Body image satisfaction in Scottish men and its implications for promoting healthy behaviors.
Keywords: overweight men, obese men, body image satisfaction, body weight, body shape, weight loss, body mass index
In 2003 the World Health Organisation reported, and not for the first time, that obesity "is one of today's most blatantly visible--yet most neglected--public health problems" (World Health Organisation, 2003), and it is a problem that has not escaped Scotland. Indeed, like many countries in the developed world, the incidence of overweight and obesity in Scottish men has risen by more than 20% in the past 20 years, which means that 70% of Scottish men are at increased risk of weight-related health complications (cf., Office of Population Censuses and Surveys, 1981; Royal College of Physicians, 2004).
Overweight and obesity place a massive burden on Scotland's National Health Service (NHS) in terms of direct treatment costs and staff time. Statistics estimating the cost of treating obesity and its associated health complications indicate that between 171 million [pounds sterling] (Walker, 2003) and 670 million [pounds sterling] (Scottish Executive, personal communication, May 2002) is spent every year in Scotland alone. However, the consequences of overweight and obesity are wider reaching, affecting psychological and physical health at the level of the individual. Recent research has found that obese individuals are more likely than normal weight individuals to exhibit dis-inhibitive eating behaviours (Provencher, Drapeau, Tremblay, Despres, & Lemieux, 2003), reduced self-esteem (Miller & Downey, 1999), and depression (Roberts, Strawbridge, Deleger, & Kaplan, 2002).
The Scottish Executive inherited its targets for a reduction in the incidence of obesity (Scottish Office, 1993) and improvement in general eating behaviours of the population (Scottish Office, 1996) from its predecessor, the Scottish Office, and these targets were to be met by 2005. However, between the publication of the eating behaviour targets in the Scottish Diet Action Plan (Scottish Office, 1996) and the most recent Scottish Health Survey (Scottish Executive, 2000), the incidence of overweight and obesity in Scottish men rose again by around 6%. Evidently the government's targets cannot be met.
In response to the growing body of evidence demonstrating the outright failure of previous public health initiatives, the Scottish Executive released 1.75 million [pounds sterling] in January 2003 (Scottish Executive, 2003) to fund a new public health campaign called HealthyLiving (http://www.healthylivingscotland.gov.uk). This campaign aims to achieve the 2005 targets by encouraging lifestyle changes such as dietary modification and a move toward a healthy weight.
Targeting eating behaviour is important in the fight against obesity; however, the efficacy of the HealthyLiving campaign is questionable given that it is based on the same information-provision principle as previous, failed, health promotion campaigns. Research has demonstrated that the provision of information about nutrition and eating behaviours does not necessarily lead to dietary change (McPherson & Turnbull, 2000; Fine et al., 1994), and barriers to this relationship have been identified--for example, educational achievement (McPherson & Turnbull, 2000) and low self-efficacy (Povey, Conner, Sparks, James, & Shepherd, 2000). The aim of the present study is to consider one additional barrier to the relationship between health promotion material and weight-related behaviour change in men: the role of body aesthetics or the desire for one's body to appear attractive.
PSYCHOLOGICAL THEORIES OF BEHAVIOUR CHANGE
The role of aesthetics in the elicitation of behaviours aimed at achieving a healthy weight has been given some consideration in the psychological literature. However, it has usually been as a small part of a larger theoretical construct addressing cognitive aspects of behaviour change rather than being given full consideration in its own right. Moreover, the inclusion of aesthetics in psychological models of behaviour change is usually based on the assumption that it plays a positive role in the cognitive processing that fosters change.
For example, the transtheoretical model of behaviour change (Prochaska & DiClemente, 1982) includes a decision-making variable--decisional balance--measuring the pros and cons of behaviour change. Furthermore, many of the measures of decisional balance relating to weight change include at least one question concerning aesthetics. For example, O'Connell and Velicer (1988) asked their research participants to rate the statement "I could wear more attractive clothing if I lost weight." However, cognitions relating to aesthetics and appearance form only a very small part of the overall pros-and-cons questioning, and much more consideration is given to factors such as personal health and self-esteem.
In addition, aesthetics has been included in the theory of planned behaviour (Ajzen, 1985). This theory predicts that a desire to look socially acceptable may contribute to the development of a positive attitude toward behaviours that encourage weight change, including dietary change, and a positive attitude is, in turn, predictive of actual behavioural change. However, as with the transtheoretical model, the contribution of aesthetics to the development of a positive attitude has been given minimal consideration because it is only a small part of the greater attitude construct.
