Relationship between nutritional status and body shape concerns among adolescents: A gender based study

Introduction

Adolescence is a period of rapid physical, emotional and social development, marked by considerable changes in height, weight, body shape and physical appearance. During this period, adolescents become increasingly aware of their bodies and may compare their appearance with that of peers and socially valued ideals. Body image is a multidimensional construct involving how individuals perceive, think and feel about their bodies, including perceptions of body size and shape, appearance-related evaluations and associated emotions (Grogan, 2002) [1] . Although body image is a broad construct, the present study focuses specifically on body shape concerns/body dissatisfaction, as assessed by the Body Shape Questionnaire-34 (BSQ-34). The BSQ-34 primarily assesses concerns related to body shape, weight and appearance and should therefore not be interpreted as a comprehensive measure of overall body image. Body dissatisfaction refers more specifically to negative evaluation or concern regarding body size, shape or appearance (Cash et al., 2011) [2] . Body shape concerns may become more pronounced when adolescents perceive a discrepancy between their actual appearance and the body shape they consider desirable. Such perceptions may be influenced by peers, family members, traditional media and social networking platforms. Nutritional status and body image are related but distinct aspects of adolescent health. Nutritional status can be assessed objectively using anthropometric indicators such as BMI, whereas body shape concerns represent a subjective evaluation of the body. Gender is an important consideration in understanding body shape concerns. Although both girls and boys may experience concerns regarding physical appearance, the nature of these concerns may differ. Girls have traditionally been exposed to a thinness-oriented appearance ideal and may place greater emphasis on body weight and achieving a smaller or thinner body. Boys may be more concerned with developing a larger, muscular, lean or physically strong physique (Grogan, 2002; McCabe and Ricciardelli, 2004; Voelker et al., 2015) [1,3] . Consequently, girls may more frequently desire weight reduction, whereas boys may desire weight gain or increased muscularity. These gender-specific appearance ideals suggest that adolescents with similar BMI values may evaluate their bodies differently. Research among Indian adolescents has also demonstrated differences in body-weight perception and body shape concerns according to gender and nutritional status (Johnson et al., 2015; Deshmukh et al., 2017) [5, occur at both lower and higher levels of BMI. Adolescents with overweight or obesity may experience dissatisfaction because of concerns regarding body size, while adolescents with normal or low BMI may also perceive their bodies negatively or feel dissatisfied with their appearance. Evidence from Indian adolescents has demonstrated significant differences in body-image attitudes across BMI categories, with girls generally reporting greater concerns regarding appearance and body satisfaction (Deshmukh et al., 2017) [4] . Flores et al. (2017) [6] , in a systematic review, reported a positive association between BMI and body-image dissatisfaction among children and adolescents. Longitudinal evidence has further indicated that body dissatisfaction may increase from adolescence into young adulthood, with increasing BMI associated with greater body dissatisfaction (Bucchianeri et al., 2013) [7] . Body shape concerns are relevant not only to perceptions of physical appearance but also to adolescent psychosocial well-being. Body dissatisfaction has been associated with psychological difficulties, including depressive symptoms, anxiety, low self-esteem and social withdrawal. Adolescents with overweight or obesity may additionally experience weight-related teasing, stigma and peer victimisation (Voelker et al., 2015) [3] . Body dissatisfaction has also been associated with unhealthy weight-control practices, including restrictive dieting and other attempts to alter body weight or appearance (Stice et al., 2002; Sztainer et al., 2006) [8,9] . Therefore, examining body shape concerns in relation to nutritional status separately among girls and boys is important for understanding whether objective BMI corresponds with adolescents' subjective evaluation of their bodies. The present study was undertaken to examine the relationship between nutritional status and body shape concerns among adolescents, with particular emphasis on gender differences.

Objectives

To assess the nutritional status of adolescent girls and boys aged 16-18 years.

To assess body shape concerns among adolescent girls and boys.

To examine gender differences in nutritional status and body shape concerns.

To determine the association and correlation between BMI and body shape concerns among girls and boys.

To identify the predictors of body shape concerns among adolescents.

