Risk Factors for Body Dissatisfaction in AdolescentBoys and Girls: A Prospective Study

Katherine Presnell,* Sarah Kate Bearman, and Eric Stice

Department of Psychology, University of Texas at Austin, Austin, Texas

Accepted 20 November 2003

Abstract: Objective: Despite evidence that body dissatisfaction predicts the onset of eatingpathology and depression, few prospective studies have investigated predictors of bodydissatisfaction. Method: We examined risk factors for body dissatisfaction using prospectivedata from 531 adolescent boys and girls. Results: Elevations in body mass, negative affect,and perceived pressure to be thin from peers, but not thin-ideal internalization, socialsupport deficits, or perceived pressure to be thin from family, dating partners, or media,predicted increases in body dissatisfaction. Gender moderated the effect of body mass onbody dissatisfaction and revealed a significant quadratic component for boys, but not girls.Gender also moderated negative affect. Discussion: Results support the assertion that certainsociocultural, biologic, and interpersonal factors increase the risk for body dissatisfaction,but differ for boys and girls. Results provided little support for other accepted risk factors forbody dissatisfaction. # 2004 by Wiley Periodicals, Inc. Int J Eat Disord 36: 389–401, 2004.

INTRODUCTION

Recent studies show that dissatisfaction with body size and shape is a commonconcern for adolescents. Approximately 60% of girls and 30% of boys report a desire tochange their size or shape (Ricciardelli & McCabe, 2001; Wood, Becker, & Thompson,1996) and nearly 25% of adolescent girls report clinically significant levels of bodydissatisfaction (Stice & Whitenton, 2002). Body dissatisfaction is the subjective negativeevaluation of one’s figure or body parts. It should be distinguished from an inability toaccurately perceive the size of one’s body and the undue influence of weight and shapein determining one’s self-worth, both of which are symptoms of eating disorders(American Psychiatric Association, 1994). Body dissatisfaction is associated with emo-tional distress, preoccupation with appearance, and unnecessary cosmetic surgery(Hoffman & Brownell, 1997; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). For

Supported by an individual research service award (MH12834) and a career award (MH01708) from theNational Institute of Mental Health and by a Grant-in-Aid of Research from Sigma Xi.*Correspondence to: Katherine Presnell, M.A., Department of Psychology, University of Texas at Austin,

1 University Station A8000, Austin, TX 78712. E-mail: presnell@mail.utexas.eduPublished online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20045

# 2004 by Wiley Periodicals, Inc.

both genders, body dissatisfaction places individuals at risk for a host of clinicallyrelevant outcomes, most notably disordered eating behaviors (Keel, Fulkerson, & Leon,1997; Stice, Presnell, & Spangler, 2002) and depression (McCreary & Sasse, 2000; Stice &Bearman, 2001). Eating disorders and depression are chronic conditions that are asso-ciated with marked functional impairment, comorbid psychopathology, and early mor-tality (Fairburn, Cooper, Doll, Norman, & O’Connor, 2000; Gotlib, Lewinsohn, & Seeley,1998; Newman et al., 1996).

Despite evidence that body dissatisfaction is pervasive and is associated withemotional distress and an increased risk for psychopathology for both genders, fewprospective studies have examined the risk factors that predict body dissatisfaction.Therefore, the goal of this study was to investigate the risk factors for body dissatisfactionin a sample of adolescent girls and boys.

Theorists have identified several sociocultural, biologic, and interpersonal factors thatmay promote body dissatisfaction. Due to the higher prevalence of body image concernsamong girls and women, many of the empirical studies have focused solely on femalesamples. In our review, we discuss each proposed risk factor separately for females andmales, because the theoretical relations may differ for each gender. In addition, we focuson prospective and experimental studies in our literature review because the direction ofinfluence cannot be unambiguously interpreted with cross-sectional data. Due to thepaucity of prospective studies examining risk factors that predict body dissatisfaction forboys, however, we incorporate cross-sectional data when we were unable to locateprospective studies.

