The association between global self-esteem, physical self-concept ...

International Journal of Obesity (2004) 28, 314–319 & 2004 Nature Publishing Group All rights reserved 0307-0565/04 $25.00 www.nature.com/ijo

PAPER The association between global self-esteem, physical self-concept and actual vs ideal body size rating in Chinese primary school children PWC Lau1*, A Lee2, L Ransdell3, CW Yu4 and RYT Sung4 1 3

Department of Physical Education, Hong Kong Baptist University, Hong Kong; 2University of Hong Kong, Hong Kong; University of Utah, USA; and 4The Chinese University of Hong Kong, Hong Kong

OBJECTIVE: To investigate whether the discrepancy between actual and ideal body size rating is related to Chinese children’s global self-esteem and global physical self-concept. DESIGN: A cross-sectional study of school children who completed questionnaires related to global self-esteem, global physical self-concept, and actual vs ideal body size. SUBJECTS: A total of 386 Chinese children (44% girls and 56% boys) aged 7–13 y from a primary school in Hong Kong, China. MEASUREMENTS: Global self-esteem and physical self-concept were measured using the physical self-descriptive questionnaire. Actual vs ideal body size discrepancy was established using the silhouette matching task. RESULTS: No significant relationship was found between global self-esteem and actual–ideal body size discrepancy of children. Global physical self-concept had a moderate negative correlation (r ¼ 0.12) with the body size discrepancy score and the discrepancy score explained very limited variance (R2 ¼ 0.015; F(1, 296) ¼ 4.51; Po0.05) in global physical self-concept. Three body size discrepancy groups (none, positive, and negative) were examined to see if there were any significant differences in global self-esteem, global physical self-concept, and specific dimensions of physical self-concept. A significant overall difference was found between groups for global physical self-concept (F ¼ 3.73, Po0.05) and the physical self-concept subscales of physical activity (F ¼ 3.25, Po0.05), body fat (F ¼ 61.26, Po0.001), and strength (F ¼ 5.26, Po0.01). Boys scored significantly higher than girls on global physical self-conceptFespecially in the sport competence, strength, and endurance subscales. CONCLUSION: This study revealed that the actual–ideal body size discrepancy rating of Chinese children was not predictive of global physical self-concept and global self-esteem. These findings are contrary to those reported in Western children, which may mean that culture plays a role in the formation of body attitude. International Journal of Obesity (2004) 28, 314–319. doi:10.1038/sj.ijo.0802520 Published online 11 November 2003 Keywords: global self-esteem; physical self-concept; body size rating; Chinese body culture; physical activity

Introduction Body image concerns have long been linked to physical activity participation and self-concept.1–7 Etzbach8 proposed that body satisfaction is one of the most significant predictors of social physique anxiety, physical activity motivation, and behavior. Results of his study supported the hypotheses that body satisfaction was negatively correlated with social anxiety and nonmotivation for physical activity. Furthermore, body image and body esteem were significant predictors of restrained eating, emotional eating, *Correspondence: Dr PWC Lau, Department of Physical Education, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong. E-mail: [email protected] Received 18 June 2003; accepted 5 September 2003

and psychological functioning of youngsters.9 Martin-DiBartolo and Shaffer5 concluded that athletes had healthier psychological well-being and less eating disorder symptomatology. Finally, the social framework of masculinity or femininity and ideal but unrealistic body physique has facilitated social pressure and anxiety regarding body weight, image, or appearance.10 These studies, taken together, lead to a conclusion that the influences of self-concept or self-image are critical contributors to individuals’ all around development. Interestingly, this trend is not limited to adults. According to Berg,11 drive for thinness, body perfectionism, and the social construction of the ideal body shape have been extended to children as young as 8 y old. Although the relationship between self-concept, body image, and body size discrepancy is relatively well

