Gender Differences in Body Image Perception among Northern Malaysian Tertiary Students

Transcription

1 Gender Differenes in Body Image Pereption among Northern Malaysian Tertiary Students Lee-Min Wong, Yee-How Say * Department of Biomedial Siene, Faulty of Siene, Universiti Tunku Abdul Rahman (UTAR) Perak Campus, Jalan Universiti, Bandar Barat, Kampar, Perak, Malaysia. ABSTRACT Aims: This study examined the assoiation of soio-ultural and psyhologial fators with body shape onern, pereption and body weight pereption among tertiary students of Northern Malaysia. Study design: This is a ross-setional study. Plae and Duration of Study: Universiti and Kolej Tunku Abdul Rahman (UTAR and KTAR), Perak ampuses, between August 2011 and January Methodology: A total of 1003 students were reruited (M = 431, F = 572; mean age ) and their body image pereption were assessed using Body Shape Conern Questionnaire, Body Weight Pereption Questionnaire, Body Shape Pereption Questionnaire (Stunkard Silhouette Chart), Multidimensional Body Self Relations Questionnaire (MBSRQ), Rosenberg s Self-Esteem Sale (RSE) and Quality of Life measurement. Results: More females than males had problems with their body shape, where more females desired a thinner body size and vie versa for males. There was mispereption of opposite sex s pereption of attrative body shape, where males hose a larger figure for attrative body shape of female ompared with females themselves, and vie versa. Overweight students had signifiantly lower parental/peer aeptane, higher body shape satisfation and hene lower body weight/shape anxiety, and made lesser body shape omparison ompared with other ounterparts. Quality of life and self-esteem were signifiantly negatively orrelated with body satisfation. Conlusion: Male and female Malaysian tertiary students were onerned with their body shape and pereived their body weight/shape differently. Keywords: body shape onern, body shape pereption, body weight pereption, ollege students, Malaysia 1. INTRODUCTION Body image an be defined as a person s pereption, attitude, and feeling about his or her body [1], [2]. It an be differentiated into pereptual body image and attitudinal body image. Aording to Grogan (2008), pereptual body image relates to the auray of selfestimation of body size to atual size while attitudinal body image is assessed by measures of four omponents: satisfation (evaluation of the body), affet (feeling assoiated with the body), ognitions (investment in appearane, beliefs about the body), and behaviors (suh as avoidane of situations where the body will be exposed) [2]. Body shape onern, body weight pereption and body shape pereption are important omponents of body image. * Tel.: ; fax: address: sayyh@utar.edu.my.

2 Positive body image or healthy body image is marked by realisti pereption and aeptane toward the individual s size and shape [3], [4]. In ontrast, negative body image or unhealthy body image omprised of shame, embarrassment, disappointment or anxiety about how the individual looks and people who are ategorized into this group may not have a realisti understanding of body size and shape [3], [4]. Our body image might be influened by soio-ultural fators and psyhologial fators. Soio-ultural influenes are important fators that may inrease psyhologial distress suh as pressure from parents and peers [5]. Soial aeptane or approval would affet one s body image [6]. People may sometimes pereive pressures from family and friends related to their body image [7]. Stie s (2002) review indiated that individuals gain pressure to be thin from family, friends and overvaluation of appearane [8]. Besides, most of males reeived weight-gain information and advies from their parents, friends or other experts [9]. Parental attitudes are important to promote positive and healthy body satisfation in young people [10]. Influene of family and the roles that parents play in development will extend into adolesent and until the early adult years [11], [12]. Opinions from the family will moderately influene university students body image pereption [13]. Parental influene differentiates into diret influene and modeling [14]. Diret influene onsists of diret parental ommuniation, omments about weight and eating while parental modeling inludes reall of parental strategies to manage weight. Wertheim, Martin, Prior, Sanson, and Smart (2002) stated that attitudes and behaviors related to one s body an be learned via parental modeling, suh as a parent expressing onern about her or his own weight, and expressing onern about their daughter s or son s weight through parental ommuniation [15]. Besides, peer also may affet our body image pereption as we will meet different types of friends everyday. People who reeive peer s appearane ritiism or teasing will experiene negative evaluation of one s own body by another and it also ontributes to internalization by refleting important features of the appearane ulture among peers [16]. Overweight and obese youth are more frequent to be teased or to be ritiized about their weight if ompared with normal weight youth [17]. Besides, females are more influened by peer pressure if ompared with male university students [13]. Poor body image an affet one s onfidene to ahieve their goals and negatively impat the happiness in life [4]. In addition, negative body image an inrease ases of abnormal eating attitudes whih inlude dietary restraint, binge-eating and other negative effets [8]. The number of subjets with eating disorders or abnormal eating attitude is inreasing in non-western ountries [18]. Body image problems whih inlude body shape dissatisfation and body weight dissatisfation, ause stronger desired for dieting and pursuit of thinness [19]. People with positive body image are less worried about their appearane and they an spend more time on others ativities that help to build up onfidene [3]. Positive body image has strong relation with health, well being and intuitive eating. Individual with positive body image has stable weight, normal range body mass index, inner positivity and most importantly is that they have an adaptive eating style based on onnetion with internal hunger and satiety ues [19]. White women prefer thin body size and white men prefer body with hypertrophied musles [20], [21], while blak males prefer a heavier ideal female body size than their white ounterparts [22]. In Asia, girls from Vietnam and Japanese prefer a thinner body image than the healthy body image but Japanese girls desire a smaller ideal size ompared with Vietnam girls [23]. Besides, Vietnam boys desire a more musular body ompared with Japanese boys. Meanwhile, Taiwanese women have been affeted by feminine ideal and they prefer thinness [24]. These indiate that there are soio-ultural differenes in body image pereption among different populations around the world.