Sociocultural factors have received the most theoretical attention in the promotion ofbody image concerns. Sociocultural messages espousing the ideal body shape may fosterbody dissatisfaction because repeated messages from parents, peers, dating partners, andthe media suggesting that one’s body is inadequate would be expected to producedispleasure with one’s physical appearance (Striegel-Moore, Siberstein, & Rodin, 1986;Thompson et al., 1999). For females, the current ideal emphasizes a thin physique that isvery difficult to attain (Wiseman, Gray, Mosimann, & Ahrens, 1992). Sociocultural pressureto be thin may manifest directly, such as parents encouraging their daughter to diet, orindirectly, such as an advertisement extolling the virtues of weight loss. In support, per-ceived pressure to be thin prospectively predicted increases in body dissatisfaction amongfemales (Field et al., 2001; Stice &Whitenton, 2002), although one study with a small samplesize did not replicate this effect (Byely, Archibald, Graber, & Brooks-Gunn, 2000).

For males, pressure from the dominant culture to attain an ideal physique is likewisebelieved to engender body dissatisfaction. In support, perceived pressure from parentsand peers regarding size and shape predicted weight change strategies for adolescentboys over an 8-month period (McCabe & Ricciardelli, 2003) and Field et al. (2001) foundthat parent concerns regarding parental weight gain prospectively predicted weightconcern among adolescent boys. Moreover, boys who reported trying to look likesame-sex figures in the media were more likely to develop weight concerns and becomeconstant dieters (Field et al., 2001). Cross-sectional studies, however, have found thatadolescent boys did not perceive strong pressure from the media to conform to aprescribed ideal (McCabe & Ricciardelli, 2001) and that parental feedback about weightwas not related to body dissatisfaction for males (Schwartz, Phares, Tantleff-Dunn, &Thompson, 1999).

Internalization of these body ideals may also foster greater body dissatisfaction, asthese culturally sanctioned ideals are very difficult to attain for most boys and girls. Forgirls, the internalization of the ultraslender ideal may lead to discontentment with their

390 Presnell et al.

own size and shape. This may be particularly damaging because appearance is believedto be central to the feminine gender role and the evaluation of women in Western culture.Thin-ideal internalization has been found to predict subsequent increases in body dis-satisfaction in longitudinal studies of girls (Stice & Bearman, 2001; Stice & Whitenton,2002). Convergent evidence comes from an experimental study that decreased thin-idealinternalization and found consequent reductions in body dissatisfaction (Stice, Mazotti,Weibel, & Agras, 2000).

For males, internalization of the ideal body type may similarly lead to body dissatis-faction, because the discrepancy between one’s ideal physique and one’s actual physiqueis believed to cause body distress. A cross-sectional examination found that adolescentmales who scored high on drive for muscularity were more likely to have low self-esteemand to engage in strategies to increase body mass (McCreary & Sasse, 2000). Anotherstudy found that internalization of sociocultural attitudes toward appearance was asso-ciated with weight control techniques for boys (Smolak, Levine, & Thompson, 2001). Athird study found that adolescent football players expressed more body satisfaction thanadolescent cross-country runners, presumably because the former more closely approxi-mated the ‘‘mesomorphic’’ male ideal (Parks & Read, 1997). Unfortunately, we could notidentify any studies that prospectively examined whether internalization of a thin ormuscular ideal predicted increased body dissatisfaction for males.

It has also been suggested that biologic factors, such as body mass, play a role in thedevelopment of body dissatisfaction. Elevated adiposity is believed to promote bodydissatisfaction in girls because, presumably, the more they deviate from the ultraslenderideal, the greater their body dissatisfaction. In addition, the heavier girls are, the morelikely they are to receive pressure from their environment to conform to the ultrathinideal. Adiposity has been found to predict body dissatisfaction in girls (Cattarin &Thompson, 1994; Field et al., 2001; Stice & Whitenton, 2002). There is also evidence thatbody dissatisfaction shows a positive linear association with age, indicating that as girlsreach puberty and begin to gain weight and greater adipose tissue, they are increasinglydissatisfied with their bodies (Richards, Boxer, Petersen, & Albrecht, 1990). However,other prospective studies that examined the relation of adiposity and body dissatisfactionhave generated null effects (Byely et al., 2000; Stice & Bearman, 2001). It is possible thatdifferences in the body mass composition of the samples in these studies may be partiallyresponsible for these conflicting findings. For instance, Stice and Bearman (2001) used anupper socioeconomic status (SES) sample with a restricted range of body mass. Further-more, the null effects in Byely et al. (2000) may have resulted from a small sample size.

