Abstract
The perception of one’s own body image is an important determinant of adolescent health. While positive body image is associated with health-promoting behaviours, negative body image may be related to engagement in health-compromising risk behaviours. Hypothetically, an adolescent’s perceived body image may also be influenced by racial/cultural ideals and related gendered expectations, governed by social norms within distinct cultural groups. Variations in perceived body image by race/ethnicity remain largely unexplored in Canada, even descriptively. A descriptive, cross-sectional study was employed using data from the 2017–2018 cycle of the Canadian Health Behaviour in School-aged Children (HBSC) study (weighted n = 18,766 participants). Self-perceptions of body image were described for Canadian adolescents, stratified by race/ethnicity and gender (boys vs. girls). There were two main findings. First, variations in perceptions of body image mainly varied by gender. Boys were more likely to report feeling ‘too thin’ while a higher proportion of girls reported feeling ‘too fat’. These trends were observed across different races/ethnicities. Second, there was little variation in patterns of self-reported body image by race/ethnicity, while the gendered variations remained within all major racial/ethnic groups. Existing research on adolescent body image typically focuses on gender norms, overlooking the potential of racial and ethnic influences on body image perceptions. Our study confirms that adolescent body image does not appear to vary substantially on racial/ethnic lines among Canadian adolescents, consistent with existing studies that highlight the strong influence of gender norms on adolescent body image.
Introduction
Body image describes how an individual thinks and feels about their body (1). Self-perceived body image is an important predictor of well-being across the life course, but is particularly salient during adolescence, as individuals navigate sociocultural, psychological and physical changes (2). Among girls, positive body image has been found to correlate with positive health indicators including having a consistent sleep cycle (3), seeking medical attention, and utilizing sunscreen (3), while also mitigating negative health behaviours, such as cigarette smoking (4), alcohol consumption (5) and dieting (5). Additionally, poor body image has been linked to the development of eating disorders, poor mental health and engagement in risk-taking behaviours (6). Among boys, the desire for muscularity has been linked to harmful behaviours including increased anabolic steroid use (7), depression and low self-esteem, as well as disordered eating (8). Many of these adolescent experiences are in turn associated with negative life course health trajectories (9). Hence, understanding patterns in self-perceptions of body image during adolescence is highly important for clinicians and public health professionals to target care, and potentially modify these trajectories.
While perceptions of body image have been examined within broad groups of Canadian adolescents, descriptions of the experiences of racially and ethnically diverse Canadians are less available (10). Such experiences are best considered in the context of social norms – the rules that govern what is acceptable within a particular social context. These include both gender-based social norms as well as norms that are defined by race and ethnicity (11). The ‘tripartite model’ proposes that the three main influences on an adolescent’s body image are parents, peers and social media (12). This is particularly salient during adolescence, as behaviours and emotions can be influenced by a young person’s perception of social norms that emerge from such contexts (13). Hence, adolescents may be influenced by culturally driven ideals about body image.
Gender-based influences on perceived body image are also important. In Western countries, girls are socialized to view themselves in reference to others, through constant comparison to a feminine ideal informed by a worldview that frames the female body in relation to the male gaze (14). Feminine body ideals are socialized such that girls are meant to internalize a view of healthy thinness (15). These socialized ideals have extended beyond the Western hemisphere through the advent of social media and globalization (16). These thin ideals are associated with negative body image, as evident from studies involving varying study designs, including longitudinal and meta-analytic studies, although effect sizes are small (16). Beyond the internalization of the ideal of ‘healthy thinness’, the normalization of cosmetic surgeries to achieve beauty standards (14), along with health messaging that charges women with taking control of their health (17), can further promote a constant internalized gaze of comparison to the visionary feminine body.
While often overlooked, boys also face societal pressures to conform to certain body ideals, most notably termed the Adonis Complex, named after the Greek god, often presented as the epitome of masculinity (18). The ideal male body is depicted as highly muscular and lean, typically associated with a high level of physical fitness, as achieved through activities such as regular weight training (19). Beyond regular weightlifting and exercise, the Adonis Complex may also manifest through steroid injections and body dysmorphia (18). However, unlike for girls, media emphasizes the importance of physical activity alone rather than diet to maintaining the ideal male body type (19).