3 In Malaysia, studies that fous on body image pereption are limited, espeially among young adults undergoing tertiary eduation. Therefore, this study was onduted to assess body shape onern, body weight pereption and body shape pereption among male and female Malaysian tertiary students of Universiti and Kolej Tunku Abdul Rahman (UTAR and KTAR), and to examine the assoiation of soio-ultural and psyhologial fators with body image pereption. 2. METHODOLOGY 2.1 Subjet and Sampling Method A ross-setional study was onduted from August, 2011 until January, 2012 to get a piture of the roles of soioultural and psyhologial fators in the body image pereption among students of UTAR and KTAR in Kampar, Perak. Conveniene sampling method was used to obtain the data from the students. Survey form was reated through online at Kwik Survey Website ( and the website address was given to students who were invited to partiipate in this survey via the soial media and s. Besides, hard opies survey forms were also printed out and distributed onveniently to students at afeterias. The self-administered questionnaire onsisted of English and Mandarin Chinese versions. All individuals partiipating in this study signed informed onsent forms. 2.2 Measures Personal Details This part of survey olleted the personal details variable suh as gender, age, ethniity, field of study, urrently in whih year and semester, self-reported body weight and body height. Body mass index (BMI) was alulated based on the self-reported by using the formula: weight (kg)/height (m 2 ). Aording to WHO/IOTF/IASO (2000), students were lassified as underweight if they have BMI 18.50kg/m 2, normal weight if BMI between 18.50kg/m 2 to 22.99kg/m 2 overweight if BMI 23.00kg/m 2 [25] Body Shape Conern Questionnaire It onsisted of 5 simple questions whih inluded whether the subjets were onerned with their body shape, do they have problems with their body shape, main reason for onern, main role model and main soure of advie Body Weight Pereptions Questionnaire There were 2 questions to test whether males and females in different body mass index ategories (underweight, normal weight and overweight) orretly pereived their body weight. They were asked whether they were very thin to very fat pereived as by themselves and others. They were also asked for their desired body height and body weight hanges Body Shape Pereption Questionnaire (Stunkard Silhouette Chart). The body shape pereption of male and female students was assessed through the silhouette hart adapted from [26]. There were 9 silhouettes from very thin to obese for eah gender. These silhouettes orrespond to different BMI ategories. There were 8 questions regarding body shape and partiipants needed to hoose one figure from the silhouette hart for eah question. Body satisfation was examined through the differenes between the urrent body shape and ideal body shape hosen by eah student. Sore of zero indiates satisfation with urrent body shape, negative sore indiates the desire to beome thinner

4 and positive sore indiates the desire to beome heavier. The internal onsisteny for eah question as estimated by Cronbah s α ranged from Multidimensional Body Self Relations Questionnaire (MBSRQ) Twenty-eight items used to assess the attitudes towards body image was adapted from the Multidimensional Body-Self Relations Questionnaire [27]. This self-reported questionnaire uses a five point Likert type sale ranging from definitely agree (1) to definitely disagree (5). The 28 items were assigned into 9 subsales to assess different ategories: 4 items for eah parental and peer aeptane, 2 items for importane of body shape, 3 items for omparison of body shape, 2 items for body shape onfidene, 3 items for body shape satisfation, 2 items for body weight satisfation and 4 items for eah anxiety and preoupation with body weight and shape. The sore of eah subsale for eah student was obtained by adding the points of questions assoiated with eah subsetion and divided by the number of questions in eah subsetion [28]. The internal onsisteny for eah question as estimated by Cronbah s α ranged from Rosenberg s Self-Esteem Sale (RSE) Rosenberg (1965) invented a Rosenberg s Self-Esteem Sale (RSE) onsisting of 10 items whih was used to assess the level of self-esteem [29]. Eah item was measured on a fourpoint Likert sale ranging from strongly disagree (1) to strongly agree (4). There were 5 positive statements and another 5 negative statement (item no.1, 3, 4, 7, 10). The negative statements were reverse sored from strongly disagree (4) to strongly agree (1). Higher sore indiates higher level of self-esteem. Assoiation of self-esteem and body satisfation was examined among male and female students. The internal onsisteny for eah question as estimated by Cronbah s α ranged from Quality of Life measurement The measurement of quality of life in this survey onsisted of 7 items adapted from Cooperative Information Projet/ World Organization of National Colleges, Aademies, and Aademi Assoiations of General Praties/ Family Physisians (COOP/ WONCA) harts [30]. Students were asked about their hanges toward their physial fitness, daily ativities, body pain, soial ativities, feelings, general health and quality of life. Eah item of this modified questionnaire was measured ranging from 1 to 3. They ranged from less effort to more effort for daily and soial ativities, inreased to dereased for bodily pain and worse to better for other items. Higher sores orrespond to higher quality of life. Assoiation of quality of life and body satisfation was assessed. The internal onsisteny for eah question as estimated by Cronbah s α ranged from Statistial analysis Statistial analysis was done by using SPSS for Windows v16.0 software (SPSS, Chiago, IL). Desriptive statistis was used to obtain the information about distribution of subjets aording sample harateristis suh as rae, age, BMI ategories and field of study. Chisquare test was used to determine the differenes in ategorial data. Data of the samples were tested for normal distribution by Kolmogorov-Smirnov test or Shapiro-Wilk test. Student s t-test was used to determine the differenes between physial measurement means or the means of the questions that used the Likert sale. One-way ANOVA test was used to test for differenes of means between more than two groups for body image attitude and Dunan s test was used for postho analysis. Mann-Whitney U test was used to determine the differene of two groups body image sores. The level of statistial signifiane was set at P =.05.

