Acta Psychologica 227 (2022) 103620

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Acta Psychologica
journal homepage: www.elsevier.com/locate/actpsy

Factors associated with body image perception of adolescents

Hyunju Chae *
Department of Nursing, Joongbu University, Geumsan, Republic of Korea

A R T I C L E I N F O A B S T R A C T

Keywords: This study aimed to confirm the status of body image perception by adolescents in South Korea and identify the
Body image associated factors using the data from the 14th Korea Youth Risk Behavior Survey (KYRBS) conducted in 2018.
Perceptual distortion The KYRBS is a government-approved statistical survey performed annually and an anonymous self-administered
Adolescents
online survey conducted in middle and high school students. The data for this study were downloaded from the
Korea Youth Risk Behavior Survey (KYRBS)
KYRBS web site and analyzed through complex sample analysis. Body image distortion was found in 40.3%
(under-perception 26.5%, over-perception 13.8%) of the boys and 39.7% (under-perception 14.4%, over-
perception 25.3%) of the girls. The factors associated with body image distortion were school achievement,
weight control, school, school type and exercise in school gym class in boys and school achievement, weight
control, and economic status in girls. These results indicated that intervention programs for the accurate
perception of body image should be provided to adolescents and these programs should consider gender dif­
ference in factors associated with adolescents' body image distortion.

1. Introduction Body image distortion involves distortions in cognition, affect, or

Body image is a multidimensional concept that includes how an in­
dividual thinks, perceives, feels, and behaves about his or her body
[Goonapienuwala, Agampodi, Kalupahana, & Siribaddana, 2016;
Voelker, Reel, & Greenleaf, 2015]. Body image is conceptualized by
incorporating body size evaluation, the estimation of body attractive­
ness, and feelings related to body shape and size [Grogan, 2010] and
interactions between physiological, cognitive, and sociocultural factors
contribute to body image development [Irvine et al., 2019]. Feelings
related to physical changes over one's lifetime have an effect on body
image. Therefore, body image is not a static characteristic of an indi­
vidual, but rather a dynamic aspect influenced by the feelings of the
individual about themselves as they experience physical changes during
their life [Markey, 2010].
Adolescence is a critical period for the development of body image
[de Araujo et al., 2018; Markey, 2010; Voelker et al., 2015]. In
adolescence, physical changes are the most rapid and diverse in human
development [Voelker et al., 2015]. The acceptance of and adjustment
to these changes are essential to the body image perception of adoles­
cents [Fidelix, Silva, Pelegrini, Silva, & Petroski, 2011]. However, these
changes can be a risk factor in the body image perception of adolescents
[Markey, 2010], and may cause adolescents to have a distorted
perception of their bodies.
behavior related to body weight or shape [Vossbeck-Elsebusch, Vocks, &
Legenbauer, 2013]. This may refer to inaccurate evaluations or thoughts
about one's body, undesirable affect regarding one's body, miscognition
of body-related stimuli, and specific body-related behaviors such as
checking or avoidnace [Schuck, Munsch, & Schneider, 2018]. Distorted
perception of body image results in unhealthy behaviors and adverse
psychological outcomes such as unhealthy diet, low self-esteem,
sadness, and suicidal ideation [Bibiloni, Mdel, Pich, Pons, & Tur,
2013; Goonapienuwala et al., 2016; Lee & Lee, 2016]. In addition, body
image distortion negatively affects peer relationships and is strongly
related to bullying behavior [Holubcikova, Kolarcik, Madarasova
Geckova, Van Dijk, & Reijneveld, 2015]. Therefore, it is necessary to
provide interventions to help adolescents perceive their body image
correctly, and for this, the factors associated with the body image
perception of adolescents should be identified.
The body image perception of adolescents has been reported to be
associated with bio-social factors such as gender, age, socioeconomic
status, and opportunities for health education [Chung, Perrin, &
Skinner, 2013; Shin & Nam, 2015]; environmental factors such as media
exposure, peers, and school [Carey, Donaghue, & Broderick, 2014;
Goonapienuwala et al., 2016; Joeng & Lee, 2018; Shin & Nam, 2015];
and behavioral factors such as weight control behavior, physical activ­
ity, sexual behavior, and eating patterns [Alwan, Viswanathan, Paccaud,