Additionally, the prevalence of different body types among different cultural groups and across different geographic regions can influence one’s body image. For example, in geographic regions where obesity is more common, individuals may be less likely to be concerned with their obesity as it is the norm, and vice versa (20). Social norms that are disseminated through the forces of media and culture can be used to better understand the phenomenon of body image among adolescents (21). However, it remains unknown whether social norms within specific racial and cultural groups are influential in promoting different ideas that stray from the thinness (girls) and muscular (boys) ideals within the Canadian context. Better understanding how social norms are experienced among adolescents can be used to inform the development of targeted healthcare interventions that challenge existing social norms, to encourage alternative norms that promote healthy behaviours (21).
In this simple, descriptive study, we profile the distribution of self-perceived body image by race/ethnicity and gender among Canadian adolescents. Based upon past evidence (22), we expected to observe gendered patterns of perceived body image that followed known ideals for boys and girls. Further, applying our underlying theoretical framework (social norms theory (11)) we hypothesized that adolescents who identify with cultures where obesity is less common would be more likely to perceive themselves as ‘too fat’, while those who identify with racial and ethnic cultures where obesity is more common will be more likely to perceive themselves as ‘too thin’ (9). The aim of this analysis is to generate evidence that can set the stage for targeted interventions, both clinical and preventive, designed to address cultural and gender-based norms in this important public health priority (16).
Methods
Overview of study design
This study involved a descriptive, cross-sectional analysis of data from Cycle 8 (2017/2018) of the Canadian Health Behaviour in School-aged Children Study (HBSC) (23). HBSC is a cross-sectional survey administered to adolescents in the target ages of 11–15 years (grades 6–10 in Canada) in approximately 50 countries (23). In Canada, this pre-COVID-19 pandemic cycle collected reports from some 21,745 students (10,347 boys, 18,870 girls, 336 self-identifying as gender-diverse) (23). Inclusion criteria were: a) the participant responded to all variables of interest; and b) provision of informed consent (active or passive, according to local school board requirements). Exclusions were: a) Individuals identifying as Indigenous, to comply with ownership, control, access and possession (OCAP) principles (24); and b) gender-diverse students and those identifying as Latin American, due to small cell sizes associated with the hypothetical risk of re-identification. The final analysis included responses from 18,766 Canadian students (9,168 boys, 9,598 girls) who had complete responses for the measures of interest.
Ethical review
The HBSC study that led to this analysis holds ethics approval from the General Research Ethics Board (REB) at Queen’s University (#6010236) and the Public Health Agency of Canada REB (2013-022P). This analysis has received ethics approval from the research ethics board at Brock University (#22-104). Access to this dataset was acquired through a written request to the study coordinator of HBSC in Canada.
Key measures
1) Self-perceived body image: An available survey item permitted survey participants to classify self-perceptions of their body weight using various response categories: i.e. they felt that their body was ‘much too thin’, ‘too thin’, ‘about the right size’, ‘too fat’ or ‘much too fat’ (23). Based on precedent (22), responses were later grouped into ‘too thin’, ‘about the right size’ and ‘too fat’ for analysis. All response categories that were not ‘about the right size’ were viewed as an expression of negative body image (22).
2) Gender: Participants were asked to self-identify as male, female, or gender-diverse (i.e. neither term describes me). In this historical cycle of the HBSC study, there remains the inherent limitations of this questionnaire item as it frames gender in relation to sex (22).
3) Race/ethnicity: Participants were asked to self-identify into at least one of 15 racial/ethnic categories: White, Chinese, South Asian, Black, Filipino, Latin American, Southeast Asian, Arab, Japanese, Korean, West Asian, First Nations, Metis, Inuit or Other (including mixed race), as per established groupings (25). To ensure sufficient sample sizes, these groups were further combined according to cultural norms and geographical areas to create the categories: White, Black, East and Southeast Asian, East Indian and South Asian, Arab and West Asian, Latin American, Indigenous and Other, which also included those who selected more than one race/ethnicity.
