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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 157-162

Self-esteem and body-image dissatisfaction among adolescents: A cross-sectional study


1 Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India
2 Department of Community Medicine, Dhanalakshmi Medical College, Perambalur, Tamil Nadu, India

Date of Submission20-Nov-2019
Date of Decision23-Jan-2020
Date of Acceptance02-Apr-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Dr. Neethu George
Department of Community Medicine, Dhanalakshmi Medical College, Perambalur, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_84_19

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  Abstract 

Introduction: Adolescence is the time period in which the values about themselves will be created. Hence, self-esteem and correct perception about own body are an important context in their life.
Objectives: The objective of this study is to find out the degree of dissatisfaction with their body size (DDBS) among adolescents and to analyze the influence of it on self-esteem.
Material and Methods: This study was cross-sectional done among the undergraduate students in a private medical college and students of high-school section of the government school. A questionnaire was used to document the sociodemographic details, subjective assessment of body image, and self-esteem.
Results: In this study, majority of the students had high (93; 50.8%) self-esteem and moderate self-esteem (62; 33.9%). Out of 183 samples, 53 (29%) were satisfied with body contour based on DDBS. In those who were underweight, it is shown that 48 (54.5%) wanted to increase their body weight, and in normal body mass index (BMI) category, 50% of participants wanted to lose their body weight. Age and BMI were significantly associated with self-esteem and body-image perception.
Conclusion: The concept of body image has to be modified to reduce the risk of overweight, obesity, and eating disorders. This, in turn, can increase and sustain the self-esteem of adolescence.

Keywords: Adolescence, body image, dissatisfaction, perception, self-esteem


How to cite this article:
George M, George N, Ajmal S, Paul A, Aathira M S, Amruthavani A K. Self-esteem and body-image dissatisfaction among adolescents: A cross-sectional study. Indian J Community Fam Med 2020;6:157-62

How to cite this URL:
George M, George N, Ajmal S, Paul A, Aathira M S, Amruthavani A K. Self-esteem and body-image dissatisfaction among adolescents: A cross-sectional study. Indian J Community Fam Med [serial online] 2020 [cited 2021 Apr 18];6:157-62. Available from: https://www.ijcfm.org/text.asp?2020/6/2/157/304803


  Introduction Top


Adolescence is defined as the period between the age group of 10–19 years.[1] India has the largest adolescent population in the world, comprising 250 million adolescents who contribute to 21% of the total population.[2] Adolescence is a vital moment in the profound development of physical and psychological health.[3] This is the time in which adolescents grow physically, mentally, and psychologically. The perception that creates during the time remains more or less similar throughout their life. This is the time where the adolescents start to value themselves, own ideas, and try to stand and pursue it. The changes in the body and own perception give confidence at the same time mistrust or skepticism about oneselves [Figure 1].
Figure 1: Perceptions and its effects

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During the growth spurt, as noteworthy changes occur in the body, weight perception is also influenced. Bodyweight perception refers to one's estimate of body image with all of the accompanying feelings, attitudes, and thoughts concerning weight, size, shape, and appearance.[4],[5],[6] Bodyweight perception plays a significant role in weight management. A previous study has concluded that body weight perception is a better predictor of body management and related behaviors than Body Mass Index (BMI), i.e., actual weight status.[7] Almost one-third of adolescents misperceive their body weight; moreover, compared to boys, girls are more likely to hold misperceptions. In a previous study, 42.2% of girls had misperceptions compared to 7.3% boys.[8]

The term self-esteem means “reverence for self.” The “self” pertains to the values, beliefs, and attitudes that we hold about ourselves. Having a strong will and self-confidence, decision-making power and originality, creativity, sanity, and mental health are directly related to self-esteem and sense of self-worth. It also refers to an individual's sense of his or her value or worth, or the extent to which a person values, approves of, appreciates, prizes, or likes him or herself.[9] There are many studies showing a decreased self-esteem for those with overweight or obesity.[10],[11] As suggested four major factors which are important in the development of self-esteem: (1) treatment and acceptance received from significant others in life, (2) a person's past successes, (3) the values and aspirations which modify and interpret a person's experiences, and (4) how a person responds to devaluation.[12] Hence, the presence of altered perception leads to dissatisfaction and defamation from others leading to lowered self-esteem.

The aim of this study was to find out the Degree of Dissatisfaction with their Body Size (DDBS) among adolescents and to analyze the influence of it on self-esteem. Furthermore, wanted to assess the change of perception between early and late adolescents in terms body size dissatisfaction and self esteem.


  Material and Methods Top


We conducted a cross-sectional study for a period of 1 month among the undergraduate students in a private medical college and students of high-school section of government school. This study was initiated after obtaining the Institution Ethics Committee approval and necessary permission from the authority.

The sampling method followed was convenient sampling, and the school was selected on a convenient basis to access early adolescents. Similar late adolescent group was accessed from the early year of medical college.

A structured interview schedule was administered to the study population. The interview schedule consisted of two parts. The first part included sociodemographic detail of the participants, including age, gender, type of family, number of family members, education, and occupation of parents. Physical parameters such as height, weight, BMI, and waist circumference were also assessed.