Methodology

Research design and participants: A differential and exploratory research design was adopted to assess gender differences in nutritional status and body shape concerns and to examine the association between BMI and body shape concerns. The study was conducted in Dharwad city, Karnataka, among 300 adolescents aged 16-18 years studying in 11th and 12th grades. Participants were selected from 10 pre-university colleges through purposive sampling, with equal representation of girls (n = 150) and boys (n = 150).

Data collection and measures

Prior permission was obtained from the concerned pre-university colleges. The purpose and procedures of the study were explained to the participants, and oral informed consent was obtained before participation. Confidentiality and anonymity of the information provided by participants were maintained. Personal and family characteristics were recorded using a self-structured schedule covering age, gender, height, weight, type of family, parental education, parental occupation and monthly family income. BMI was calculated using the formula: BMI = Weight (kg) / Height (m 2 )

Nutritional status was classified according to the WHO (2007) BMIfor-age reference into severe thinness, thinness/underweight, healthy weight, overweight and obese categories. Body shape concerns were assessed using the Body Shape Questionnaire-34 (BSQ-34) developed by Cooper et al. (1987) [10] . The reliability of the BSQ-34 in the present study was assessed using Cronbach's alpha and the Guttman split-half method, yielding coefficients of 0.97 and 0.96, respectively. Socioeconomic status was assessed using the Modified Kuppuswamy Socio-Economic Status Scale updated by Radhakrishnan et al. (2023) [11] .

Statistical analysis: Data were coded and entered in Microsoft Excel and analysed using SPSS version 21.0. Descriptive statistics, chi-square test, independent-samples ttest, correlation and hierarchical multiple regression were used for analysis. Statistical significance was considered at the levels reported in the respective tables

Results

The majority of the adolescents (74.00%) were aged 16-17 years, while 26.00 per cent were aged 17-18 years. Regarding maternal education, the largest proportion of mothers had completed high school (37.70%), followed by intermediate/diploma education (20.70%) and middle school education (17.00%). About 8.30 per cent were graduates, 5.30 per cent had professional/honours education and 8.00 per cent were illiterate. Among fathers, 25.30 per cent had intermediate/diploma education and 24.70 per cent were graduates, followed by high school (20.30%) and middle school education (15.00%). Only 5.30 per cent of fathers were illiterate (Table 1).

N = 300 Figures in parenthesis indicates percentage

Most mothers were homemakers/unemployed (73.30%), whereas fathers were predominantly engaged in agricultural/fishery work (31.70%) and skilled work/shop and market sales (24.70%). Most adolescents belonged to nuclear families (71.00%), while 29.0 per cent belonged to joint families. With regard to socioeconomic status, 40.30 per cent belonged to the lower-middle category, 32.00 per cent to the upper-middle category and 24.70 per cent to the upper-lower category. Only 2.30 per cent belonged to the upper category and 0.70 per cent to the lower category. The socio-demographic profile indicates that the study participants predominantly came from nuclear families and lower-middle to upper-middle socioeconomic backgrounds. The relatively similar representation of girls and boys provides a basis for gender-based comparison within the study population. Overall, the adolescents predominantly belonged to nuclear families and lower-middle to upper-middle socio-economic groups, with mothers largely being homemakers and fathers mainly engaged in agricultural and skilled occupations. N = 300 Figures in parenthesis indicates percentage, *Significant at 0.05 level, ** Significant at 0.01 level A significant gender difference was observed in nutritional status (Tale 2). Girls constituted a greater proportion of adolescents with severe thinness (64.00%) and thinness/underweight (62.20%), whereas boys constituted a greater proportion of adolescents with normal BMI (57.10%) and obesity (75.00%). The proportion of overweight adolescents was equal among girls and boys (50.00% each; fig. 1). The association between gender and BMI was statistically significant (χ 2 = 10.58, p < 0.05). Further, boys had a significantly higher mean BMI than girls (20.42 ± 4.06 vs. 18.09 ± 3.53; t = 3.01, p < 0.01). The coexistence of thinness and excess weight in the study population indicates the varied nutritional challenges experienced during adolescence and reflects the broader double burden of malnutrition. Similar evidence among Indian adolescents has demonstrated the simultaneous occurrence of undernutrition, overweight and obesity (Pandurangi et al., 2022; Jaleel et al., 2024) [13,12] . Wangaskar et al. (2021) also reported the coexistence of thinness, overweight and obesity among adolescents. Liao et al. (2013) [14] reported lower BMI among female adolescents compared with males. The higher representation of girls in the thinness categories and the higher mean BMI among boys may be related to differences in adolescent growth patterns, body composition and nutritional require-ments. However, the cross-sectional nature of the present study does not permit conclusions regarding the causes of these gender differences. The findings nevertheless indicate the importance of assessing both undernutrition and excess weight among adolescents rather than focusing exclusively on obesity. The findings demonstrated a significant gender difference in body shape concerns (Table 3). Among adolescents classified as not concerned, 43.20 per cent were girls and 56.80 per cent were boys. In the slightly concerned category, girls constituted 36.60 per cent and boys 63.40 per cent. In contrast, girls constituted 69.10 per cent of the moderately concerned group and 85.70 per cent of the highly concerned group (fig. 2). The association between gender and BSQ-34 concern category was statistically significant (χ 2 = 29.54, p < 0.001). Girls also had a significantly higher mean BSQ-34 score than boys (102.80 ± 44.56 vs. 83.21 ± 33.85; t = 4.48, p < 0.001).

