A biopsychosocial model for understanding body image and body change strategies among children
Introduction
Several studies have shown that many children, particularly girls, aged as young as 5 years report dissatisfaction with their body, display concerns about becoming overweight, and engage in weight loss behaviors such as eating less and exercising to lose weight (e.g., Davison, Markey, & Birch, 2000). In addition, the preference for a large and muscular ideal among boys has also been shown to develop somewhere between the ages of 6 and 7 years (Spitzer, Henderson, & Zivian, 1999). Poor body image, dieting, and related behaviors during childhood are considered major risks factors, which are associated with chronic body image problems, weight cycling, obesity, eating disorders, exercise dependence, and the use of steroids in adolescence and adulthood Birch & Fisher, 1998, Kotler et al., 2001, Shisslak et al., 1999.
The present study was designed to assess the role of biopsychosocial factors in understanding body image concerns and cognitions and behaviors related to both decreasing weight and increasing muscles among preadolescent children. Biological, psychological, and sociocultural factors have been shown to be relevant in understanding the development of body image concerns and weight loss strategies among children (see reviews by Ricciardelli & McCabe, 2001a, Shisslak & Crago, 2001, Smolak & Levine, 2001). However, these factors have not been examined together in a single study. Thus, the relative influence of each factor and how these factors may interact is not known. Further, there is little research that has examined the contribution of these factors to the understanding of cognitions and behaviors to increase muscles among children.
Several studies from different countries, which include Australia, Croatia, Great Britain, Israel, Japan, Mexico, Sweden, and the United States, reviewed by Ricciardelli and McCabe (2001a) have examined the prevalence of body image concerns among children (e.g., Hill et al., 1994, Maloney et al., 1989, Rolland et al., 1997, Thomas et al., 2000). Estimates of the number of young girls who desire a thinner body size range between 28% and 55%. In contrast, a smaller number of girls desire a larger/broader body size, with estimates ranging from 4% to 18% (Ricciardelli & McCabe, 2001a). A notable number of young boys also desire a thinner body size, with estimates ranging from 17% to 30% (Ricciardelli & McCabe, 2001a). However, many other boys desire a larger/broader body size, with estimates ranging from 13% to 48% (Ricciardelli & McCabe, 2001a).
Although many children report dissatisfaction with their bodies and desire either a thinner or broader body size, the importance placed on body size by children has received no attention. This is despite the finding that body image importance is viewed as the core clinical feature of psychopathology in eating disorders (Cooper & Fairburn, 1993). Body image importance has also been found to be a relevant variable for adolescents. Both adolescent girls and boys who place higher levels of importance on their body image are more likely to display body dissatisfaction and engage in body change strategies to lose weight or increase muscles McCabe & Ricciardelli, 2003a, McCabe et al., 2001.
Many young children have also been shown to demonstrate early symptoms of eating disturbance. Based on the Children's Eating Attitude Test scores (ChEAT) (Maloney et al., 1989), 8.8–14% of young girls and 4.7–8% of boys score above the threshold (>20), indicative of disordered eating (Ricciardelli & McCabe, 2001a). Estimates for dieting to lose weight vary from 20% to 55.6% for girls and 31% to 39% for boys. Young children also report exercising to lose weight (43.5% of girls and 36.5% of boys), while fewer children report binge eating (6.5% of girls and 14.2% of boys) and self-induced vomiting (1.8% of girls and 0.7% of boys) (Ricciardelli & McCabe, 2001a). Muscle building strategies among children have been studied less frequently Holt & Ricciardelli, 2002, Smolak et al., 2001. However, a large number of children, particularly boys, report cognitions and behaviors associated with gaining muscles. In one recent study, cognitions and behaviors associated with gaining muscles ranged between 29.4% and 84.5% for boys and 14.1% and 57.4% for girls (Holt & Ricciardelli, 2002).
It is proposed that a biopsychosocial model is the most comprehensive theoretical framework within which to conceptualize and evaluate cognitions and behaviors related to body change strategies among children. Empirical evidence to support the use of such a framework is outlined below.
