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Body Image Discrepancy and Surgical Concerns: Thin Ideal Internalization as a Mediator.

Byline: Mian Ahmad Hanan, Noshina Saleem and Arooj Arshad

Previous literature regarding body image highlighted that surgical concerns are more evident in women having distorted body image. However, the exposure to media images of thin-and-beautiful women creates the discrepant body image in young women leading to surgical concerns is not well understood. Additionally, the role of thin ideal internalization as a mediator between body image discrepancy and increasing surgical concerns is largely unknown. The sample of 450 U.S. working Women with Pakistani origin (M = 28.5; SD = 4.36) were taken and the data was collected using self-report questionnaires.

The findings revealed that Body Image Discrepancy (Actual vs. Media Ideal Body Image) have positive relationship with the surgical concerns. While more discrepancy results in the increase level of thin ideal internalization. Furthermore, results from Structural Equation Modeling revealed that the thin ideal internalization partially mediate the relationship between body image discrepancy and surgical concerns of U.S working women with Pakistani origin. This study concludes that women develop surgical concerns as a result of thin ideal body image discrepancy as cultivated by media glorification of thin body ideals.

Keywords. Body image discrepancy, thin ideal internalization, surgical concerns.

In western countries the demand for cosmetic surgery is increasing rapidly in order to alter and maintain body shape (Riggs, 2012). Women who are exposed to media ideal and thin body images usually engage themselves in different methods to modify their body image and shape, even they wear padded or small bra to form the illusion of having a size of ideal breasts, and such females often undergo plastic surgery, cosmetic surgery and breast surgery to attain perfect body image (Harrison, 2003; Henderson-King and Brooks, 2009).

The global trends to make body beautiful and attractive through cosmetic surgeries have increased in the past decade and more than 10 million women gone through plastic surgeries and procedures (Davis, 2013). Hence, specialists and psychologist both are concerned to identify the possible predisposing factors of those individuals who undergoes or have concerns regarding cosmetic surgery (Honigman, Phillips, and Castle, 2004). On the other hand, some people seeking psychosocial difficulties to a degree, by cosmetic surgery experiences because they are not satisfied with their physical appearance and it is quite possible that they may experience no change in psychological characteristics so they want repeated procedures that creates issues for plastic surgeons too. So, the confusion and debate exists in the surgical concerns as well as in the predisposing factors leading to the development of these kinds of issues in people seeking or having concerns about plastic surgery.

Still there's no "identity prole" or measurable outline or reliable scale exists to identify these factors before surgical interventions. Even though despite a technically satisfactory results of surgical procedures, some people have a poor outcome in terms of psychological adjustment and psychosocial functioning (Gilmartin, Long, and Soldin, 2014).

In this context, the point of plastic surgery can be said to be the endeavor to redress a person's failure to acknowledge how she sees herself due to body image discrepancies that may lead to the development of thin ideal internalization (Nouri, Hill, and Orrell-Valente, 2011; Ura and Preston, 2015; Chaker, Chang, and Hakim-Larson, 2015) and increase the need to undergo a plastic surgery repeatedly (Sarwer, 2002; Posavac, and Posavac, 2002). So, a critical inquiry here ought to be whether these people are truly emotionally disturbed or not? This research aims at addressing this issue by taking the role of media in creating the discrepant body image and likely developing surgical concerns because of the internalization of thin ideal zero size body image among working women with Pakistani origin residing in U.S.

The thought that individuals have diverse self-perception states has been depicted by scholars for over a century, and formalized by Higgins (1987). In his self-discrepancy theory (SDT), he highlighted that there are outcomes that emerge when people contrast one self-state with another and find that a disparity exists between the two self alludes to the traits that the individual might want to have or that the individual tries to have (I need to be a firefighter); the "should", self-mirrors, the characteristics that the individual trusts she or he has a commitment or obligation to have. Notwithstanding characterizing these three spaces of self, SDT additionally recommends that these selves can be conceptualized from one's own perspective, as well as from the viewpoint of critical others (family, peers, life partner, and media) (Anton, Perri, and Riley, 2000).

Interestingly, seeing an inconsistency between one's actual self and one's ideal self (actual-should error) ought to inspire unsettling related feelings. For example, nervousness and blame, in light of the fact that one has abused some standard and these disparities can likewise move the person to take part in practices that will diminish the error. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image discrepancy has been thought to play a key role in the decision to seek cosmetic procedures (Sarwer and Crerand, 2004; Price, Gregory, and Twells, 2014).

