(Dis)satisfaction With Body Image, Lifestyles and Life Satisfaction in Higher Education Students

Introduction

Body image can be developed through an individual's conscious thoughts, feelings, and perceptions of themselves and is not necessarily linked to physical appearance, since body image differs depending on the cognitive, behavioural, emotional, cultural, and perceptual elements of the individual in question [1]. This can change throughout life because it depends on the self-esteem of the subjects themselves [2]. As individuals navigate through life's diverse experiences and interpersonal interactions, their evolving self-esteem intricately intertwines with societal norms, personal beliefs, and social comparisons, continuously moulding and reshaping the subjective perceptions of their own bodies.

The pressure to achieve the ideal body, imposed by society, has contributed to an excessive increase in body dissatisfaction and concern about weight, sometimes leading people to achieve extreme thinness, adopt risky behaviours and develop diseases [3,4]. Body dissatisfaction begins to develop mostly in adolescence [5,6] and is especially present in the female sex, since women and girls are more concerned with having a weight within the parameters defined as normal and a good physical condition [7,8]. According to Grossbard [9], women are more concerned about their weight. On the other hand, men have a better perception of their body image, greater self-esteem and a greater desire for muscularity.

Low satisfaction with body image is associated with unhealthy habits and individuals are more likely to gain weight, avoid public places and avoid exposing their bodies [10,11], as well as develop depression, anxiety, and mental illness [12-14].

The lifestyle of the population should be understood as the choices that each individual makes that are reflected in their behaviour. In this context, lifestyle includes behaviours such as physical activity, sleeping or eating [15]. The student period is considered a bridge between adolescence and adulthood, and the stabilisation of these behaviours during this period can affect the whole of life [16]. According to Baron et al. [17], male higher education students tend to fulfil the recommendations for physical activity for health more than girls. However, in an analysis carried out by Lobo [18] on body image satisfaction in higher education students, both boys and girls were dissatisfied.

The literature shows that an active lifestyle is related to improved life satisfaction [19], specifically with regard to university students [20]. Life satisfaction is a measure of mental well-being that evaluates a person's feelings and attitudes towards life at a given time. It is a global method of cognitive self-assessment of well-being through a set of factors related to the individual's lifestyle, including work, family, physical and mental health, and sex life [21].

Given the importance of satisfaction with body image in the population´s health, this study seeks to assess satisfaction with body image in higher education students and whether dissatisfaction with body image is related to lifestyle behaviours and life satisfaction. Understanding body image satisfaction among higher education students is paramount, as this demographic faces unique social and academic pressures that may influence their perceptions of self-image. By examining potential correlations between body image dissatisfaction and lifestyle behaviours such as exercise patterns, dietary habits, and substance use, the study aims to elucidate the complex interplay between physical and mental well-being among students. Moreover, investigating the impact of body image dissatisfaction on life satisfaction can provide valuable insights into strategies for promoting holistic well-being among this population. Ultimately, this research contributes to the broader discourse on mental health and quality of life among higher education students, offering actionable insights for interventions aimed at fostering healthier lifestyles and improved body image perception.

Methodology

Sample

This study involved 166 higher education Portuguese students, 97 female and 69 male, with an average age of 21.57 ((4.3) years. The students attended Higher Technical Courses (31.93%) and Undergraduate Degrees in the Schools of Education (58.4%), Agriculture (1.2%) and Health (40.4%). Of all the courses, 56% of the students derived from the sports programmes.

Instruments

Weight was measured using a SECA 750 mechanical scale. Height was measured with a SECA stadiometer.

Body Image. Body image was assessed using the Figure Rating Scale [22], in which nine silhouettes of boys and nine of girls are presented. The students indicate which silhouette best represents their current image and which of the silhouettes reflects their ideal image. The score representing satisfaction with body image is calculated using the difference between the ideal image and the current image, and is categorised into three levels: "satisfied" (score = 0); "dissatisfied due to excess weight" (score > 0); and "dissatisfied due to thinness" (score <0).

Behaviours

- Active. Active choices during daily life were assessed using the Active Choice Index [23]. Each daily activity (e.g., climbing stairs instead of using lifts or escalators) is assessed on a Likert scale from 1 (Never) to 5 (Whenever possible). The active behaviour score corresponds to the average of the 6 questions, with higher values corresponding to more active behaviour.