While acknowledging that body aesthetics is only one part of an individual's decision to engage in behaviours aimed at achieving a healthy weight, this paper does not seek to elicit the relative contribution of aesthetics to an individual's overall decision. Rather, the aim of this paper is to take a step back and demonstrate that body aesthetics warrants research and debate because until now the role of body aesthetics has been assumed rather than demonstrated in research findings.
BODY IMAGE (DIS)SATISFACTION
Body aesthetics, or the desire for one's body to appear attractive, is bound up with the concept of body image, which has been defined as "the picture we have in our minds of the size, shape and form of our bodies" (Slade, 1988 p. 20). Body images are therefore subjective and constructed using affective cognitions based on comparisons with others, which leaves them open to over- and under-exaggeration. The exaggeration might be with reference to an individual's body weight and/or body shape but, irrespective of the source of exaggeration, dissatisfaction with one's body has been identified as causal in the development of eating disorders (American Psychiatric Association, 1994).
In addition, even in the absence of eating disorders, individuals who are dissatisfied with their body weight and/or shape are likely to engage in behaviours aimed at altering the aspect of dissatisfaction. Conversely, it seems appropriate to hypothesise that individuals who are satisfied with their body weight and shape will not engage in behaviours that would ultimately lead to a change in anthropometric status--for example, dietary modification.
Early studies reported that men exhibit a general satisfaction with their bodies when compared to women, who almost always report a desire to lose weight (e.g., Fallon & Rozin, 1985; Pliner, Chaiken, & Flett, 1990). However, more recent evidence has demonstrated that men do experience body image dissatisfaction, often to the same degree as women, but men's dissatisfaction has a bidirectionality that is rarely exhibited by women (Raudenbush & Zellner, 1997: McPherson, 2002). Some men report dissatisfaction with their bodies being too small.
Indeed, it would appear that, as well as being bidirectional, men's body image perception is also multidimensional (e.g., McCreary & Sasse, 2000: McPherson, 2002; Pope et al., 2000: Raudenbush & Zellner, 1997). Findings have supported the notion that body image evaluations made by men concern not only body size per se but also body composition (Cafri & Thompson, 2004). That is, men display a concern with body size but also with whether that size is achieved through muscle or adipose tissue, that is, connective tissue consisting chiefly of fat cells.
In light of the evidence in support of the role of muscularity in the way men think about their bodies, Cafri and Thompson (2004) have called for male body image assessment to centre on muscularity (p. 25). However, while the continued work investigating the role of muscularity in men's evaluations of their own and other men's bodies is invaluable to fully understanding men's body image, a number of issues are associated with this.
First, because of a general problematising of the female body, validated measures of body image (dis)satisfaction have tended to focus on (dis)satisfaction with adiposity (e.g., Stunkard, Sorenson, & Schulsinger, 1983). More recently, a small number of muscularity-based measures have been used (e.g., Thompson & Tantleff, 1992), but these scales do not include measures of (dis)satisfaction with adiposity. Therefore, although there is a recognition at the theoretical level that men's body image (dis)satisfaction is multidimensional (based on evaluations of muscularity and adiposity), the available scales have not facilitated empirical demonstration of this.
Second, the majority of studies that have been used as the basis for the promotion of muscularity over adiposity have been conducted using the highly selective population of American undergraduate students, despite research that has demonstrated American undergraduate men are a homogenised population that exhibits lower levels of body image dissatisfaction and related psychological phenomena, for example, cognitive restraint, than the wider population (Bezner, Adams, & Steinhardt, 1997). As yet, it is unclear whether or not the conclusions generated from data collected in such homogenised samples are generalisable to the wider population of men.
Indeed, in line with the findings of the papers noted above, recent qualitative work carried out in the U.K. (Grogan & Richards, 2002) suggests that men use both adiposity and muscularity in their body image assessments. However, these U.K. men also talked about a desire not to become too muscular, a phenomenon that has not been reported in samples of American college men. Moreover, the men taking part in the focus groups talked about a "fear of fat" in such a way as to suggest that adiposity is as central to their understanding of their bodies as muscularity is.
Evidently, body image (dis)satisfaction in men is a complex issue that requires further investigation using measures that will facilitate the disentanglement of the relative contribution of adiposity and muscularity to men's evaluation of their bodies. However, it is axiomatic that men who report dissatisfaction with their body's being too big, irrespective of the composition of their body, are likely to attempt behaviours known to promote a reduction in body size, for example dietary modification. Furthermore, it is unlikely that those men who report dissatisfaction with their body's being too small and those who report body image satisfaction will engage in behaviours likely to promote a reduction in body size. Although this has little consequence for individuals who are of a normal weight and, therefore, not at risk of weight-related health complications, it could have serious consequences if overweight and obese individuals are reporting body image satisfaction or--although it is unlikely--dissatisfaction at their body being too small, because they are unlikely to modify their behaviour as a consequence of health promotion. This could have serious implication for a country such as Scotland where more than half of the population of men are currently overweight or obese.
