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To determine body image satisfaction among newly entrant women students in a professional institution.
A cross-sectional study using body image satisfaction described in words was undertaken, which also explored relationship with body mass index (BMI) and other selected co-variables such as socio-demographic details, overall satisfaction in life, and particularly in academic/professional life, current health status using 5-item based Likert scale. Height, weight, hip and waist circumference measurement was carried out using standard protocol. Data collection was carried through personal interview using pre-designed, pre-tested semi-structured interview schedule by female investigators during August-September 2010 and analysis carried out by computing percentages and Chi-square test.
Out of 96 study samples, 16.66%, 51.04%, and 32.29% girl students perceived their body image as fair, good and excellent, respectively while overall 13.54% were dissatisfied with their body image. The body image satisfaction had significant relationship with image perception (P<0.001), current general health status (P<0.001) and self weight assessment (P<0.001). Mother's education had a statistically significant (P=0.004) but negative relationship with outcome variable. Students with low weight (BMI <18.5 kg/m2) had a significantly higher (85.71%) prevalence of body image satisfaction while overweight students (BMI≤23 kg/m2) had a significantly higher (54.54%) prevalence of dissatisfaction (P<0.001).
High body image satisfaction is reported in this study and was found to be significantly related to anthropometric measurements. On an encouraging note, this level needs to be preserved for overall mental and healthy development of students. Proactive preventive measures could be initiated on personality development, acceptance of self and individual differences while maintaining optimum weight and active life style.
The concept of body image as a psychological phenomenon was initially established in 1935, by the Austrian psychiatrist Paul Ferdinand Schilder (1886-1940), who said that the mental images that individuals have of their own bodies explain the way their bodies are introduced to them. According to the psychiatrist, one's mental body image is established by senses, ideas and feelings that, most of the time, are unconscious. This representation is built and rebuilt throughout life.[1,2] Body image is a multidimensional dynamic construct that involves internal biological and psychological factors as well as external cultural and social determinants.[3,4]
Individuals who perceive their bodies negatively with regard to culturally valued features may have low self-esteem, low satisfaction in life and feeling of inferiority and pose themselves at higher risk for depression, anxiety or eating disorders. At the highest level of dissatisfaction, this may result in significant impairment of social, educational and/or occupational functioning. Currently, beautiful is considered good and thinness is synonymous with beauty, which makes it valued by society while its opposite, obesity, is strongly rejected. Although the ideals of female beauty vary as a function of esthetical standards adopted at each time, studies show that women have tried to change their bodies to follow these standards.
Obesity has been identified as one of the rising epidemic across globe with consequential rise of non-communicable diseases including disproportionate health care cost on individuals, family and society. According to latest WHO estimates, 14.4% (male) and 15% (female) adult aged 15 years and above are obese in the world. More than half a billion adults (205 million men and 297 million women over the age of 20 years) world-wide were obese in 2008. The prevalence of overweight and obesity was highest in WHO regions of America and lowest in South-East Asia.
Overweight children, adolescents, and adults generally have lower body esteem than do their normal-weight peers and this is especially true for females. It is generally believed that body image distortion and related consequences is a western societal phenomenon however, it has made its presence felt into diverse culture including developing countries also. With the change in epidemiological shift, India is witnessing simultaneous manifestation of double burden of communicable and non-communicable disease with a challenging and daunting task for stakeholders to identify issues, resolve conflict, mobilize resources and overcome situation with innovative solution and strategies. Considering this background, a cross-sectional descriptive study sought to determine body image satisfaction, a hitherto underexplored arena in our setting. Using body satisfaction described in words, this study also investigated relationship with body mass index (BMI) and other selected co-variables.
The study variables included body image satisfaction, overall satisfaction in life, and particularly in academic/professional life, current health status and body image perception through self rating on 5-items based Likert scale (poor, fair, good, very good and excellent). Other variables included were related to native place, type of family, social caste, marks obtained in qualifying exam (12th class), education of mother and father, monthly family income, siblings and self assessment of weight into lean (underweight), normal, overweight/obese category. Attempt at changing weight was inquired, if undertaken during last one-year and whether meals were skipped as a method of dieting during last three months. Physical activity considered in present study was: 30 min of intense physical/sports activity that lead to large increase in breathing/heart rate and undertaken for atleast 4-5 days/week (regularly); 1-3 days/week (sometimes) and none.