Global self-esteem, physical self-concept, and body rating PWC Lau et al

315 established in adults, few have studied these relationships in younger children. It has been suggested that the most critical and dynamic life changes, including self-image, occur during adolescence.12,13 Body changes are very prominent during this growth stage and the contemporary Western culture may present growing children with an unrealistic ‘super-ideal body shape’.10 This message could result in emotional damage to our younger generation. In order to understand the relationship between physical self-concept, actual vs ideal body size discrepancy, and global self-esteem, the present study was designed to: 1. investigate the associations between global self-esteem, global physical self-concept, subscales of physical selfconcept, and actual–ideal body size discrepancy using the silhouette matching task (SMT) in Chinese primary school children aged 7–13 y; 2. determine the predictive ability of actual–ideal body size discrepancy for children’s global self-esteem, global physical self-concept, and subscales of physical selfconcept; 3. examine group differences in global self-esteem, global physical self-concept, and specific dimensions of physical self-concept between the body size discrepancy groups (no discrepancyFno difference between actual and ideal body size; positive discrepancyFactual body size is heavier than ideal body size; negative discrepancyFactual body size is lighter than ideal body size); 4. examine gender difference in the aforementioned variables. Traditionally, the terms self-concept and self-esteem have been used interchangeably.14 To avoid this confusion, we have defined our terms using the theory of Marsh.14 For the purposes of the current study, Global self-esteem is defined as a general self-description profile based upon the multitude of roles and attributes that make up our self.4 Global physical self-concept refers to a specific component of global selfesteem.

Methods Participants In all, 386 Chinese children aged 7–13 y were recruited as participants in the present study. They came from a standard primary school, with similar facilities and equipment allocated by the Education and Man Power Bureau in Hong Kong. Prior to the study, participants were given a consent letter, which explained the aims and procedures. They were also reminded that their participation in the study was voluntary and they could withdraw at any time without penalty. A total of 336/386 questionnaires were completed for a response rate of 87%.

Instruments and procedures Global self-esteem and physical self-concept were measured using the physical self-descriptive questionnaire (PSDQ).15 The theoretical framework and design of the PSDQ were based on the well-established multidimensional self-description questionnaire. The psychometric properties of the PSDQ have been validated in diverse cultures.15,16 The PSDQ consists of 70 items designed to measure nine specific components of physical self-concept (health, coordination, physical activity, body fat, sports competence, appearance, strength, flexibility, endurance), global physical self-concept, and global self-esteem. Each of the 70 PSDQ items is a simple declarative statement that can be answered on a six-point true–false response scale. Sample items from the global selfesteem scale and global physical self-concept scale are ‘Overall, I have a lot to be proud of’ and ‘I am satisfied with the kind of person I am physically.’ An example of an item from the appearance subscale of physical self-concept is ‘I am attractive for my age.’ The PSDQ scale scores were computed by averaging the responses to items designed to measure each component. Negatively worded items were reverse scored. Body size discrepancy was assessed using the SMT.17 Children were presented with a set of silhouette pictures of 12 girls and 12 boys varying from very thin (score ¼ 1) to very obese (score ¼ 12). They were asked to choose the silhouette that was most like them (actual body size, 1–12) and most like the ‘ideal’ person (ideal body size, 1–12). The body size discrepancy score was calculated by subtracting the actual score from the ideal score. When the actual score was higher than the ideal score, the child was placed in the ‘positive’ group. When the actual score was lower than the ideal score, the child was placed in the ‘negative’ group. When there were no differences between the actual body size score and the ideal body size score, those children were placed in the ‘no discrepancy’ group. All questionnaires were administered during normal class periods and all questionnaires were translated into Chinese using the translation–back translation method.

Statistical analysis Descriptive statistics for all key variables were calculated. Pearson’s product moment correlations were used to examine the relationships between children’s global selfesteem, global physical self-concept, and body size discrepancy scores. Stepwise regression analyses were conducted to investigate the ability of actual–ideal body size discrepancy to predict children’s global self-esteem and global physical self-concept. A series of one-way ANOVAs were conducted to examine if there were any significant differences in global self-esteem, global physical self-concept, and specific dimensions of physical self-concept among the three body size discrepancy groups. Finally, independent t-tests were employed to examine gender difference in constructs. International Journal of Obesity


316 Table 1 Descriptive statistics and questionnaire scores for Hong Kong Chinese children Variable

N

Min.