- Sleep hours. Students were asked about the average number of hours they slept during the week and at the weekend.

- Tobacco and alcohol consumption. Students were asked if they currently smoked. As for alcohol consumption, they were asked about the number of days in the last 30 that they had consumed alcohol.

- Satisfaction with Life. Satisfaction with life was assessed using a five-item scale developed by Diener et al. [21] and adapted for the Portuguese population by Reppold et al. [24]. The answers are on a 5-point Likert scale ranging from "strongly disagree" to "strongly agree". The Satisfaction with Life score varies between 5 and 30, and the higher the value, the higher the level of satisfaction.

Procedures

During World Physical Activity Day 2022, which was publicised to all students on campus, various activities took place for the educational community. The students who took part in these activities were made aware that the questionnaire was available to fill in via a QR code. The sample for this study therefore included the students who took part in this activity, making it a convenience sample. Before filling in the questionnaire, the participants expressed their interest in taking part in the study through informed consent, in accordance with the Declaration of Helsinki.

Statistical analysis

Data analysis was carried out using the IBM SPSS 28 programme. Descriptive statistics were presented in the form of mean and standard deviation or absolute and relative frequency. Comparisons between the sexes were made using Student's t-test and the Chi-square test. The Kruskal-Wallis test and the Chi-square test were used to compare body image categories ("satisfied", "satisfied with thinness" and "satisfied with excess weight") with regard to life satisfaction, hours of sleep, Active Choice Index, and alcohol and tobacco consumption. A 5% significance level was used for all tests.

Results

After analysing the data, with regard to the characteristics of the sample, it was found that body weight and height averaged 67.24 kg (±12.82) and 167.84 cm (±10.62), respectively. The average scores for perceived and desired body image, based on the Figure Rating Scale, were 2.89 (±1.28) and 2.48 (±0.94), respectively. On average, respondents reported consuming alcohol 4.10 days (±5.01) a week; sleeping 7.25 hours (±1.11) during the week and 8.60 hours (±1.62) at the weekend. The majority of the sample (74.70 per cent) reported not using tobacco. On average, the life satisfaction score was 17.28 (±3.56), out of a range of 0 to 30. Active choices during everyday life, assessed using the Active Choice Index, showed an average of 3.09 (±0.89) on a scale of 1 to 5. With regard to body image satisfaction, while 42.8 per cent of the sample said they were satisfied with their body image, 42.2 per cent said they were dissatisfied because they were overweight (Table 1).

Table 1. Characteristics of the sample.

Table 1 also shows the differences between the sexes, calculated using Student's t-test. Thus, there were statistically significant differences (p<0.05) between female and male with regard to perceived (p=0.041) and desired (p=0.014) body image and satisfaction with body image (p<0.001). Males had higher mean values for desired body image (2.67 ±0.90). On the other hand, females had higher mean values for perceived body image (3.03±1.33). There is a predominance, although slight, of boys who are satisfied with their body image (50.70 %); on the other hand, there is a predominance of girls who are dissatisfied with being overweight (55.70 %). However, males were more dissatisfied with thinness (26.10%) than females (7.20%).

Table 2 and Table 3 show the differences in body image satisfaction according to the variable’s life satisfaction, Active Choice Index, alcohol consumption, sleep hours (week and weekend), and tobacco consumption in males and females, respectively. Analysis of variance (Kruskal-Wallis test) was used to assess the possible existence of differences in body image satisfaction in relation to life satisfaction and lifestyle behaviours: Active Choice Index, alcohol consumption, hours of sleep (weekdays and weekends) and smoking, in males and females. There were no differences between the categories of satisfaction with body image in the different behaviours analysed, in either males or females.

Table 2. Differences in body image satisfaction in relation to the variables life satisfaction, Active Choice Index, alcohol consumption, sleep hours (week and weekend) and tobacco consumption in males.

Table 3. Differences in body image satisfaction in relation to the variables life satisfaction, Active Choice Index, alcohol consumption, sleep hours (week and weekend) and tobacco consumption in females.

