This study examined the relationship between weight status and body image in a nationally-representative sample of US adolescents. As posited in our first hypothesis, obesity was associated with body image dissatisfaction in boys and girls, confirming previous findings (McCabe, Ricciardelli, & Holt, 2010
; Mond, van den Berg, Boutelle, Hannan, & Neumark-Sztainer, 2011
; Neumark-Sztainer et al., 2002
; Schwartz & Brownell, 2004
). Although the prevalence of overweight/obesity was higher in boys compared to girls, adolescent girls reported significantly more body image dissatisfaction than boys. Social engagement moderated the relationship between weight status and body image for girls, but not for boys, thus partially supporting our second hypothesis. However, for boys, social engagement was associated with more body satisfaction, regardless of their weight status.
Given the high prevalence of obesity, more adolescents may be struggling with body dissatisfaction. Both obesity and body dissatisfaction are risk factors for low self esteem and depression, and can lead to psychosocial and physical problems (Brausch & Gutierrez, 2009
; van den Berg, Mond, Eisenberg, Ackard, & Neumark-Sztainer, 2010
). They may also lead to disordered eating behaviors which can increase the risk for weight gain (Neumark-Sztainer et al., 2002
). The high percentage of adolescent boys (33.9%) and girls (27.4%) who were overweight/obese in this nationally representative sample, along with the consistent association between overweight/obesity and body dissatisfaction across gender, highlight the urgency to address the increasing prevalence of body dissatisfaction in adolescents.
Much of the research examining peer influences on body image among adolescent boys and girls focuses on the messages peers impart rather than on a more comprehensive measure of social engagement. However, some studies have shown that low friendship quality may contribute to body dissatisfaction in adolescent girls (Schutz & Paxton, 2007
) so the peer group in general might have an important influence on body image. The desire to conform to the specific norms of a peer group places pressure on adolescents to be thin. This conflict between conforming to ideal norms of thin bodies and the reality of their actual body size may result in body dissatisfaction for boys and girls (Gerner & Wilson, 2005
; Presnell, Bearman, & Stice, 2004
). The positive association for boys and girls between social engagement and body satisfaction supports the idea that peers and social relationships are important for adolescent development.
Despite the increasing prevalence of obesity, society remains extremely disapproving towards overweight individuals as demonstrated by the high prevalence of institutional and interpersonal weight-based discrimination (Puhl, Andreyeva, & Brownell, 2008
). The stigma associated with obesity increases the probability that overweight individuals will internalize negative thoughts about themselves and develop body dissatisfaction (Makara-Studzinska & Zaborska, 2009
). Even more distressing, adults who had child or adolescent onset obesity have the most significant body image disturbances (Makara-Studzinska & Zaborska, 2009
Social engagement moderated the relationship between weight status and body image for girls, but not for boys, thus partially supporting our second hypothesis. For boys, social engagement was associated with body satisfaction, regardless of their weight status. To our knowledge, no studies have investigated the association between peer groups and body image among boys but these findings suggest the need for further examining mechanisms linking social engagement to body satisfaction within this group.
For adolescent girls, social engagement was a moderator of the relationship between weight status and body image. Overweight/obese girls with less social engagement had more body dissatisfaction than overweight/obese girls with more social engagement, suggesting the importance of social engagement for adolescent girls, especially if they do not meet the norms for weight status. Bowker, Spencer and Salvy (2005)
showed that supportive friendships were negatively associated with emotion-focused coping while friendship conflict was positively associated with internal blame among overweight but not normal/underweight adolescents. Overweight adolescents are more likely to be socially isolated and on the periphery of social networks (Strauss & Pollack, 2003
), and overweight girls in particular may be more likely to experience peer exclusion (Neumark-Sztainer et al., 2002
; Pearce, Boergers, & Prinstein, 2002
) which may reinforce overweight/obese girls’ perceptions of body dissatisfaction (Gerner & Wilson, 2005
Based on the literature review and our conceptual framework, we hypothesized that the major differences would be between adolescents with normative/society-approved weight status (normal weight and underweight) and those whose weight deviates from the normative/ideal standards. The weight status categories were dichotomized at the 85th
percentile but there could have been differences between the overweight and obese groups. However, both overweight and obese adolescents have been found to experience more teasing than average weight adolescents (Neumark-Sztainer et al., 2002
.) In addition, prior to collapsing the underweight and normal weight categories, we tested for significant differences in mean body image across these groups, for boys and girls. Our results showed that there were no significant differences, for either gender. It is possible that body dissatisfaction works differently in underweight adolescents but our sample of underweight adolescents was insufficient to analyze separately. Future studies should look at this specific population.
This study has many strengths including the use of a large nationally representative sample that is socially and economically diverse, the use of a previously tested valid and reliable measure of body image, and the examination of associations that are central to adolescent development, yet were seldom the focus of previous research. One important limitation includes the cross-sectional nature of the study which does not allow directional conclusions. Our proposed framework suggests that obesity leads to body dissatisfaction, but a reverse direction might also be true, e.g., body dissatisfaction may cause adolescents to indulge in excessive eating that could result in overweight/obesity (Neumark-Sztainer et al., 2006
). Both pathways are plausible and can only be disentangled in future longitudinal studies. Additionally, it is important to note that there may be a bias in who reports social engagement. Depression, for example, may cause an adolescent to report less social engagement and body dissatisfaction. Another limitation is that weight status was calculated from self-reported, rather than actual, height and weight. Studies however, have shown that the bias in self-reported height and weight is minimal and certainly acceptable for analysis of group data (Dietz & Bellizzi, 1999
; Goodman, Hinden, & Khandelwal, 2000
In summary, establishing friendships is an essential developmental task for adolescents and as this study showed, social engagement can protect adolescents from having body image dissatisfaction. Our findings show that social engagement is protective against body dissatisfaction for all boys, regardless of their weight status, and especially protective for overweight/obese girls. Therefore, encouraging adolescents, particularly overweight/obese teenage girls, to develop strong, healthy relationships with peers may prevent them from having body dissatisfaction. When faced with adolescent girls or boys, regardless of their weight status, who are dealing with body dissatisfaction, physicians, psychologists, parents and teachers could inquire about their social engagement and possibly encourage them to establish more interaction with friends, for example through involvement in clubs and team sports. Given the continuous rise in overweight/obesity among adolescents, the accompanying increase in the prevalence of body dissatisfaction, and the numerous adverse health consequences that could develop from body dissatisfaction, successful strategies that could prevent the development of negative body image are needed. Encouraging social engagement among adolescents may be one such strategy. More research is needed, however, to examine potential racial differences in the proposed framework and to evaluate the relative importance of parental influence and social engagement in the association between adolescents’ weight status and body image.