Thin-ideal internalization and body dissatisfaction in Sri Lankan adolescents

Abstract

In this study, a survey of Sri Lankan adolescents explored relationships between thin-ideal internalization and body dissatisfaction—issues that have received greater research attention in East Asia and the West. Girls scored lower in thin-ideal internalization and awareness and higher in self-esteem compared to boys; however, unlike in previous studies, body dissatisfaction did not differ significantly by gender. Hierarchical linear multiple regression analyses revealed that self-esteem moderated the relationship between thin-ideal internalization and body dissatisfaction among girls, but this was not observed for boys. Self-esteem as a protective factor against body dissatisfaction among Sri Lankan female adolescents was confirmed.

Keywords

body dissatisfaction gender differences self-esteem Sri Lanka thin-ideal internalization

Introduction

Body dissatisfaction—“the experience of negative thoughts and esteem about one’s body” (Dittmar et al., 2006: 284)—has received attention as a risk factor for the development of problematic eating behaviors and has been investigated extensively due to its negative consequences, including negative self-perception, depression, and pathological eating patterns. Numerous scholars have argued that societal ideals of thinness underlie body dissatisfaction among women (Heinberg et al., 1995; Rodgers et al., 2011). Body dissatisfaction has been also focused within the context of obesity. Marks (2015) explains that body dissatisfaction has reciprocal relationships with overweight/obesity, negative affect, and energy-dense consumption, resulting in homeostatic obesity imbalance.

Recent findings on disordered eating and body dissatisfaction among women around the world highlighted that such problems are prevalent across countries and cultures. In particular, studies on non-Western populations have expanded in the 21st century (Shroff and Thompson, 2003; Soh et al., 2006) with findings demonstrating that body dissatisfaction and disordered eating behaviors are present among young women in these populations.

Sri Lanka has undergone drastic changes since the end of the civil war in 2009. As the nation experiences rapid economic growth, adolescents could be exposed to more diverse values, including the thin ideal. To date, little research has focused on such issues, possibly due to the lengthy civil war, and few studies have examined pathological eating behaviors and body image among Sri Lankans. Findings from India have indicated the existence of body dissatisfaction and pathological eating behaviors (Shroff and Thompson, 2003). Given how close in proximity India and Sri Lanka are, it is assumed that such behaviors are increasing in Sri Lanka. This study investigated thin-ideal internalization, self-esteem, and body dissatisfaction among Sri Lankan adolescents.

Sociocultural explanation of body dissatisfaction as a risk factor

Literature on eating disorders often describes body dissatisfaction as a risk factor for excessive dieting and eating disorders. Sociocultural explanations for body dissatisfaction hold that individuals become dissatisfied with their own bodies as they internalize a societal preference for thinness: the “thin ideal.” Thin-ideal internalization is reinforced by exposure to idealized representation of female bodies through various media, such as magazines and television, and interpersonal pressure (Farooq and Latif, 2012; Mask and Blanchard, 2011; Rodgers et al., 2011). Berg et al. (2002) examined the importance of “appearance comparison,” or a tendency to use others’ appearance as a source of self-evaluation, and the influence of family and media on body dissatisfaction. The tripartite influence model of body image and eating disturbances argues that peers, family, and media influence appearance comparison, which subsequently creates body dissatisfaction and disturbed eating behaviors (Rodgers et al., 2011).

Body dissatisfaction among under-researched subgroups

Most researchers in this field believe that the thin ideal is specific to Western culture, and that eating disorders are Western, culture-bound syndromes. Furthermore, sociocultural explanations of body dissatisfaction highlight a gender difference, in that women are more prone to thin-ideal internalization and body dissatisfaction. Accordingly, most patients with eating disorders are women. However, recent findings in non-Caucasian populations (Austin and Smith, 2008; Bojorquez-Chapela et al., 2014; Farooq and Latif, 2012; Yamazaki and Omori, 2016) and men (Smolak et al., 2001) have challenged these views by demonstrating links between body dissatisfaction and pathological eating behaviors and between thin-ideal internalization and body dissatisfaction or drive for thinness among non-Caucasians and boys. More attention to differences in body images among under-researched groups may improve our understanding of how body dissatisfaction and disordered eating behaviors develop.