* Joongbu University, 201, Daehak-ro, Chubu-myeon, Geumsan-gun, Chungcheongnam-do, 32713, Republic of Korea.
E-mail address: hjchae@joongbu.ac.kr.

https://doi.org/10.1016/j.actpsy.2022.103620
Received 15 March 2021; Received in revised form 3 April 2022; Accepted 12 May 2022
Available online 24 May 2022
0001-6918/© 2022 The Author. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
H. Chae
& Bovet, 2011; Bibiloni et al., 2013]. However, few studies have been
conducted to identify the factors associated with body image perception
of Korean adolescents [Kim & So, 2014] and these studies reported
different results in associated factors such as socioeconomic status and
place of residence [Lim & Wang, 2013; Kim & So, 2014]. Therefore,
repetitive studies are needed to establish evidence for the factors asso­
ciated with the perception of body image by adolescents [Shin & Nam,
2015]. In addition, studies on the factors associated with the body image
perception of adolescents did not consider the school-related factors
although school is an important social environment for adolescents
[Joeng & Lee, 2018; Kim & Kawachi, 2016]. Body image can be
observable as a social phenomenon and is influenced by social factors
[Hosseini & Padhy, 2020], so studies on the factors associated with the
body image perception of adolescents need to consider school-related
factors. Therefore, this study aimed to identify the factors associated
with the body image perception of adolescents by considering school-
related factors, and through this, provide evidences for intervention to
help adolescents perceive their body image correctly.
2. Methods
2.1. Participants and procedure
This study used data from the 14th Korea Youth Risk Behavior Sur­
vey (KYRBS), which is an online survey conducted annually by the Korea
Centers for Disease Control and Prevention (KCDC). The 14th KYRBS
was conducted from June 4 to July 19, 2018. The samples were
extracted through population stratification, sample distribution, and
stratified cluster sampling and 60,040 students from 400 middle schools
and 400 high schools participated. The participants of this study were
58,336 students, excluding 1704 students who did not answer the height
or weight. The data for this study were downloaded from the KCDC
website. This study was approved by the Institutional Review Board of J
university.
2.2. Measurements
2.2.1. General characteristics
School was classified into middle school and high school and school
type was classified into coed school and single-gender school according
to gender distribution. School achievement and economic status were
measured by the subjectively perceived degree and the possible re­
sponses were one of five categories (high, middle-high, middle, middle-
low, and low). In this study, the five categories were reclassified into
three categories of high (high and middle-high), middle, and low (low-
middle and low). Living with family was reclassified according to the
residence type. Among the five residence types (living with family,
living with relatives, lodging, dormitories, and childcare facilities),
living with family or relatives was classified as yes and the rest as no.
Nutrition education and sex education were measured receipt of the
education at school within 12 months and was classified as response of
yes and no. Sexual intercourse measured the experience of sexual in­
tercourse and was classified as yes and no. Internet use on weekdays and
weekends measured internet usage except for learning purposes and was
classified as yes and no. Physical activity and exercise in school gym
class measured the degree of activity in the recent seven days and was
reclassified as yes and no. Weight control measured weight control ef­
forts for the recent one month and was reclassified as yes and no.
2.2.2. Body mass index (BMI)