Statistical analysis
Proportions of self-reported body image and related 95% confidence intervals (CIs) were calculated for boys and girls within each racial/ethnic category. Data were weighted for proportional representation by province. Rao-Scott Chi-Square tests were completed to determine if proportions differed by gender within racial/ethnic groups, adjusted for the clustered nature of the sampling design. Similar tests augmented by post-hoc tests were completed to identify if differences existed between racial/ethnic groups when stratified by gender. All analyses were completed using RStudio 2024.09.0+375.
Results
Table 1 profiles the experiences of young Canadians according to their self-perceptions of body image, stratified first by gender and race/ethnicity. Across all racial/ethnic groups, 17.0% (95% CI: 15.7% to 18.3%) of boys reported feeling ‘too thin’ compared with 9.9% (95% CI: 8.7% to 10.9%) of girls (χ2 = 66.21, p < 0.001). On the other hand, 27.2% (95% CI: 25.2% to 28.7%) of girls reported feeling ‘too fat’ compared to 22.2% (95% CI: 20.7% to 23.6%) of boys (χ2 = 10.22, p < 0.01).
Self-perceptions of body image by race/ethnicity and gender, Canada, Health Behaviour in School-aged Children Study 2017–18, n = 18,766. Prevalence proportions and 95% confidence intervals are presented stratified by gender and race, alongside p-values calculated through Rao Scott Chi-Square test for comparisons within and across different racial/ethnic groups.
, ^, × indicate that within each corresponding gender and body image group, post-hoc comparison tests have identified significant differences between the indicated groups at the p < 0.05 level of significance. Multiple symbols are used to indicate between which two racial/ethnic groups differences were identified.
Among boys, the largest proportions of young people who perceived their body to be ‘too thin’ were Arab and West Asian (23.0%, 95% CI: 11.5% to 34.6%), East Indian and South Asian (23.0%, 95% CI: 14.6% to 31.3%) and East and Southeast Asian (23.2%, 95% CI: 15.7% to 30.8%). The smallest proportions were reported for White boys (15.2, 95% CI: 13.8% to 16.7%). Across all racial/ethnic groups, statistically significant differences were found between the proportions of boys reporting to be too thin (χ2 = 32.96, p < 0.001). Post-hoc tests revealed significant differences between White and East Indian and South Asian boys (p < 0.01), and between White boys and boys reporting their race/ethnicity as Other (p < 0.01). However, confidence intervals for these three groups were overlapping. Proportions of boys who reported that they perceived their bodies to be ‘too fat’ were highest among East Indian and South Asian participants (31.1%, 95% CI: 21.9% to 40.3%), with lower proportions observed for Black participants (16.1%, 95% CI: 9.8% to 22.4%). Comparing proportions across different racial/ethnic groups among boys revealed significant differences (χ2 = 32.98, p < 0.001). Post-hoc tests revealed that significant differences were presented between White and East Indian and South Asian boys (p < 0.01) and White and those reporting their race/ethnicity as Other (p < 0.01). Within the ‘about right’ category, a higher proportion of White boys (63.1, 95% CI: 61.2% to 65.0%) reported to be ‘about right’ compared to East Indian and South Asian (45.9%, 95% CI: 36.0% to 55.8%) and boys reporting race/ethnicity as Other (54.7%, 95% CI: 50.2% to 59.0%) (p < 0.01).
Among girls, the highest proportions of individuals reporting to be ‘too fat’ were among Arab and West Asian (31.0%, 95% CI: 18.3% to 43.6%), East Indian and South Asian (31.9%, 95% CI: 22.8% to 41.1%) and East and Southeast Asian (35.4%, 95% CI: 27.0% to 43.9%). The smallest proportions were reported among Black girls (23.2%, 95% CI: 16.0% to 30.4%). Post-hoc tests revealed that there were no statistically significant differences between the proportions reporting to be ‘too fat’ across the different racial/ethnic groups. Proportions of girls reporting to be ‘too thin’ ranged from 9.1–12.5% across all racial/ethnic groups. Within this category was a statistically significant difference (p = 0.04) between the proportion of White girls (9.1%, 95% CI: 8.0% to 10.2%) and girls identifying as Other (12.5%, 95% CI: 9.7% to 15.2%).