Discussion

Body image has been recognised in the literature as a public health issue and different components of body image are associated with the physical, mental, and social health of higher education students [25,26]. Satisfaction with body image is related to favourable health behaviours, making it an indicator of general health [27]. The aim of this study was to assess body image satisfaction and its relationship with life satisfaction and lifestyles.

The majority of the students in our sample reported dissatisfaction with their body image, either because they were thin or overweight. These results are similar to those presented in other studies with university students [28,29]. Analysing body image satisfaction by gender, this study found that the majority of males are satisfied with their body image; however, males are also more likely to be dissatisfied due to thinness, since, as several studies indicate, men are more likely to desire greater muscularity [9,30]. On the other hand, females were dissatisfied with their body image because they were overweight. This difference between the sexes, in which satisfaction with body image is higher in boys compared to girls, is in line with what has been postulated in other studies [29-32].

Dissatisfaction with body image has consequences for young people's health, such as depressive symptoms, adoption of unhealthy body weight management behaviours, and the development of eating disorders [33,34]. Given these risk factors that are associated with the presence of body image dissatisfaction, as well as the secular trend towards an increase in the prevalence of body image dissatisfaction in both sexes [27], it is important to define strategies to reverse this increase, educating about health behaviours and preventing the development of other health complications.

Entering higher education is a time of transition between adolescence and adulthood, characterised by greater autonomy and lack of parental supervision, which can lead to stress problems [35] and compromise health behaviours [36]. Active behaviours, as well as the other health behaviours analysed in this study (hours of sleep per week and alcohol and tobacco consumption), did not differ between the different levels of body image satisfaction. However, a meta-analysis study by Campebell and Hausenblas [37] emphasises the importance of physical exercise in body image perception. The study by Ancos et al. [38] is also not in line with our results in indicating that fewer hours of sleep and poor sleep quality may be related to having a higher body weight and greater dissatisfaction with body image. Other studies carried out on university students corroborate that a low level of physical activity is a predictor of body image dissatisfaction [39]. The overall results of this study can be explained by the fact that the level of physical activity was not considered, but rather the active behaviour scale (Active Choice Index). This scale exclusively considers daily active behaviours but does not include physical exercise.

Longitudinal studies show that an insufficient number of hours of sleep is a risk factor for overweight and obese nutritional status [40]. It is also known that body image perception is a predictor of nutritional status [41]. In our study, it was found that students who were dissatisfied with their body image (due to being overweight) also slept fewer hours at the weekend, which, in accordance with the above, could influence their nutritional status [40,41].

Body image satisfaction is strongly associated with the development of depressive symptoms and life satisfaction in young adults, as they are under great social and peer pressure to conform to social images of attractiveness and imitate the cultural ideal [42]. The relationship between body image satisfaction and life satisfaction was not statistically significant in this study, contrary to previous studies [43,44].

Based on the limitations of this study, it is possible to point to potential future recommendations. Firstly, the sample characteristics in terms of size and diversity. One of the constraints of our study is related to the constitution of the sample, since it is made up mostly of students from the School of Education, namely students attending the Sports programme. The literature shows that students from this area have a positive satisfaction with their body image compared to students from other areas [45]. Secondly, it would be important to assess the level of physical activity, preferably using objective methods, in order to clarify the influence of physical activity on the perception of body image and its mediating effect on life satisfaction.

Conclusions

In conclusion, study underscores the critical significance of body image satisfaction among higher education students and its profound implications for their overall health and well-being. With body image recognized as a pivotal aspect of public health, it becomes evident that various components of body image intertwine with the physical, mental, and social health of students.

The research underscores the detrimental repercussions of body image dissatisfaction on young adults' health, including increased risks of depressive symptoms, unhealthy weight management practices, and eating disorders. Urgent strategies are warranted to address rising prevalence rates, particularly among both sexes, through targeted interventions and support mechanisms. Education on health behaviours and preventative measures emerges as essential in fostering healthier body image perceptions and mitigating associated health complications.

Furthermore, the research underscores the transitional nature of higher education, marked by increased autonomy and evolving health behaviours. While certain lifestyle factors such as physical activity were not directly assessed, existing literature underscores its pivotal role in shaping body image perceptions.

