels2, PhD
1Faculty of bioscience Engineering, Ghent University, Belgium
2Department of Public health, Ghent University, Belgium
Corresponding Author: Dr Nathalie Michels, PhD
Address: Ghent University; De Pintelaan 185 – 4K3; 9000 Gent, Belgium;
Email: Nathalie.michels@ugent.be; Tel: 0032 9 332 83 74
Funding: No funding was received for this study
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ABSTRACT
Background: Understanding the sociocultural perception of body size and its relation to
body weight management is essential for policy and intervention planning. Herein, African
adolescents deserve special interest because of a possible shift in body size ideals due to
globalization and because of adolescence as a vulnerable stage of life. Therefore, the
objective of this study was to explore body size beliefs and its determinants (socio-
demographic and beliefs) in Ghanaian adolescents. Furthermore, the association of these
ideals with body size dissatisfaction and measured body size was examined to detect the link
with well-being and overweight.
Methods: A cross-sectional study involving 370 adolescents (53% girls; 11-18y) from the
Greater Accra Metropolitan Area in Ghana was conducted. Questionnaires on body size
beliefs were administered and anthropometric measurements were obtained. Body size ideals
and dissatisfaction were based on the Stunkard figure rating scale. Multinomial, ordinal and
linear regressions were adjusted for gender, age and parental education.
Results: Though 64% preferred the normal-weight ideal, the traditional preference for the
overweight ideal was still present. Body size dissatisfaction was higher in adolescents who
preferred the overweight or underweight ideal. Both underweight and overweight adolescents
reported teasing. Sexual attractiveness and health beliefs were predictors of body ideals, but
beliefs on the role of lifestyle were not.
Conclusions: The associations of the ideal body size with beliefs show that promoting the
normal-sized body as healthy might be a good way to influence ideals in this population.
Interventions should stimulate body esteem and a healthy lifestyle without extremes.
Keywords: body size ideals; beliefs; dissatisfaction; adolescents; Ghana
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INTRODUCTION
Obesity is increasingly prevalent in African countries due to many factors including the
nutrition transition 1. An overweight prevalence of 11.7% has been reported in Ghanaian
adolescents 2. Further, one’s awareness of being overweight is an essential factor for
successful weight management 3. A research gap that exists in most of Africa’s obesity
research is the sociocultural perception of obesity. These perceptions as well as the socio-
demographic determinants are important in understanding the aetiology of obesity in these
societies and its implications on obesity interventions and policies. In most African societies
including Ghana, the preference has been for the obese body size, and being overweight has
been perceived as attractive, associated with good health, beauty, dignity, respect and
happiness in marriage 4-8. These traditional body and beauty ideals have been challenged by
exposure and acceptance of Western fashion and beauty ideals 9. However, few studies
carried out in Africa have determined whether this ideal body size (IBS) has changed in the
face of continuing globalization and its possible impact on the rising trend of obesity.
Factors that affect body image perception and dissatisfaction include beliefs and attitudes
about body size, socioeconomic status, ethnicity, gender and acceptance in social groups 10, 11.
Existing literature in both Western and African countries reports contrasting relationships
between these determinants depending on the context 10, 12-15. As such, understanding these
determinants and their inter-correlations within the adolescent Ghanaian population will
inform the formulation of socio-culturally friendly policies and interventions to combat the
rise in obesity and its associated chronic diseases.
Several theories including the social comparison and self-discrepancy theories explain body
dissatisfaction as resulting from body comparison 16, 17. Perceiving a discrepancy between
one’s current self and one’s ideal self would stimulate dejection-related emotions, such as
dissatisfaction and depression 18. Body weight perception and dissatisfaction during
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adolescence are correlates of weight control practices, strong predictors of disordered eating
and they could thus be linked to the risk of obesity 19, 20. In a formative stage of life,
adolescents are more vulnerable to societal influences as they try to establish their
personalities; as such, body size perception plays an important role in the management of
their body weight 21, 22.