Max.

Mean

s.d.

Age BMI PSDQ global physical self-concept PSDQ global self-esteem Actual body rating Ideal body rating Actual–ideal discrepancy score

337 331 308 308 304 298 298

7.10 11.88 1.00 1.00 1.00 1.00 7.00

13.70 27.91 6.00 6.00 11.00 11.00 7.50

9.92 17.86 4.10 4.07 6.59 6.64 0.05

1.74 3.11 1.35 0.98 1.78 1.51 2.03

Results Descriptive statistics are presented in Table 1. The mean body mass index (BMI, kg m2) of the 386 participants was 17.86 (s.d. ¼ 3.11), which is below the overweight or obese standard. Mean age was 9.92 y (s.d. ¼ 1.74). Actual body rating was 6.59 (s.d. ¼ 1.78) and ideal body rating was 6.64 (s.d. ¼ 1.51). In general, the discrepancy between actual and ideal body size rating was close to zero for the whole sample. Table 2 presents Pearson’s product moment correlation coefficients as used to assess the degree of association between variables. Particular attention was paid to relationships among global self-esteem, global physical self-concept, and actual–ideal body size discrepancy. No significant relationship was found between global self-esteem and actual–ideal body size discrepancy. Actual–ideal body size discrepancy was significantly and negatively associated with the body fat subscale (r ¼ 0.57), suggesting that the greater the discrepancy between their actual and ideal body size, the fatter the children perceive themselves to be. Actual–ideal body size discrepancy was moderately related to strength (r ¼ 0.16) and flexibility (r ¼ 0.12). With regard to the relationship between global physical self-concept and actual–ideal body size discrepancy, a moderate negative correlation was found (r ¼ 0.12). This indicates that the greater the actual–ideal body size discrepancy, the lower the

Table 2

global physical self-concept. A medium strong and significant relationship (r ¼ 0.45) was shown between global selfesteem and global physical self-concept. This indicates that individuals with higher global physical self-concept tend to have higher global self-esteem. Actual body size score was moderately correlated with the health (r ¼ 0.16) and strength (r ¼ 0.19) subscales, indicating that a larger self-rated body size is associated with betterperceived health and strength. Actual body size score was strongly and negatively associated with the body fat subscale (r ¼ 0.57), indicating that children who were larger knew that they were larger as was reflected in their body fat subscale scores. As expected, the actual–ideal body size discrepancy score and the actual body size score were significantly correlated with the body fat subscale among Chinese children in Hong Kong. Also, with one exception, all of the PSDQ subscales were significantly correlated with physical self-concept and global self-esteem (Pp0.01). Stepwise multiple regression was used to determine statistically if actual–ideal body size discrepancy rating could predict children’s global self-esteem, global physical selfconcept, and subscales of physical self-concept. Actual–ideal body size discrepancy was a weak predictor of global physical self-concept (R2 ¼ 0.015; F(1, 296) ¼ 4.51; Po0.05). It was not at all predictive of global self-esteem. Table 3 presents a stepwise multiple regression analysis with the physical self-concept subscale scores as predictors and global self-esteem as the criterion variable. This analysis showed that the appearance, strength, health, and body fat subscale scores significantly predicted global self-esteem (R2 ¼ 0.35; F (4, 303) ¼ 41.15; Po0.001) and explained 35% of the variance. Table 4 presents a series of one-way ANOVAs, conducted to examine if there were any significant differences between the three body size discrepancy groups in global self-esteem, global physical self-concept, and specific dimensions of physical self-concept. Significant between-group differences

Correlations between actual–ideal body size rating scores and PSDQ scores Actual body score

Actual body size score Ideal body size score Actual–ideal body size discrepancy PSDQ global self-esteem PSDQ global physical self-concept PSDQ appearance PSDQ body fat PSDQ health PSDQ coordination PSDQ physical activity PSDQ sports competence PSDQ strength PSDQ flexibility PSDQ endurance **Po0.01, *Po0.05.

