Body Image Distress and Its Associations from an International Sample of Men and Women across the Adult Life Span: Web-Based Survey Study

“Physical activity was measured by the International Physical Activity Questionnaire short form, which classifies individuals into 1 of 3 levels of physical activity (inactive vs minimally active vs health-enhancing physical activity) [72].”

“Furthermore, owing to the breadth and sheer size of the Global Health and Wellbeing Survey 2015, validated measures for eating disorders such as Eating Disorder Inventory, third edition [126] and the Eating Attitudes Test [127] were not viable to use.”

“It has been well documented that viewing appearance-focused media contributes to the development of body image concerns [14,15].”

“For addressing aim 3, an initial scoping analysis using Pearson product-moment r correlations [81] was conducted to independently assess the strength of the relationship between body image distress and these health and well-being items (healthy weight; no vs yes based on BMI data), current dieting status (no vs yes),…”

“Overall, these findings fit the current cultural narrative that a thin body is both desirable and idealized in Western societies [22].”

“For addressing aim 3, an initial scoping analysis using Pearson product-moment r correlations [81] was conducted to independently assess the strength of the relationship between body image distress and these health and well-being items (healthy weight; no vs yes based on BMI data), current dieting status (no vs yes),…”

“However, the use of BMI is limited and has several deficiencies as a measure of obesity [124].”

“Body image is a multifaceted construct encompassing one’s body-related self-perceptions and self-attitudes, including thoughts, feelings, behaviors, and beliefs toward the body [6].”

“Given the difference between current body ideals and the actual body shape and size of most of the population, it is not surprising that many people view their bodies negatively and experience distress because of this negative self-perception [12].”

“Some studies have demonstrated that the use of highly visual social media such as Instagram or Snapchat is linked to upward social comparison and internalization of symptoms of body dysmorphia, resulting in increased body image distress [112-115].”

“Perceived social support and conflict in close relationships were measured by the 5-item Schuster Social Support and Conflict Scale [80].”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Social well-being has also been reported to play a part in both positive and negative body image, particularly in adolescents [59,62-64].”

“The more time spent on social media, the more significant the body image concerns [116-118].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Furthermore, there is scant large-scale international research examining body image across the adult life span [4] and from the perspectives of both men and women [5].”

“Social well-being has also been reported to play a part in both positive and negative body image, particularly in adolescents [59,62-64].”

“Previous literature supports this phenomenon [104-107].”

“The association between weight status (as measured by BMI) and body image dissatisfaction has been previously explored [16].”

“Pearson product-moment r correlations [81] was conducted to independently assess the strength of the relationship between body image distress and these health and well-being items (healthy weight; no vs yes based on BMI data), current dieting status (no vs yes), perception of weight (about the right weight vs all othe…”

“This study supports the clear link between body image distress and poorer health and well-being [28].”

“This is consistent with data from previous studies demonstrating that women are more likely to perceive themselves as overweight compared with men [35,92-95].”

“In the literature, possible factors that may contribute to this discrepancy include self-esteem [96], sociocultural influences, and expectations [97-99].”

“Research suggests that body image dissatisfaction occurs when there is a discrepancy between how an individual views their body (actual body image) and how they want it to be (ideal body image) [7,8].”

“The more time spent on social media, the more significant the body image concerns [116-118].”

“Research has demonstrated that increased BMI is associated with greater body image dissatisfaction in college students [17], help-seeking adults [18], adolescent men [19], and nonclinical samples of adult women [20].”

“For example, the K10 is the standard tool used to measure distress in Australia’s National Survey of Mental Health and Wellbeing (Burgess et al [122]) and is used widely in international studies.”

“This is consistent with data from previous studies demonstrating that women are more likely to perceive themselves as overweight compared with men [35,92-95].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Thus, although body image distress decreases with age, in line with the Webster and Tiggemann study [26], our contradictory finding is that dieting behaviors remain relatively consistent.”

“For optimizing recruitment in the 5 target countries, the following strategies were used: both paid and free advertising across multiple social media channels such as Facebook, Twitter, and YouTube for survey dissemination [65]; layering of recruitment messages [66]; passive web-based snowballing via social media to s…”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Some studies have demonstrated that the use of highly visual social media such as Instagram or Snapchat is linked to upward social comparison and internalization of symptoms of body dysmorphia, resulting in increased body image distress [112-115].”

“In the literature, possible factors that may contribute to this discrepancy include self-esteem [96], sociocultural influences, and expectations [97-99].”

“This change could be attributed to a shift in body comparisons with age-appropriate peers [8], less cultural fat phobia [105-107], or a focus on body function rather than body appearance [108].”

“Research has reported that body image dissatisfaction is associated with higher levels of depression, anxiety, disordered eating [43-45], and distress [46].”

“Meanwhile, individuals with more supportive parental relationships have reported higher body image satisfaction [62].”

“Furthermore, research has identified associations between body image with other aspects of health, such as tobacco smoking [47], alcohol misuse [48], poor self-esteem [18,49,50], and poor mental and physical health–related quality of life [46].”