This paper examines body size ideals, body size beliefs and body size dissatisfaction in
Ghanaian adolescents. The first aim was to determine the IBS and its socio-demographic
determinants in this population. In doing this, participants’ and their peers’ IBS, as well as the
healthiest and Ghana’s preferred IBS were examined. As a second aim, beliefs on causal
factors of weight status (e.g. lifestyle and genetics) were explored as IBS determinants since
they might be modifiable predictors and thus useful targets in interventions. As a final aim,
the association of this IBS with dissatisfaction and actual measured body size was tested to
know whether an extreme IBS might induce decreased well-being and weight problems.
METHODS
Study Design and Population
The study was conducted in the Greater Accra Metropolitan Area. Accra, the capital city of
Ghana, has a population of 1,848,614 million people (2010 National Population Census,
Ghana Statistical Service, 2012); it is one of the most populated and fastest growing cities in
Africa. Accra’s population is, like in most urban centres, very youthful with 56% of the
population under the age of 24 years. As a result, we consider it representative of an urban
African region highly exposed to Western culture. The study was cross-sectional and data
from adolescents (11-18y), without any diagnosed illness was sampled from July to August
2014. Five secondary schools with average population around 500 were selected randomly
from a list of all schools in the Accra Metropolitan area. In each school, half of the classes
(spread over all years) were invited of which a total of 370 adolescents accepted to
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participate, resulting in a participation ratio of 32.2%. Questionnaires were completed by the
adolescents and anthropometric measurements were executed by a researcher on the same
day.
Questionnaires
Though questionnaires were self-administered, participants were assisted to understand and
complete each questionnaire.
Demographic and socio-economic data
Gender, age and ethnicity were the main demographic variables. Ethnicity and parental
education answer possibilities can be found in Table 1. Parental occupation was reported with
an open question and afterwards categorized as blue collar, white collar or unemployed.
Current body size, IBS, and body size dissatisfaction
For IBS, the participants’ own IBS, their peers’ IBS, the healthiest IBS and the IBS in Ghana
were requested. This was obtained from the Stunkard figure rating scale 23. This is a rating
scale made up of nine silhouettes for both boys and girls ranging from extreme underweight
(1) to very obese (9). These silhouettes were classified as underweight (figures 1 and 2),
normal weight (figures 3 and 4) and overweight (figures 5 through 9). Further division is
obese was not performed due to very low prevalence. The same scale was used to self-rate
their current body size. Body size dissatisfaction was calculated as the difference between the
chosen figure for current body size and IBS. Dissatisfaction was categorised as follows: (1)
body size too thin when current-IBS<1; (2) body size satisfactory when current-IBS=0; (3)
body size too heavy when current-IBS ≥1. In addition, two questions were answered on a 3-
level scale (disagree-neutral-agree): “I am satisfied with my body size”; “My peers make fun
of me because of my body size”.
Body size beliefs
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Finally, participants’ body size beliefs were inquired about the relation with health, physical
activity, diet, socio-economic status, family clustering, gender differences and sexual
attractiveness (how males like females to be; how females like males to be). Participants had
to choose from three answer possibilities: disagree, neutral, agree.
Anthropometric Data
Anthropometric measurements were done by trained personnel. To minimise random errors,
all measurements were taken twice and the average was calculated.
Body weight and height were measured according to standard procedures outlined by Gibson
24 without shoes and in light clothing. Weight was measured to the nearest 0.1kg using a Seca
weighing scale. Height was measured in the Frankfurt plane using a portable stadiometer to
the nearest 0.1cm. The BMI-age z-scores were calculated using WHO Anthro-Plus Software
25 and were further categorised using WHO recommended cut-offs 26. Waist circumference
measurements were carried out with a Seca circumference measuring tape to the nearest
0.1cm at the midpoint of the iliac crest top and lower coastal boarderMarfell-Jones, Olds 27.
Data and Statistical Analysis
Data were analysed in SPSS, version 22. The normality of continuous variables was
confirmed using QQ-plots, histograms and skewness (±1)/kurtosis (±2). All tests were carried
out at the significance level of 0.05.