BMI was calculated using the weight and height (kg/[m]2) and
classified into three categories of underweight (less than the 5th
percentile), normal (more than the 5th percentile and less than the 85th
percentile), and overweight or obese (more than the 5th percentile and
less than the 85th percentile) according to the 2017 Korean Child and
Youth Growth Chart [Kim et al., 2018].
2
Acta Psychologica 227 (2022) 103620
2.2.3. Body image perception
Body image perception was measured using the question “What do
you think is your body image?” The answers to this question consisted of
five categories: very thin, a little thin, ordinary, a little obese, and very
obese. In this study, the answers were reclassified into three categories:
thin (very thin and a little thin), ordinary, and obese (a little obese and
very obese).
Concordance with BMI was calculated by comparing body image
perception and BMI and classified into three categories of under-
perception, equal-perception, and over-perception. Body image distor­
tion was calculated using concordance with the BMI and was classified
into two categories of no (equal-perception) and yes (under-perception
and over-perception).
2.3. Data analysis
The data were analyzed through complex sample analysis using the
IBM SPSS 25.0 program. The KYRBS used a complex sample design, so
the data analysis reflected elements of the complex sample design such
as strata, cluster, weight. Complex sample x2-test was used to identify
the differences in body image perception according to gender and body
image perception according to general characteristics. Complex sample
logistic regression was used to identify the factors associated with body
image distortion.
3. Results
3.1. General characteristics of participants
Coed school students (65.7% of boys, 63.9% of girls) were more than
single-gender school students and high school achievement was the most
common (40.2% of boys, 37.4% of girls). Most of the boys (95.7%) and
girls (96.4%) lived with their family. The majority of the boys and girls
performed physical activity (64.4% of boys, 63.6% of girls) and exer­
cised in school gym class (83.4% of boys, 82.5% of girls) (Table 1).
3.2. Body image perception according to gender
In boys, under-perception (26.5%) was more prevalent than over-
perception (13.8%), whereas, in girls, over-perception (25.3%) was
more prevalent than under-perception (14.4%) (x2 = 2037.19, p <
.001). However, there was no gender difference in the presence or
absence of body image distortion (Table 2).
3.3. Body image distortion according to general characteristics
In boys, middle school students had more body image distortion than
high school students (x2 = 9.37, p = .003) and coed school students had
more body image distortion than single-gender school students (x2 =
4.85, p = .034). Boys with high school achievement had more body
image distortion than boys with middle or low school achievement (x2
= 14.14, p = .001). Boys who did not exercise in school gym class had
more body image distortion than boys who exercised in school gym class
(x2 = 7.45, p = .008) and boys who did not try to control their weight
had more body image distortion than boys who tried to control their
weight (x2 = 91.23, p < .001).
Girls with low school achievement had more body image distortion
than girls with middle or high school achievement (x2 = 28.88, p < .001)
and girls of low economic status had more body image distortion than
girls of middle or high economic status (x2 = 15.74, p = .001). Girls who
did not try to control their weight had more body image distortion than
girls who tried to control their weight (x2 = 8.11, p = .003) (Table 3).
3.4. Factors associated with body image distortion
In both boys and girls, boys and girls with school achievement [high]
H. Chae Acta Psychologica 227 (2022) 103620