“Research has demonstrated that increased BMI is associated with greater body image dissatisfaction in college students [17], help-seeking adults [18], adolescent men [19], and nonclinical samples of adult women [20].”

“This change could be attributed to a shift in body comparisons with age-appropriate peers [8], less cultural fat phobia [105-107], or a focus on body function rather than body appearance [108].”

“Research has reported that body image dissatisfaction is associated with higher levels of depression, anxiety, disordered eating [43-45], and distress [46].”

“Responses may have been subject to bias as BMI is often calculated with overestimated height and underestimated weight data [125].”

“Furthermore, there is more tolerance in what body sizes are considered acceptable with increasing age [4,27].”

“This in itself is concerning, as obesity is considered one of the greatest health epidemics worldwide [88-91].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Furthermore, research has identified associations between body image with other aspects of health, such as tobacco smoking [47], alcohol misuse [48], poor self-esteem [18,49,50], and poor mental and physical health–related quality of life [46].”

“Some studies have demonstrated that the use of highly visual social media such as Instagram or Snapchat is linked to upward social comparison and internalization of symptoms of body dysmorphia, resulting in increased body image distress [112-115].”

“There is also the possibility of avidity bias occurring, as those with a greater interest in the subject may be more likely to participate [121].”

“In the literature, possible factors that may contribute to this discrepancy include self-esteem [96], sociocultural influences, and expectations [97-99].”

“Days out of role was extracted from the Brief Disability Questionnaire [76] to investigate functioning.”

“Research has reported that body image dissatisfaction is associated with higher levels of depression, anxiety, disordered eating [43-45], and distress [46].”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Social well-being has also been reported to play a part in both positive and negative body image, particularly in adolescents [59,62-64].”

“This is consistent with data from previous studies demonstrating that women are more likely to perceive themselves as overweight compared with men [35,92-95].”

“Participants were a voluntary community sample of men and women (aged ≥16 years) who reported that they had lived in 1 of the 5 target countries (Australia, Canada, New Zealand, the United Kingdom, or the United States) for the best part of the past 12 months.”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Current body ideals predominantly promote thinness for women and muscularity for men [10,11].”

“Furthermore, literature examining body appreciation has reported associations with greater subjective happiness [56] and fewer days of feeling mentally or physically unhealthy [87].”

“Research has demonstrated that increased BMI is associated with greater body image dissatisfaction in college students [17], help-seeking adults [18], adolescent men [19], and nonclinical samples of adult women [20].”

“Respondents’ levels of suicidal thoughts and behaviors in the past 12 months were measured using the 5-item suicidal thoughts and acts subscale from the Psychiatric Symptom Frequency Scale [75].”

“This change could be attributed to a shift in body comparisons with age-appropriate peers [8], less cultural fat phobia [105-107], or a focus on body function rather than body appearance [108].”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“There is some evidence that self-compassion training can be beneficial for weight loss, nutrition behaviors, eating behaviors, and body image [103].”

“Current dieting status was determined by the question “Are you currently dieting?” adapted from Blashill and Wilhelm [70]; this item provided 3 response options (“yes, to lose weight”; “yes, to gain weight”; and “no”).”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Furthermore, research has identified associations between body image with other aspects of health, such as tobacco smoking [47], alcohol misuse [48], poor self-esteem [18,49,50], and poor mental and physical health–related quality of life [46].”

“For optimizing recruitment in the 5 target countries, the following strategies were used: both paid and free advertising across multiple social media channels such as Facebook, Twitter, and YouTube for survey dissemination [65]; layering of recruitment messages [66]; passive web-based snowballing via social media to s…”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“However, a major advantage to using a web-based surveying methodology is that previous research has found that it is associated with increased disclosure of sensitive information [120], such as the items asked in this survey.”

“For optimizing recruitment in the 5 target countries, the following strategies were used: both paid and free advertising across multiple social media channels such as Facebook, Twitter, and YouTube for survey dissemination [65]; layering of recruitment messages [66]; passive web-based snowballing via social media to s…”

“The picture appears to be more complex for men [23].”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Research has reported that body image dissatisfaction is associated with higher levels of depression, anxiety, disordered eating [43-45], and distress [46].”

“This change could be attributed to a shift in body comparisons with age-appropriate peers [8], less cultural fat phobia [105-107], or a focus on body function rather than body appearance [108].”

“Risk of body dissatisfaction is not restricted to individuals with higher BMI; adolescent women with either a healthy or an overweight BMI experience higher levels of body dissatisfaction, whereas underweight women have the highest levels of body satisfaction [19].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Evidence-based interventions include self-monitoring, cognitive restructuring, exposure exercises, fitness training, mirror work [100], media literacy, self-esteem enhancement, and psychoeducation.”

“This is consistent with data from previous studies demonstrating that women are more likely to perceive themselves as overweight compared with men [35,92-95].”

“Some studies have demonstrated that the use of highly visual social media such as Instagram or Snapchat is linked to upward social comparison and internalization of symptoms of body dysmorphia, resulting in increased body image distress [112-115].”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Conversely, optimism, positive affect, self-compassion, life satisfaction, and subjective happiness [51-61] are associated with positive body image.”