Chi-square statistics were used to determine differences within socio-demographic groups for
gender, self-reported body size, IBS, beliefs and dissatisfaction. For descriptive purposes,
self-reported and actual BMI categories were compared with a chi-square test. The waist-to-
height ratio was always used as a continuous variable, while BMI and IBS were always used
categorically (underweight/normal/overweight) since U-shaped relations may also exist.
Multinomial regression was used to determine the predictive value of body size beliefs to
IBS. Multinomial regression was also used to test the predictive value of IBS to actual and
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self-reported BMI (underweight versus normal; overweight versus normal), while linear
regression was used for waist-to-height (continuous variable) as outcome. Multinomial
regression was used to test actual and IBS as predictor for body discrepancy (too thin versus
satisfactory; too heavy versus satisfactory), while ordinal regression was used for satisfaction
(disagree/neutral/agree) and ‘peers making fun of body’ (disagree/neutral/agree).
Multinomial regression has the advantage of comparing three groups of the outcome variable
at once instead of executing two logistic regression analyses. All regression analyses were
adjusted for gender, age and parental education.
RESULTS
Socio-Demographic Characteristics of Participants
Table 1 shows the background characteristics of the 370 adolescents (53% girls) who
participated. Based on measured weight and height, 19% of the adolescents were overweight.
No gender differences were found in these socio-demographic characteristics; only in
anthropometrics.
IBS, body size beliefs and body size dissatisfaction are described in table 2 and socio-
demographic differences were tested. Most participants perceived their current body size,
IBS, healthiest body size and IBS among peers to be the normal body size but the perceived
IBS in Ghana was obese. More girls than boys reported their IBS to be underweight while
more boys reported the obese IBS. Also, more boys compared to girls said the IBS among
peers was obese. More girls indicated the normal body size as the healthiest one, while more
boys indicated the obese body size. Concerning ethnicity, more Ga-Adangmes compared to
other ethnic groups reported their current body size to be obese.
The questions on beliefs describe health consequences, sexual differences and causal factors
of body size. Concerning health consequences, though most participants disagreed that an
overweight size correlates with good health, they also disagreed with the reverse. Participants
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with highly educated mothers were more neutral to the belief that an underweight body size
correlates with good health. Concerning sexual attractiveness, the majority disagreed that
boys prefer overweight girls, but many adolescents agreed that girls preferred boys with more
muscular bodies. Participants generally disagreed that boys prefer to have overweight bodies
and also that girls preferred being overweight. In the latter, girls more often disagreed.
Concerning causal factors, the majority of adolescents agreed that physical activity and diet
affect body size. More girls, participants with northern ethnicity, with blue collar fathers and
with lower parental education disagreed that physical activity affects body size. Participants
with highly educated fathers disagreed more often with dietary effects on body size. A small
majority agreed that socio-economic status and family history influence body size. In the
latter, more Akans compared to the other ethnic groups agreed.
Body size dissatisfaction was generally high, but gender differences existed: more boys
reported their body as too thin, while more girls found that their body size was too heavy.
Reported and actual body size were significantly positively associated with each other
(p<0.001). Nevertheless, still 64.7% of underweight adolescents and 65.3% of the
overweight/obese adolescents thought themselves to be normal weighted.
Body Size Beliefs as Determinants of IBS
Table 3 describes the associations between body size beliefs and participants’ choice of IBS.
Since significant gender interaction was detected, the analyses were stratified by gender. In
boys, health beliefs regarding body sizes were predictive of choosing less the overweight
IBS. In girls, the overweight IBS was chosen more if they considered overweight bodies as
sexually more attractive for the other gender and if they agreed with familial clustering of
adiposity. Logically, girls also preferred less the underweight IBS if they agreed that girls
generally liked the overweight body size. Beliefs on the role of physical activity, diet and
socio-economic status were not significantly related to IBS.
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Association between IBS and Actual Body Size
Table 4 depicts IBS as possible predictor of adiposity status. Significant associations were
only found for self-reported body size. Those with preference for the underweight IBS were
more likely to be underweight, while those with the overweight IBS were more likely to be
overweight.