Table 1 Table 2
General characteristics of participants (N = 58,336). Body image perception according to gender (N = 58,336).
Characteristics Categories Boys (n = 29,613) Girls (n = 28,723) Body image Categories Boys (n = Girls (n = x2 (p)
a a perception 29,613) 28,723)
n % (SE) n % (SE)
na % na %
School High school 14,641 53.4 14,227 53.3
(SE) (SE)
(1.4) (1.4)
Middle 14,972 46.6 14,496 46.7 Concordance Under- 7835 26.5 4151 14.4 2037.19
school (1.4) (1.4) with BMI perception (0.3) (0.2) (<0.001)
School type Coed 19,767 65.7 18,776 63.9 Equal- 17,732 59.7 17,367 60.3
(2.1) (2.2) perception (0.3) (0.3)
Single- 9846 34.3 9947 36.1 Over- 4046 13.8 7205 25.3
gender (2.1) (2.2) perception (0.2) (0.3)
School achievement High 12,033 40.2 10,803 37.4 Body image No 17,732 59.7 17,367 60.3 2.06
(0.4) (0.4) distortion (0.3) (0.3) (0.152)
Middle 8381 28.4 8776 30.8 Yes 11,881 40.3 11,356 39.7
(0.3) (0.3) (0.3) (0.3)
Low 9199 31.4 9144 31.8 a
(0.3) (0.4) Unweighted frequency.
Economic status High 12,830 43.4 10,773 38.2
(0.5) (0.5) 4. Discussion
Middle 13,076 44.1 14,063 48.6
(0.4) (0.4)
Low 3707 12.5 3887 13.2 In body image perception, boys had more under-perception than
(0.3) (0.3) over-perception, whereas, girls had more over-perception than under-
Living with family Yes 28,104 95.7 27,418 96.4 perception, these results are consistent with previous studies [Blashill
(0.3) (0.3)
& Wilhel, 2014; Carey et al., 2014; Kim & So, 2014; Lim & Wang, 2013].
No 1509 4.3 1305 3.6
(0.3) (0.3)
However, there was no gender difference in the presence or absence of
Nutrition education in No 14,261 47.9 15,922 55.0 body image distortion. Since girls are more sensitive and more dissat­
school (0.6) (0.6) isfied with their bodies than boys [Carey et al., 2014; Goonapienuwala
Yes 15,352 52.1 12,801 45.0 et al., 2016], studies related to body image perception are often con­
(0.6) (0.6)
ducted only on girls. However, continuous exposure to slim body image
Sex education in No 6392 22.4 5384 19.3
school (0.5) (0.5) through mass media had affected not only girls but also boys' perception
Yes 23,221 77.6 23,339 80.7 of body image. Shin and Nam (2015) reported that 17.1% of male stu­
(0.5) (0.5) dents overestimated their weight while 8.6% underestimated their
Sexual intercourse No 27,673 92.9 27,751 96.6 weight, and 24.0% of female students overestimated their weight while
(0.3) (0.1)
Yes 1940 7.1 972 3.4
5.3% underestimated their weight. Therefore, interventions to correct
(0.3) (0.1) body image distortion need to be provided to both boys and girls, and for
Internet use on No 8723 29.3 6550 22.3 this, further studies on body image perception need to be include both
weekdays (0.4) (0.3) boys and girls, not only specific genders.
Yes 20,890 70.7 22,173 77.7
In additions, in this study, body image perception was measured as a
(0.4) (0.3)
Internet use on No 6850 23.2 6407 21.7 single-item questionnaire, but instruments that can measure body image
weekends (0.3) (0.4) perception more practically and accurately have been proposed and
Yes 22,763 76.8 22,316 78.3 validity has been verified [Mciza et al., 2005; Zaccagni, Rinaldo, Bra­
(0.3) (0.4) manti, Mongillo, & Gualdi-Russo, 2020]. Previous studies have reported
Physical activity No 10,537 35.6 10,429 36.4
(0.4) (0.4)
that these instruments can be used not only to identify risk groups that
Yes 19,076 64.4 18,294 63.6 are likely to cause health risk behavior due to distortion of body image
(0.4) (0.4) [Mciza et al., 2005], but also to intervention studies on body image
Exercise in school gym No 4897 16.6 5056 17.5 perception [Zaccagni et al., 2020]. Therefore, it is necessary to use in­
class (0.4) (0.4)
struments to measure body image perception in future studies, and it is
Yes 24,716 83.4 23,667 82.5
(0.4) (0.4) also necessary to consider the use of these instruments in a national
Weight control No 15,403 52.1 12,074 42.7 representative survey.
(0.3) (0.4) The factors associated with body image distortion were school
Yes 14,210 47.9 16,649 57.3 achievement, weight control, school, school type and exercise in school
(0.3) (0.4)
gym class in boys and school achievement, weight control, and eco­
SE Standard Error. nomic status in girls.
a
Unweighted frequency. In school achievement, boys with high school achievement had 1.10
times higher body image distortion than boys with middle school
had higher body image distortion than students with school achieve­ achievement. Compared to girls with middle school achievement, girls
ment [middle] (odds ratio (OR) = 1.10, p = .001, OR = 1.12, p < .001, with high school achievement had 1.12 times higher body image
respectively), and boys and girls who did not tried weight control had distortion and girls with low school achievement had 1.15 times higher
higher body image distortion than those who tried weight control (OR = body image distortion. These results are inconsistent with previous
1.26, p < .001, OR = 1.08, p = .002, respectively). studies. In previous studies, male and female students who were not
In addition to common factors, boys had higher body image distor­ overweight had lower overweight misconception as their academic
tion in middle school students (OR = 1.06, p = .024), coed school stu­ performance was higher [Fan, Jin, & Khubchandani, 2014], female
dents (OR = 1.05, p = .048), and students who did not exercise in school students had lower body image distortion as their academic perfor­
gym class (OR = 1.09, p = .007), while girls had higher body image mance was higher, and male students had no relation to academic per­
distortion in students with school achievement [low] (OR = 1.15, p < formance and body image distortion [Joeng & Lee, 2018]. These studies
.001) and with economic status [low] (OR = 1.14, p = .001) (Table 4). suggested that since body image distortion and school achievement were