The second part has subjective self-assessment of body image.

The figure rating scale adapted by childress and coworkers consists of eight figures representing several children's and adolescents' body outlines, ranging from very slim (contour 1) to obese (contour 8). This was available for both boys and girls.[13] From the eight outline figures available, the schoolchildren chose the one that matched their Current Body Size (CBS – the figure showing the contour they believe they have) and the one matching their ideal body size (IBS – the figure showing the contour the child would like to have); this was done in a private room, the children having had prior individualized explanation given by the chief researcher. DDBS) was obtained by subtracting the CBS from the IBS. The DDBS score showed the degree of dissatisfaction with body shape; the magnitude may be positive when the individual wishes to increase their body size and negative if they wish to reduce their size. To characterize body dissatisfaction, regardless of whether individual wishes to increase or reduce their contour, (a dissatisfied individuals with DDBS >/<0 and b) satisfied – individuals with DDBS = 0. The part 3 has the assessment of self-esteem.[14]

Rosenberg Self-esteem Scale (10 items) was used to assess self-esteem. There were five items for positive self-esteem and five items for negative self-esteem. They were scored for positive self-esteem as 3 for strongly agree, 2 for agree, one for disagree, and zero for strongly disagree. Reverse scoring is done for negative self-esteem. The total score of self-esteem ranged from 0 to 30 for 10 items. Levels of self-esteem were classified as very high self-esteem (25–30), high self-esteem (19–24), moderate self-esteem (13–18), low self-esteem (7–12), and very low self-esteem (0–6).

After obtaining formal administrative approval and necessary consent from school authorities and assent from children, the questionnaire was administered by the researchers. Necessary physical and general examinations were done to record the anthropometric measurements. Each part of the questionnaire was explained to the students in the local language and filled by the researcher based on their answers.

The purpose and objectives of the study were explained for the late adolescent group (1st year MBBS students) and motivated for the self-completion of questionnaire. The doubts were cleared, and physical and general examinations were done to record the anthropometric measurements

The data collected were entered in Microsoft Excel and analyzed using the SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. (Chicago, USA, SPSS Inc.). The descriptive analysis was analyzed using frequencies, mean, standard deviation, and proportions. Appropriate statistical tests were conducted to find further association.


  Results Top


The mean age of the study population was 15.3 ± 3.32 years. The youngest study subject was 11 years of age, and the oldest study subject was 19 years of age. In the study population, 107 (58.3%) were females. Among the population, 110 (60.1%) belong to the early adolescent group, i.e., from 10 to 13 years [Figure 2]. Majority (126; 68.9%) belonged to the nuclear family. In this study, 31 (16.9%) had more than five members in the family.
Figure 2: Age distribution of the study population

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In this study, most of the participant's parents were graduates (24% paternal and 19.7% maternal). In the occupation pattern, most (35%) of the fathers were daily wagers, and mother's (63.4%) were homemakers. Among the study population, 88 (48%) were underweight according to the WHO BMI classification [Figure 3].[15]
Figure 3: Distribution of body mass index among the population

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In this study, majority of the students had high 93 (50.8%) self-esteem and moderate esteem 62 (33.9%). Both for girls (52; 48.6%) and boys (41; 53.9%), majority had high self-esteem [Table 1]. Out of 183 samples, 53 (29%) was satisfied with body contour based on DDBS [Figure 4].
Figure 4: Degree of dissatisfaction with body size

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Table 1: Self-esteem according to the Rosenberg Self-esteem Scale (n=183)

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Association was done between BMI and DDBS. In those who are underweight, it is shown that 48 (54.5%) wanted to increase their bodyweight, and in normal BMI category, 50% of participants wanted to lose their bodyweight. In the overweight category, majority 13 (76.5%) wanted to lose their body weight. This difference was statistically significant [Table 2].
Table 2: Body dissatisfaction distribution (n=183)

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The variables self-esteem and DDBS were subjected to inferential statistical tests with other sociodemographic variables (age categories [early and late], gender, type of family, number of family members, education and occupation of father and mother, and BMI) to find any associations.

The table shows that the association between age and DDBS was statistically significant. Among the early adolescents, 84 (76.36%) were not satisfied with their body image compared to 46 (63.01%) of late adolescents [Table 3].
Table 3: Association between age and degree of dissatisfaction with body size

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Age as a continuous variable and total self-esteem score was correlated to see any significant result. It was found that as age increases self-esteem decreases. There exists a weak negative correlation between age and self-esteem (r = 0.24, P = 0.001). In early adolescents, the number of participants with moderate and high self-esteem was high than in late adolescents. There was no significant association between DDBS categories and self-esteem categories (χ2 = 4.78, P = 0.18).

Our study shows that self-esteem was negatively correlated with BMI (self-esteem weak correlation [Correlation coefficient = −0.15, P = 0.03]). Furthermore, we did not find any significant association between degree of dissatisfaction and self-esteem categories. However, we could see that 69.2% of participants who had low self-esteem had dissatisfaction with their body size.