Association of Dissatisfaction with Actual body size and IBS
As can be seen in Table 5, body size dissatisfaction and related items such as ‘feeling good
about body size’ and ‘peers making fun of body size’ were significantly associated with
actual body size, self-reported body size and IBS. Results for actual BMI, waist-to-height and
self-reported BMI were very similar: overweight/obese adolescents perceived their body size
more often too heavy, less often too thin, so they had an overall lower body size satisfaction.
In comparison to their normal peers, both underweight and overweight adolescents were
made fun of; the odds ratio was even higher for the underweight group. Adolescents with the
overweight IBS were overall less satisfied (more often ‘too thin’ but less often ‘too heavy’)
and were more often made fun of by peers. Those with the underweight IBS more often
reported a ‘too heavy’ body. The results for IBS remained the same after adjustment for
actual BMI (data not shown).
DISCUSSION
Apart from being a risk factor for developing obesity, body dissatisfaction could lead to
psychosocial health problems especially in adolescence. Since dissatisfaction is precipitated
by comparison of one’s self to the societal ideal, it is imperative to recognise existing IBS in
the population in order to promote a healthy IBS. In our study, most adolescents preferred the
normal body size. Some body size related beliefs (attractiveness for the other sex; health
relevance) could predict IBS but the IBS could not predict the actual body size. Results show
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that both overweight and underweight adolescents can suffer from dissatisfaction or peer
prejudices but especially the overweight IBS might increase dissatisfaction.
IBS and body size beliefs: descriptive data and socio-demographic covariates
An important finding was that most adolescents preferred the normal body size.
Consequently, the traditional African IBS (i.e. the overweight body size) is no longer
predominant in this young, urban population perhaps due to western influences. Nevertheless,
the general Ghanaian preference for overweight bodies was still present and probably
accepted in the older generations since a quarter of the adolescents still preferred an
overweight IBS. In general, girls desire to have slimmer bodies and boys desire more
muscular bodies 28-30, pointing to gender bias in lean versus fat mass. The gender difference in
IBS and the sexual-oriented beliefs found in our study were completely in line with this.
Probably, this reflects the different socio-cultural pressures on girls and boys to conform to
an idealized physique 31. Adolescents in this study recognised that an overweight body was
not necessarily equivalent to good health, or an underweight body to sickness. This provides
an opportunity for health interventions and policies to project a healthy body size within the
population. Additionally, study participants identified physical activity and diet as important
factors that affected body size and this implies they have knowledge on how to attain a
healthy body size 32. Ethnic differences were found and mostly (but not always) adolescents
from low socio-economic status did not associate a healthy body size with lifestyle. This is in
agreement with literature showing that participants of lower socioeconomic status did not
associate physical activity with body size 33.
Beliefs as predictors of IBS
The content and the structure of self-beliefs may represent vulnerability factors for body
dissatisfaction and maladaptive eating behaviour 34. In our sample, sexual attractiveness was
an important determinant for choosing a particular IBS; it was especially the overweight one,
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in agreement with the traditional African IBS. For boys, health beliefs about body size
predicted their choice of the healthier IBS. Consequently, promoting the normal-sized body
as healthy and focussing less on attractiveness for the other sex might be a good way to
influence IBS in this population. Beliefs on the role of physical activity, diet and
socioeconomic status were not significantly related to IBS. It has been shown that even when
individuals know and desire a healthy body size, perceived sexual attractiveness, socio-
cultural ideals and the opinions of significant others in their life play a role in whether or not
they actively pursue in attaining this body size 4, 18, 35, 36. As demonstrated by the tripartite
model 37, the self-discrepancy theory 17, 18 and other studies 38, influencing the individual
choices in healthy body size should therefore involve interventions which target peers and
parents as well.
The relation between IBS, actual body size and dissatisfaction
In this study, both overweight and underweight were related to teasing which may lead to low
psychological well-being 31, 39, 40. Interestingly, both actual (BMI and waist-to-height ratio)
and self-reported overweight body size were associated with body dissatisfaction. Indeed,
both the actual and perceived body size have previously been shown to significantly
influence dissatisfaction 41, 42. This implies that perceived and actual body sizes are equally
important in the design of interventions. As we have seen, actual and reported body sizes are
often highly correlated but still a lot of individuals misclassify their own body size.