International Journal of Obesity

1 0.25 0.69 0.04 0.09 0.08 0.57** 0.16** 0.01 0.06 0.04 0.19** 0.03 0.01

Ideal body score

0.25** 1 0.52 0.02 0.05 0.05 0.08 0.05 0.05 0.02 0.07 0.00 0.12** 0.02

Actual–ideal discrepancy 0.69** 0.52** 1 0.02 0.12** 0.03 0.57** 0.10 0.03 0.04 0.01 0.16** 0.12* 0.01

PSDQ global physical self-concept

PSDQ global selfesteem

0.09 0.05 0.12 0.45** 1 0.55** 0.37** 0.12** 0.58** 0.46** 0.71** 0.52** 0.62** 0.58**

0.04 0.02 0.02 1 0.45** 0.51** 0.23 0.24** 0.39** 0.27** 0.33** 0.43** 0.34** 0.34**


317 Table 3

Predictors of children’s global self-esteem

Model Variable 1 2 3 4

PSDQ PSDQ PSDQ PSDQ

appearance strength health body fat

R

R2

Adjusted R2 Std error of the estimate

0.51 0.56 0.58 0.60

0.26 0.31 0.33 0.35

0.26 0.30 0.33 0.34

0.84 0.82 0.80 0.79

Table 4 Results of one-way ANOVAs for differences in global self-esteem, global physical self-concept, and specific dimensions of physical self-concept among the three discrepancy groups df

Mean square

F

Sig.

PSDQ PSDQ PSDQ PSDQ PSDQ PSDQ PSDQ

global self-esteem global physical self-concept health coordination physical activitya body fatb,c sports competence

2 2 2 2 2 2 2

1.42 6.64 1.07 2.24 4.39 92.50 3.30

1.48 3.73 1.16 1.67 3.25 61.26 1.73

0.23 0.03* 0.32 0.19 0.04* 0.00** 0.18

PSDQ PSDQ PSDQ PSDQ

appearance strengthc flexibility endurance

2 2 2 2

0.47 6.47 2.73 1.94

0.34 5.26 2.46 1.30

0.71 0.01** 0.09 0.27

**Po0.01, *Po0.05. aPost hoc tests ¼ no discrepancy and negative discrepancy groups different. bPost hoc tests ¼ no discrepancy and positive discrepancy groups different. cPost hoc tests ¼ positive and negative discrepancy groups different.

were found for global physical self-concept (F ¼ 3.73, Po0.05) and the physical activity (F ¼ 3.25, Po0.05), body fat (F ¼ 61.26, Po0.001), and strength (F ¼ 5.26, Po0.01) subscales. Post hoc comparisons revealed that the main differences in the physical activity subscale were between the ‘no discrepancy’ and ‘negative discrepancy’ groups (mean difference ¼ 0.59, Po0.05); the main differences in the body fat subscale were between the ‘no discrepancy’ and ‘positive discrepancy’ groups (mean difference ¼ 1.76, Po0.001) and the ‘positive discrepancy’ and ‘negative discrepancy’ groups (mean difference ¼ 1.57, Po0.001); the main differences in the strength subscale were between the ‘positive discrepancy’ and ‘negative discrepancy’ groups (mean difference ¼ 0.40, Po0.05). There were no betweengroup differences in global self-esteem (F ¼ 1.48, P ¼ 0.229). A one-way ANOVA was performed to examine gender differences among variables. The results showed that boys were significantly higher than girls in global physical selfconcept (F(1,306) ¼ 4.86, Po0.05), sport competence (F(1,306) ¼ 7.75, Po0.01), strength (F(1,306) ¼ 9.76, Po0.01), and endurance (F(1,306) ¼ 6.52, Po0.05).

