Gender Differences in Body Image and Health Perceptions: MEASURES
Respondents reported on personal demographic information, including age, race, U.S. citizenship, marital status, number of children, income, health status and health history (ever diagnosed by a physician for any of the following conditions: high blood pressure, diabetes, cancer, heart disease and breathing problems).
Body mass index (BMI) was calculated in kg/m2 using self-reported height and weight; participants were categorized according to NIH guidelines: underweight <18, acceptable 19-24, overweight 25-29, obese 30-34, extreme obesity (obesity II) >35. Respondents were asked to report on their own weight history and the current weight status of close relatives and their significant other.
Body Awareness Variables
Self-perception as overweight and/or obese was measured using two questions: “Do you consider yourself now to be overweight?” and “Do you consider yourself now to be obese?” A dichotomous summary variable was constructed to represent all individuals who responded yes to either of these items. A variable representing accuracy of self-perception of overweight or obese was constructed by comparing self-perception items with current weight status. Those who were underweight or had acceptable weight and misclassified themselves as overweight or obese were categorized as inaccurate. Those who were overweight, obese or extremely and did not classify themselves as at least overweight were also categorized as inaccurate.
Body Satisfaction Variables
Dissatisfaction with Body Weight. Ideal weight was assessed by asking respondents, “How much would you like to weigh?” Ideal weight was subtracted from self-reported current weight to provide an indicator of dissatisfaction with body weight. Negative scores on the Dissatisfaction with Body Weight score indicate a desire to weigh less, and positive scores indicate a desire to weigh more. A three-category summary variable for dissatisfaction with body weight was created with the following response categories: “Desires to stay the same weight” when ideal weight equaled current weight; “Desires to weigh less” when ideal weight was less than current weight and “Desires to weigh more” when ideal weight was greater than current weight.
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Area-Specific Body Satisfaction. To measure area-specific body image perceptions, participants were asked to think of the following body parts: arms, stomach, chest, hips, thighs, buttocks and legs. The participants were asked to state if they would like for specific body parts to be bigger, smaller or stay the same. This scale is an adaptation of the Body Cathexis Scale by Resnicow et al. for the GO GIRLS Study, a nutrition and physical activity program for low-income, overweight African-American, adolescent females. This measure represents the participant’s actual satisfaction with their body parts. Each item was scored using a Likert Scale, where 1 is “bigger”, 2 is “smaller”, and 3 is “stay the same”. Three summary variables were created: 1) “Number of body areas desired to be smaller,” a count of the body areas listed above where the response was “smaller;” 2) “Number of body areas desired to be larger,” a count of the body areas listed above where the response was “bigger” (both count variables have a minimum score of 0 and a maximum score of 7); and 3) “Desires upper torso to be larger” categorized individuals by “desire for chest and/or arms to be larger” versus “would keep chest and/or arms to stay the same or smaller.” This dichotomous variable represents a desire for greater muscularity in upper body.
Perceived Impact of Weight Variables
Perceived Risk of Disease Due to Weight. Three statements related to respondents’ perception that their weight put them at risk for heart disease. Respondents indicated the extent of agreement with each item using a Likert scale of five anchored points, which included “strongly agree,” “agree,” “undecided,” “disagree” or “strongly disagree.” Each question was dichotomized to represent perceived risk for each condition; the response categories were “strongly agree or agree” versus “undecided”, “disagree” and “strongly disagree”. A summary variable for perceived risk of disease due to weight was created to indicate a perceived risk for any disease due to weight (heart disease, cancer or diabetes) compared with those who did not perceive any risk for any one of the three chronic illnesses stated.
Perceived Impact of Weight on Social Interactions. The Perceived Impact of Weight on Social Interactions Scale (PIWSIS) was operationalized with a set of 13 items adapted from previous studies, mostly related to social interactions of young adults with chronic health conditions. The items formed one 13-item subscale, which assessed the respondent’s perceptions of the extent to which their weight negatively influenced social interactions (e.g., because of my weight people often treat me differently). Respondents indicated the extent of agreement with each item using a Likert scale of five anchored points, which included “strongly agree,” “agree,” “undecided,” “disagree” or “strongly disagree.” Individual scores are calculated by summing the answers of the 13 items. The total score for the subscale can range from 13-65, with lower scores indicating perceptions of greater negative impact. The standardized alpha for a subscale using these 13 items was 0.94, indicating high reliability for this subscale. In this study, scores on PIWSIS were correlated with measures of depression (r=-0.13, p<0.05). Those higher scores on depression were correlated with scores reflecting greater impact scores on the PIWSIS. PIWSIS items are listed in Appendix A.
A dichotomous variable was created that classified participants as “perceives high impact” versus “other.” Those participants who scored in the bottom 10% of scores on the PIWSIS or responded “strongly agree” or “agree” to >3 of the items on the PIWSIS were classified as “perceives high impact.”
Sociodemographic, weight-related, self-perception of body size and body image satisfaction variables were summarized using means and frequencies. All variables were stratified by gender. Chi-squared tests and t tests were used to determine if there was a statistically significant difference between males and females. For each gender group, Chi-squared and t tests were performed to assess the association of perceived impact of weight variables and body satisfaction, weight-related variables and sociodemographic variables. A gender comparison of self-perception of body size and perceived impact of weight-by-weight status was examined in a weight-stratified analysis of respondents with a BMI >25 kg/m2. For each weight status category (overweight, obese and extremely obese), Chi-squared tests and t tests were used to compare variables by gender. In addition, one-way ANOVA tests were conducted to test for linear associations between continuous variables and increasing weight status.
Multivariate logistic regression was used to assess the association between weight-related variables and body satisfaction variables with the perceived impact of weight variables, while controlling for sociodemographic variables.
Multiple linear regression analyses, stratified by gender, were used to examine the association between weight-related variables and self-perception of body size variables with PIWSIS, while controlling for sociodemographic variables. All regression analyses were gender-specific (i.e., separate models for males and females). Only variables associated at the p<0.05 statistical level of significance were included in the regression analysis. Data were analyzed using SPSS (version 9.0, 1999 SPSS Inc., Chicago, IL) with statistical significance at the p<0.05.