5 RESULTS 3.1 Subjet harateristis The baseline harateristis of the subjets are shown in Table 1. The proportion of ethniity of subjets in this study was refletive of the population in UTAR/KTAR. Majority of them ome from the business field, followed by arts and soial siene, siene and engineering. Table 1 also shows a good situation that there were more than half of the students were normal weight while the rest were almost equally distributed among underweight and overweight. Females were 10.4% more ompared with males who were underweight while twie as many males were overweight ompared with females. Table 1. Sample harateristis Variables Male Female Total (n = 431) (n = 572) (n = 1003) Age (Mean SD) Ethniity n (%) n (%) n (%) Chinese 421 (97.7) 555 (97.0) 976 (97.3) Indian 10 (2.3) 17 (3.0) 27 (2.7) Field of Study Siene 94 (21.8) 139 (24.3) 233 (23.2) Engineering 27 (6.3) 13 (2.3) 40 (4.0) Arts and Soial Sienes 166 (38.5) 197 (34.4) 363 (36.2) Business 144 (33.4) 223 (39.0) 367 (36.6) BMI ategory (kg/m²) Underweight ( 18.5) 78 (18.1) 163 (28.5) 241 (24.0) Normal weight ( ) 215 (49.9) 319 (55.8) 534 (53.2) Overweight ( 23) 138 (32.0) 90 (15.7) 228 (22.7) Figures in parenthesis are perentages within gender 3.2 Body Shape Conerns Almost all of the students (91%) in UTAR and KTAR were onerned with their body shape as shown in Table 2. There was just slightly higher amount of female students (92.0%), those with normal weight (92.5%) and those from Arts and Soial Sienes field (92.8%) who were onerned with their body shape ompared to other ategories. Therefore, there was no assoiation between onern of body shape with gender, BMI ategory and field of study (all P =.05). Body shape problems were assoiated with gender as signifiantly more females (63.8%) stated that they had problems with their body shape ompared with males (48.7%). There was also signifiantly higher amount of overweight students (72.8%) who enountered problems with their body shape ompared to normal (56.0%) and underweight students (45.6%). Compared to Siene (50.2%), Arts and Soial Sienes (54.8%) and Business (63.2%), there was signifiantly higher amount students from Engineering who had problems with their body shape (67.5%).

6 Questions regarding body shape onerns Table 2. Body shape onerns aording to genders, BMI ategories and fields of study. Gender BMI Category Field of Study Arts & Underw Overwei Enginee Male Female Normal Siene Soial eight ght ring Sienes Busines s n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Are you onerned with your body shape? Yes 383 (88.9) (92.0) (88.8) (92.5) (88.2) (87.1) (85.0) (92.8) (91.3) (9) No 48 (11.1) 46 (8.0) (7.5) 27 (11.8) 6 (15.0) 26 (7.2) 32 (8.7) (11.2) (12.9) (9.4) χ 2 ; P 2.77; ; ;.07 Do you have problems with your body shape? Yes 210 (48.7) (63.8) (45.6) (56.0) (72.8) (50.2) (67.5) (54.8) (63.2) (57.3) No 221 (51.3) (27.2) (36.2) (54.4) (44.0) (49.8) (32.5) (45.2) (36.8) (42.7) χ 2 ; P 22.87; ; ;.005 Main reason for onern To be healthy 195 (45.2) (36.9) (38.6) (37.6) (49.1) (39.1) (52.5) (38.8) (41.7) (40.5) To gain more selfonfidene 89 (2) To look good 125 (29.0) To have more friends 137 (24.0) 212 (37.1) 46 (19.1) 95 (39.4) 129 (24.2) 187 (35.0) 51 (22.4) 55 (24.1) 49 (21.0) 85 (36.5) 7 (17.5) 84 (23.1) 86 (23.4) 10 (25.0) 130 (35.8) 112 (30.5) 6 (1.4) 4 () 1 (0.4) 6 (1.1) 3 (1.3) 3 (1.3) 0 (0.0) 3 (0.8) 4 (1.1) Others 16 (3.7) 8 (1.4) 6 (2.5) 11 (2.1) 7 (3.1) 5 (2.1) 2 (5.0) 5 (1.4) 12 (3.3) Main soure of influene/ role model for body shape None 143 (33.2) (36.5) (44.8) (33.7) Sportsmen/ (24.4) 18 (3.1) 18 (7.5) Sportswomen (11.4) 64 (28.1) 44 (19.3) 85 (36.5) 30 (12.9) 13 (32.5) 118 (32.5) 136 (37.1) 9 (22.5) 42 (11.6) 42 (11.4) Total 226 (22.5) 337 (33.6) 10 (1.0) 24 (2.4) 352 (35.1) 123 (12.3)