One of the main biological determinants of body dissatisfaction, dieting, and other aspects of problem eating among adolescents is BMI (Stice, 2002). The research with children also highlights the importance of BMI. Researchers have shown that both boys and girls who have a larger BMI desire to be thinner (e.g., Candy & Fee, 1998, Gardner et al., 1997, Oliver & Thelen, 1996, Rolland et al., 1997). Dieting and related behaviors among children are also closely related to a larger BMI (e.g., Candy & Fee, 1998, Ohzeki et al., 1993, Rolland et al., 1997, Thelen & Cormier, 1995). However, BMI has not been found to be related to strategies to increase muscles in either preadolescent girls or boys (Holt & Ricciardelli, 2002).
Two of the main psychological factors that have been found to be related to body dissatisfaction and body change strategies among adolescent girls and boys are self-esteem and negative affect McCreary & Sasse, 2000, Neumark-Sztainer & Hannan, 2000, Ricciardelli & McCabe, 2001b, Stice, 2001. Self-esteem has also been shown to be related to children's body dissatisfaction and dieting. Children who report higher levels of body dissatisfaction and dieting report poorer self-esteem and are generally dissatisfied with other aspects of their lives, such as school achievement (e.g., Folk et al., 1993, Kelly et al., 1999, Lawrence & Thelen, 1995, Mendelson & White, 1982, Mendelson et al., 1996). However, the relationship between self-esteem and attempts to increase muscles has yet to be explored among children.
Only two published studies were located that have examined the relationship between negative affect and weight and shape concerns Holt & Ricciardelli, 2002, Veron-Guidry et al., 1997. One study found no relationship between depression and body dissatisfaction, but depression was correlated with ChEAT scores in preadolescent girls (Veron-Guidry et al., 1997). The second study found that negative affect, as assessed by the Positive and Negative Affect Schedule for Children (PANAS-C), was associated with dieting and muscle preoccupation among young girls and binging and food preoccupation among young boys (Holt & Ricciardelli, 2002).
An increasing body of research with adolescents and young adults has examined the relationship between sociocultural factors and weight and shape concerns (e.g., McCabe & Ricciardelli, 2003b, Polivy & Herman, 2002, Stice, 1994, Thompson & Heinberg, 1999). The main socializing agents are family, peers, and the media Byely et al., 2000, Ricciardelli et al., 2000, Vincent & McCabe, 2000, Wertheim et al., 1997.
The perceived views of parents are important correlates of children's levels of body dissatisfaction and related behaviors. Perceptions by both young girls and boys that parents are concerned about their child's weight have been associated with children's levels of body dissatisfaction (Gardner et al., 1997). Similarly, for young girls, the desire to be thinner is correlated with actual encouragement to lose weight received from both mothers and fathers (Thelen & Cormier, 1995) and by the mother's dieting (Abramovitz & Birch, 2000). Another study found that body esteem for girls was related to mother's comments about daughter's weight, mother's complaints about her own weight, mother's weight loss attempts, and father's complaints about his own weight (Smolak, Levine, & Schermer, 1999). However, these relationships may be mediated by BMI. The relationship between parental encouragement to lose weight and young girls' preoccupations with thinness has been shown to become nonsignificant once the differences in BMI are partialled out (Thelen & Cormier, 1995). On the other hand, for young boys, the desire to be thinner has not been shown to be related to perceived or actual encouragement to lose weight from either mother or father (Thelen & Cormier, 1995). Perhaps this finding is due to the fact that parents are unlikely to encourage boys to lose weight since this strategy would take boys away from societal ideal boys for males (Spitzer et al., 1999). Boys may be more likely to perceive that their parents encourage them to increase muscles; however, this has yet to be confirmed by empirical research.
Peers have also been shown to significantly influence body image concerns among both girls and boys. Poor body image in young girls and boys is associated with a history of teasing by peers (Gardner et al., 1997). In addition, young girls who talk about their bodies and compare their own bodies to friends' bodies report higher levels of body dissatisfaction (Oliver & Thelen, 1996). Similarly, young girls and boys often desire a thinner body size in order to be liked more by same-sex and opposite sex peers (Oliver & Thelen, 1996). Whether young children also engage in body change strategies to increase muscles in order to be more popular with their peers has yet to be studied.