Comparative studies challenged conventional views on self-esteem and body dissatisfaction and their relationship, showing either similarities between Eastern and Western populations (Akan and Grilo, 1995) or even higher body dissatisfaction in the East compared to that in the West (Soh et al., 2008). Akan and Grilo (1995) compared eating attitudes and behaviors, body image, and psychological functioning among female American college students from different cultural backgrounds, including African Americans, Asian Americans, and Caucasians. Although Caucasians scored the highest in disordered eating, dieting behaviors, and body dissatisfaction, researchers found that problematic eating behaviors and attitudes, as well as body dissatisfaction, were positively correlated with low self-esteem and high public self-consciousness in all ethnic groups. Furthermore, levels of acculturation and assimilation within the African American and Asian American groups did not affect these relationships, implying that these relationships exist within each of these cultures.

Soh et al. (2008) examined body image disturbance among 154 young women with and without eating disorders, comparing North-European Australian, East-Asian Australian, Singaporean-Chinese, and North-European expatriates in Singapore. These researchers explored associations between body image disturbance, cultural orientation, and sociocultural factors. They found that women with eating disorders had similar body dissatisfaction levels across cultural backgrounds. Among those without eating disorders, body dissatisfaction was highest among Singaporean Chinese. No difference in body dissatisfaction between those with and without eating disorders was observed in Singaporean-Chinese participants; participants from all other cultural backgrounds demonstrated correlations between higher levels of body dissatisfaction and eating disorders. This study offers strong evidence that body dissatisfaction is not confined to Western cultures.

While findings from East Asia have been growing steadily, research on body dissatisfaction, disordered eating, and the relationship between them in South-Asian countries, such as India and Sri Lanka, remains sparse. Only one published article on anorexia nervosa in Sri Lanka appears to exist (Perera et al., 2002). The presumption of thinness not being emphasized in South-Asian culture could be a reason for the lack of research, as “thinness was not emphasized as a requirement for feminine beauty” (Soh et al., 2006: 59). In other words, studies on thin-ideal internalization and disordered eating as the representation of that idealized thinness were thought irrelevant. However, curvy ideals are being replaced by more boyish, Western ideals in the media; while traditional TV programs feature curvy figures, this seems to be slowly changing to the slimmer Western physical types (De Zoysa, 2014, personal communication).

Preliminary results also indicate that body dissatisfaction and body image disturbances exist among South-Asian women (Kayano et al., 2008; Shah et al., 2012; Shroff and Thompson, 2003). Shah et al. (2012) found that body image concerns among Indian girls were consistent with findings from other regions, reporting that girls were more dissatisfied with their own body compared to boys. A survey conducted with 96 adolescent females and 93 adult females in India revealed that teasing and internalization mediated the effect of the body mass index (BMI) on body dissatisfaction (Shroff and Thompson, 2003). A cross-cultural study compared attitudes toward body weight and shape, as well as the desire for thinness, in Japanese male and female adolescents with their peers from India, Oman, Europe, the United States, and the Philippines (Kayano et al., 2008). Study participants from India, Oman, and the Philippines demonstrated eating attitudes similar to or worse than those found in Western countries and Japan, while their desire for thinness was not as strong.

Links between self-esteem and body dissatisfaction

Fewer studies have examined the psychological correlates for body image and body dissatisfaction among non-Caucasian women compared to Caucasian (Phan and Tylka, 2006). Significant gaps within the literature include the variables that determine body image or protect against negative body image and disordered eating behaviors. However, many studies have empirically demonstrated that low self-esteem is a risk factor for body dissatisfaction, putting individuals at risk of pathological eating behaviors, including bulimia and sub-threshold binging and purging (Furnham et al., 2002; Mintz and Betz, 1988; Shea and Pritchard, 2007; Stice et al., 2002).