The aim of this research is to explore this further by considering the notion of body image satisfaction in Scottish men of low socioeconomic status by identifying the Body Mass Index (BMI) and waist measurement at which the participants reported satisfaction with their body weight and shape. Body image satisfaction has rarely been considered by researchers because it has been seen as a positive state. This might be the case when considering the role of body image dissatisfaction in the aetiology of eating disorders, but, as the evidence cited above attests, body image satisfaction could act as a barrier to the adoption of positive health behaviours in groups at risk of weight-related health problems.
Data were collected from 80 Scottish men of low socioeconomic status who volunteered to participate in a longitudinal panel study investigating psychological aspects of being overweight. All participants were employees within the same U.K.-wide company. Comparison of data from an employee health analysis and government statistics demonstrated the workforce to be representative of the Scottish population. There were 12 discrete waves of monthly data collection, and only participants for whom nine months of data had been collected were retained for analysis. The mean age of the sample was 41.98 years (SD = 10.02), and the mean BMI and waist measurement of the participants for each of the 12 months is displayed in Table 1. None of the men took part in body building or other exercise that would promote increased or excess muscularity.
At monthly meetings with one of the researchers, participants were asked to provide their current weight (reported weight) and their aesthetic-ideal weight, Where necessary these numbers were converted from imperial measurements into kilograms. Although there is evidence to demonstrate that men do not report their weight accurately (cf. McPherson & Turnbull, 2002), accuracy is not important in this research. The reported weight value was used in conjunction with aesthetic-ideal weight to create an index of weight (dis)satisfaction rather than accuracy.
After participants had reported their weight, anthropometric measurements were taken by the researcher. Actual weight was measured in kilograms (kg) to the nearest 0.1 kg using calibrated digital scales. The digital display was not obscured, and participants were free to see each reading.
Height was measured in centimetres (cm) to the nearest 0.1 cm, using a portable stadiometer and following the recommendations of the World Health Organisation (1989). Actual waist measurement (cm) was also taken by the researcher, using a plastic measuring tape. Finally, participants were asked to pick the figure from the Contour Drawing Rating Scale (Thompson & Gray, 1995) that best represented their current body shape and the one that best represented their aesthetic-ideal body shape. The Contour Drawing Rating Scale measures adipose-only body shape (dis)satisfaction.
Actual BMI was calculated as weight [kg/[height.sup.2]], using the measurements taken by the researcher, and interpretation of the value was made following the categories defined by the Scottish Intercollegiate Guidelines Network (SIGN) guidelines (1996). Participants' reported weight (kg) was subtracted from their aesthetic-ideal weight (kg) to give a bidirectional index of weight (dis)satisfaction where zero indicates satisfaction with weight. Finally, current body shape was subtracted from aesthetic-ideal body shape to give a bidirectional index of shape (dis)satisfaction where zero indicates satisfaction with body shape.
To provide a single, composite measure of body weight and shape (dis)satisfaction, a superordinate variable was calculated by principle components analysis of reported weight (dis)satisfaction and shape (dis)satisfaction scores and used in the following calculations. Negative body weight and shape (dis)satisfaction scores represent overweight dissatisfaction, where the individual desired a smaller body size. Positive values represent underweight dissatisfaction, where the individual desired a larger body size. A score of zero meant that the individual was satisfied with his body weight and shape.
For each of the 12 waves of the study, actual BMI and waist measurement as measured by the researcher were regressed in turn, using a forced entry method, on the corresponding weight and shape (dis)satisfaction scores. The constant values represent the values of BMI and waist measurement at which the sample reported body weight and shape satisfaction. All statistical analyses were carried out using SPSS 10.0.
The constant value from each of the single regression analyses is presented in Table 1. The regression analyses produced [R.sup.2] values ranging from 0.61 to 0.86 and F-ratio values of between 55.02 and 297.10 (p = < 0.001). Over the 12 months, the mean actual BMI at which participants reported satisfaction was 27.04 (SD = 0.20), and the mean actual waist measurement at which they reported satisfaction was 95.21 cm (SD = 0.83). Therefore, according to the SIGN guidelines (1996), the participants who reported weight and shape satisfaction were medically overweight and at increased risk of weight-related health complications.
In identifying the anthropometric values at which satisfaction is expressed, it has also been possible to demonstrate patterns of dissatisfaction. Specifically, the majority of men in the sample with a BMI of less than 27.04 and a waist measurement of less than 95.21 cm were reporting dissatisfaction with their BMI and waist measurement being too small. Conversely, the majority of men with larger BMIs and waist measurements were reporting dissatisfaction with their BMI being too high and their waist measurement being too large.