7 Questions regarding body shape onerns Table 2. ontinued Gender BMI Category Field of Study Arts & Underw Overwei Enginee Male Female Normal Siene Soial eight ght ring Sienes Busines s n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Main soure of influene/ role model for body shape Friends 82 (19.0) 59 (25.9) 9 (22.5) 91 (25.1) 74 (20.2) (24.7) (17.0) (23.0) (21.0) (22.2) Artistes/ (14.4) 37 (16.2) 3 (7.5) 80 (22.0) 76 (2) models (25.0) (22.4) (21.3) (19.7) (20.4) 38 Relatives 6 (1.4) 32 (5.6) 8 (3.3) 23 ( (3.1) 11 (4.7) 1 (2.5) 11 (3.0) 15 (4.1) (3.8) Teahers/Let urers 1 (0.2) 1 (0.2) 0 (0.0) 1 (0.2) 1 (0.4) 1 (0.4) 0 (0.0) 1 (0.3) 0 (0.0) 2 (0.2) Others 32 (7.4) 28 (4.9) 12 (5.0) 32 (6.0) 16 (7.0) 11 (4.7) 5 (12.5) 20 (5.5) 24 (6.5) 207 No 221 (51.3) (36.2) Soures of advise for body image 121 None 129 (29.9) (21.2) Family (6.0) members only (11.7) 108 Friends 115 (26.7) (18.9) Family members and friends 108 (25.1) 231 (40.4) 131 (54.4) 71 (29.5) 16 (6.6) 50 (2) 81(33.6) 235 (44.0) 126 (23.6) 57 (1) 122 (22.8) 176 (33.0) 62 (27.2) 53 (23.2) 116 (49.8) 57 (24.5) 13 (32.5) 15 (37.5) 164 (45.2) 135 (36.8) 92 (25.3) 86 (23.4) 20 (8.8) 22 (9.4) 2 (5.0) 23 (6.3) 46 (12.5) 51(22.4) 82 (36.0) 51 (21.9) 79 (33.9) 8(20.0) 76 (20.9) 88 (24.0) 12 (30.0) 130 (35.8) 118 (32.2) Total 60 (6.0) 428 (42.7) 250 (24.9) 93 (9.3) 223 (22.2) Professionals 21 (4.9) 21 (3.7) 11(4.6) 22 (4.1) 9 (3.9) 13 (5.6) 2 (5.0) 14 (3.9) 13 (3.5) 42 (4.2) Others 32 (7.4) 24 (4.2) 12 (5.0) 31 (5.8) 13 (5.7) 11 (4.7) 1 (2.5) 28 (7.7) 16 (4.4) 56 (5.6) χ 2 by Pearson s hi-square test, signifiant at P =.05; figures in parenthesis are perentages within gender, BMI ategory and field of study. 339 (33.8)

8 The major reason students hose for onern on their body shape was to be healthy (40.5%), followed by to look good (33.6%). Other reasons were to gain more self-onfidene (22.5%), others (24%) and to have more friends (10%). More females (37.1%) than males (29%) were onerned with their body shape beause of the desire to look good. Higher amount of overweight students (49.1%) hose to be healthy as their reason for onern with their body shape ompared with underweight (38.6%) and normal weight students (37.6%). Besides, more underweight students (39.4%) were onerned with their body shape beause they wanted to look good ompared with normal (35.0%) and overweight students (24.1%). Compared with students from Siene (39.1%), Arts and Soial Sienes (38.8%), Business (41.7%), there were more than half of Engineering students (52.5%) who hose to be healthy as their reason for onern with their body shape (Table 2). More than one-third (35.1%) of the students did not have a role model for body shape. Only few females (3.1%) hose sportsmen/sportswomen as their model for body shape ompared with males (24.4%). In ontrast, artistes or models ontribute so muh more influene on females (25.0%) body shape onerns than males (14.4%). Relatives (3.8%) and teahers/leturers (0.2%) exerted little influenes for their overall body shape onerns. More underweight students (44.8%) did not have a role model for body shape than normal (33.7%) and overweight (28.1%) students. Besides, higher perentage of students from Arts and Soial Sienes (25.1%) were influened by friends on their body shape than students from Siene (21.0%), Engineering (22.5%) and Business (20.2%) (Table 2). About a quarter of students did not have a soure of advie for their body image (24.9%), whereas about one-third of the students seeked advie from family members and friends (33.8%), friends only (22.2%) and family members only (9.3%). Professional help was the least seeked after (4.2%). Higher amount of underweight students did not ask for advie from other people (29.5%) than normal (23.6%) or overweight students (23.2%). Other than that, more students from Arts and Soial Sienes (35.8%) asked advie for their body image from family members and friends, while more students from Business seeked advie either from family members only (12.5%) or friends only (24.0%) ompared with students from other fields (Table 2). 3.3 Body weight pereption Table 3 shows that majority of the male students in underweight, normal and overweight BMI ategories had orret body weight pereption. There was signifiant differene for selfpereived weight among different BMI ategories in males as majority of the underweight males pereived themselves as thin, normal weight males pereived themselves as normal and overweight males pereived themselves as fat. There were just 21.8% of underweight and 26.1% of overweight males who thought they had a normal weight. Besides, there was also signifiant differene in the pereption by others among different BMI ategories for males. Nine perent of underweight and 35.5% of overweight males felt that others pereived them as having a normal weight. Equal perentages of normal weight males (20%) pereived themselves as thin and very thin or fat and very fat, while 43.7% and 12.5% felt that others pereived them as thin and very thin or fat and very fat and thin, respetively (Table 3). There was signifiant differene for self-pereived weight among different BMI ategories for females but ompared to males, more the females in the overweight ategory orretly pereived themselves as fat (Table 3). There were only about half of the female students in the underweight and normal BMI ategories orretly pereived themselves as very thin/thin (41.7%) and normal (46.7%), respetively, while at the same time, almost half of underweight females mispereived themselves as having normal weight. They were more than two-fold normal weight females (50.5%) who pereived themselves as fat/very fat as