The importance of SDT theory to the body image literature is the way that there are social standards that uphold specific benchmarks of appeal that are delivered through media which now has attained the position of a great socializing agent in modern world. TV commercials/ advertisements are the creation of genius minds, who want to convince the people into doing what the advertisers want. Whereas the reality is different and advertising is a skill of creating whole lies out of half-truth". Some studies have revealed that TV advertisements with catchy jingles and phrases create a continuous appeal for women, which remain in their minds for a long time. From flawless actresses to pin-thin models, the young and vulnerable females are bombarded with images of "perfect girls" and "ideal body image" on a daily basis which is harmful for them and adversely affects all facets of their lives (Vartanian, 2012).

In numerous societies, the standards or norms as presented by media, recommended a thin body for females and muscular and strong body for men. In this manner, when individual finds a discrepancy between one's actual selves and the thin ideal as portrayed by media because it is very likely that the individual will not reach up to the desired media depiction of standard beauty and thinness and for the individuals these standards are unattainable without the utilizations of cosmetic surgery procedures (Stice, Spangler, and Agras, 2009).


This study was designed with the following aims: (a) to investigate the relationship between Body Image Discrepancy (Actual vs. Media ideal Body Image) with Surgical Concerns among U.S. working Women with Pakistani origin and (b) to find out the mediating role of thin ideal internalization between body image discrepancy and surgical concerns among U.S. working women with Pakistani origin.


The following hypotheses are formatted after reviewing the above theoretical and empirical evidences.

1) Body image discrepancy (actual vs. media ideal body image) likely to increase surgical concerns among U.S. working women with Pakistani origin.

2) Thin Ideal Internalization is likely to be more in women who show concerns about Body Image Discrepancy.

3) Thin Ideal Internalization is likely to mediate the relationship between Body Image Discrepancy and Surgical Concerns among U.S. working Women with Pakistani origin.



Data was collected from 450 working women with Pakistani origin living in different parts of United States including Illinois, Virginia, New York, New Jersey, Texas, Michigan and California, falling within the age range of 20 to 45 (M = 28.5; SD = 4.36) years using with the help of convenient sampling technique. Initially, 512 participants were contacted, few refused to respond and some participants incompletely fill the questionnaire so their responses were discarded in initial data screening, hence it makes an overall response rate of 88%.

Participants reported an average body-mass index (BMI = weight in kilograms/height in metres2) of 29 and average waist circumference 33. Moreover, the permanently employed women were 189 (42%) whereas contractual job holders were 261 (58%). Women with any kind of serious physical and psychological ailments were excluded.

Assessment Measures

Body Discrepancy Scale (BDS), (Anton et al., 2000). The discrepancies between actual and ideal media body image is measured by adapting the Body Discrepancy Scale (BDS) developed by Anton and colleagues that was designed to assess the discrepancy between a woman's actual and ideal body weight and size. The ideal body image items were adapted as specifically ideal body image portrayed by the media. Participants are asked to rate their ``current'' clothes and waist sizes and their ``ideal'' clothes and waist sizes (i.e., sizes they would choose if they could be any size they wanted) using Likert scale going from, (0) not important to (3) extremely important. Scores were combined to compute a woman's total body discrepancy score and higher scores reflect greater discrepancies between ``actual'' and ``ideal'' ratings. Test-retest reliability of this measure was calculated from an independent sample of 35 college students and was found to be .81.

For this sample, the internal consistency of this measure was high (alpha = .84) (Anton at al., 2000). For the present study, the scale has a reasonable high reliability coefficient ([alpha]=.75).

Socio-Cultural Attitudes towards Appearance Questionnaire, (Heinberg, Thompson, and Stormer, 1995). To evaluate the degree of the thin ideal internalization, internalization subscale from the Socio-Cultural Attitudes towards Appearance Questionnaire was used (Heinberg et al., 1995). The scale has 8 items including one reverse coded item with a 5-point scale from 1-5 (completely disagree-completely agree). An example item is "Women who appear in TV shows and movies project the type of appearance that I see as my goal." Cronbach's alpha for the current study is .78.

Surgical Concerns Scale. A 5 items measure was developed to assess the surgical concerns using 5-point Likert scale, ranging from (1) strongly agrees to (5) strongly disagree. Example item included; if you are convinced that there will be no side effects, then can you undergo a surgery to attain a thin body. The reliability value for this scale is found to be .60.

Demographic Information Sheet. includes information such as age, BMI (weight, height), waist circumference and employment status.


Approval for the use of human subjects in the current study was obtained from the University Institutional Review Board. Participants were informed about the nature and purpose of the present study and also informed consent was taken from them before collecting information from the participants specifying confidentiality, anonymity and right to withdrawal from participation at any time without penalty. A percentage of the respondents finished the surveys on web (individual administration), and some were sent printed version of the survey together with an answer paid-envelope for return. The survey pack incorporated a data sheet and explanation. The surveys were finished in the request exhibited above and took roughly 30 minutes to complete.