Overall, major differences were identified in the ‘too thin’ category, where across almost all racial/ethnic categories, boys were reporting as ‘too thin’ at a higher rate than girls. In contrast, both the ‘too fat’ and ‘about right’ categories were congruent between boys and girls. Comparing differences between boys and girls within racial/ethnic groups revealed that boys identifying as Arab and West Asian (χ2 = 18.13, p < 0.001), East Indian and South Asian (χ2 = 13.43, p < 0.001), White (χ2 = 45.24, p < 0.001), East and Southeast Asian (χ2 = 4.03, p = 0.04) and Other (χ2 = 66.21, p < 0.001) were all more likely to report feeling ‘too thin’ than their female counterparts. Differences were not as prominent when comparing boys and girls who reported feeling ‘too fat’ or ‘about right’ within the respective racial/ethnic categories. White girls were more likely to report feeling ‘too fat’ compared to White boys (χ2 = 8.30, p < 0.01), while East Indian and South Asian girls were more likely to report feeling ‘about right’ than their male counterparts (χ2 = 5.17, p = 0.03). Proportions within the rest of the racial/ethnic groups were comparable between the two genders in both the ‘too fat’ and ‘about right’ categories. Across racial/ethnic groups, similarities were most prominent among races/ethnicities that predominate from the Asian continent. Arab and West Asian, East Indian and South Asian, and East and Southeast Asian boys and girls had the highest proportions of individuals reporting negative body image.
Discussion
In this descriptive analysis, we used national population health data to explore patterns of self-perceived body image among Canadian adolescents by racial/ethnic identity, stratified by gender. This analysis sought to provide foundational evidence to inform clinical and prevention efforts, and to provide a focus for deeper etiological analyses.
Our findings confirm known patterns of body image, consistent with the ‘thin ideal’ in girls (26) and the ‘muscular ideal’ in boys (27). However, existing comparisons between boys and girls have highlighted the fact that while researchers regularly place emphasis on body image and dysmorphia within girls, the phenomenon may be more prevalent among boys. Within the sample of study, the proportions of boys and girls reporting to be ‘too fat’, a phenomenon typically associated with body image concerns among girls, was quite similar. On the other hand, the proportions of boys reporting to be ‘too thin’ was significantly higher across nearly all racial/ethnic categories. Consequently, it appears that gender and social norms, perpetuated through industries such as diet and fashion, which often target women, encourage conversations about body image among women while curtailing such conversations among men (28). The tripartite model (12) suggests that different spheres of influence – parents, peer groups, the media – drive the emergence of social norms (29). Among girls, patriarchal norms allow for people beyond the nuclear family unit to comment on a women’s body type, which can put pressure on girls to conform to certain ideals (30). The normalization of cosmetic procedures (31) alongside the increasing prevalence of discourses and industries around dieting, exercise and fitness (15) has made the body a forum for public discussion. Such discourses further reinforce the internalization of a constant monitoring gaze, whereby both boys and girls may constantly gauge where their body fits within current discourses (15,18). Comparison is reinforced through social media platforms that emphasize use of images and filters that are modified to appeal to certain body ideals, which present adolescents with unrealistic images that can encourage negative body image to develop (32). Parental perceptions of body image can also influence adolescent feelings about their body. For example, understanding that their mother desires thinness, boys have been found to have an increased propensity for negative body image and a greater drive for muscularity (33). On the other hand, girls who observe their mothers being critical of their bodies or diet have been found to model the behaviour of their mothers by reporting lower body satisfaction and negative eating attitudes through the development of dieting behaviours (34).