Concerning IBS, adolescents with the normal-weight IBS reported less dissatisfaction.
Although the IBS was not associated with actual measured body size, the associated
dissatisfaction could possibly lead to health compromising behaviours 43. Taken together, the
two extreme IBS should be targeted by stressing a normal BMI. Moreover, psychological
aspects of body size acceptance should be considered. Obesity prevention strategies should
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not focus primarily on a person’s weight but promote an overall lifestyle and increase body-
esteem and resilience.
Strengths and Limitations
Very few studies have examined the IBS and especially the associated beliefs within an
African adolescent population. The current study addresses IBS, the associated beliefs as well
as their socio-demographic determinants. The study design made comparisons possible by
using both self-reported and measured weight status since these two might impact differently
on various determinants. Nonetheless, most analyses showed similar results and hence the
findings of the study were further reinforced. Body size dissatisfaction was measured with
both written statements and body silhouettes. This enabled us to accurately measure the level
of dissatisfaction by (1) making a distinction in dissatisfaction because of a too thin or too
heavy body and (2) avoiding socially desirable answers via indirect derivation from the body
silhouettes. Multinomial regressions enabled us (1) to adjust for gender, age and
socioeconomic status and (2) to avoid repeated logistic regression analyses.
Nevertheless, some limitations should be noted. A cross-sectional study design was used and
thus inferences about causation cannot be established, only associations can be tested. Since
convenience sampling was used in adolescents selected from an urban area, generalisations
and inferences should be made cautiously. In our questionnaires on body size ideals, body
size beliefs and body dissatisfaction, some terminology limitations should be mentioned: (1)
the questions used to measures ideas on sexual attractiveness related to body size were very
limited; (2) the questions suffer for some gender bias (the focus was on muscular tissue for
boys while the focus was on fat mass for girls); (3) to avoid influencing the adolescents’ ideas
about healthy bodies we intentionally did not use the terminology underweight/overweight in
the questions on body size beliefs, but we used the more subjective terms ‘heavy’ and ‘thin’ .
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Finally, body dissatisfaction was measured as overall dissatisfaction with the whole body
although dissatisfaction may also be due to specific parts of the body.
Conclusion
In Ghanaian adolescents, the traditional African overweight IBS was not very predominant,
although still more present in boys. In examining the second aim, IBS was predicted by body
size related beliefs on sexual attractiveness and on health relevance but not by their beliefs on
the lifestyle role. Concerning the third aim, dissatisfaction was higher in both those with an
overweight and underweight IBS, independent of actual BMI. In addition, both actual and
self-reported overweight body size were associated with body dissatisfaction.
We should take care that the decreasing trend of ‘overweight IBS’ is not making a shift to the
‘underweight IBS’ to avoid health compromising behaviors like extreme dieting. In fighting
the two extreme IBS and associated body size dissatisfaction, the normal-sized body should
be promoted with an emphasize on the health perspective. Interventions should not focus
primarily on a person’s weight but also on improving the self-efficacy, body esteem and
resilience of adolescents to maintain a healthy body size.
Ethical Declaration
Approval to conduct the studies was sought from the Ethical clearance committee of the
Ghent University Hospital and the institutional review board of the Noguchi Memorial
Institute of Medical Research. In addition, verbal and written consent of the participants and
their parents were sought prior to data collection.
Acknowledgements
Funding: No funding was retrieved for this study.
Competing Interests: None Declared
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The authors want to thank the participating adolescents, their teachers and Dr Irene Ayi of the
Noguchi Memorial Institute of Medical Research, Ghana.
Author Disclosure Statement
All authors have approved the manuscript for publication. Nathalie Michels was paid by the
Ghent University as a postdoctoral researcher. She participated in the design, coordinated the
fieldwork and analyses and helped to draft the manuscript. Sophia Amenyah was a master
student at the Ghent University. She conceived the hypothesis, participated in the study
design, did the fieldwork and statistical analyses and drafted the manuscript.