Height, weight, hip and waist circumference measurements were carried out for each candidate using standard protocol under comfortable conditions after adequate rest in order to compute BMI (kg/m2) and waist/hip ratio, as applicable to Asian citizens. Body weight of the candidate wearing light clothing and without footwear was measured to the nearest 0.5 kg using a weighing scale; height was assessed to the nearest 0.1 cm by using a non elastic measuring tape with the participant standing erect against a wall, without shoes and the head looking straight. Midpoint of inferior margin of last rib and the crest of ilium was measured for waist circumference. The hip circumference was measured around the maximum circumference of the hips. Waist–hip ratio is related to the metabolic complications of obesity and criteria recommended by WHO, of absence of risk (<0.8) and risk of abdominal obesity (≤0.8), were followed. Hemoglobin status to determine presence/absence of anemia (<12 g/dl), as a routine health procedure investigated at the time of admission to institution, was also collected and recorded.
Considering feasibility, all available newly entrant female students undergoing professional courses and residing in women's hostel were contacted. It was proposed for complete enumeration, however, out of a total of 101 resident students, 2 declined to participate, 3 could not be contacted despite of two repeat visits and 96 (95.04%) consented to participate in this study. Data collection was carried through personal interview by the female investigator using pre-designed, pre-tested semi-structured interview schedules during August-September 2010 after taking informed consent of participants ensuring complete confidentiality in a non-judgmental manner and at their convenient time. Data management was done using MS Excel and analysis was carried out by computing descriptive and inferential statistic (Chi-square test) using software statistical package (SPSS ver. 16). For the purpose of analysis, P value of less than 0.05 was considered significant and some items of scale was grouped into a single entity such as poor and fair, into fair, and very good and excellent, into excellent.
Out of 96 students who participated, 20.83%, 35.41%, and 43.75% were associated with BDS, MBBS and nursing streams, respectively; 67.70% belonged to rural background; 71.87% lived in joint family system; 51.04%, 37.5%, and 11.45% secured <80%, between 80-90% and >90% marks in 12th class. Mothers education of majority (54.16%) of participants was up to 12th class, while majority (63.54%) of candidates fathers were atleast graduate; 41.66% had monthly family income between Rs. 20,000-40,000 followed by 38.54% with >Rs. 40,000; 40.62% had sibling as brother only, 5.20% as sister only while 54.16% had both, Table 1.
Nearly, 16 (16.66%), 49 (51.04%), and 31 (32.29%) female students perceived their body image as fair, good and excellent, respectively while overall 13 (13.54%) were dissatisfied with their body image. Further analysis of body image satisfaction was carried out with selected variables and association was found to be statistically non-significant with professional stream (P=0.058), native place (P=0.44), type of family (P=0.66), social caste (P=0.34), marks obtained in 12th class (P=0.32), education of father (P=0.28), monthly family income (P=0.10), gender of sibling (P=0.70), physical activity (P=0.41), global satisfaction in life (P=0.30) and satisfaction in academic life (P=0.76). Nearly 34.37% participants attempted at changing (increase/decrease) their weight (P=0.73) during last one-year while 9.37% skipped at least one meal during last three months as a strategy for weight reduction (P=0.82).
The body image satisfaction had significant relationship with image perception (P<0.001), current general health status (P<0.001) and self weight assessment (P<0.001). Mother's education had an inverse bearing on the outcome variable (P=0.004). According to BMI nearly 11.54% girls were found to be overweight (or obese) while 29.16% were under-nourished; 26.04% had waist/hip ratio of more than 0.8 and was significantly related to body image. Nearly, 75% girls were found to be anemic but this was not statistically related to body image in the sampled population (P=0.86), Table 2.