Despite numerous findings on relationships between self-esteem and body dissatisfaction and disordered eating, how low self-esteem predicts body dissatisfaction has not been well explored. In addition, the directionality of the links between self-esteem, body dissatisfaction, and disordered eating remain inconsistent. In one experimental study, self-esteem was manipulated and affected body dissatisfaction (Svaldi et al., 2012) with low self-esteem increasing body dissatisfaction levels. Longitudinal studies revealed that body dissatisfaction was predicted by low self-esteem (Gilbert and Meyer, 2005). Conversely, a 5-year prospective study found body dissatisfaction responsible for low self-esteem, casting doubt on the directionality of these factors (Paxton et al., 2006).

In order to understand better how body image is predicted, Phan and Tylka (2006) tested a model of disordered eating with Asian Americans to expand prior findings on the connections between self-esteem and body dissatisfaction. They presumed that women with high self-esteem would be less likely to allow sociocultural pressure to be thinner to cause negative body images and disordered eating behaviors. As predicted, self-esteem was found to moderate relationships between the pressure to be thin and body preoccupation. The authors hypothesized that perceived pressure to be thin predicts thin-ideal internalization, but is moderated by self-esteem; however, others argue that thin-ideal internalization is more multifaceted and may include factors in addition to societal pressure (Thompson et al., 2004). These researchers felt that there was no clear distinction made between perceived pressure to be thin and thin-ideal internalization. They speculated that thin-ideal internalization, not perceived pressure to be thin, predicts body dissatisfaction and is moderated by self-esteem.

The present study

This study was designed to investigate the relationships between thin-ideal internalization, self-esteem, and body dissatisfaction in Sri Lankan adolescents. Although evidence indicates that adolescents in non-Western societies are also prone to body dissatisfaction, sufficient evidence has not been collected for adolescents in South Asia.

Our first hypothesis concerns gender differences in thin-ideal internalization: that thin-ideal internalization would be higher among girls than boys. Our second hypothesis was that self-esteem would moderate the relationship between thin-ideal internalization and body dissatisfaction.

Methods

Participants

A total of 2016 middle- and high-school students were recruited from Colombo and Kandy in Sri Lanka; those who did not enter a response for gender and/or age were excluded. There were 1929 (1066 boys and 863 girls) final participants (mean age: 15.52 years; range: 12–18 years, standard deviation (SD) = 1.56). Participants’ socioeconomic status (SES) was measured in terms of their fathers’ academic attainment; most fathers had a high-school diploma (682 boys’ fathers and 546 girls’ fathers).

Procedure

Anonymous surveys were conducted in February 2010; counseling psychologists who were native Sinhala speakers distributed the questionnaires to prospective participants during school recess. Prior to the survey, these psychologists were trained for the survey, which included an explanation of the research, distribution and collection of questionnaires, and responding to questions. Potential participants were provided with written information about the study, including the purpose, an assurance of anonymity, and details about the voluntary nature of participation. This information was also explained to participants orally. Completed questionnaires were collected by the psychologists at the schools. The survey and study design were approved by the institutional review board of the first author’s institution.

Instruments

All instruments were translated into Sinhala.

Self-esteem

The Rosenberg Self-Esteem Scale (Rosenberg, 1965) is a 10-item instrument designed to assess self-esteem. Each item is scored on a 5-point Likert-type scale from 1 (strongly agree) to 5 (strongly disagree). Scores were computed with higher scores indicative of higher self-esteem. Previous studies have reported good test–retest reliabilities (.85 to .88) and sufficient validity (Rosenberg, 1979).

The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ)

This 14-item questionnaire assesses internalized societal preference for thinness (Heinberg et al., 1995). Each item is scored on a 5-point Likert-type scale from 1 (definitely disagree) to 5 (definitely agree). It has two subscales, awareness (Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ)—Awareness) and internalization (SATAQ—Internalization) (Heinberg et al., 1995). High scores on the awareness subscale indicate familiarity with the thinness ideal; high scores on the internalization subscale indicate the extent to which participants have adopted this ideal. This instrument has adequate internal consistency (Cronbach’s α= .71 for awareness; α = .88 for internalization), a replicable factor structure, and good convergent validity for use with college-age women (Heinberg et al., 1995). Since the SATAQ was originally devised to measure thin-ideal internalization specifically among women, we changed all references to “women” in the original questionnaire to “people.”