Discussion This study was designed to examine relationships between body size discrepancy and global self-esteem, global physical

self-concept, and the subscales of global physical selfconcept. Several significant results were reported. First, actual vs ideal body size discrepancy was not correlated with global self-esteem. It is not a surprise that global self-esteem and actual–ideal body size discrepancy are not correlated. Although body dissatisfaction has previously been a significant predictor of self-esteem18 in adolescents, this finding may be age-related.19 Ball et al20 suggested that obesity in children may not necessarily be related to global self-esteem because children may not place as much importance on body image as adolescents. Children may place more importance on other self-concept dimensions (eg academic or social).21 It is also possible that because this sample was leaner than previous samples with children, they were less likely to experience a discrepancy between actual and ideal body size, thus the correlation was nonsignificant. A second important finding is that body size discrepancy was negatively related to global physical self-concept (r ¼ 0.12). Our results are consistent with those of Marsh,14 who found a moderate negative correlation between similar variables in an older population (r ¼ 0.47). Fox4 also indicated that body attractiveness is highly correlated to global physical self-concept (r ¼ 0.70). It is possible that the reported correlation in this study is lower than that previously reported with Western populations because the Hong Kong culture imparts different influences on global physical self-concept. As this population reported lower BMIs than previous populations, it is possible that they had lower body size discrepancy. Second, it is possible that the media has less influence on the Hong Kong culture than on American culture. When examining the results of the regression analysis, actual–ideal body size discrepancy did not effectively predict global physical self-concept or global self-esteem. Although our results are inconsistent with previous findings,22,23 two factors might explain this phenomenon. First, different cultures have different perspectives of acceptable body size. Brewis et al24 conducted a study examining the perception of body size in a sample of Samoans. They found that although Samoans ideal body shape was slim and they attempted to lose weight, they did not have negative views on obesity. Other studies25,26 also contended that cultural beliefs were very powerful constructs when explaining the weight concern in different countries. The Chinese body culture likely offers a very different perspective than other cultures and this might explain these regression analysis results. A second possible explanation is that the normal aging process, especially maturation, can be a major factor accounting for the weight concern and body esteem in adolescents.19 They suggested that older students in college had more concern about their weight and this had a greater impact on their body esteem than is true with their high school counterparts. In the current study, participants were 7–13 y old and they might not be very sensitive to their body. Although the Western literature has presented the trend that personal appearance and physical beauty have become more International Journal of Obesity


318 and more prominent in the social norm,27,28 this phenomenon has not been observed in this age group. The regression results indicated that global self-esteem was predicted by the subscales of appearance, strength, health, and body fat. These findings were similar to those of Ball et al,20 who found that selective dimensions of self-esteem were related to global self-esteem. Ball et al20 reported that 6to 10-y-old obese children only associated lower social and academic self-perception with their body weight. Interestingly, no relationship was found between physical appearance, athletic competence, and global self-worth. Our findings and those of Ball et al20 are in contrast to those of other studies, which indicate that poor self-esteem is related to body weight concern.18,23,29,30 Global self-esteem was not significantly different between actual vs ideal body size groups (no, positive or negative discrepancy). These findings support the notion that global self-esteem is not related to body size discrepancy at this ageFwhether or not children wanted to stay the same, or become fatter or thinner. When the post hoc comparisons were examined, the ‘negative discrepancy’ group had higher mean scores for the physical activity subscale than the ‘no discrepancy’ group. This is probably because the negative discrepancy group participates in more physical activity more often and has a lower corresponding body weight. It was logical that the ‘negative discrepancy group’ had higher scores on the strength subscale compared to the ‘positive discrepancy group’ because children who weigh less are typically more active. There was significant difference in BMI among the three body size discrepancy groups. Those in the ‘positive discrepancy group’ had a higher BMI than those in other groups and wanted to be thinner. Hence, subjects were pretty accurate in their perception and body rating. However, it is worth noting that the mean BMI of the positive discrepancy group was only 19.77 (s.d. ¼ 3.35), which was by no means ‘too fat.’ Based upon the international sex- and age-based cutoff points31 used to classify children (2–18 y) based on BMI, those in the ‘positive discrepancy group’ were still not overweight or obese. This indicates that the perception of being too fat and wanting to be thinner might originate from the body-biased attitude or social stereotype11 for a slimmer or lighter body. This adult-level ideal body pressure has apparently spread to early childhood.32,33 Turnbull and colleagues reported that children aged 2–5 y old ascribed stronger negative attitudes to fat figures than normal weight figures. Fat girl figures were labelled with an undesirable body shape and girls suffered greater stigmatization than boys. Kraig and Keel33 also supported this finding in their study of children aged 7–9 y old. These children rated the thin body figures most favorably, and their chubby counterparts were rated least favorably. These two recent findings indicate that the ideal body shape has moved into early childhood from an adult’s world. This trend is being reported earlier and earlier. An alarm should be sounded relative to the relationship between weight discrepancy, global International Journal of Obesity