3
H. Chae Acta Psychologica 227 (2022) 103620

Table 3
Body image distortion according to general characteristics (N = 58,336).
Characteristics Categories Boys(n = 29,613) x2 (p) Girls (n = 28,723) x2 (p)

No Yes No Yes

% (SE) % (SE) % (SE) % (SE)

School High school 60.5 (0.4) 39.5 (0.4) 9.37(0.003) 60.2 (0.4) 39.8 (0.4) 0.26(0.631)
Middle school 58.8 (0.4) 41.2 (0.4) 60.5 (0.4) 39.5 (0.4)
School type Coed 59.3 (0.4) 40.7 (0.4) 4.85(0.034) 60.0 (0.4) 40.0 (0.4) 1.79(0.209)
Single-gender 60.6 (0.5) 39.4 (0.5) 60.8 (0.5) 39.2 (0.5)
School achievement High 58.5 (0.5) 41.5 (0.5) 14.14(0.001) 59.8 (0.5) 40.2 (0.5) 28.88(<0.001)
Middle 61.0 (0.6) 39.0 (0.6) 62.5 (0.5) 37.5 (0.5)
Low 60.1 (0.5) 39.9 (0.5) 58.8 (0.5) 41.2 (0.5)
Economic status High 60.2 (0.4) 39.8 (0.4) 1.20(0.367) 60.8 (0.5) 39.2 (0.5) 15.74(0.001)
Middle 59.3 (0.4) 40.7 (0.4) 60.8 (0.5) 39.2 (0.5)
Low 59.5 (0.8) 40.5 (0.8) 57.4 (0.8) 42.6 (0.8)
Living with family No 57.6 (1.3) 42.4 (1.3) 2.51(0.095) 67.0 (0.3) 33.0 (0.3) 3.17
Yes 59.8 (0.3) 40.2 (0.3) 60.4 (6.6) 39.6 (6.6) (0.054)
Nutrition education No 59.8 (0.5) 40.2 (0.5) 0.19(0.693) 60.8 (0.4) 39.2 (0.4) 3.56(0.065)
Yes 59.6 (0.4) 40.4 (0.4) 59.7 (0.5) 40.3 (0.5)
Sex education No 59.8 (0.6) 40.2 (0.6) 0.05(0.822) 59.8 (0.7) 40.2 (0.7) 0.91(0.376)
Yes 59.7 (0.3) 40.3 (0.3) 60.5 (0.3) 39.5 (0.3)
Sexual intercourse No 59.8 (0.3) 40.2 (0.3) 2.30(0.164) 60.4 (0.3) 39.6 (0.3) 3.21(0.114)
Yes 58.1 (1.2) 41.9 (1.2) 57.6 (1.8) 42.4 (1.8)
Internet use on weekdays No 60.0 (0.5) 40.0 (0.05) 0.52(0.465) 60.8 (0.6) 39.2 (0.6) 0.74(0.387)
Yes 59.6 (0.3) 40.4 (0.3) 60.2 (0.4) 39.8 (0.4)
Internet use on weekends No 59.5 (0.6) 40.5 (0.6) 0.24(0.629) 60.8 (0.6) 39.2 (0.6) 0.74(0.367)
Yes 59.8 (0.3) 40.2 (0.3) 60.2 (0.3) 39.8 (0.3)
Physical activity No 59.2 (0.5) 40.8 (0.5) 1.79(0.173) 60.4 (0.5) 39.6 (0.5) 0.03(0.872)
Yes 60.0 (0.4) 40.0 (0.4) 60.3 (0.4) 39.7 (0.4)
Exercise in school gym class No 58.0 (0.7) 42.0 (0.7) 7.45(0.008) 59.7 (0.7) 40.3 (0.7) 0.84(0.360)
Yes 60.1 (0.3) 39.9 (0.3) 60.4 (0.3) 39.6 (0.3)
Weight control No 57.1 (0.4) 42.9 (0.4) 91.23(<0.001) 59.4 (0.4) 40.6 (0.4) 8.11(0.003)
Yes 62.5 (0.4) 37.5 (0.4) 61.0 (0.4) 39.0 (0.4)