The aim of this study was to identify the actual BMI and waist measurement at which the participants reported satisfaction with their body weight and shape, because it is axiomatic that men who are satisfied with their body weight and shape will not wish to engage in behaviours that promote weight loss. The mean BMI, as measured by the researcher, at which the present sample of men reported satisfaction fell within the "overweight" category as defined by the SIGN guidelines (1996). Furthermore, the mean waist measurement at which the men reported satisfaction fell within the "increased risk of weight-related health complications" category, as defined by the SIGN guidelines (1996).
In identifying the anthropometric values of body weight and shape satisfaction in a group of Scottish men of low socioeconomic status, this study has, by default, identified the anthropometric values of body weight and shape dissatisfaction in the same group. The majority of normal-weight men in this sample would have liked a larger body, and the majority of obese men would have liked a smaller body. It was the overweight men who wanted to remain as they were.
These results suggest that, although they are the target audience for Scotland's weight-related health promotion, it is unlikely that moderately overweight men will implement the behaviours currently being promoted as desirable for health (for example, dietary modification) because they consider the consequences of doing so to be aesthetically undesirable, that is, they report satisfaction with their weight and shape in terms of its adiposity. This information is important to those with the unenviable task of encouraging the 70% of Scottish men who are currently overweight or obese (Royal College of Physicians, 2004) to change their behaviour in an effort to achieve a healthy weight.
Public health educators must consider the role of body aesthetics when developing educational material. Indeed, it would seem that for public health initiatives such as HealthyLiving to be efficacious they would need to begin by changing men's beliefs about aesthetically desirable body weight and shape.
As the very first study to have explored the relationship between anthropometry and body image (dis)satisfaction in Scottish men, there are inevitably a number of aspects relating to the current findings that require further investigation before firm conclusions can be drawn. First and foremost, the measure of body shape (dis)satisfaction employed is a measure of adipose-only body shape (dis)satisfaction and does not take into account muscularity, which is a core aspect of men's evaluations of their bodies. It is, therefore, imperative that this research be replicated using a measure that takes account of muscularity. A measure such as the Somatomorphic Matrix (Gruber, Pope, Borowiecki, & Cohane, 1999), which measures body shape (dis)satisfaction incorporating both muscularity and adiposity, would enable investigation of both. Second, data must be collected from different samples of men to test the generalisability of these findings. The majority of the men in the present sample were overweight, as indicated by their BMI, and it is currently unclear whether or not the preference expressed by these participants for a larger body would be replicated in a sample of normal-weight men or men with increased levels of muscularity.
This notwithstanding, this research suggests that encouraging normal-weight men to maintain their anthropometric status and encouraging overweight men to achieve a healthy weight may prove more difficult than simply providing them with information about how to do so. However, it does offer a glimmer of hope for obese men. There was a positive relationship between increasing BMI and dissatisfaction with weight in men who were obese. Therefore, these men consider a reduction in anthropometric status to be desirable. Consequently, as they have a desire to change, obese men are more likely to access pubic health information concerned with how to change.
Table 1 Participants' Mean BMI and Waist Measurement across the 12 Months and the BMI and Waist Measurement (cm) at Which Body Weight and Shape Satisfaction Was Reported Month n BMI Waist Measurement Satisfaction Mean (SD) Mean (SD) BMI Waist 1 70 26.76 (4.46) 95.26 (13.50) 26.74 96.23 2 64 26.74 (4.77) 93.54 (13.36) 26.68 94.45 3 54 27.38 (4.63) 96.18 (15.02) 26.87 94.86 4 58 27.29 (4.72) 94.27 (14.57) 27.08 94.26 5 59 26.76 (4.04) 93.79 (12.08) 26.92 94.61 6 60 26.77 (4.56) 93.53 (12.97) 27.05 94.36 7 60 27.35 (4.51) 95.00 (13.40) 27.19 94.75 8 59 26.94 (4.21) 94.66 (13.34) 27.19 95.29 9 58 27.17 (4.30) 95.71 (13.03) 27.21 96.46 10 54 27.58 (4.88) 96.01 (15.25) 27.27 95.77 11 45 27.50 (4.03) 97.13 (13.44) 27.29 96.49 12 65 27.17 (4.93) 94.34 (12.05) 27.01 94.98
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Correspondence concerning this article should be sent to Kerri E. McPherson, School of Social Sciences, Media and Communications, Queen Margaret University College, Edinburgh EH12 8TS, Scotland, U.K. Electronic mail: email@example.com.
KERRI E. MCPHERSON
JANE D. TURNBULL
Queen Margaret University College