A group of 10 persons (counting the researcher) was prepared to gather the information on one to one basis; first the examination associates were given brief depiction about the whole research, its method of reasoning, destinations and about the intended interest group. Guidelines were given about the ethical considerations in regards to how the respondents were to be dealt with. The directions about the exploration study were at the highest point of the review survey yet on the off chance that anybody required any sort of affirmation, surety or clarity; they were tenderly informed about the whole nature of the research. As per the field action plan the research team started collecting data from the sampled population in the months of March till June, 2015.


This section presents the analysis and interpretation of the data.

To find out the relationship between Body Image Discrepancy, thin ideal internalization and surgical concerns among U.S. based Pakistani working women. Pearson, Product Moment Correlation analysis was employed to establish the relationship between variables (see table 1).

Table 1 Summary of Correlations for Study Variables (N=450).


Body Image Discrepancy###.44**###.38**###2.38###.66

Thin Ideal Internalization###-###.40**###3.37###1.19

Surgical Concerns###-###-###3.38###.94

The findings highlighted that there is a positive relationship of Body Image Discrepancy with surgical concerns. Furthermore it also reveals that surgical concerns are likely to be more in those Pakistani working Women who scored higher on their level of thin ideal internalization, moreover thin ideal internalization is more in those women that show body image discrepancies.

Moreover, as it is hypothesized that thin ideal internalization will likely to mediate the relationship between Ideal Body Discrepancy and surgical concerns among U.S. based Pakistani working women, Structural Equation Modeling using Amos was conducted. The results are given in table 2 below using 2000 bootstrap samples and bias-corrected bootstrap 90% CI for the standardized effects (Preacher and Hayes, 2008).

Table 2 Goodness of Fit Indices for Path Analysis in U.S. Working Women With Pakistani Origin (N=450).


###(90 % CI)



As shown in above table that the insignificant value of the Chi-square (IA2 = .76, p = .65) and various fit indices (CFI, NFI, RMSEA and chi-square) provide a comprehensive indication of excellent fit of the data with the tested model. The paths drawn in the Final Model are shown in Figure 2.

Figure 2 shows the final model with all the significant predictions, for which the values of goodness of fit and indirect effects were obtained. Then the paths were analyzed through direct and indirect effects. Three significant direct paths were evident, body image discrepancy positively predicted surgical concerns ([beta]=.25, p<.001) and thin ideal internalization ([beta]=.43, p<.001). Moreover thin ideal internalization positively predicted surgical concerns ([beta]=.29, p<.001), among U.S. based Pakistani working women. Furthermore, thin ideal internalization partially mediated the relationship between body image discrepancies and surgical concerns ([beta]=.13, p<.001) hence accepting the study hypothesis 4.


The results revealed that thin ideal internalization partially mediate the relationship of body image discrepancy with surgical concerns among Pakistani working women residing in USA thus accepting the study hypothesis. These findings are in line with the previous research findings (Sarwer and Crerand, 2004; Ura and Preston, 2015) suggesting that a greater psychological investment in physical appearance and greater internalization of mass media images of beauty predicted more favorable attitudes towards cosmetic surgery. Yamamiya, Cash, Melnyk, Posavac, and Posavac, (2005) indicated that relative to a control group, the exposure to thin-and-beautiful media images adversely influenced perceived body image of participants with high internalization levels. Moreover, Sperry, Thompson, Sarwer, and Cash (2009) revealed that viewership of reality corrective surgery shows was altogether identified with more great restorative surgery states of mind.

A hefty portion of the examination relating to the impact of media on self-perception and body disappointment looks at the distinction in models and magazine articles over time (Anton et al., 2000; Price et al., 2014). In all cases, it was found that cover models had diminished body mass and expanded presentation throughout the years. Media publicizing offers far beyond items; media sells values, doubtful desires, and standards of achievement and self-esteem (Fernandez and Pritchard, 2012). Body image distortion for young ladies starts to develop through examination with implausible self-perceptions and the creation of unreasonable desires of the self. Poor self-perception can possibly develop into a cosmetic surgery concerns as media promoting attracts the individual ever more profound. Moreover, media does not show people how to view to their bodies, esteem their own particular remarkable inner experience, or how to acknowledge the different contrasts in regular body sizes.

Rather our life's standards and media publicizing build the weight to end up more slender, more flawless, and to fit in with one perfect (Grabe, Ward, and Hyde, 2008).

Conclusion. The key findings of this study indicates that the U.S. working Women with Pakistani origin involve in surgical concerns because of thin ideal internalization as the result of body image discrepancy created by the media framed ideal body image. In spite of the fact that the present study is correlational, it gives a structure to future speculations and explains the connection between contemporary media impacts, body disappointment, binge eating, and cosmetic surgical concerns in US working women.


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Publication:Journal of Behavioural Sciences
Date:Dec 31, 2017
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