Figure 2. Percentage distribution of body shape concern among girls and boys.

This finding is consistent with previous studies reporting greater body dissatisfaction or body shape concerns among adolescent girls than boys (Voelker et al., 2015 [3] ; Jimenez Flores et al., 2017 [6] ; Deshmukh and Kulkarni, 2017 [4] ; Bustos et al., 2019) [15] . Martini et al. (2022) [16] , in a systematic review, reported that weight dissatisfaction was more prevalent among girls, while Flores et al. (2017) [6] similarly identified greater body-image dissatisfaction among adolescent girls. Napp (2026) [17] also reported higher body dissatisfaction among girls than boys across international adolescent samples. The greater body shape concern observed among girls may be associated with gender-specific appearance ideals, sociocultural expectations regarding body shape and greater sensitivity to appearance-related evaluation and comparison during adolescence. At the same time, boys also demonstrated body shape concerns, indicating that appearance-related concerns are not exclusive to girls. The nature of these concerns may differ, with boys potentially placing greater emphasis on muscularity, leanness or physical strength (McCabe and Ricciardelli, 2003, 2004; Voelker et al., 2015) [18,19] . An important conceptual consideration is that the BSQ-34 measures body shape concerns/body dissatisfaction, rather than overall body image. Therefore, the higher scores among girls in the present study should be interpreted specifically in terms of greater concern regarding body shape, weight and appearance. * Significant at 0.05 level, (Blank cells are excluded from the analysis) Among girls, adolescents who were not concerned were predominantly thin/underweight (45.10%) or had normal BMI (41.20%). Among highly concerned girls, the majority had normal BMI (72.20%), followed by overweight (16.70%) and thinness/underweight (11.10%). BMI was significantly associated with BSQ-34 concern categories among girls (χ 2 = 22.73, p < 0.05) and showed a significant positive correlation with BSQ-34 scores (r = 0.28, p < 0.01). Among boys, BMI was also significantly associated with BSQ-34 concern category (χ²=22.35, p < 0.05), but the correlation between BMI and BSQ-34 score was not statistically significant (r = 0.11). Adolescents with normal BMI constituted the largest proportion of the not concerned (67.20%), slightly concerned (57.60%) and moderately concerned (66.70%) groups. Among highly concerned boys, 66.70 per cent were overweight and 33.30 per cent were thin/underweight (Table 4). The findings therefore indicate that BMI and body shape concerns are related, but the relationship differs by gender. The significant positive correlation among girls suggests that higher BMI was associated with greater body shape concerns. Among boys, although BMI categories were significantly associated with concern categories, the absence of a significant correlation suggests that the linear relationship between BMI and the continuous BSQ-34 score was weak.