Table 4
Factors associated with body image distortion.
Gender Characteristics Categories OR (95% CI) p Model

Boys (n = 29,613) School Middle school 1.06 (1.01–1.11) 0.024 F = 21.42, p < .001
High school Reference
School type Coed 1.05 (1.00–1.11) 0.048
Single-gender Reference
School achievement High 1.10 (1.04–1.17) 0.001
Low 1.05 (0.98–1.11) 0.156
Middle Reference
Exercise in school gym class No 1.09 (1.02–1.16) 0.007
Yes Reference
Weight control No 1.26 (1.20–1.31) <0.001
Yes Reference
Girls (n = 28,723) School achievement High 1.12 (1.06–1.19) <0.001 F = 10.33, p < .001
Low 1.15 (1.09–1.22) <0.001
Middle Reference
Economic status Low 1.14 (1.05–1.23) 0.001
Middle 1.01 (0.95–1.06) 0.796
High Reference
Weight control No 1.08 (1.03–1.13) 0.002
Yes Reference

inversely proportional, body image distortion was related to cognitive
ability and could be corrected through educational interventions for
accurate body image perception [Fan et al., 2014; Joeng & Lee, 2018].
However, in this study, both boys and girls showed more body image
distortion in the case of high school achievement than in the case of
middle school achievement, so it is difficult to say that body image
distortion was related to cognitive ability. Therefore, further studies on
the relationship between body image perception and school achieve­
ment need to be conducted.
In weight control, boys who did not try to control their weight had
1.26 times higher body image distortion than boys who tried to control
their weight and girls who did not try to control their weight had 1.08
times higher body image distortion than girls who tried to control their
weight. A previous study on overweight and obese adolescents reported
that adolescents with an accurate body weight perception were more
likely to try to lose weight than adolescents with an inaccurate body
weight perception [Khambaila, Hardy, & Bauman, 2012]. These results
can be because adolescents who accurately perceived their body image
recognized their weight problem and tried to lose weight, whereas ad­
olescents who misinterpreted their body image did not recognize their
problem and did not perceive the need for weight loss. However, the
body image distortion of adolescents leads to dissatisfaction with their
bodies and promotes harmful weight control behaviors such as starving,
excessive exercising, and drug use [Fan et al., 2014; Son, Lee, & Lee,
2015]. Therefore, further studies on the relationship between weight
control and body image distortion should be conducted. In addition,
since weight control by adolescents is related to body image perception
and not true weight [Son et al., 2015], adolescents who are normal