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Table 1: Socio-demographic characteristics of participants by gender (N=370)
Variable Gender
Boys N (%) Girls N (%) Total N (%) p-value
Age (years)
11-14
15-18
57(32.4)
119(67.6)
69(35.6)
125(64.4)
126(34.1)
244(65.9)
0.519
Ethnicity
Akan
Ga-Adangme
Ewe
Northern
Others
79(44.9)
46(26.1)
31(17.6)
19(10.8)
1( 0.6)
90(46.4)
45(23.2)
30(15.5)
27(13.9)
2( 0.1)
169(45.7)
91(24.6)
61(16.5)
46(12.4)
3( 0.8)
0.809
Father’s education
High School
Tertiary vocational training
Bachelors
Masters
36(20.5)
50(28.4)
29(16.5)
61(34.7)
30(15.5)
56(28.9)
40(20.6)
68(35.1)
66(17.8)
106(28.6)
69(18.6)
129(34.9)
0.542
Mother’s education
High School
Tertiary vocational training
Bachelors
Masters
72(40.9)
56(31.8)
25(14.2)
23(13.1)
74(38.1)
68(35.1)
23(11.9)
29(14.9)
146(39.5)
124(33.5)
48(13.0)
52(14.1)
0.779
Father’s job
White Collar
Blue Collar
Unemployed
96(54.5)
77(43.8)
3( 1.7)
112(57.7)
78(40.2)
4( 2.1)
208(56.2)
155(41.9)
7( 1.9)
0.777
Mother’s job
White Collar
Blue Collar
Unemployed
68(38.6)
105(59.7)
3( 1.7)
66(34.0)
124(63.9)
4( 2.1)
134(36.2)
229(61.9)
7( 1.9)
0.645
Weight Status
Underweight
Normal
Overweight/Obese
13( 7.4)
134(76.1)
29(16.5)
4( 2.1)
147(75.8)
43(22.2)
17( 4.6)
281(75.9)
72(19.5)
0.027*
*Mean differences significant at the 0.05 level using chi-square statistics
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Table 2: Body size ideals, beliefs and dissatisfaction by socio-demographic characteristics of participants
Frequency (%) Age Gender Ethnicity Father’s
education
Mother’s
education
Father’s
job
Mother’s
job
p-values
Current body size 1(12.4), 2(72.4), 3(15.1) 0.603 0.428 0.013* 0.164 0.640 0.693 0.298
Body size ideals
Your ideal body size 1( 8.1), 2(63.5), 3(28.4) 0.759 <0.001* 0.410 0.710 0.428 0.124 0.698
Healthiest body size 1( 5.7), 2(60.5), 3(33.8) 0.773 <0.001* 0.473 0.439 0.787 0.636 0.946
Peers’ ideal body size 1( 7.0), 2(67.6), 3(25.4) 0.838 <0.001* 0.131 0.570 0.472 0.824 0.814
Ghana’s ideal body size 1( 2.4), 2(29.2), 3(68.4) 0.336 <0.140 0.365 0.772 0.876 0.300 0.881
Beliefs about body size
Heavy body size corresponds to good
health and thin body size with sickness
1(70.5), 2(18.4), 3(11.1) 0.500 0.488 0.487 0.922 0.312 0.702 0.925
Thin body size corresponds to good
health and heavy body size with sickness
1(38.6), 2(28.9), 3(32.4) 0.087 0.495 0.515 0.218 0.033* 0.764 0.456
Males prefer females with heavy bodies 1(41.1), 2(36.8), 3(22.2) 0.356 0.453 0.786 0.333 0.902 0.962 0.653
Females prefer males with muscular
bodies
1(18.1), 2(20.5), 3(61.4) 0.121 0.578 0.494 0.050 0.070 0.073 0.255
Males prefer to have more plump bodies 1(53.2), 2(27.3), 3(19.5) 0.781 0.823 0.476 0.162 0.763 0.617 0.625
Females prefer to have heavy bodies 1(40.8), 2(32.2), 3(27.0) 0.810 0.001* 0.813 0.525 0.312 0.174 0.795
Physical activity affects body size 1(26.2), 2( 7.6), 3(66.2) 0.521 0.006* 0.020* 0.019* 0.036* 0.033* 0.108
Body size affected by diet 1(11.6), 2(14.1), 3(74.3) 0.800 0.348 0.011* 0.001* 0.121 0.228 0.560