“Within cohorts of middle-aged women, only 11% of participants endorsed being satisfied with their bodies [25].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Current body ideals predominantly promote thinness for women and muscularity for men [10,11].”

“Furthermore, research has identified associations between body image with other aspects of health, such as tobacco smoking [47], alcohol misuse [48], poor self-esteem [18,49,50], and poor mental and physical health–related quality of life [46].”

“This may include more comprehensive assessment when accessing health services and the use of health information technologies to improve support services [111].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“For example, adolescent men tend to be equally divided between wanting to lose weight (predominantly high body fat) and gain weight (muscle mass) [5,24].”

“As highlighted above, research with adolescents is much more extensive than with their adult counterparts, with several studies demonstrating an association between body dissatisfaction and anxiety [29-33], depression [29,30,34-37], self-harm [38-42], and low self-esteem [28,36,37].”

“Further demographic details can be found in related publications [82,83].”

“This can validate harmful behaviors like disordered eating and discourage individuals from seeking necessary health interventions [95].”

“Between 24% and 46% of adolescent girls, and 12% to 26% of adolescent boys report marked dissatisfaction with their bodies (Wang et al., 2019), and 75% of adolescents and young adults are in body image distress (Milton et al., 2021).”

“A web-based international survey with 10,765 youths aged 16 to 25 years from Australia, Canada, New Zealand, the United Kingdom, and the United States showed a body image dissatisfaction rate as high as 75.19% [3].”

“Body dissatisfaction is prevalent in Western societies, where it is estimated to affect 60% of women and 30% of men (Milton et al., 2021).”

“Conversely, body dissatisfaction, defined as a negative attitude toward one’s physical appearance, is strongly associated with disordered eating patterns, depression, anxiety, and reduced physical activity [3].”

“…4至 5天进行深呼吸练习，第 6至 7天进行针对身体的 慈悲冥想练习，结果显示完善后的提升方案具有同效性，且弥补了样本流失的问题。 5.3 FFI 与 SCBI 的比较 FFI 和 SCBI 同属于线上干预训练，又名便携式疗法(Germer & Neff, 2013)，具有跨地 域与跨时间的便携性和良好的生态效度。但是比起线下传统的干预训练，线上干预需要参 与者具有更高的依从性以及更多的主动反馈。 相比较而言，FFI 与 SCBI 有如下区别：其一，在性质和形式上，FFI 以自主在线团体 辅导的形式进行，而部分 SCBI需要线下与线上干预结合进行，如 Toole 和…”

“Adolescents are subjected to more extensive research, with one study, in particular, demonstrating a positive relationship between body dissatisfaction and depression [18].”

“Body image concerns and eating disorders have increased over the last decade [1, 7], particularly since the Covid-19 pandemic, with some studies reporting almost a doubling in the incidence of eating disorder related care in 2019 for adolescents compared with previous years [8–10].”

“…students with an ED, studies specifically report alcohol abuse problems (e.g., Tavolacci et al., 2015), poorer self-rated health status (e.g., Milton et al., 2021; Stuckless, 2023), and comorbid anxiety (e.g., Eisenberg et al., 2011; Mollazadeh Esfanjani et al., 2013; Stuckless, 2023),…”

“…dissatisfaction can lead to a range of physiological issues, such as low self-esteem [9], anxiety [10], and depression [11], as well as behavioral burdens, such as eating disorders [12], extreme weight loss behaviors [13], alcohol, drug abuse [14], and excessive pursuit of cosmetic procedures [15].”

“Given that a large proportion of young adults report experiencing body image distress or preoccupations, body dissat-isfaction remains a widespread and concerning issue during the transition to adulthood (Milton et al., 2021).”

“Approximately 59% of women and 39% of men experience body dissatisfaction [11], and 20% of undergraduate students (men and women) experience disordered eating [12].”

“…and psychological distress among females at risk for an ED, an observation congruent with literature linking problematic social media usage with body image distress (Milton et al., 2021), ED symptomology and risk (Haines & Neumark-Sztainer, 2006), and poorer mental health (Dane & Bhatia, 2023).”

“Studies conducted in Australia had similar findings, including those among younger people and rural populations; one found that ‘body image distress’ had risen sharply among women aged 16–25 [30, 31].”

“Body image is one of the important factors affecting mental health across all ages [12].”

“Individuals’ evaluations of their bodies and their genetic characteristics play a role in shaping healthy or unhealthy eating attitudes [14,18].”

“Such differences may reflect gender norms and sociocultural expectations surrounding body image, which may further contribute to body image concerns being overlooked among males [4, 34].”

“This creates both risk and opportunity: social media can rapidly disseminate misinformation, unrealistic ideals, and commercialised wellness messages, but it can also be used to deliver accessible, evidence-based health promotion in formats that young people already use [2–4].”

“Other research in young Australians aged 16–25 has found that an increasing majority of young people report body image distress, with 44.2% of participants reporting distress in 2009 ( n = 949), 66.89% in 2012 ( n = 1731), and 77.32% in 2015 ( n = 388; Milton et al. 2021).”