Body dissatisfaction

The six-item Body Dissatisfaction subscale of the Eating Disorder Inventory (EDI) (Garner, 1983) was used to assess body dissatisfaction. This subscale asks participants whether they think specific parts of their body, which are associated with shape change or increased “fatness” during puberty (such as hips, thighs, and buttocks), are too large. Each item is scored on a 6-point Likert-type scale from 1 (never) to 6 (always). Higher scores indicate stronger body dissatisfaction. This subscale has adequate reliability (Cronbach’s α = .90–.91) and criterion-related validity (Garner, 1983).

SES

Fathers’ educational attainment was a proxy for SES for use as a control variable. Participants were asked to indicate their fathers’ educational attainment by choosing one of the following: 1 (middle school or less), 2 (high-school diploma), 3 (college degree), or 4 (masters or doctoral degree).

Results

Our primary goals were twofold: to examine thin-ideal internalization and body image dissatisfaction among Sri Lankan adolescents and to examine the relationships among thin-ideal internalization, self-esteem, and body dissatisfaction. Hierarchical multiple regression analyses were conducted to test our hypotheses for both girls and boys. Correlations among variables were examined before hierarchical multiple regression analyses were performed.

Preliminary analyses

Means and SDs of the variables for the total sample and for girls and boys are presented in Table 1.

Table 1.

Descriptive statistics and correlations for each variable for girls and boys.

	Descriptive statistics			Correlations			Chen et al.’s study
	Mean	SD	N	2	3	4	Mean	SD	N
Girls
1. SATAQ—Internalization	2.01	0.74	858	.52**	.11*	−.13**	3.05		431
2. SATAQ—Awareness	2.80	0.84	834		.01	−.06	3.17
3. Body dissatisfaction	2.77	0.76	826			−.17***	–
4. Self-esteem	3.83	0.52	778				2.39
Boys
1. SATAQ—Internalization	2.23	0.76	1016	.47***	.03	−.15***	2.70		452
2. SATAQ—Awareness	2.96	0.80	994		−.01	−.07*	2.92
3. Body dissatisfaction	2.72	0.77	932			−.22***	–
4. Self-esteem	3.74	0.51	931				2.40

SATAQ: The Sociocultural Attitudes Towards Appearance Questionnaire; SD: standard deviation.

***

p < .001; **p < .01; *p < .05.

We conducted two-tailed t-tests to examine gender differences for each variable. Girls scored lower on SATAQ—Internalization (t (1817) = −6.48, p < .001) and SATAQ—Awareness (t (1857) = −4.15, p < .001) and higher on self-esteem (t (1748) = 3.43, p < .001) compared to males (Table 1). Body dissatisfaction did not differ significantly between girls and boys (t (1795) = 1.50, NS).

We compared our variables mean values to those observed in another study conducted in Taiwan (Chen et al., 2010). To delineate sample characteristics in comparison to other regions of Asia, Chen et al. conducted a survey with 452 boys and 431 girls at middle schools. Although the comparison was not direct, both boys and girls in our study scored higher on self-esteem and lower on SATAQ.

Table 1 also presents the correlation coefficients between variables by gender. A significant positive correlation between SATAQ—Internalization and body dissatisfaction was found for girls (r = .11, p < .01), but not for boys (r = .03, NS). Self-esteem was negatively correlated with body dissatisfaction for both girls and boys (r = −.17, p < .001; r = −.22, p < .001, respectively). SATAQ—Awareness was not significantly correlated with body dissatisfaction for girls (r = .00, NS) or boys (r = −.01, NS). Accordingly, SATAQ—Internalization was employed as the thin-ideal internalization variable for the following analyses.