A study was undertaken to determine body image satisfaction and perception among newly entrant girl students (17-22 years) of a professional institution. In the present study nearly 83.33% rated their perceived body image from good to excellent while overall 13.54% were dissatisfied with their image. Our study reports a relatively lower proportion of body image dissatisfaction among college going girl students in comparison with other selected studies done at international platform. The study methodology may differ but on review of literature, level of body image dissatisfaction ranged from 33% (China), 34.9% (Australia), 45% (Greece), 47.3% (Brazil), 50% (Taiwan), 56% (Norway), 29.8% and 56.7% (Turkey), 69% (European Union), and 73.3% (USA).[10,11,12,13,14,15,16,17,18] Probably culture, upbringing, professional stature and ethnicity may be some predominant factors behind high body image satisfaction, as another study carried out in UK also reported that Asian women were less likely to describe themselves as too fat, were less dissatisfied with their body size, and less likely to want to lose weight in comparison with white women. The other possibility of low dissatisfaction could be that the first year students have just emerged from the protected environment of their family and may throw surprising results if study is repeated after few years when they are exposed to more competitive situations later in life. On the contrary, a study conducted amongst all resident medical female students in south India reported image dissatisfaction to the tune of 33.3%.
Similar results were observed from another study conducted in Karnataka, with 29.1% underweight girl students but only 3.2% being overweight while more than 65% perceived themselves to be either slim or thin. A study carried amongst nursing students (mean BMI: 20.14) in West Bengal also revealed double burden of nutritional disorder with prevalence of faulty weight perception of 38.6% and was found to be weighted towards feeling higher weight. In study conducted in Delhi, half of overweight/obese youth had low body satisfaction, while one-quarter of the non-overweight youth felt the same; among overweight/obese youth, girls were more likely than boys to perceive themselves as overweight (P=0.047) and to have low body satisfaction (P=0.052). In Lucknow, 73.4% adolescent girls were satisfied with their body image, while 26.6% were dissatisfied.
In the present study (mean BMI: 20.13), nearly 15.62% perceived themselves to be overweight/obese while actually 11.54% could be grouped into this category (BMI >23 kg/m2). Similarly, 8.33% perceived themselves to be underweight/lean but infact 29.16% were found to be so (BMI <18.5 kg//m2). Students with low weight (BMI <18.5 kg/m2) had a significantly higher (85.71%) prevalence of body image satisfaction while overweight students (BMI ≤23 kg/m2) had a significantly higher (54.54%) prevalence of dissatisfaction (P<0.001). Body image satisfaction had significant relationship with BMI and waist–hip ratio in the present and was similar to as reported in other studies. Further, higher proportion of dissatisfaction was found amongst subjects with higher level of mother's education probably due to increased aspiration and expectations in life.
The burden of under-nutrition including anemia is widespread amongst Indians especially the vulnerable groups. According to community based National Family Health Survey (NFHS-3 survey, nearly 36% of women are undernourished (BMI <18.5) while the percentage of married women age 15-49 who are overweight or obese, increased from 11% in NFHS-2 (1998-99) to 15% in NFHS-3 (2005-06) and almost half of the girls in age 15-19 were undernourished. District Level Household Survey (DLHS) and Indian Council of Medical Research surveys have repeatedly shown that over 70% of pre-school children, adolescent girls and pregnant mothers are anemic. Akin to this observation, our study also reflected similar situation with 75% of girls being anemic who need adequate and priority management. Authors acknowledges some of the limitations of our study such as small sample size; possibility of under-reporting; non-use of scales like visual analog, figure rating or contour drawing comparison scale etc. Similar studies may be undertaken at other centers in India to determine frequency/variations/trends overtime with inclusion of male member of society also.
To conclude, high body image satisfaction is reported in this study and found to be significantly related to anthropometric measurements. On an encouraging note, this level needs to be preserved for overall mental and healthy development of students. Proactive preventive measures could be initiated in institutions on personality development, acceptance of self and individual differences while maintaining optimum weight and active life style.
Vice-Chancellor and Director, University of Health Sciences, Rohtak, India.
Source of Support: Nil
Conflict of Interest: None declared.