self-esteem, global physical self-concept, and other aspects of self-esteem. Finally, compared to girls, boys had significantly higher global physical self-conceptFespecially in the sport competence, strength, and endurance subscales. Similar findings were reported in previous studies. Chen and Swalm34 found that both Chinese and American men stressed the importance of physical strength while both countries’ women valued firmness and plumpness of the body. Also, boys were more physically active and had higher physical self-perceptions than girlsFespecially in the strength and sport competence subscales.35 This may be because boys usually spend more time participating in sport and therefore report higher perceived physical competence.7

Conclusion The current study has reported on the relationships between aspects of body image, global self-esteem, global physical self-concept, and subscales of physical self-concept in Chinese children from Hong Kong. Several unique findings were reported, which could indicate that culture and age play a significant role in the relationship between body image, global self-esteem, and global physical self-concept. Specifically, compared to the American culture, the Chinese culture may place less value on body image relative to global self-esteem and physical self-concept. This could be because Chinese children are typically lighter than American children and they may have less exposure to unrealistic media images that can negatively affect body image. Additionally, it is possible that this sample of children was too young to recognize the relationship between body image and various dimensions of self-esteem. These findings are important in that factors related to self-esteem may be related to culture and maturation.

References 1 Butki BD. The relationship between physical activity and multidimensional self-concept among adolescents. University Microfilms International, University of Oregon: Ann Arbor, MI, 1999. 2 Gately PJ, Cooke CB, Butterly RJ, Knight C, Carroll S. The acute effects of an 8-week diet, exercise, and educational camp program on obese children. Pediatr Exerc Sci 2000; 12: 413–423. 3 James K. ‘You can feel them looking at you’: the experiences of adolescent girls at swimming pools. J Leisure Res 2000; 32: 262– 280. 4 Fox KR. The physical self: from motivation to well-being. Human Kinetics: Champaign, IL, 1997. 5 Martin-DiBartolo P, Shaffer C. A comparison of female college athletes and nonathletes: eating disorder symptomatology and psychological well-being. J Sport Exerc Psychol 2002; 24: 33–41. 6 McDermott L. A qualitative assessment of the significance of body perception to women’s physical activity experiences: revisiting discussions of physicalities. Sociol Sport J 2000; 17: 331–363. 7 Trew K, Scully D, Kremer J, Ogle S. Sport, leisure and perceived self-competence among male and female adolescents. Eur Phys Educ Rev 1999; 5: 53–73.