Socioeconomic status affects diet 1(28.4), 2(28.6), 3(43.0) 0.731 0.223 0.324 0.522 0.222 0.812 0.117
Family history influences body size 1(32.2), 2(21.6), 3(46.2) 0.622 0.643 0.002* 0.668 0.099 0.425 0.918
Body size dissatisfaction
Degree of body dissatisfaction 1(41.6), 2(40.0), 3(18.4) 0.990 <0.001* 0.372 0.222 0.313 0.319 0.667
Satisfied with body size 1(12.7), 2(12.7), 3(74.6) 0.236 0.678 0.333 0.427 0.962 0.560 0.678
Good feeling about body size 1(11.1), 2(12.7), 3(76.2) 0.267 0.684 0.942 0.035* 0.842 0.239 0.004*
Peers make fun because of body size 1(58.6), 2(11.4), 3(30.0) 0.776 0.267 0.746 0.309 0.745 0.465 0.455
*Differences significant at 0.05 level; Current and ideal body size (1=underweight, 2=normal, 3=overweight/obese); Beliefs about body size and body
size dissatisfaction (1=disagree,2=neutral,3=agree); degree of body dissatisfaction (1=too thin, 2=satisfactory, 3=too heavy)
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Table 3: Body size beliefs as determinants of body size ideal
Boys Girls
p OR 95%CI P OR 95%CI
Thin body corresponds to good
health and heavy body with
sickness
Underweight 0.330 0.732 0.391-1.370 0.670 1.102 0.705-1.722
Normal weight 1 1
Overweight 0.016* 0.678 0.495-0.930 0.450 0.870 0.606-1.249
Males prefer females with heavy
bodies
Underweight 0.080 1.591 0.946-2.678
Normal weight 1
Overweight 0.017* 1.647 1.092-2.486
Females prefer males with
muscular bodies
Underweight 0.690 1.160 0.559-2.406
Normal weight 1
Overweight 0.324 1.200 0.836-1.722
Males prefer to have more plump
bodies
Underweight 0.165 0.573 0.260-1.259
Normal weight 1
Overweight 0.979 1.004 0.733-1.376
Females prefer to have heavy
bodies
Underweight 0.018* 0.502 0.283-0.891
Normal weight 1
Overweight 0.676 0.920 0.624-1.358
Physical activity affects body
size
Underweight 0.196 0.684 0.385-1.216 0.853 1.038 0.700-1.540
Normal weight 1 1
Overweight 0.118 0.779 0.570-1.065 0.452 1.129 0.822-1.551
Diet affects body size Underweight 0.662 1.193 0.541-2.627 0.954 1.015 0.602-1.714
Normal weight 1 1
Overweight 0.569 0.898 0.619-1.302 0.607 1.114 0.737-1.684
Socioeconomic status affects
body size
Underweight 0.139 0.573 0.274-1.197 0.317 0.800 0.517-1.239
Normal weight 1 1
Overweight 0.169 0.783 0.553-1.109 0.747 1.061 0.741-1.520
Family history affects body size Underweight 0.530 1.206 0.672-2.165 0.705 1.096 0.683-1.758
Normal weight 1 1
Overweight 0.662 1.067 0.797-1.429 0.022* 0.654 0.455-0.941
OR, odds ratio; CI, confidence interval *Differences significant at the 0.05 level. Multinomial regression analyses (outcome variable with 3 categories i.e.
underweight, normal weight, overweight) were adjusted for age and parental education and stratified by gender. All predictor items were included in the model
at once. Stratification by gender was done because significant belief*gender interactions were found and since there were also some gender-specific statements
(these statements were only included in the regression model for that specific gender group).
