Body image perception and body image satisfaction among female medical students of Mysuru

INTRODUCTION

Body image is defined by Grogan as "a person's perceptions, thoughts, and feelings about their body" and depends on a variety of factors: psychological components and sociocultural influences such as family, peers, and ethnicity.¹ People with a positive body image will generally have higher physical and mental health levels and better personal development. A positive body image will influence self-esteem, self-acceptance, and a healthy outlook and behavior.

It is important to remember that everyone is different. Each person's genetic inheritance affects the bone structure, body size, shape and weight differently. Focusing on balanced meals containing nutritious foods and regular physical activity will help you achieve balance and reach your ideal weight. It is also important to avoid comparing their body image to the bodies of their friends or people they see in advertisements or TV shows.²

Since India is still a developing country, many opinions about body image tend to carry a stigma. In India, more than one-quarter of young women (28%) reported moderate to severe body dissatisfaction.³ The impact of poor body image on mental health goes beyond the occasional negative thought. Body dissatisfaction can also cause mental health problems such as eating disorders. Body dissatisfaction leads to poor overall well-being in both sexes and a decline in mental health in women.

Recently, the authors noted that the association between exposure to extreme bodies and misperception of one's own body size resembles a visual adaptation effect. Visual adaptation is a phenomenon that has been known for many decades, perhaps even since Aristotle. The magnitude of body size adjustment effects was found to be related to body satisfaction. The mechanism of these effects is unknown. One proposed explanation for this difference is that the level of body satisfaction affects the amount of attention given to bodies of different shapes and sizes.⁴

The display of exaggerated beauty standards for women, which lead to the distortion of body image, is influenced by sociocultural factors. While the impact of the media on women's body image in Western nations has been extensively studied, there hasn't been enough research on this topic among the Indian population. References to the media or Westernization are additional intricate sociocultural aspects that influence Indian women's body image concerns5. The objective of the study is to assess the body image perception among female medical students of Private Medical College, Mysuru and to assess the body image satisfaction among them. This study also aims to compare the body image perception with the body mass index of the participants.

METHODS

This cross-sectional study was conducted among 210 female medical students of a Private Medical College in Mysuru for a period of two months from November 1st to December 31st 2022, after obtaining ethical clearance and permission from the Head of the institution. According to the normal body image perception of 83.3 % of female students based on a study conducted by Shwetha et al 6 sample size was calculated using the formula.

Sample size,

The sample size was calculated at a 95% confidence interval and 5% allowable error and the sample size was calculated to be around 210.

Sample size,

Participants were selected from Phase 1, Phase 2, Phase 3 (part 1) and Phase 3 (part 2) MBBS students by systematic sampling method.

There is a total of 425 female medical students. The student list was obtained from the college office. The sampling frame was made by rearranging it into alphabetic order. The sampling interval was calculated to be 2 by dividing the total number of students by the required sample size. Every alternate student as per the sampling frame was taken for study. If the selected student was not willing, the next person on the list was considered

Female medical students aged more than 18 years who are willing to participate in the study were included in the study and those with diagnosed health problems which may interfere with anthropometric measurements or body image perception like kyphosis, and scoliosis were excluded. Data was collected using a self-administered questionnaire containing details of sociodemographic information and a validated visual analogue scale, consisting of 8 pictures depicting girls of different silhouettes7. The first three girls depicted in the picture were lean, the next two were normal weight, and the last three were overweight. Participants were asked to name the silhouettes that they felt represented their current weight. Height was measured with a calibrated Seca Stadiometer to the nearest to 0.1cm, weight was measured to the nearest to 0.1 kg using a calibrated digital weighing machine and body mass index is calculated. Body mass index levels were classified according to Asia-Pacific BMI classification [Underweight - < 18.5, Normal – 18.5 – 22.9, Overweight - 23-24.9, Obese - ≥ 25] 8

Data was analyzed using SPSS Version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). The percentage was calculated for descriptive variables. The chi-square test was applied to analyse qualitative data. Associations with p-valve <0.05 at 95% CI were considered to be statistically significant

RESULTS

In the current study, the participants' age ranges from 18 to 24 years, with a mean age of 20.8±1.54.