References

1. Peralta REE, Salinas MRQ. Autopercepción de la imagen corporal y prácticas para corregirla, en adolescentes de una institución educativa, Lima, Perú. An Fac Med [Internet]. 2016 Jun;77(2):117-22. doi: https://doi.org/10.15381/anales.v77i2.11815

2. Rodríguez-Camacho DF, Alvis-Gomez KM. Generalidades de la imagen corporal y sus implicaciones en el deporte. Rev Fac Med [Internet]. 2015;63(2):279-87. doi: https://doi.org/10.15446/revfacmed.v63n2.49387

3. Stice E, Bearman SK. Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: a growth curve analysis. Dev Psychol [Internet]. 2001;37(5):597-607. doi: https://doi.org/10.1037//0012-1649.37.5.597

4. Bucchianeri MM, Arikian AJ, Hannan PJ, Eisenberg ME, Neumark-Sztainer D. Body dissatisfaction from adolescence to young adulthood: findings from a 10-year longitudinal study. Body Image [Internet]. 2013;10(1):1-7. doi: https://doi.org/10.1016/J.BODYIM.2012.09.001

5. Eisenberg ME, Neumark-Sztainer D, Paxton SJ. Five-year change in body satisfaction among adolescents. J Psychosom Res [Internet]. 2006;61(4):521-7. doi: https://doi.org/10.1016/j.jpsychores.2006.05.007

6. Bearman SK, Presnell K, Martinez E, Stice E. The skinny on body dissatisfaction: A longitudinal study of adolescent girls and boys. J Youth Adolesc [Internet]. 2006;35(2):217-29. doi: https://doi.org/10.1007/S10964-005-9010-9

7. Lawler M, Nixon E. Body dissatisfaction among adolescent boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. J Youth Adolesc [Internet]. 2011;40(1):59-71. doi: https://doi.org/10.1007/s10964-009-9500-2

8. Meland E, Haugland S, Breidablik HJ. Body image and perceived health in adolescence. Health Educ Res [Internet]. 2007;22(3):342-50. doi: https://doi.org/10.1093/her/cyl085

9. Grossbard JR, Lee CM, Neighbors C, Larimer ME. Body image concerns and contingent self-esteem in male and female college students. Sex Roles [Internet]. 2009;60(3-4):198-207. doi: https://doi.org/10.1007/s11199-008-9535-y

10. Irvine KR, McCarty K, McKenzie KJ, Pollet TV, Cornelissen KK, Tovée MJ, et al. Distorted body image influences body schema in individuals with negative bodily attitudes. Neuropsychologia [Internet]. 2019;122:38-50. doi: https://doi.org/10.1016/j.neuropsychologia.2018.11.015

11. Von Spreckelsen P, Glashouwer KA, Bennik EC, Wessel I, De Jong PJ. Negative body image: Relationships with heightened disgust propensity, disgust sensitivity, and self-directed disgust. PLoS One [Internet]. 2018 Jun 5;13(6): e0198532 doi: https://doi.org/10.1371/journal.pone.0198532

12. Oliveira Regis JM, Ramos-Cerqueira ATA, Lima MCP, Torres AR. Social anxiety symptoms and body image dissatisfaction in medical students: prevalence and correlates. J Bras Psiquiatr [Internet]. 2018;67(2):65-73. doi: https://doi.org/10.1590/0047-2085000000187

13. Herbert C, Meixner F, Wiebking C, Gilg V. Regular physical activity, short-term exercise, mental health, and well-being among university students: The results of an online and a laboratory study. Front Psychol [Internet]. 2020;11. doi: https://doi.org/10.1590/0047-2085000000187

14. Hossain S, Anjum A, Hasan MT, Uddin E, Hossain S, Sikder T. Self-perception of physical health conditions and its association with depression and anxiety among Bangladeshi university students. J Affect Disord [Internet]. 2020;263:282-8. doi: https://doi.org/10.1016/j.jad.2019.11.153

15. Blaxter M. Health and Lifestyles. London: Routledge; 2003. 288 p.

16. Al-khawaldeh OA. Health promoting lifestyles of jordanian university students. Int J Adv Nurs Stud [Internet]. 2014;3(1):27-31. doi: https://doi.org/10.14419/ijans.v3i1.1931