9 Table 3. Pereption of body weight by self and others among male and female subjets Males (atual BMI ategories) Females (atual BMI ategories) Underweight n (%) Normal n (%) Overweight n (%) Total n (%) Underweight n (%) Normal n (%) Overweight n (%) Total n (%) I feel that I am: Very thin 27 (34.6) 9 (4.2) 0 (0.0) 36 (8.4) 25 (15.3) 3 (0.9) 0 (0.0) 28 (4.9) Thin 34 (43.7) 34 (15.8) 3 (2.2) 71 (16.5) 43 (26.4) 6 (1.9) 0 (0.0) 49 (8.6) Normal 17 (21.8) 129 (60.0) 36 (26.1) 182 (42.2) 74 (45.4) 149 (46.7) 10 (11.1) 233 (4) Fat 0 (0.0) 42 (19.5) 81 (58.7) 123 (28.5) 17 (10.4) 154 (48.3) 57 (63.3) 228 (39.9) Very fat 0 (0.0) 1 (0.5) 18 (13.0) 19 (4.4) 4 (2.5) 7 (2.2) 23 (25.6) 34 (5.9) χ 2 ; P ; ;.001 Others think that I am: Very thin 35 (44.9) 22 (10.2) 2 (1.4) 59 (13.7) 33 (35.9) 14 (6.1) 0 (0.0) 47 (13.7) Thin 34 (43.6) 72 (33.5) 2 (1.4) 108 (25.1) 36 (39.1) 34 (14.8) 0 (0.0) 70 (20.3) Normal 7 (9.0) 94 (43.7) 49 (35.5) 150 (34.8) 18 (19.6) 122 (53.3) 4 (17.4) 144 (41.9) Fat 1 (1.3) 25 (11.6) 72 (52.2) 98 (22.7) 2 (2.2) 55 (24.0) 12 (52.2) 69 (20.1) Very fat 1 (1.3) 2 (0.9) 13 (9.4) 16 (3.7) 3 (3.3) 4 (1.7) 7 (30.4) 14 (4.1) χ 2 ; P ; ;.001 I want my height to be: Shorter 1 (1.3) 5 (2.3) 3 (2.2) 9 (2.1) 11 (6.7) 9 (2.8) 1 (1.1) 21 (3.7) Maintained/ Normal 30 (38.5) 45 (20.9) 42 (30.4) 117 (27.1) 55 (33.7) 98 (3) 30 (33.3) 183 (32.0) Taller 47 (60.3) 165 (76.7) 93 (67.4) 305 (70.8) 97 (59.5) 212 (66.5) 59 (65.6) 368 (64.3) χ 2 ; P 10.12; ;.10 I want my weight to be: Lighter 2 (2.6) 66 (3) 111 (80.4) 103 (41.4) 59 (36.2) 261 (81.8) 81 (90.0) 401 (70.1) Maintained/ Normal 16 (20.5) 99 (46.0) 23 (16.7) 138 (32.0) 60 (36.8) 56 (17.6) 9 (10.0) 72 (20.8) Heavier 60 (76.9) 50 (23.3) 4 (2.9) 114 (26.5) 44 (27.0) 2 () 0 (0.0) 46 (8.0) χ 2 ; P ; ;.001 χ 2 by Pearson s hi-square test, signifiant at P =.05; figures in parenthesis are perentages within BMI ategory.

10 ompared with male students (20%). Besides, there was also signifiant differene in the pereption by others among different BMI ategories for females. Close to 20% of underweight or overweight females felt that others thought that they had a normal weight. Almost half of the normal weight females also felt that others thought them as thin/very thin (20.9%) and fat/very fat (25.7%). Majority of the males and females had a strong desire to beome taller, while most of the underweight males wanted to beome heavier (76.9%), normal weight males wanted to maintain their weight (46.0%) and overweight males wanted to beome lighter (80.4%) (Table 3). Almost all of the females in the overweight ategory desired to lose weight (90%) but majority of the underweight females wanted to maintain their weight or beome lighter (73%) and most of the normal weight females want to lose weight (81.8%). 3.4 Body Shape Pereption As shown as Table 4 and Figure 1, female students had a signifiantly smaller urrent body shape ompared with male students. Male students desired an ideal body shape ( ) nearly the same as their urrent body size ( ) but females desired a smaller ideal body size ( ) than their urrent body size ( ). To be healthy and attrative, males hose a similar body size that is the same as urrent body shape ( and vs ) but females hose one that was smaller for males than the one desired by the male students themselves ( vs ; vs ). In ontrast, females preferred a smaller size than their urrent body shape to be healthy and attrative ( and vs ) but males hose one that was bigger than the one desired by the female students themselves ( vs ; vs ). Table 4. Pereption of body shape based on figure rating sale of Stunkard et al. (1993) Body shape Male Female Mean Mean SD SD z P Current body shape Ideal body shape The most healthy body shape (male) The most healthy body shape (female) Attrative body shape (same sex) Attrative body shape (opposite sex) Body dissatisfation n (%) n (%) χ 2 P Desired a bigger body size (-9 to -1) 174 (40.4) 79 (13.8) Satisfied with urrent body size (0) 62 (14.4) 86 (15.0) Desired a thinner body size (+1 to +9) 195 (45.2) 407 (71.2) z by Mann-Whitney U test, signifiant at P =.05; χ 2 by Pearson s hi-square test, signifiant at P =.05 Body Dissatisfation = urrent body shape - ideal body shape Desired a bigger body size: urrent body shape ideal body shape Satisfied with urrent body size: urrent body shape = ideal body shape Desired a thinner body size: urrent body shape > ideal body shape

11 Fig. 1. Seletion of body shape aording to gender based on figure rating sale of Stunkard et al. (1993). Both males and females had positive value for body dissatisfation but females expressed a signifiantly higher level of body dissatisfation than males. Almost equal amounts of males and females were satisfied with their urrent body size. Besides, there was signifiantly higher amount of females (71.2%) who desired a thinner body size ompared with males (45.2%). Compared to females (13.8%), there were signifiantly higher amount of males (40.4%) who desired a bigger body size. In short, body dissatisfation was assoiated with gender, with the trend of females desiring a smaller body size and vie versa for males. As shown in Figure 2, majority of the male and female students hose silhouette no.9 as the least healthy body shape for males (8% and 82%, respetively) and females (80% and 81.3%, respetively). There was no signifiant differene for the ones who answered silhouette no.9 as the unhealthy body shape for males and females between genders (p=14 and 20, respetively). Only small amount of students answered silhouette no.1 and other figures as the least healthy body shape for males (14% and 4.5%, respetively) and females (14.2% and 5.1%, respetively). 3.5 Attitudes towards body image As shown in Table 5, overweight males and females had signifiantly lower parental and peer aeptane, and made signifiantly lesser omparison of their body shape ompared with their underweight or normal weight ounterparts. Besides, overweight females and males had signifiantly higher body shape satisfation and hene signifiantly lower body weight and shape anxiety ompared with their normal weight or underweight ounterparts. Body shape onfidene and body weight satisfation were signifiantly highest among normal weight males and underweight females. However, the importane of body shape and