Testing the moderating effect of self-esteem on the relationship between thin-ideal internalization and body dissatisfaction

A series of hierarchical multiple regression analyses were performed by gender to examine whether the relationship between thin-ideal internalization and body dissatisfaction was moderated by self-esteem, and whether this relationship varied by gender. Following the standard procedure, predictors were centered to maximize interpretability and minimize potential problems with multicollinearity (Aiken and West, 1991). The criterion variable was body dissatisfaction. Fathers’ academic background was entered at Step 1 as the control variable. Previous findings comparing female adolescents in Hong Kong, Shenzhen, and Rural Hunan revealed regional differences in BMI, desired BMI, body dissatisfaction, and dieting behaviors (Lee and Lee, 2000). Thus, we assumed that SES needed to be controlled for in our analyses. Thin-ideal internalization, as measured by SATAQ—Internalization, was entered at Step 2 and self-esteem at Step 3. In the fourth step, interaction terms between SATAQ—Internalization and self-esteem were entered. Results of hierarchical multiple regression analyses are shown in Table 2.

Table 2.

Hierarchical multiple regression analyses predicting body dissatisfaction from SATAQ—Internalization and self-esteem.

	Girls				Boys
	Step 1	Step 2	Step 3	Step 4	Step 1	Step 2	Step 3	Step 4
	β	β	β	β	β	β	β	β
Father’s academic background	−.02	−.20	−.02	−.02	−.03	−.03	−.02	−.02
SATAQ—Internalization		.11**	.09*	.07		.01	−.03	−.03
Self-esteem			−.14**	−.14**			−.22***	−.21***
SATAQ—Internalization × self-esteem				−.13**				−.07
Adjusted R²	.00	.01*	.03***	.04***	.00	.00	.04***	.05***
ΔR²	.00	.01**	.02**	.01**	.00	.00	.04***	.01

SATAQ: The Sociocultural Attitudes Towards Appearance Questionnaire.

***

p < .001; **p < .01; *p < .05.

Girls

After controlling for SES at Step 1, the model at Step 2 was significant for girls (R² = .01, p < .05) and the change in R² from Step 1 to Step 2 was significant (ΔR² = .01, p < .01). Similarly, entries of variables into the model at each step led to significant changes in R² (from Step 2 to Step 3: ΔR² = .02, p < .01; Step 3 to Step 4: ΔR² = .02, p < .01). The final model indicated that the higher the thin-ideal internalization, the higher the body dissatisfaction (β = −.11, p < .01). Self-esteem was a significant predictor of body dissatisfaction (β = −.14, p < .01). Finally, an interaction term was significant, indicating that the relationship between SATAQ—Internalization and body dissatisfaction varied according to self-esteem (β = −.13, p < .01).

In order to examine moderation effects, we performed simple slope tests according to the procedures developed by Aiken and West (1991). The regression line of thin-ideal internalization on body dissatisfaction was established with values of self-esteem one SD above and below the mean. Figure 1 presents the interaction between SATAQ—Internalization and self-esteem on body dissatisfaction among girls.

Figure 1.

Relationship between SATAQ—Internalization and body dissatisfaction moderated by self-esteem.

Where self-esteem was one SD below the mean, SATAQ—Internalization showed a significant association with body dissatisfaction (b = 2.88, β = .18, p < .001). However, SATAQ—Internalization did not influence body dissatisfaction when self-esteem was one SD above the mean (b = 2.67, β = −.03, NS). Therefore, the results indicate that thin-ideal internalization was positively correlated with body dissatisfaction in girls with low self-esteem in this study.

Boys

As for boys, the Step 3 model with an entry of self-esteem was significant (R² = .04, p < .001) and the change in R² from Step 2 to Step 3 was significant (ΔR² = .04, p < .001). Low self-esteem among boys was the only significant predictor of body dissatisfaction (β = −.22, p < .001). The Step 4 model was significant, but the change in R² from Step 3 to Step 4 was not significant (ΔR² = .01), indicating that self-esteem did not moderate the relationship between thin-ideal internalization and body dissatisfaction among boys. These results suggest that low self-esteem was uniquely associated with body dissatisfaction among boys.