17. Baron P, Hermand É, Peze T, Kuehn C, Dieu O, Bourlois V, et al. No gender difference in association between sleep quality and physical activity level of French students. Sport Sci Health [Internet]. 2023;19:277-83. doi: https://doi.org/10.1007/s11332-022-00920-5

18. Lôbo ILB, Mello MT, Oliveira JRV, Cruz MP, Guerreiro RC, Silva A. Body image perception and satisfaction in university students. Rev Bras Cineantropom Desempenho Hum [Internet]. 2020;22:1-11. doi: http://dx.doi.org/10.1590/1980-0037.2020v22e70423

19. Stanton R, Happell B, Reaburn P. The mental health benefits of regular physical activity, and its role in preventing future depressive illness. Nurs Res Rev [Internet]. 2014 May 1;4:45-53. doi: https://doi.org/10.2147/NRR.S41956

20. Senmar M, Azimian J, Noorian S, Aliakbari M, Chegini N. Relationship between spiritual intelligence and lifestyle with life satisfaction among students of medical sciences. BMC Med Educ [Internet]. 2023;23(1):1-9. doi: https://doi.org/10.1186/s12909-023-04506-8

21. Diener E, Emmons RA, Larsem RJ, Griffin S. The Satisfaction with life scale. J Pers Assess [Internet]. 1985;49(1):71-5. doi: https://doi.org/10.1207/s15327752jpa4901_13

22. Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis [Internet]. 1983;60:115-20. Available from: https://pubmed.ncbi.nlm.nih.gov/6823524/

23. Mullen SP, Silva MN, Sardinha LB, Teixeira PJ. Initial Validation of the Activity Choice Index Among Overweight Women. Res Q Exerc Sport [Internet]. 2016;87(2):174-81. doi: https://doi.org/10.1080/02701367.2016.1152349

24. Reppold C, Kaiser V, Zanon C, Hutz C, Casanova JR, Almeida LS. Satisfaction with Life Scale: Evidences of validity and reliability among Portuguese college students. Rev Estud Investig Psicol Educ [Internet]. 2019;6(1):15-23. doi: https://doi.org/10.17979/reipe.2019.6.1.4617

25. Silva WR da, Bonini Campos JAD, Marôco J. Impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students. PLoS One [Internet]. 2018;13(6):e0199480. doi: https://doi.org/10.1371/journal.pone.0199480

26. Rivera-Ochoa M, Arroyo-Bello M, Mañas A, Quesada-González C, Vizmanos-Lamotte B, González-Gross M, et al. Body Dissatisfaction and Its Association with Health-Related Factors in Rural and Urban Mexican Adolescents from the State of Jalisco. Int J Environ Res Public Health [Internet]. 2021;18(22):1-10. doi: https://doi.org/10.3390/ijerph182212215

27. Halliwell E. Future directions for positive body image research. Body Image [Internet]. 2015;14:177-89. doi: https://doi.org/10.1016/j.bodyim.2015.03.003

28. Alvarenga MS, Philippi ST, Lourenço BH, Sato PM, Scagliusi FB. Insatisfação com a imagem corporal em universitárias brasileiras. J Bras Psiquiatr [Internet]. 2010;59(1):44-51. doi: https://doi.org/10.1590/S0047-20852010000100007

29. Lemoine JE, Konradsen H, Lunde Jensen A, Roland-Lévy C, Ny P, Khalaf A, et al. Factor structure and psychometric properties of the Body Appreciation Scale-2 among adolescents and young adults in Danish, Portuguese, and Swedish. Body Image [Internet]. 2018;26:1-9. doi: https://doi.org/10.1016/j.bodyim.2018.04.004

30. Ralph-Nearman C, Filik R. New Body Scales Reveal Body Dissatisfaction, Thin-Ideal, and Muscularity-Ideal in Males. Am J Mens Health [Internet]. 2018;12(4):740-50. doi: https://doi.org/10.1177/1557988318763516