Table 1 shows that 55 female students are taken from Phase 1, 57 from Phase 2, and 48 and 50 students from Phase 3 (part 1) and Phase 3 (part 2) respectively. The participants' height in the current study ranges from 134 to 175 cm, with a mean of 160±6.5. The participant's weight in the current study ranges from 41 to 89 kg with a mean of 58.22±9.6. The BMI of the participants in the current study ranges from 16.1 to 32.7, with a mean BMI of 22.534±3.553

The majority of the participants in the current study are normal (47.1%) calculated by BMI and (52.4%) with the visual analogue scale, followed by overweight/obese (39%) with BMI and (34.3%) with the visual analogue scale and underweight corresponding to (13.8%) with BMI and (13.3%) with the visual analogue scale of the total study population (Table 2) (Figure 1).

Among the study participants, majority perceive themselves that they had normal body weight (61.9%), followed by overweight (26.2%) and lean (11.9%). In the current study, most participants are neutral regarding their body image (37.1%), (33.8%) are satisfied whereas 24.3% are unsatisfied about their body image (Table 3).

Values are expressed as frequency and parentage. The p-value is by chi-square test. A p-value of less than 0.05 is considered statistically significant.

Family history of obesity shows an association with Visual Analogue Body Perception with a chi-square value of 6.4 and a p-value of 0.04, which shows statistical significance. 16.7% perceived themselves as overweight shows a positive family history of obesity.

Several body image perception factors show an association with the Visual Analogue Body Perception scale. Similarly, the factors associated with a Visual Analogue Body include the intention to decrease or increase body weight, increasing and decreasing the frequency and quantity of meal intake, and skipping meals to reduce or increase body weight. Psychological parameters like feeling anxious, lack of confidence and attempts to change their body weights are also associated (p-value <0.05) (Table 4).

In the current study, 55.6% of participants perceive themselves as overweight but their relatives consider them as normal weight and 69.4% of participants perceive themselves as overweight but their friends consider them as normal weight. Among the study participants, 63.9% perceived themselves as overweight feel anxious about their body type and also 58.3% perceiving themselves as overweight were not confident about their body type and 81.9% perceived themselves as overweight makes attempts to change their body weight.

DISCUSSION

The present study reflects the patterns of body image perception and body image satisfaction, assessing the BMI and the various attempts to alter their body weight and the psychological factors of female medical students of Mysuru.

In the present study, the majority of the participants had neutral perceptions (37%) regarding their body image, 33.8% were satisfied whereas 24.3% were unsatisfied about their body image. Similar rates of dissatisfaction had been found in studies conducted by Rashmi BM et al (19%), Dixit S et al (26.6%), and Priya D et al (33.3%).^9-11 There is lesser body image dissatisfaction among Asian women compared to American and Caucasian women as per some studies.¹²

In the present study, 60.7 % who perceive themselves as lean wanted to decrease or increase their body weight. In a similar study conducted by Priya D et al, all the participants who felt lean wished to increase their weight.¹¹ The present study concludes skipping meals was practiced among the study participants. The study denotes 38.9% who perceive themselves as overweight skip their meals to reduce weight. Researchers suggest the effects of skipping a meal can be different from one person to another according to age, general health, and diet of the subject. Research also shows that people who skip breakfast are at a higher risk of developing type 2 diabetes and also an increased risk of heart disease.¹³

Among the study participants, 63.9% perceived themselves as overweight feel anxious about their body type and also 58.3% perceived themselves as overweight and were not confident about their body type and 81.9% perceived themselves as overweight makes attempts to change their body weight. A survey conducted by Qurat - ul-Ain et al suggests that females have a low level of confidence in their body image as compared to male adolescents.¹⁴

Self-esteem grows up in young people through positive body image. If self–body image is negative and unfavorable then it prompts distress and dissatisfaction with oneself which leads to a low level of self-esteem.