Discussion

This study is the first to examine relationships between thin-ideal internalization and body dissatisfaction among Sri Lankan adolescents. Findings indicated a lower thin-ideal internalization and higher self-esteem among girls compared to boys, which are inconsistent with previous findings of studies with participants from different cultural backgrounds. Furthermore, no significant difference was found for body dissatisfaction between girls and boys. Hierarchical linear multiple regression analyses indicated that self-esteem moderated relationships between thin-ideal internalization and body dissatisfaction only in girls. Although eating disorders in Sri Lanka are rarely reported, these findings imply that relationships between thin-ideal internalization and body dissatisfaction among Sri Lankan adolescent girls are similar to those found previously in other populations (e.g. Phan and Tylka, 2006).

The major limitation of the study was that, since this was the first exploration of body image among Sri Lankan adolescents, none of the assessments had been previously translated into Sinhala. Although the internal consistencies of items were moderately satisfactory, thorough analyses of psychometric properties had not been fully conducted prior to the study. It is recommended that future studies refine the instruments in this language, performing a back translation of items, and establishing the reliability and validity of each instrument.

It was very surprising that girls scored lower on thin-ideal internalization and higher on self-esteem compared to boys, and that no significant gender difference was found for body dissatisfaction. This did not conform to previous findings conducted in Western countries (Cusumano and Thompson, 2001; Hughes and Gullone, 2011; Jackson and Chen, 2011; Moksnes et al., 2010; Presnell et al., 2004; Rodgers et al., 2009; Yuan, 2010) that repeatedly concluded that girls are more likely to internalize the thin ideal and are therefore more dissatisfied with their bodies compared to boys. Since no previous studies on this phenomenon have been conducted on Sri Lankan adolescents, we can only speculate that these unique findings may reflect cultural differences characteristic of Sri Lanka. Further explorations using diverse samples and cross-cultural comparisons need to validate the impact of thin-ideal internalization and body dissatisfaction on Sri Lankan youths.

This study’s findings regarding body image may result from limitations in how body dissatisfaction was measured. We used the six-item Body Dissatisfaction EDI subscale, which was designed specifically for females, asking whether they perceived certain parts of their body (thighs, hips, and waists) as being too large. However, body dissatisfaction might manifest differently between males and females; males may be more dissatisfied with certain body parts because they are too thin for their ideal. Leanness and masculinity are considered more imperative for men’s psychological health and well-being (McFarland and Petrie, 2012). Cafri and Thompson (2004) recommended that a measurement should be used to assess both muscular appearance and body fat because of the importance of these aspects in men’s body image. They identified that the Drive for Muscularity developed by McCreary and Sasse and the Somatomorphic Matrix devised by Gruber, Pope, Borowiecki, and Cohane (both in Cafri and Thompson, 2004) are useful. Therefore, gender differences in body dissatisfaction must be investigated in conjunction with gender-specific prototypes of ideal body images.

While results pertaining to gender differences contradict previous findings, the relationship patterns between thin-ideal internalization, body dissatisfaction, and self-esteem were similar to those in previous studies. Self-esteem moderated the relationship between thin-ideal internalization and body dissatisfaction among girls; thin-ideal internalization was positively correlated with body dissatisfaction in girls with low self-esteem, while the same thin-ideal internalization did not result in body dissatisfaction in girls with high self-esteem. This confirms previous findings that identify self-esteem as an important predictor of body satisfaction or dissatisfaction (e.g. Monteath and McCabe, 1997). In addition, our results expand on previous findings that claim that the internalization of the thin ideal contributes to body dissatisfaction (Austin and Smith, 2008; Fitzsimmons-Craft et al., 2012; Frisen and Holmqvist, 2010; Nouri et al., 2011) and low self-esteem (Rodgers et al., 2011).

Thus, this study provides two significant contributions. Findings observed among Sri Lankan adolescents were similar to those found in North America. Future studies should depict sociocultural factors characteristic to the Sri Lankan culture. The second is that there are implications indicating that high self-esteem may serve as a protective factor against body dissatisfaction in adolescent girls. Educators and professionals in Sri Lanka are reminded to focus on self-esteem when developing programs to reduce body dissatisfaction and pathological eating behaviors among girls with the aim being to augment their psychological and physical health.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Global Center of Excellence Program “Science of Human Development for Restructuring the ‘Gap-Widening Society’” at Ochanomizu University.

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