The presence of considerable body shape concern among girls with normal BMI is particularly important. It indicates that objective nutritional status alone may not adequately explain how adolescents evaluate their bodies. Flores et al. (2017) [6] similarly reported that body dissatisfaction can occur among adolescents across different BMI categories. Deshmukh et al. (2017) [4] reported differences in body shape concerns according to BMI and gender among Indian adolescents, while Calzo et al. (2012) [20] found that the association between BMI and body dissatisfaction differed between adolescent boys and girls. The present findings also demonstrate that body shape concerns should not be considered solely a consequence of overweight or obesity. Adolescents with normal or low BMI may also experience concerns regarding their body shape. Perceived discrepancy between actual and ideal appearance, social comparison and appearance-related expectations may contribute to these concerns. Consequently, screening for body shape concerns may be relevant across the BMI spectrum rather than being restricted to adolescents with high BMI. Hierarchical multiple regression was conducted to determine the contribution of personal, parental and familial characteristics to body shape concerns (Table 5). In Model I, age, gender and BMI together explained 24.9 per cent of the variance in BSQ-34 scores. With the addition of parental characteristics in Model II, the explained variance increased to 27.2 per cent. The final model, which additionally included familial characteristics, explained 28.0 per cent of the variance (R 2 = 0.280; adjusted R 2 = 0.255). . Deshmukh et al. (2017) [4] also reported differences in body shape concerns according to gender, BMI and socioeconomic status among Indian adolescents. The significant association with socioeconomic status may reflect differences in social environments and appearance-related experiences; however, the mechanisms underlying this association cannot be established from the present study. Importantly, the final model explained 28.0 per cent of the variance, indicating that a substantial proportion of individual differences in body shape concerns remained unexplained by the variables included in the model. Other psychosocial and appearance-related factors may therefore contribute to body shape concerns. Because the present study used a cross-sectional design, the regression findings represent statistical associations rather than causal relationships. The findings should therefore not be interpreted as demonstrating that higher BMI, gender or socioeconomic status causes greater body shape concerns. Taken together, the findings demonstrate the coexistence of nutritional and psychosocial dimensions of adolescent health. Girls were more represented in the thinness categories and reported greater body shape concerns, whereas boys had a higher mean BMI and were more represented in the normal and obese categories. BMI category was significantly associated with BSQ-34 concern category among both girls and boys, but a significant positive correlation between BMI and BSQ-34 score was observed only among girls. The findings further demonstrate that body shape concerns may occur even among adolescents with normal BMI. Thus, objective anthropometric status and subjective body-related concerns should be considered as related but distinct dimensions of adolescent well-being. The findings support the importance of gender-sensitive approaches that address healthy growth, realistic perceptions of body shape, appearance-related pressures and prevention of unhealthy weight-control practices.

Conclusion

The study demonstrates significant gender differences in both nutritional status and body shape concerns among adolescents aged 16-18 years. Girls were more represented in the severe thinness and thinness/underweight categories and reported significantly higher BSQ-34 body shape concern scores, whereas boys had a significantly higher mean BMI and were more represented in the normal and obese categories. BMI was significantly associated with body shape concern categories among both genders, although the positive correlation between BMI and BSQ-34 score was significant only among girls. Gender, BMI and socioeconomic status emerged as significant statistical predictors of BSQ-34 scores, together explaining 28.0 per cent of the variance. Importantly, body shape concerns were observed across different nutritional-status categories, including among adolescents with normal BMI. These findings suggest that assessment of adolescent health should incorporate both objective nutritional assessment and screening for body shape concerns. Gender-sensitive counselling and health education may help adolescents develop realistic and healthy perceptions of body shape and weight. The findings are specific to the adolescents included in the present study and should not automatically be generalized to all adolescents.