CONCLUSION

From the present study, it can be concluded that 37% had a neutral perception and 24% are unsatisfied with their body image. Familial obesity also plays a key role as there is an association with body image perception. Several body image perception factors are associated with the participants' Visual Analogue Body Perception. Psychological parameters like feeling anxious, lack of confidence, and attempts to change their body weight are associated with body image perception which may further result in affecting their mental health. Counselling services and the provision of IEC materials regarding body image and its taboos would be useful. They should be counselled to stop discussions regarding body shape, weight loss, dieting, and even appearance in general.

ACKNOWLEDGEMENTS

We acknowledge all the students who participated in the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Grogan S. Promoting Positive Body Image in Males and Females: Contemporary Issues and Future Directions. Sex Roles. 2010;63(9):757-65.
2. 2. Every Body is Different. National Eating Disorders Association. 2017. Available at: https://www.nationaleatingdisorders.org/every-body-different. Accessed on 22^nd January 2023.
3. 3. Soohinda G, Mishra D, Sampath H, Dutta S. Body dissatisfaction and its relation to Big Five personality factors and self-esteem in young adult college women in India. Indian J Psychiatr. 2019;61:400-4.
4. 4. Stephen ID, Sturman D, Stevenson RJ, Mond J, Brooks KR. Visual attention mediates the relationship between body satisfaction and susceptibility to the body size adaptation effect. PLoS One. 2018;13(1):e0189855.
5. 5. Kapadia MK. Body image in Indian women as influenced by the Indian media. 2009 Aug 30 [cited 2023 Jan 12]; Available at: https://twu-ir.tdl.org/handle/11274/3939. Accessed on 22^nd January 2023.
6. 6. Goswami S, Sachdeva S, Sachdeva R. Body image satisfaction among female college students. Ind Psychiatry J 2012;21:168-72.
7. 7. Mciza Z, Goedecke JH, Steyn NP, Charlton K, Puoane T, Meltzer S, et al. Development and validation of instruments measuring body image and body weight dissatisfaction in South African mothers and their daughters. Public Health Nutrition. 2005;8(05):509-19.
8. 8. World Health Organization. Regional Office for the Western Pacific. The Asia-Pacific perspective: redefining obesity and its treatment [Internet]. Sydney: Health Communications Australia; 2000 [cited 2023 Jan 14]. 55 p. Available at: https://apps.who.int/iris/handle/10665/206936. Accessed on 22^nd January 2023.
9. 9. Rashmi BM, Patil SS, Angadi MM, Pattankar TP. A cross-sectional study of the pattern of body image perception among female students of BBM college in Vijayapur, North Karnataka. J Clin Diagn Res. 2016;10:LC05-9.
10. 10. Dixit S, Agarwal GG, Singh JV, Kant S, Singh N. A study on consciousness of adolescent girls about their body image. Indian Journal of Community Medicine. 2011;36(3):197
11. 11. Priya D, Prasanna KS, Sucharitha S, Vaz NC. Body image perception and attempts to change weight among female medical students at Mangalore. Indian J Community Med. 2010;35(2):316-20.
12. 12. Wardle J, Bindra R, Fairclough B, Westcombe A. Culture and body image: Body perception and weight concern in young Asian and Caucasian British women. J Community Appl Soc Psychol. 1993;3:173-81.
13. 13. Bi H, Gan Y, Yang C, Chen Y, Tong X, Lu Z. Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies. Public Health Nutr. 2015;18(16):3013-9.
14. 14. Javaid QA, Ajma, A. The impact of body language on self-esteem in adolescents. Clin Counselling Psychol Rev. 2019;1(1):44-54.