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Table 4: Weight status of participants according to their body size ideals
Multinomial regression Linear regression
Outcome 1:
actual BMI
Outcome 2:
self-reported BMI
Outcome 3:
waist-to-height ratio
p OR 95%CI p OR 95%CI p Mean (SD)
Body size ideal: Underweight vs normal (ref) Underweight vs normal (ref)
Underweight ideal
Normal (reference category)
Overweight/Obese ideal
0.719
1
0.269
0.67
1
0.50
0.07-6.12
1
0.15-1.71
<0.001*
1
0.322
10.87
1
1.51
4.47-26.44
1
0.67- 3.40
0.388 0.41(0.007)
0.43(0.004)
0.42(0.005)
Body size ideal: Overweight vs normal (ref) Overweight vs normal (ref)
Underweight ideal
Normal (reference category)
Overweight/Obese ideal
0.962
1
0.197
1.02
1
0.65
0.40-2.62
1
0.33-1.26
0.607
1
<0.001*
0.58
1
4.50
0.07-4.63
1
2.38-8.50
OR, odds ratio; CI, confidence interval; SD, standard deviation of the estimated marginal means
Regression analyses were adjusted for age, gender and parental education. Multinomial regressions were executed for the
outcome variables with 3 categories (i.e. categories underweight, normal weight, overweight). Linear regression was
executed for the continuous outcome variable.
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436
437
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Table 5: Association between actual/ideal body size and body dissatisfaction
Multinomial regression Ordinal regression
Outcome 1:
Body size discrepancy
Outcome 2:
Satisfied with body?
Outcome 3:
Peers make fun of body?
p OR 95%CI p OR 95%CI p OR 95%CI
PREDICTOR 1: Actual BMI (categorical variable) Too thin vs satisfactory
Underweight
Normal (reference category)
Overweight/Obese
0.258
1
0.311
1.84
1
0.71
0.64-5.29
1
0.37-1.38
0.120
1
0.034*
0.43
1
0.54
0.15-1.24
1
0.30-0.95
0.036*
1
0.012*
2.83
1
1.96
1.07-7.50
1
1.16-3.30
Too heavy vs satisfactory
Underweight
Normal (reference category)
Overweight/Obese
/
1
0.001*
/
1
3.15
/
1
1.58-6.28
PREDICTOR 2: Self-reported BMI (categorical variable) Too thin vs satisfactory
Underweight
Normal (reference category)
Overweight/Obese
0.066
1
<0.001*
1.89
1
0.13
0.96-3.71
1
0.04-0.38
0.441
1
<0.001*
0.75
1
0.29
0.36-1.56
1
0.16-0.54
0.007*
1
0.035*
2.30
1
1.84
1.25-4.23
1
1.04-3.24
Too heavy vs satisfactory
Underweight
Normal (reference category)
Overweight/Obese
/
1
0.001*
/
1
3.31
/
1
1.64-6.68
PREDICTOR 3: Waist-to-height (continuous variable) Too thin vs satisfactory
0.031* 0.93 0.87-0.99 0.005* 0.93 0.88-0.98 0.004* 1.06 1.01-1.10
Too heavy vs satisfactory
<0.001* 1.15 1.08-1.24
PREDICTOR 4: Ideal body size (categorical variable) Too thin vs satisfactory
Underweight ideal
Normal (reference category)
Overweight/Obese ideal
/
1
<0.001*
/
1
4.09
/
1
2.37-7.05
0.236
1
0.022*
1.93
1
0.55
0.65-5.76
1
0.33-0.92
0.707
1
0.047*
1.15
1
1.61
0.54-2.45
1
1.01-2.57
Too heavy vs satisfactory
Underweight ideal
Normal (reference category)
Overweight/Obese ideal
0.045*
1
0.035*
2.24
1
0.20
1.05-5.17
1
0.05-0.89
OR, odds ratio; CI, confidence interval * Significant association with p<0.05. Regression analyses were adjusted for age, gender and parental education. Multinomial
regression was executed for the nominal variable (with categories 1=too thin; 2= satisfactory; 3 = too heavy). Ordinal regression was executed for the ordinal variable
(with categories 1=disagree; 2= neutral; 3= agree).
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