For males, body mass may operate differently because boys often wish to be larger andmore muscular than their current figure (McCreary & Sasse, 2000; Pope et al., 2000).However, there may be an optimal range of body mass, because overweight boys havesignificantly lower self-esteem and are more self-conscious than their normal-weightcounterparts (Blyth et al., 1981) and because boys report nearly equal rates of wantingto lose and gain weight (Cohn & Adler, 1992; Raudenbush & Zellner, 1997). Empiricalevidence suggests that body mass is related to body dissatisfaction for boys. Field et al.(2001) reported that weight concerns were more strongly related to body mass for boysthan girls in one prospective study examining these relations. That is, girls weredissatisfied with their bodies regardless of their actual weight, whereas boys becameconcerned only when they were objectively overweight. A second prospective studyfound that boys were most satisfied with their bodies when they were average weight,and were most dissatisfied when they were either underweight or overweight (Richardset al., 1990).

Risk Factors for Body Dissatisfaction 391

Interpersonal processes have also been proposed as risk factors for body dissatisfac-tion. Deficits in social support may promote body image concerns because a lack ofunconditional support from family and friends is believed to produce negative feelingsabout oneself and one’s physical appearance (Stice & Whitenton, 2002). Feelingsupported by one’s immediate social environment may also serve as a protective factorfrom the myriad pressures that are hypothesized to foster body dissatisfaction. Adoles-cents lacking a supportive network may turn to a pursuit of the ideal body type to gainsocial acceptance. Again, contradictory evidence has been found regarding this relation.One study found that social support deficits did not predict increases in girls’ bodydissatisfaction (Byely et al., 2000), whereas another study with a larger sample found thatdeficits in social support predicted increases in body dissatisfaction among girls (Stice &Whitenton, 2002). It is expected that lack of social support would operate similarly inboys. However, we were unable to locate any prospective or cross-sectional studies thatinvestigated the effects of social support on boys’ body image.

Finally, negative affect has emerged as a potential risk factor in the prediction of bodydissatisfaction. Theoretically, negative mood is associated with a depressogenic informa-tion processing bias that results in the perception that one’s body is far from the ideal andelicits a preference for information that confirms this belief. Although experimentalstudies have found that acute negative affect inductions resulted in acute body dissatis-faction in girls (Baker, Williamson, & Sylve, 1995; Taylor & Cooper, 1992), null findingswere generated by a prospective study that investigated the relation between depressivesymptoms and increases in body dissatisfaction (Stice & Whitenton, 2002). We wereunable to locate any studies examining the effects of depression or negative affect onbody dissatisfaction in boys, although negative affect did predict body change strategiesin a sample of adolescent boys (Ricciardelli & McCabe, 2003). Further examination of thisvariable is warranted to determine whether negative affect has more lasting effects ongirls’ body image and whether it predicts body dissatisfaction for boys.

Because a large number of adolescent girls report experiencing body dissatisfaction(Thompson et al., 1999), the existing literature has primarily focused on examining thisphenomenon in samples of girls. However, inconsistencies in the literature suggest thatquestions remain regarding the risk factors involved in the development of body dis-satisfaction. Moreover, little research has prospectively examined the variables thatpredict body dissatisfaction among adolescent boys, despite evidence that problemsassociated with body image concerns are increasing for this population (Carlat, Camargo,& Herzog, 1997; Wood et al., 1996). An understanding of the risk factors for bodydissatisfaction is a crucial step in developing interventions to prevent psychiatric out-comes such as eating disorders and depression. In view of these gaps in the literature, thegoal of this study was to examine gender differences in a set of putative risk factors forbody dissatisfaction.