  Discussion Top


The objective of our study was to find out the DDBS among adolescents and to analyze the influence of it on self-esteem. In this study, majority of the students had high 93 (50.8%) self-esteem and moderate esteem 62 (33.9%). Out of 183 samples, 53 (29%) is satisfied with body contour based on DDBS.

Adolescents during their period always are at conflict of views even in their body image perception. The way they look at themselves matters the most in their physical and psychological health. Furthermore, these perceptions affect their self-evaluation which emerges as the single strongest pointer toward their self-esteem. Adolescents with a negative body image concerns are also more likely to have psychological symptoms such as depression, anxiety, and suicidal tendencies than those without dissatisfaction over their appearance, even when compared to adolescents with other psychiatric illnesses.

In our study, most 130 (71%) of the adolescents were not satisfied with their CBS. This finding is similar in studies[16] where 77.6% and 81%[17] were not satisfied with their body size. In our study, 66 (36.1%) want to lose the body weight to reach an ideal size, and 64 (35%) want to gain weight to reach an ideal size. Twenty-nine (38.2%) boys want to gain weight to reach ideality, and 40 (37.4%) girls want to lose weight to reach ideal size. The dissatisfaction difference based on gender was not significant in our study. However, many studies have shown increased dissatisfaction among girls compared to boys.[17],[18],[19],[20] Girls during their adolescence perceive different body images. It can be easily influenced by external media and peer pressure. The perception is far more easily influenced and changed than a boy.

In our study, the early adolescents 84 (76.36%) were not satisfied with their body image compared to 46 (63.01%) of late adolescents. This finding is comparable to a study where they analyzed body image perception at different periods of adolescence where fund that younger adolescents had higher dissatisfaction than their peers.[21] However, a study showed that younger adolescents were found to be least dissatisfied.[22]

In our study, we have found that as BMI increases, DDBS decreases. It shows that people with overweight BMI want to have a lean body weight compared to lesser BMI participants. In those who are underweight, it is shown that 48 (54.5%) wanted to increase their bodyweight, and in normal BMI category, 50% of participants wanted to lose their bodyweight. In overweight category, majority 13 (76.5%) wanted to lose their bodyweight. This finding can also be noted in other studies.[16],[19] These results suggest a strong affinity toward thin shape even when the subject has normal BMI.

Self-esteem is the attitude toward oneself and can act as a pointer toward mental well-being. Hence, in adolescence as compared to any other age group, the presence self-esteem is highly linked to the physical appearance. In our study, we found that majority of the students had high 93 (50.8%) self-esteem and moderate esteem 62 (33.9%). The presence of high self-esteem in our study is comparable with other studies.[23],[24],[25] The self-esteem decreases as age progresses. May be the overload of responsibilities and other duties which bestowed as age progresses reduced the self-esteem. Furthermore, the presence of academic achievement in school increases self-esteem among a person. The decrease in self-esteem as age progresses is also noted by many studies.[26],[27] This can be also be attributed to maturity, acculturation, peer interaction, responsible role acquisition, peer pressure, inferiority complexes psychological, and physical upheaval (storm and stress period) during the age spectrum.

In our study, we did not find any association between self-esteem and body dissatisfaction. From our study, it was found that even though 71% is dissatisfied with the body image (29% satisfied with the image), only 7% had low self-esteem. This shows that physical appearance single handily does not influence self-esteem, but it is a cumulative dominion of inter-woven elements of various realm. There are many studies which showed negative association with both. The studies showed the negative effect of body dissatisfaction on self-esteem in adolescents, which confirmed that a negative discernment of one's body leads to low self-esteem resulting in psychological distress.[22],[28],[29]

Studies[9],[16],[23],[27] have shown that family size, type, and education of parents influence both the body dissatisfaction and self-esteem, which is not found in our study.

Recommendations and limitations

The adolescence is a delicate time which has to be handled in such a way that positive attitude about oneself has to be installed first. The influence of media on these body image perceptions has to be taken care of and should impart a healthy concept instead of beauty. Active part has to be taken by community, family, and parents to build self-confidence, courage to resist both external and internal pressure about negative perceptions and provide support to raise their self-esteem. The school teachers can also be a supporter to deviate the young minds to more fruitful ideas. We should create a mind that loves own body or self which reciprocates to others.

This study was limited to few adolescents which reduces the results completeness. Furthermore, adolescents from different streams such as rural/urban, government school/private school, arts/science, medical/engineering, and socioeconomic groups should have been compared to get an extraimage of the current situation. Furthermore, gender reverse questionnaire should have been included to discuss what other gender feels about. Qualitative questions would have added more value the study.


  Conclusion Top


In this study, majority of the students had high (93; 50.8%) self-esteem and moderate esteem (62; 33.9%). Out of 183 samples, 53 (29%) is satisfied with body contour based on DDBS. The distorted body-image perceptions among adolescences have to be considered as a serious issue, and strategies have to be made to increase the understanding of the actual size of the body. There should be an awareness drive about healthy body not outward beauty body.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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