12 body weight preoupation did not differ among BMI ategories for both genders and for males, respetively Fig. 2. Numbers and perentages of subjets who answered silhouette no.9 (fattest), silhouette no.1 (thinnest) or other silhouettes as unhealthy. Table 5. Subsales for attitude Parental aeptane Peer aeptane Inportane of body shape Comparison of body shape Body shape onfidene Body shape satisfation Underw eight a Attitude towards body image among male and female subjets aording to BMI ategory Normal Weight b Overwei Male Female ght M F M F M F F P Post ho b>a= b=a> F P Post ho b>a> a>b> a>b> b>a> >b> a a>b> a>b> >b> a

13 Subsales for attitude Body weight satisfation Body weight and shape anxiety Body weight and shape preoupati on Underw eight a Normal Weight b Table 5. ontinued Overwei Male Female ght M F M F M F F P Post ho b>a> a>b> F P Post ho a>b> a>b> a>> b F and P by one-way ANOVA test, signifiant at P =.05; Postho test by Dunan s test. A higher sore for eah subsales indiates: greater parental aeptane, greater peer aeptane, less body shape importane, less body shape omparison, higher body shape onfidene, lower body shape satisfation, lower body weight satisfation, less body weight and shape anxiety and less body weight and shape preoupation. 3.6 Quality of life, self-esteem and their assoiation with body satisfation By partial orrelation test ontrolling for gender and ethniity, both quality of life and selfesteem had weak signifiant negative orrelation with body satisfation (r = , P =.001; r = , P.001, respetively), indiating that those with lower self-esteem and lower quality of life were more likely to be dissatisfied with their body. As shown in Table 6, males and females were satisfied with urrent body size had a weak signifiant differene for quality of life, and males who were unsatisfied with their urrent body size had a signifiantly higher level for quality of life ompared with females. For self-esteem, there was no signifiant differene for students who were satisfied with their urrent body size by gender, but a signifiant weak assoiation was found for students who were unsatisfied with their urrent body size by gender (Table 6). Table 6. QUALI TY OF LIFE SELF ESTEE M Assoiation of quality of life and self-esteem with body satisfation. SATISFIED WITH CURRENT BODY SIZE MALE FEMALE S S UNSATISFIED WITH CURRENT BODY SIZE Z P MALES FEMALES Z P z and P by Mann-Whitney U test, signifiant at P = DISCUSSION Body Shape Conerns Majority of the UTAR and KTAR male and female students were onerned with their body shape. This happens beause students progressing from seondary to tertiary study

14 environment will have inreased exposure to more surrounding people with different physial appearane and attitudes [12]. Besides, university students are onsious about soial figures, elebrities and fashion model and deide whether to use them as benhmarks for hoosing their lifestyle or partners [31]. Other than that, body perfetionism is no longer a phenomenon whih only involves females, but also males [32]. Most of the students said that the reason they were onerned with their body shape was to be healthy. But female students were onerned with their body shape beause they wanted to look good. This is beause females plae a high importane on appearane at a very young age [33]. Gender differenes in body image have been well established by previous studies [12], [16], [34]. Overweight students were onerned on their body shape as they might hope to beome healthy while underweight students were onerned with their body shape beause they might want to have a nie appearane. Although most of the students said they did not have any model for body shape, there were more males who hose sportsmen as their model for body shape ompared with females while more females hose artistes or models as their model ompared with males. This finding is supported by a previous Malaysian study whih found males preferring strong and musular body [35]. Besides, the result supports existing literature stating that males spend more time on sport ativities and interested in sports while females spend more time on reading fashion magazines [36]. Other than that, females are the major targets for the beauty, osmeti and fashion industries [37]. All these will influene who they will hose for their main roles models for body shape. Majority of the university students in this study gained advie for body image from both family members and friends. This finding shows that family members and friends play an important role in the pereption of body image. Parents do advise their hildren to are about their body shape from small to have better future health, self enhanement, soial ommuniations and areer development [38]. 4.2 Body Weight Pereption Majority of males in all BMI ategories orretly pereived themselves as underweight, normal or overweight. In ontrast, more females mispereived their body weight. This finding is onsistent with other studies that showed higher amount of females mispereiving their body weight [39]-[41]. Females always think that they are not thin enough and they want to lose weight to beome slimmer due to ontinual exposure to the thin figures of models or artistes in fashion magazines [42]. A student with positive physial self-onept feels happy and will always aept their urrent body whereas student with negative physial selfonept is not happy with their appearane [43]. This auses majority of the normal weight females and some of the underweight females wanted to lose weight and thus, trying to lose weight is almost the norm for females nowadays [44]. Overall, higher amount of both overweight males and overweight females orretly pereived their body weight. Overweight students pereived themselves as fat or very fat and only little amount of them thought they were thin or normal. So, higher amount of overweight students hoped to lose weight and this is supported by a previous finding whih stated that overweight people were more likely to try lose weight [45]. 4.3 Body Shape Pereption The ideal body shape may differ for males and females. At most of the time, males relate to musular firmness while females assoiate with thinness [38]. This an be affeted by the Western ulture whih relies on thin females and men with hypertrophied musles [20], [21]. Males want a musular and fit body beause this is assoiated with physial strength,