319 8 Etzbach ME. Physical activity motivation of adolescents: an impression management perspective. Microform Publications, University of Oregon: Eugene, OR, 2000. 9 Berry TR, Howe BL. Risk factors for disordered eating in female university athletes. J Sport Behav 2000; 23: 207–218. 10 Drummond M. Boy’s bodies in the context of sport and physical activity: implications for health. J Phys Educ 2001; 34: 53–64. 11 Berg FM. Afraid to eat: children and teens in weight crisis, 2nd edn. Healthy Weight Publishing Network: Hettinger, ND, 1997. 12 Brettschneider W, Heim R. Identity, sporting commitment and youth development. In: Fox KR (ed). The physical self: from motivation to well being. Human Kinetics: Champaign, IL, 1997. pp 205–228. 13 Erikson E. Identity, youth & crisis. Norton: New York, 1971. 14 Marsh HW. Construct validity of physical self-description questionnaire responses: relations to external criteria. J Sport Exerc Psychol 1996; 18: 111–131. 15 Marsh HW, Richards GE, Jonhnson S, Roche L, Tremayne P. Physical self-description questionnaire: psychometric properties and a multitrait–multimethod analysis of relations to existing instruments. J Sport Exerc Psychol 1994; 16: 270–305. 16 Marsh HW, Marco IT, Abcy FH. Cross-cultural validity of the physical self-description questionnaire: comparison of factor structures in Australia, Spain, and Turkey. Res Q Exerc Sport 2002; 73: 257–270. 17 Stunkard AJ, Sorenson T, Schulsinger F. In: Kety S (ed). The genetics of neurological and psychiatric disorders. Raven: New York, 1983. p 119. 18 Hill AJ, Williams J. Psychological health in a non-clinical sample of obese women. Int J Obes Relat Metab Disord 1998; 22: 578–583. 19 Moode FM, Wiggins MS. An analysis of the body esteem of female high school and college athletes. KAHPERD J 1999; 35: 19–21. 20 Ball GDC, Marshall JD, Roberts M, McCargar LJ. Adiposity- and sex-related differences in physical activity, aerobic fitness, and self-esteem among 6–10 year old children. Avante Gloucester 2001; 7: 14–26. 21 Fox KR. The physical self-perception profile manual. Office for Health Promotion, Northern Illinois University: DeKalb, IL, 1990.

22 Burrows A, Cooper M. Possible risk factors in the development of eating disorders in overweight per-adolescent girls. Int J Obes Relat Metab Disord 2002; 26: 1268–1273. 23 Wade TD, Lowes J. Variables associated with disturbed eating habits and overvalued ideas about the personal implications of body shape and weight in a female adolescent population. Int J Eating Disord 2002; 32: 39–45. 24 Brewis AA, McGarvey ST, Jones J, Swimburn BA. Perceptions of body size in Pacific Islanders. Int J Obes Relat Metab Disord 1998; 22: 185–189. 25 Krane V, Waldron J, Stiles-Shipley JA, Michalenok J. Relationships among body satisfaction, social physique anxiety, and eating behaviors in female athletes and exercisers. J Sport Behav 2001; 24: 247–264. 26 Ogden J, Chanana A. Explaining the effect of ethnic group on weight concern: finding a role for family values. Int J Obes Relat Metab Disord 1998; 22: 641–647. 27 Aardahl A. The influence of height on body image, self-confidence, and performance of female basketball players. Microform Publications, University of Oregon: Eugene, OR, 1999. 28 Hilhorst MT. Physical beauty: only skin deep? Med Health Care Philos 2002; 5: 11–21. 29 Nardini M. Body image, disordered eating, and obligatory exercise among women fitness instructors. Microform Publications, University of Oregon: Eugene, OR, 1999. 30 Rosmond R, Bjorntorp P. Quality of life, overweight, and body fat distribution in middle-aged men. Behav Med 2000; 26: 90–94. 31 Cole TJ et al. Establishing a standard definition for child overweight and obesity worldwide international survey. BMJ 2000; 320: 1240–1243. 32 Turnbull JD, Heaslip S, McLeod HA. Pre-school children’s attitudes to fat and normal male and female stimulus figures. Int J Obes Relat Metab Disord 2000; 24: 1705–1706. 33 Kraig KA, Keel PK. Weight-based stigmatization in children. Int J Obes Relat Metab Disord 2001; 25: 1661–1666. 34 Chen W, Swalm RL. Chinese and American college students’ body-image: perceived body shape and body affect. Perceptual and Motor Skills 1998; 87: 395–403. 35 Crocker PRE, Eklund RC, Kowalski KC. Children’s physical activity and physical self-perceptions. J Sports Sci 2000; 18: 383–394.

International Journal of Obesity