With respect to racial and ethnic differences in such ideals, the past evidence base is mixed. Some studies (35,36) have demonstrated differences in perceived body image within such racial/ethnic groups, while others mirror our findings, showing more similarities than differences (37,38). To illustrate, Black girls have been shown to express a desire and greater acceptance towards larger body ideals and do not necessarily identify with mainstream body ideals (38), and thus report lower levels of negative body image when compared to other races/ethnicities (23,24). In contrast, East Asian and Southeast Asian girls have been found to be more likely to consider themselves in reference to the mainstream thinness ideals (38). Among South Asian communities, girls can often be subject to comments and pressure from family, friends and older community members to work towards an ideal of heathy and thin (39), where they are not ‘too fat’ and not ‘too thin’. Many of these views often stem from cultural perceptions around the expectation of marriage but also the internalization of Eurocentric ideals that extend beyond body weight to skin tone and facial shape (39). Within this study, East Indian and South Asian boys and girls had the highest proportions of individuals reporting to be ‘too fat’. Other studies have simultaneously examined the individual and combined associations of gender and race/ethnicity on perceived body image ideals. Some have shown that gender had a higher influence on body image than did racial and ethnic influences, and hence that gendered social norms prevail over those espoused within particular cultures (29), such that boys are more likely to report feeling ‘too thin’ while girls are more likely to report feeling ‘too fat’, irrespective of race or ethnicity (29,40). These trends persisted in the present study sample; however, the differences in proportions between the genders were more profound in the ‘too thin’ category compared to the ‘too fat’ category.
The social norms theory on which this analysis is based suggests that individuals will judge themselves, and their perception of what is ‘normal’, based upon their social reference group. Hence, we anticipated that young people with geographic origins where obesity is less common (31) would be more likely to identify as ‘too fat’, as their reference group would present as thinner on average (20). We also predicted that the opposite would be true for adolescents in other circumstances, where reference groups would be larger on average (20). This was partially substantiated by our results, such that the highest proportions of negative body image were reported among East and Southeast Asian girls and East Indian and South Asian boys, aligning with areas of the world where obesity is less common (41). Despite not living in the same geographic region, it can be said that the trends from different regions of the world are imported through the distinct cultural communities that exist in Canada and socialize into youth through the tripartite model (12).
Study strengths include our large and nationally representative sample, the importance of the topic, and the grounding of the study in two accepted theories. Limitations include the fact that the race/ethnicity variable conflates the two concepts, which ideally would be considered as separate constructs. The resultant misclassification would likely make it more difficult to observe salient differences. Further, sample size challenges exist, whereby stratification by race/ethnicity naturally meant that some cell sizes were small compared to the White sample, which impacted the precision of estimates, increasing the risk of overestimated effect sizes and making it difficult to detect small subgroup differences (42). In contrast, the large sample size for the White subgroup meant that estimates were more precise, and small differences could easily reach statistical significance (42). It was also not possible to present information on gender-diverse adolescents due to ethical restrictions, which is unfortunate due to the emergent importance of these groups within adolescent society. Although similar trends existed within boys and girls respectively, some racial/ethnic groups still had statistically different experiences than the total sample, demonstrating the need for future research to explore what cultural experiences, specifically, are driving some groups to have poorer body image than the total population of Canadian adolescents (10).
Conclusion
This analysis has demonstrated how trends of body image largely fall along the lines of gender rather than race/ethnicity, whereby regardless of race/ethnicity, girls will tend to report feeling ‘too fat’ at a higher rate while boys will tend to report feeling ‘too thin’ at a higher rate. However, small differences have been noted between adolescents’ body image by race/ethnicity. Specifically, this analysis has highlighted how poor body image appears to be more prevalent among both boys and girls identifying as Other, as well as boys of East Indian and South Asian descent. These findings point to an area of further exploration to better understand the mechanisms that may underlie as well as further confirm these relationships in order to better guide future health promotion work that may target these populations. However, the dominance of gender-based norms across different racial/ethnic groups points to an important priority for future health promotion work that can transcend the lines of race/ethnicity in order to improve population health outcomes.
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: The 2017/2018 (Cycle 8) of the Health Behaviour in School-aged Children (HBSC) study in Canada was completed through funding support from the Public Health Agency of Canada. This project was also completed in conjunction with a Canadian Institutes of Health Research Grant (grant #DC0190GP) held by Dr. Pickett.