The role of the media on children's weight and shape concerns has received little research attention. One measure developed for children is the Multidimensional Media Influence Scale (Cusumano & Thompson, 2001). A factor analysis of this scale identified three factors for both boys and girls: internalization of the thin ideal (e.g., “I try to look like the models in magazines”), awareness of the thin ideal (e.g., “Clothes look better on people who are thin”), and perceived pressure from the media to achieve thinness (e.g., “Watching TV or reading magazines makes me want to diet or lose weight”). The subscales were found to be moderately correlated with body dissatisfaction in girls but only weakly associated with body dissatisfaction in boys. This is probably due to the fact that Cusumano and Thompson's (2001) scale did not assess internalization, awareness, and perceived media pressure to achieve muscularity, which may be more relevant to boys of all ages.
The present study was designed to determine the relevance of a biopsychosocial model to body dissatisfaction, body image importance, and both weight loss and muscle gain strategies among boys aged between 8 and 11 years. This age range was selected because significant gender differences in the eating attitudes and behaviors of young children have been found to emerge during this period (Ricciardelli & McCabe, 2001a). Specifically, the study examined gender differences in body image and attitudes and behaviors related to both weight loss and increasing muscles. It further examined which aspects of the biopsychosocial model (BMI, negative affect, self-esteem, and perceived pressures from mother, father, peers, and media) better predicted body dissatisfaction, body image importance, weight loss strategies, and muscle gain strategies among boys and girls. Body dissatisfaction and body image importance were also examined as individual predictors of weight loss and muscle gain strategies, as previous work with adolescents has shown these variables to be relevant McCabe & Ricciardelli, 2003a, McCabe et al., 2001, Ricciardelli & McCabe, 2003.
In addition, the study examined BMI as a potential moderator of the psychological factors, self-esteem and negative affect, and as a moderator of the sociocultural pressures. Although the importance of BMI has been well documented in studies with both children and adolescents, its potential moderating effects have not been examined in past studies. For example, underweight and overweight children may be more affected by low self-esteem and high negative affect and sociocultural messages to either lose weight or gain muscles. However, little is known about the relationship between either psychological or sociocultural factors and body image concerns and body change strategies in children with differing BMIs. Finally, the study assessed whether self-esteem and negative affect moderated the association between sociocultural influences and body image concerns and body change strategies. Self-esteem and negative affect have been found to moderate the relationship between sociocultural influences and body change strategies in adolescents (Ricciardelli & McCabe, 2001a); however, the same associations have yet to be examined in children.
Section snippets
Participants
Approval to conduct the study was first obtained from the Deakin University Ethics Committee and the Education Department. Information letters and consent forms were sent to the parent(s) or legal guardian(s) of all the Grades 3, 4, and 5 children at 10 metropolitan schools in Melbourne, Australia. Children were only allowed to participate in the study if they had returned their signed consent form. Thirty percent of children who returned these consent forms participated in the study. These
Descriptive data
Similar numbers of girls and boys were dissatisfied with their body, although the descriptive statistics show that more girls than boys desired a thinner body size (47.4% of girls and 38.4% of boys), while more boys than girls desired a larger body size (14.1% of girls and 20.7% of boys). Comparable number of girls and boys rated their weight as important (52.3% of girls and 58.5% of boys), while fewer girls than boys rated their muscles as important (37.8% of girls and 59.5% of boys). A
Discussion
The present study examined BMI, self-esteem, negative affect, and perceived pressure to lose and/or increase muscles in relation to body image concerns and body change strategies among girls and boys aged between 8 and 11 years. In addition, the study examined BMI as a potential moderator of the psychological and sociocultural factors and whether self-esteem and negative affect further moderated the sociocultural influences.
There were more similarities than differences among girls' and boys'
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