The present study attempted to enhance the understanding of associations among overweight status, body image dissatisfaction, and depressive symptoms in Asian and Hispanic adolescents. We examined the mediation pathway from overweight status in seventh grade to the subsequent experience of depressive symptoms in eighth grade through body image dissatisfaction across subgroups of adolescents with varied ethnicity (Asian and Hispanic), gender (boy and girl) and acculturation levels (low and high acculturation levels). Our results showed significant gender difference in the hypothesized mediation effect. When gender further interacted with either ethnicity or acculturation, the mediation was significant among Asian girls and boys with high acculturation. In addition, several previous prospective studies suggested early depression predicted subsequent risk of overweight.57, 58
We have run alternative models in this direction and did not observe any significant results.
The gender differences observed in our study are consistent with previous findings in the literature. The relationship between body dissatisfaction and self-esteem has often been found to be significant and stronger in girls than in boys.4
In Stice’s study, for instance, body image dissatisfaction was a significant factor in predicting whether adolescent girls developed depression later.59
The observed moderation effect of gender may be correlated with sociocultural norms and attitudes towards physical appearance in boys and girls,60
in which sociocultural standards of beauty for boys emphasize strength and muscularity whereas thinness body ideal is advocated for girls.61
Sociocultural factors including pressures from peers, relatives, parents, media, and other social environment may affect the ways in which adolescents set their own weight standards, no matter if these standards are healthy or unrealistic.21
Given the fact that muscle is valued more in boys, we also ran additional analysis with the focus on underweight, depressive symptoms in boys and did not find any significant results. In addition, the gender difference may also be related to the fact that girls may be more likely to use social comparisons, a practice that has been shown to increase body dissatisfaction and unhealthy weight-control behaviors in adolescent girls.60
The effect of acculturation on the mediation pathway in our study was related to gender difference as we observed and discussed above. When the role of gender was considered, the mediation effect was only significant in female adolescents with high acculturation levels. The underlying mechanism of how gender interacted with acculturation on the mediation pathway in this study should be related to gender differences in social cultural norms, attitudes, and weight-related behaviors as we discussed above. The literature is sparse regarding the role of acculturation in regulating the overweight-depressive symptoms association. Acculturation can be described as the process by which minority individuals balance and adapt their own cultural behaviors and beliefs with those of majority culture when they encounter challenges of cultural views and practices from mainstream society.62
Enhanced risks of body image dissatisfaction and eating disorders among more highly acculturated non-Western women were reported in previous study.28
This enhanced risk has been suggested to relate to the internalization of Western body ideal, which tends to be especially hard to meet for non-Western girls whose skin color and ethnically defined physical features may be in contrast to the ideal.28, 62
Simultaneously, among Hispanic and Asian adolescents in the United States, acculturation tends to increase the risk of overweight and its behavioral risk factors such as fast food consumption and sedentary behavior.63
Therefore, highly acculturated adolescents may be at risk both of becoming overweight and of endorsing unrealistically thin body-image ideals. The large discrepancy between their body size and their ideal body size may make them especially prone to depression. In addition, other culturally relevant variables, such as cultural conflict, may be able to provide explanation for the mixed observations in our study. Defined as the negative affect and cognitive dissonance resulting from an attempt to assimilate values and expectations of the majority culture and the culture of origin, cultural conflict may especially affect those minority adolescents who have strong ties to their families’ cultures to experience of body image dissatisfaction, psychological distress, and maladaptive eating behaviors.62
Fresh evidence can be found from a recent study among South Asian American women, in which cultural conflict was significantly associated with teasing and body image dissatisfaction.62
Recent cross-cultural studies also reported greater overall body-image dissatisfaction and maladaptive attitudes among Asian women and Hispanic youth who were identified with a stronger adherence and affiliation with traditional Asian or Mexican cultural values than their highly acculturated counterparts.25,29
Finally, another possible explanation may be the influence of pubertal development in associations of overweight, body image, and depressive symptoms experience. As well documented in the current body of literature, gender differences in pubertal development in terms of pubertal timing and velocity of transition result in different patterns of body fat accumulation, which may in turn be related to different experience of body image concerns and risk of adolescent depression.64
Specifically, driven by both growth and sex hormones, adolescents during puberty experience sexual maturation and a fast accumulation in both lean and fat mass. Early maturation in both boys and girls has been suggested to enhance the risk of being overweight and further influence the severity of obesity in adulthood.41,42
For boys, in addition to the increase in fat mass accumulation, most of the weight gain is explained by an increase in muscle tissue, whereas for girls the physical changes of puberty involve significant deposition of fat mass on abdomen, buttocks, and thighs.43
The increase in fat mass accumulation is significantly greater in girls than boys. Because of this additional weight and body fat, puberty is associated with a rise in body dissatisfaction.44
Significant relationships between early onset of menarche and lower ratings of body image were observed in large-scale studies.45
In our study, pubertal status was measured by one single item asking for age of menarche (for girls) or physical change (for boys), which may not be able to capture the developmental process of pubertal status. Future studies should incorporate more objective measures of pubertal development for investigation of its interacting relations with ethnicity and acculturation on associations of overweight, body image, and psychological well-being.
When both gender and ethnicity were considered, significant effect modification of ethnicity in the mediation pathways was observed in Asian girls. In this study, we did not further differentiate adolescents into specific different cultural background within the same ethnic category (eg, differentiate Chinese, Vietnamese, Korean, and Japanese adolescents). Future studies can focus on exploring both within- and between-ethnic group differences in the influence of acculturation on associations among overweight, body image, and depressive symptoms. In addition, body image dissatisfaction was assessed using comparison of subject’s selection of silhouette drawings for actual and ideal body size.37
Although this method has been used in quite a few studies, it may not reflect the multidimensional aspects of body image that not only include physical appearance and “the body’s competence or fitness, biological integrity or health/illness”37
but also expand to evaluative, cognitive, and behavioral components.65
Development of a valid multidimensional instrument of body image assessment is needed for better assessing its associations with overweight and psychological well-being.
In conclusion, our study revealed different associations of overweight, body image dissatisfaction, and depressive symptoms experienced across gender and acculturation levels in Asian and Hispanic adolescent populations. Our findings may greatly contribute to better understanding the association of overweight, and depressive symptoms in adolescents.