31. Gonzaga I, Ribovski M, Claumann GS, Folle A, Beltrame TS, Laus MF, et al. Secular trends in body image dissatisfaction and associated factors among adolescents (2007-2017/2018). PLoS One [Internet]. 2023;19;18(1):e0280520. doi: https://doi.org/10.1371/journal.pone.0280520

32. McLean SA, Rodgers RF, Slater A, Jarman HK, Gordon CS, Paxton SJ. Clinically significant body dissatisfaction: prevalence and association with depressive symptoms in adolescent boys and girls. Eur Child Adolesc Psychiatry [Internet]. 2022;31(12):1921-32. doi: https://doi.org/10.1007/s00787-021-01824-4

33. Lewis-Smith H, Bray I, Salmon D, Slater A. Prospective pathways to depressive symptoms and disordered eating in adolescence: A 7-year longitudinal cohort study. J Youth Adolesc [Internet]. 2020;49(10):2060-74. doi: https://doi.org/10.1007/s10964-020-01291-1

34. Bray I, Slater A, Lewis-Smith H, Bird E, Sabey A. Promoting positive body image and tackling overweight/obesity in children and adolescents: A combined health psychology and public health approach. Prev Med [Internet]. 2018;116:219-21. doi: https://doi.org/10.1016/j.ypmed.2018.08.011

35. Goswami S, Sachdeva S, Sachdeva R. Body image satisfaction among female college students. Ind Psychiatry J [Internet]. 2012;21(2):168-72. doi: https://doi.org/10.4103/0972-6748.119653

36. Lee SY, Agocha VB, Hernandez PR, Park CL, Williams M, Carney LM. Coping styles moderate the relationship between perceived discrimination and eating behaviors during the transition to college. Appetite [Internet]. 2022;168:105699. doi: https://doi.org/10.1016/j.appet.2021.105699

37. Campbell A, Hausenblas HA. Effects of exercise interventions on body image: a meta-analysis. J Health Psychol [Internet]. 2009;14(6):780-93. doi: https://doi.org/10.1177/1359105309338977

38. Ancos MP, León BN, Gellida AR, Selma BV, Espí PC. Relación entre estrés y estilo de vida en estudiantes de Medicina de la UJI. Àgora de Salut [Internet]. 2023;9:173-83. doi: http://dx.doi.org/10.6035/AgoraSalut.2023.9.17

39. Hao M, Yang J, Xu S, Yan W, Yu H, Wang Q. The relationship between body dissatisfaction, lifestyle, and nutritional status among university students in Southern China. BMC Psychiatry [Internet]. 2023;23(1):1-8. doi: https://doi.org/10.1186/s12888-023-05215-8

40. Jensen CD, Duraccio KM, Barnett KA, Carbine KA, Stevens KS, Muncy NM, et al. Sleep duration differentially affects brain activation in response to food images in adolescents with overweight/obesity compared to adolescents with normal weight. Sleep [Internet]. 2019;42(4):1-11. doi: https://doi.org/10.1093/sleep/zsz001

41. Cash TF. Body image: past, present, and future. Body Image [Internet]. 2004;1(1):1-5. doi: https://doi.org/10.1016/S1740-1445(03)00011-1

42. Olchowska-Kotala A, Chromik K. Body satisfaction and time spent on physical activity in Polish students. Hum Mov [Internet]. 2013;14(4):285-90. doi: https://doi.org/10.2478/humo-2013-0033

43. Yoo JJ, Lee SE. Factors influencing life satisfaction: Role of physical fitness, body satisfaction, and shopping. Family & Consumer Sciences [Internet]. 2022;51(2):90-102. doi: https://doi.org/10.1111/fcsr.12461

44. Al Sulaimi MR, Hutaglung FD, Bin Syed Ali SK. The mediating effect of physical activity in the relationship between body image and life satisfaction. Int J Instr [Internet]. 2022;15(2):349-72. doi: https://doi.org/10.29333/iji.2022.15220a

45. Sundgot-Borgen C, Sundgot-Borgen J, Bratland-Sanda S, Kolle E, Torstveit MK, Svantorp-Tveiten KME, et al. Body appreciation and body appearance pressure in Norwegian university students comparing exercise science students and other students. BMC Public Health [Internet]. 2021;21:1-11. doi: https://doi.org/10.1186/s12889-021-10550-0