15 hardness and power [46]. Besides, females also prefer males with inverted triangle body shape whih links to physial strength and musle development in the upper body [46]. Larger body mass is more advantageous for male students who partiipate in sports suh as football [47]. On the ontrary, UTAR and KTAR male students seleted a figure as same as urrent body shape as their ideal body shape but not a musular or very strong body. For females, they seleted a smaller size than their urrent body shape as ideal and this finding is onsistent with previous studies [35], [48]. The ideal thin portrayed by magazine or others mass media primarily fouses on females but not on males [49]. Males hose a larger figure for attrative body shape of female ompared with females themselves and females also seleted a slightly smaller figure for attrative body shape of male ompared with male students themselves. They have mispereived the opposite sex s pereption of attrative body image. Aording to a previous study by Bergstrom, Neighbors, and Lewis (2004), females might underestimate male pereptions of attrative female body shape and they think that males prefer a thinner partner [50]. Male subjets in that study had more aurate pereptions of what females find attrative but there was mispereption for opposite sex s pereption of attrative body shape among males and females in this study. Although most of the students were dissatisfied with their body size but the diretion of dissatisfation with their body was different between gender and this is onsistent with previous studies [32], [51]. Higher amount of females desired a thinner body than their urrent body size ompared with males and more males desired a bigger body than females [51], [52]. Males want a bigger size beause they want to be stronger and fitter, to have better body image and perform better in sport ativities [9]. For males who were dissatisfied their urrent body size, half of them hoped to have a thinner body and half of them desired have a bigger body and the same finding was observed in a Hong Kong study [52]. A previous study stated that there should be negative body dissatisfation in the male gender [13]. In ontrast to the expeted result, both genders in this study had positive body dissatisfation but the positive value of male gender was near to 0 while female was near to 1. This indiates that there were slightly more males who desired a thinner instead of a bigger body size. 4.4 Attitudes towards body image There are a few influenes for males and females to adopt a ertain weight suh as self, friends, family members and others [33]. Besides, it is a human nature to do omparison with others appearane and people who are not attrative fear others would not aept them [53]. Overweight males and females had a lower parental aeptane as observed in a Malaysian study [35]. In that study, overweight females had lower peer aeptane but overweight males still had higher peer aeptane. In ontrast to the result, both overweight females and males had a lower peer aeptane in this study. Besides, both overweight males and females had less body shape onfidene and satisfation. They also expressed signifiantly greater body weight and shape anxiety ompared with underweight and normal weight males. Overweight students had more anxiety towards their body weight and shape beause they might have greater body image onerns to hange their urrent body weight and body shape ompared with normal and underweight students [54]. People with body image anxiety sometimes will refrain from the publi beause they fear of soial evaluation [55]. Khor et al. (2009) stated that only overweight female expressed signifiantly more omparisons of their body shape but both overweight females and overweight males expressed signifiantly more omparisons in this study [35]. Males ompare body shape with best friends, indiating a more ompetitive relationship [56]. 4.5 Quality of life, self-esteem and body satisfation

16 Quality of life and self-esteem had signifiant negative orrelation with body satisfation. Students in this study with lower self-esteem and lower quality of life were more likely to be dissatisfied with their body. Results in this part were also onsistent with existing literature that state females will be more dissatisfied with their body and had lower self-esteem sores [57], but inonsistent with a previous study that indiated people with high lower quality of life will more likely be satisfied with their body [58]. 4.6 Limitations of study There were some limitations in this study. First, body weight and body shape were selfreported by students who partiipated this survey. It will more desirable to measure the atual height and weight of the partiipants. Some students might overestimate or underestimate their height and weight beause they did not know their atual measurements. This may affet the grouping of BMI ategories. But the inauray is dereased in view of the large sample size in this study. Seondly, BMI was only the indiator of body-fat ontent. It does not disriminate the ratio between musle and fat mass. Thus, musular people might have a high BMI beause their weight will inrease as the result of inreased amount of musle. It might be some students that were being grouped into the overweight ategory beause of their high ontent of musle but not fat, espeially among male students. Thirdly, silhouette hart was used to examine the body image visually. For this, it is also hard to differentiate whether the students regard the body size of this silhouette hart of having exess musle or fat. Musular people who have high ontent of musle have a bigger size of body shape and they might selet a bigger figure equivalent to overweight or obese as their urrent body size. Self-reported questionnaires were used to ollet the data from the students. There might be sampling bias and students response fatigue bias. For sampling bias, data olleted sometimes will not be aurate or do not represent the group as error will arise during sample olletion. Some students were also more likely to be hosen than others. Questionnaires that require some time to be ompleted an indue fatigue among partiipants and may ause them to give inaurate answers. 5. CONCLUSION In onlusion, onern towards their body shape was different among male and female UTAR/KTAR students. Male and female students pereived their body weight and body shape in different ways. Soio-ultural fators and psyhologial fators affeted attitudes towards body image among students with different BMI ategories in different levels. More studies need to be onduted to get a better understanding of gender differenes in body image pereption among Malaysian university students. Future researh is also neessary to examine the parents pereption and peers pereption of university students body image in Malaysia. A study about how ulture affet body image pereption of Malaysians should be arried out also as Malaysia is a multi-ethni and multi-ultural population. ACKNOWLEDGEMENTS The author would like to gratefully aknowledge all the volunteers who have partiipated in this study. This projet was funded by the Department of Biomedial Siene, Faulty of Siene, Universiti Tunku Abdul Rahman, whih had no roles in the study design, olletion, analysis and interpretation of data; in the writing of the manusript