References

1. Grogan S. Body image: Understanding body dissatisfaction in men, women and children. Routledge; 2002.
2. Cash TF, Smolak L. Body image: A handbook of science, practice, and prevention (2nd ed.). Guilford Press; 2011.
3. Voelker DK, Reel JJ, Greenleaf C. Weight status and body shape concernss in adolescents: Current perspectives. Adolescent Health, Medicine and Therapeutics. 2015;6:149-158.
4. Johnson AR, Balasubramanya B, Jaimol SR, Shaiby SR, Gifty S, Britto RD. Body image perception and nutritional status of adolescents in a school in rural South India. Journal of Indian Association for Child and Adolescent Mental Health. 2015;11(4):260-278.
5. Flores PJ, Cruz AJ, Gascon MB. Body-image dissatisfaction in children and adolescents: a systematic review. Nutricion hospitalaria. 2017;34(2):479-489.
6. Bucchianeri MM, Arikian AJ, Hannan PJ, Eisenberg ME, Neumark-Sztainer D. Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body Image. 2013;10(1):1-7.
7. Stice E, Shaw HE. Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research. 2002;53(5):985-993.
8. Sztainer ND, van den Berg P, Hannan PJ, Story M. Self-weighing in adolescents: Helpful or harmful? Longitudinal associations with body weight changes and disordered eating. Journal of Adolescent Health. 2006;39(6):811-818.
9. Cooper PJ, Taylor MJ, Cooper Z, Fairburn CG. The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders. 1987;6(4):485-494.
10. Radhakrishnan M, Nagaraja SB. Modified Kuppuswamy socioeconomic scale 2023: Stratification and updates. International Journal of Community Medicine and Public Health. 2023;10(11):4415-4418.
11. Jaleel A, Chilumula M, Chukkala Satya SG, Singnale P, Telikicherla UR, Pandurangi R. The assessment of nutritional status of adolescents aged 15-18 years using BMI cutoffs and BMI Z scores: A secondary analysis of National Family Health Survey5 (2019-21) data. Cureus. 2024;16:e59800.
12. Pandurangi R, Mummadi MK, Challa S, Reddy NS, Kaliaperumal V, Khadar Babu C, Telikicherla UR, Pullakandham R, Geddam JJB, Hemalatha R. Burden and predictors of malnutrition among Indian adolescents (10-19 years): Insights from Comprehensive National Nutrition Survey data. Frontiers in Public Health. 2022;10:877073.
13. Liao Y, Liu T, Cheng Y, Wang J, Deng Y, Hao W, Chen X, Xu Y, Wang X, Tang J. Changes in eating attitudes, eating disorders and body weight in Chinese medical university students. International Journal of Social Psychiatry. 2013;59(6):578-585.
14. Bustos FJ G, Infantes-Paniagua A, Gonzalez-Marti I, ContrerasJordan OR. Body dissatisfaction in adolescents: Differences by sex, BMI and type and organization of physical activity. International Journal of Environmental Research and Public Health. 2019;16(17):3109.
15. Martini SMC, de Assumpcao D, Barros MBA, Mattei J, Barros Filho AA. Prevalence of body weight dissatisfaction among adolescents: A systematic review. Revista Paulista de Pediatria. 2022;41:e2021204.
16. McCabe MP, Ricciardelli LA. Body image and strategies to lose weight and increase muscle among boys and girls. Health Psychology. 2003;22(1):39-46. International Journal of Agriculture Extension and Social Development https://www.extensionjournal.com 26180731, 2026, 9(9), Downloaded from https://www.doi.org/10.33545/26180723.2026.v9.i9m.4302 by International Journal of Agriculture Extension and Social Development on [26/09/2026]. See the Terms and Conditions (https://www.extensionjournal.com) for rules of use; OA articles are governed by the applicable Creative Commons License
17. McCabe MP, Ricciardelli LA. A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls. Adolescence. 2004;39(153):145-166.
18. Calzo JP, Sonneville KR, Haines J, Blood EA, Field AE, Austin SB. The development of associations among body mass index, body dissatisfaction, and weight and shape concern in adolescent boys and girls. Journal of Adolescent Health. 2012;51(5):517523.
19. Paxton SJ, Eisenberg ME, Neumark-Sztainer D. Prospective predictors of body dissatisfaction in adolescent girls and boys: A five-year longitudinal study. Developmental Psychology. 2006;42(5):888-899.
20. Quick V, Eisenberg ME, Bucchianeri MM, Neumark-Sztainer D. Prospective predictors of body dissatisfaction in young adults: 10year longitudinal findings. Emerging Adulthood. 2013;1(4):271282.
21. Hedaoo R, Gavaravarapu SM. Understanding body shape concerns and body image discontentment in early adolescence. Indian Journal of Community Health. 2020;32(2):411-417.
22. Rajagopalan J. Attitudinal and perceptual dimensions of body image in adolescents. Journal of Indian Association for Child and Adolescent Mental Health. 2020;16(4):142-163.
23. World Health Organization. Growth reference data for 5-19 years: BMI-for-age. 2007. How to cite this article: Mantur MK, Kammar MR. Relationship between nutritional status and body shape concerns among adolescents: A gender based study. International Journal of Agriculture Extension and Social Development. 2026;9(9):974-981. doi: https://www.doi.org/10.33545/2618072