4
H. Chae
weight or underweight may also try inappropriate weight control
measures. Therefore, further studies on the relationship between weight
control and body image distortion need to involve not only overweight
or obese adolescents but also normal weight or underweight
adolescents.
In addition to school achievement and weight control, the body
image distortion of boys was 1.06 times higher in middle school students
than in high school students and 1.05 times higher in coed school stu­
dents than in boys' school students. Rapid changes in the body, including
secondary sexual character, make adolescents think more about their
body than before and evaluate it by comparison to others [Women's
health nursing curriculum research group, 2020]. Since the secondary
sexual character of boys begin to appear the around the age of 13 on
average [Women's health nursing curriculum research group, 2020],
middle school students are more likely to experience body changes than
high school students, and as a result, they are more likely to fail to adapt
to these changes and perceive their bodies distortedly. However, prior
studies reported that the lower the grade, the lower the risk of body
image distortion [Son et al., 2015], or that there was no relationship
between age and body image distortion [Khambaila et al., 2012; Kim &
So, 2014]. Therefore, it is necessary to conduct further studies on the
relationship between body image distortion and age.
Adolescence is also a time when interest in the opposite sex in­
creases, so adolescents try to look attractive to the opposite sex
[Women's health nursing curriculum research group, 2020]. The gender
composition of a school could affect the students' perception of the ideal
body image and students of single-gender schools form less rigorous
standards for the ideal body image than students of coed schools [Choi,
Park, & Behrman, 2015; Kim & Kawachi, 2016]. Therefore, in­
terventions for correct body image perception need to focus more on
single-gender school students than on coed school students.
The body image distortion of boys was also 1.09 times higher in
students who did not exercise in school gym class than students who
exercised in school gym class, this result is congruent with previous
studies [Joeng & Lee, 2018; Patte, Laxer, Qian, & Leatherdale, 2016].
Physical activity is beneficial to health by improving body function and
weight loss and can also help to form a positive body image [Son et al.,
2015]. As adolescents spend a lot of time at school and have to focus on
schoolwork, the amount of physical activity time decreases. This study
and previous studies showed that participation in school gym class
reduced the risk of body image distortion. Therefore, it is necessary to
promote school gym classes for the health and positive body image
recognition of adolescents.
In addition to school achievement and weight control, the body
image distortion of girls was 1.14 times higher in girls with low eco­
nomic status than in girls with high economic status, this result is
congruent with previous studies [Datar & Chung, 2016; Sarafrazi,
Hughes, Borrud, Burt, & Paulose-Ram, 2014]. The higher the economic
level, the higher the interest in health and the higher the probability of
accessing health-related information. Therefore, these results suggest
that adolescents with high economic status also have many opportu­
nities to access health-related information, and through this, they
correctly perceived their body image. However, regarding the rela­
tionship between economic status and body image distortion, different
results were reported depending upon the study, which both a positive
relationship and no relationship were reported [Fredrickson, Kremer,
Swinburn, de Silva-Sanigorski, & McCabe, 2013; Lim & Wang, 2013].
Therefore, further studies on the relationship between economic status
and body image distortion should be conducted.
The strengths of this study are as follows. First, this study used data
from the 14th Korean Youth Risk Behavior Survey, which is a national
survey that ensures the representativeness of the data. Second, this study
added school related factors to the analysis of factors related to body
image distortion in adolescents. Previous study suggested school
achievement and school gender composition as school related factors
[Kim & Kawachi, 2016]. Another previous study suggested the need for
5
Acta Psychologica 227 (2022) 103620
physical education and sex education as school-related factors, and
included them in school-related factors, but only adolescents of normal
weight were targeted [Joeng & Lee, 2018]. This study included all the
factors suggested the need to be considered as school-related factors in
previous studies, and targeted both normal-weight and underweight and
overweight adolescents. In additions, in this study, nutrition education
in school was added as a school-related factor to analyze the relationship
with body image distortion. This study has weaknesse that need to be
considered. In this study, BMI was calculated using self-reported height
and weight, not using directly measured height and weight. Self-
reported data can be used as valid data when measured data are not
available [Sherry, Jefferds, & Grummer-Strawn, 2007], but, self-
reporting tended to overestimate height and underestimate body
weight, resulting in BMI underestimation [Moukonen, Mannisto, &
Tolonen, 2018; Bae et al., 2010]. In the literature review, the differences
between self-reported BMI means and directly measured BMI means
were minimal in the nationally representative studies [Sherry et al.,
2007]. Since this study used national representative data, it can be said
that the limitations of BMI based on self-reported data are small, but
these points need to be considered when interpreting the results of this
study.
5. Conclusions
In this study, boys had more under-perception than over-perception,
and girls had more over-perception than under-perception, and there
was a difference according to gender. However, there was no difference
according to as to whether or not body image perception was distorted.
Therefore, interventions to correct body image distortion should be
provided to both boys and girls and further studies on body image
perception should include both boys and girls, not only girls. School
achievement and weight control were factors associated with body
image distortion in both boys and girls. However, the risk of body image
distortion according to school achievement differed between boys and
girls. In addition, body image distortion in boys was associated with
school-related factors such as school, school type, and exercise in school
gym class, and body image distortion in girls was associated with non-
school factors such as economic status. Therefore, it is necessary to
consider gender differences when providing intervention programs for
accurate body image perception in adolescents.
As the perception of the ideal body image has changed due to
exposure to various and worldwide mass media, the risk of body image
distortion in adolescents and health problems due to body image
distortion are increasing. For accurate body image perception in ado­
lescents, continuous studies on the status of adolescents body image
perception and the associated factors need to be conducted, and through
this, evidence-based intervention programs should be provided.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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