Brief research reportMore than just body weight: The role of body image in psychological and physical functioning
Introduction
In recent decades, rates of overweight and obesity have increased throughout most of the world, and 69% of adults in the United States are now classified as overweight (body mass index [BMI] greater than 25 kg/m2) or obese (BMI greater than 30 kg/m2) (Flegal, Carroll, Kit, & Ogden, 2012). Obesity is linked to increased mortality and morbidity (Calle, Rodriguez, Walker-Thurmond, & Thun, 2003) and decreased health-related quality of life (HRQL; Jia & Lubetkin, 2005). Psychosocial factors can impact disease directly and indirectly, and it is essential to examine their role in the relationship between physical health and increased weight (Muennig, Jia, Lee, & Lubetkin, 2008).
Recent studies suggest that body image dissatisfaction, the disliking and disparaging of one's body, may contribute to the negative health outcomes associated with increased weight. Groups that place more importance on a thin body ideal appear to experience disproportionately negative health outcomes at lower BMI levels than those who demonstrate more acceptance of adiposity levels (e.g., Cash, Phillips, Santos, & Hrabosky, 2004). Moreover, Muennig et al. (2008) found that current-ideal weight discrepancy, a single-item measure of body image dissatisfaction, predicted mental and physical health more strongly than BMI predicted mental and physical health.
The relationship between weight, body image dissatisfaction and psychosocial functioning is similarly important but imperfectly understood. Overweight and obesity occur in the context of prevalent weight bias and stigmatization, resulting in negative social and economic consequences (Puhl & Heuer, 2009). Interestingly, the literature has not supported a clear association between increased BMI and psychosocial impairment; however, there is support that a proportion of people with overweight and obesity experience significant psychosocial impairment, including dysphoric mood, eating psychopathology, and reduced self-esteem (Puhl & Heuer, 2009). Body image dissatisfaction is common at all sizes, but in non-clinical samples increased BMI is typically associated with increased body image dissatisfaction (Sarwer, Thompson, & Cash, 2005). Body image dissatisfaction is associated with increased levels of depression and reduced self-esteem (Sarwer et al., 2005), and body image dissatisfaction may mediate an association between obesity and psychosocial functioning in women (Mond et al., 2007) and weight-loss treatment seekers (Friedman, Reichmann, Costanzo, & Musante, 2002).
Despite the growing evidence that body image dissatisfaction may affect both physical health and psychosocial functioning, to our knowledge, a mediational model linking BMI, body image dissatisfaction, and physical health had not been tested. The current study extends past research by testing a mediational model of physical HRQL and using a multi-item instrument designed to capture cognitive and affective aspects of body image dissatisfaction (the Body Shape Questionnaire [BSQ]; Cooper, Taylor, Cooper, & Fairburn, 1987). In light of health consequences emerging at lower BMIs in groups with lower weight ideals and the high prevalence of body image dissatisfaction at all BMI levels, we examined potential mediation effects across the full range of BMIs. We also aimed to contribute more generally to the understanding of the relationship between BMI, body image dissatisfaction, and psychosocial outcomes by examining these factors in a continuous, non-clinical sample. Because women commonly report higher levels of body image dissatisfaction than men (Murnen, 2011), we examined these relationships separately by gender.
We hypothesized that there would be an association between BMI and physical HRQL, but that this association would be mediated by body image dissatisfaction. We also hypothesized that in regression analyses that include BMI and body image dissatisfaction as independent variables, only body image dissatisfaction would account for a significant amount of variation in HRQL and psychosocial functioning (specifically, anxiety, depressive symptoms, stress, and self-esteem).
Section snippets
Participants
Participants were 414 college students from a large public university in Hawaiʻi (Mage = 21.5, SDage = 4.9; MBMI = 23.6, SDBMI = 5.2). The majority of participants were female (69%). Reflective of the ethnic diversity found in Hawaiʻi, the sample was 40% Asian, 19% Caucasian, 2% Hispanic, 1% Pacific Islander, 1% Black, and 37% reported mixed ethnicities. Participants were recruited from undergraduate classes and received course credit for participation. After informed consent, participants were
Descriptives
Gender differences were assessed using independent sample t-tests and Cohen's d statistics were used to estimate effect sizes. Men and women were comparable on most variables, but women reported greater stress (d = −.23, p < .05) and body image dissatisfaction (d = −.93, p < .001) than men.
Correlations
Higher BMI was significantly associated with greater body image dissatisfaction in men (r = .35, p < .01) and women (r = .33, p < .01). Higher BMI was also significantly associated with poorer physical HRQL in men (r = −.28, p <
Discussion
Although higher BMI was modestly associated with poorer physical HRQL, this relationship was mediated by body image dissatisfaction. Similarly, in all other analyses, body image dissatisfaction, and not BMI, was associated with or predicted poorer physical and psychosocial functioning. These findings suggest that in an average body weight sample that includes all weight categories, it may be body dissatisfaction, rather than BMI, that is more closely associated with impairments in both physical
Acknowledgements
Thank you to Kelly Vitousek for providing thoughtful and incisive analysis, Yiling Zhang for invaluable editing assistance, and Caylene Castagno who assisted in the preparation of this manuscript.
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