17 COMPETING INTERESTS Authors have delared that no ompeting interests exist. AUTHORS CONTRIBUTIONS Author LMW performed the questionnaire, analyzed the data and o-wrote the paper. Author YHS oneived the study and wrote the paper. All authors read and approved the final manusript. REFERENCES 1. Gallagher S. Phenomenologial and experimental ontributions to understanding embodied experiene. In: Ziemke T, Zlatev J, Frank RM, editors. Body, language, and mind. Berlin: Walter de Gruyte; 2007: Grogan S. Body image: Understanding body dissatisfation in men, women, and hildren. 2nd ed. New York: Psyhology Press; Shepphird SF. 100 questions & answers about anorexia nervosa. London: Jones and Bartlett Publishers; Reynaga-Abiko G. Body image. In: Stange MZ, Oyster CL, Sloan JE, editors. Enylopedia of women in today s world. California: SAGE Publiations; 2011; Gan WY, Nasir MTM, Zalilah MS, Hazizi AS. Diret and indiret effets of soioultural influenes on disordered eating among Malaysian male and female university students. A mediation analysis of psyhologial distress. Appetite 2011;56: Bhuiyan AR, Gustat J, Srinivasan SR, Berenson GS. Differenes in body shape representations among young adults from a Biraial (Blak-White), semirural ommunity. Am J Epidemiol. 2003;158: MCabe MP, Riiardelli LA. The struture of the pereived soioultural influene on body image and body hange questionnaire. Int J Behav Med. 2001;8: Stie E. Risk and maintenane fators for eating pathology: A meta-analyti review. Psyhol Bulletin. 2002;128: Odea JA, Rawstorne PR. Male adolesents identify their weight gain praties, reasons for desired weight gain, and soures of weight gain information. J Am Diet Asso. 2001;101: Sira N, Ballard SM. Gender differenes in body satisfation: An examination of familial and individual level variables. Fam Si Rev. 2011;16: Aquilino WS, Supple AJ. Long-term effets of parenting praties during adolesene on well-being outomes in young adulthood. J Fam Issues. 2001;22: Gillen MM, Lefkowitz ES. Gender and raial differenes in body image development among ollege students. Body Image. 2012;9: Khan AN, Khalid S, Khan HI, Mehnaz J. Impat of today s media on university student s body image in Pakistan: a onservative, developing ountry s perspetive. Pub Health. 2011;11: Abrazinskas M, Fisak B, Barnes R. The relation between parental influene, body image, and eating behaviours in nonlinial female sample. Body Image. 2012;9: Wertheim EH, Martin G, Prior M, Sanson A, Smart D. Parent influenes in the transmission of eating and weight related values and behaviors. Eat Disord. 2002;10: Jones DC, Vigfusdottir TH, Lee Y. Body image and the appearane ulture among adolesent girls and boys: An examination of friend onversations peer ritiism, appearane magazines, and the internalization of appearane ideals. J Adoles Res. 2004;19:

18 Neumark-Sztainer D, Falkner N, Story M, Perry C, Hannan PJ, Mulert S. Weight-teasing among adolesents: orrelations with weight status and disordered eating behaviours. Int J Obesity. 2002;26: Makino M, Tsuboi K, Dennerstein L. Prevalene of eating disorders: a omparison of western and non-western ountries. Health Psyhol. 2004;7: Cash TF, Smolak L, editors. Body Image: A handbook of siene, pratie, and prevention. 2 nd ed. New York: Guilford Press; Allender S, Cowburn G, Foste C. Understanding partiipation in sport and physial ativity among hildren and adults: A review of qualitative studies. Health Edu Res. 2006;21: Nioli MG, Raphael DR Binge eating disorder and body image pereption among university students. Eating Behav. 2011;12: Thompson SH, Sargent RG, Kemper KA. Blak and while adolesent males pereptions of ideal body size. Sex Roles. 1996;34: Sano A, Le DS, Tran MH, Pham HT, Kaneda M, Murai E et al. Study on fators of body images in Japanese and Vietnamese adolesents. J Nutr Si Vitaminol (Tokyo). 2008;54: Shih MY, Kubo C. Body shape preferene and body satisfation of Taiwanese and Japanese female ollege students. Psyhi Res. 2005;133: WHO/IOTF/IASO. The Asia-Paifi perspetive: Redefining obesity and its treatment. Hong Kong: World Health Organization, International Obesity Task Fore, International Assoiation for the Study of Obesity; Stunkard AJ, Sorensen T, Shulsinger, F. Use of the Danish Adoption Register for the study of obesity and thinness. In: Seymour SK, Rowland LP, Sidman RL, Matthysse SW, editors. Genetis of neurologial and psyhiatri disorders. New York: Raven Press; 1983: Cash TF. Body Image Assessments: MBSRQ Aessed 9 January Available: Hamilton SR. A relationship between pereived body image and depression: How ollege women see themselves may affet depression. Stud J Psyhol. 2008;1: Rosenberg M. Soiety and the adolesent self-image. Prineton: Prineton University Press; Hoopman R, Terwee C, Aoronson NK. Translated COOP/WONCA harts found appropriate for use among Turkish and Moroan ethni minority aner patients. J Clin Epidemiol. 2008;61: Vitolo MR, Bortolini GA, Horta RL. Prevalene of binge eating in female university students in different fields of knowledge (Unpublished dotoral dissertation). Sao Leopoldo, Brazil: University Vale do Rio dos Sinos (UNISINOS); Furnham A, Badmin N, Sneade I. Body image dissatisfation: Gender differenes in eating attitudes, self-esteem and reasons for exerise. J Psyhol. 2002;136: Malinauskas BM, Raedeke TD, AAeby VG, Smith JL, Dallas MB. Dieting praties, weight pereptions, and body omposition: A omparison of normal weight, overweight, and obese ollege females. Nutri J. 2006;5: Feingold A, Mazzella R. Gender differenes in body image are inreasing. Psyhol Si. 1998;9: Khor GL, Zalilah MS, Phan YY, Ang M, Maznah B, Norimah AK. Pereption of body image among Malaysian male and female adolesents. Singapore Med J. 2009;50: Tiggemann M, Rüütel E. A ross-ultural omparison of body dissatisfation in Estonian and Australian young adults and its relationship with media exposure. J Cross Cult Psyhol. 2001;32: Riji HM. Beauty or health? A personal view. Mal Fam Physiian 2006;1:42-4.