METHODS

Participants

The study sample included 531 students (238 boys and 293 girls) from two requiredsenior classes at two high schools in a southwestern metropolitan area of the UnitedStates, ranging in age from 16 to 19 (mean age ¼ 17). The sample was composed of4% Asian/Pacific Islanders, 3% African Americans, 79% Caucasians, 10% Hispanics,

392 Presnell et al.

1% Native Americans, and 3% who specified other or mixed racial heritage. Parentaleducation ranged from grade school (1%) to graduate degree (9%), with a mode of collegegraduate (33%). Data were collected early in the fall semester (Time 1 [T1]) and again latein the spring semester (Time 2 [T2]), resulting in a 9-month lag between assessments.Although participation was high among the students who were present during datacollection, the majority of students who did not participate primarily resulted from somestudents taking both required courses during the same semester. These students were,therefore, not available at T2.

Procedures

This study was presented as an investigation of student attitudes and behaviors. Allconsenting students completed anonymous questionnaires in classroom groups at T1 andT2, approximately 9 months apart. Questionnaires were matched through codes withunique identifiers, and participants’ names were not associated with any of the data.Completed surveys were placed in a slotted box to further protect confidentiality andresearch assistants responsible for data collection and entry were blind to all hypotheses.

Measures

Perceived Pressure to be ThinThe eight-item Perceived Sociocultural Pressure Scale (Stice & Bearman, 2001) assessed

the amount of pressure to be thin that participants perceived from family, friends, datingpartners, and the media. Items used a 7-point response format ranging from none to a lotand items were averaged to form a scale score. This scale has adequate internal consist-ency (a ¼ .88), test-retest reliability (r ¼ .93), and predictive validity (Stice & Bearman,2001). It had an a ¼ .84 at T1.

Thin-Ideal InternalizationInternalization of the thin ideal was assessed with the Ideal-Body Stereotype Scale-

Revised (Stice & Bearman, 2001). This scale asks participants to indicate their level ofagreement with 10 statements concerning what attractive women look like (e.g., ‘‘Slenderwomen are more attractive’’) on 5-point scales ranging from strongly disagree to stronglyagree. Itemswereaveraged foranalyses.This scalehasacceptable internal consistency (a¼ .89),as well as predictive validity (Stice & Bearman, 2001). This scale had an a ¼ .86 at T1.

AdiposityBody mass index (BMI), based on self-report data, was used to reflect adiposity. BMI

divides weight by height squared (i.e., kg/m2) to control for variations in weight due toheight, and is thus a measure of relative weight. Self-reported weight and height havebeen found to correlate well with confederate measured weight, with the correlationstypically ranging from .94 to .99 (e.g., Crockett, Schulenberg, & Petersen, 1987; Galambos,Almedia, & Petersen, 1990). Research has documented that BMI is a reliable and validindex of adiposity (Pietrobelli et al., 1998).

Social SupportPerceived social support was measured with 20 items adapted from the Network

of Relationships Inventory (Furman & Buhrmester, 1985) assessing companionship,guidance, intimacy, affection, admiration, and reliable alliance from parents using5-point scales ranging from strongly disagree to strongly agree. The internal consistency

Risk Factors for Body Dissatisfaction 393

(Ma ¼ .89), test-retest reliability (Mr ¼ .69), and criterion validity of this measure havebeen documented (Furman, 1996; Furman & Buhrmester, 1985). This scale had an a ¼ .90at T1.

Negative AffectivityThe Negative Temperament scale from the General Temperament Survey (Watson &

Clark, 1993) was adapted as a measure of negative affectivity. This scale measuresproneness to negative emotional experiences, including dysphoria, anxiety, preoccupa-tion, irritation, anger, and stress (sample item: ‘‘Small annoyances often irritate me’’). TheNegative Temperament scale has been shown to be internally consistent, temporallyreliable, and valid (Watson & Clark, 1992, 1993). The response options were expandedto a 4-point format to increase the scale variance. To reduce the length of the measure, theeight questions with the lowest item-total correlations in a pilot study (N ¼ 97) weredeleted. The resulting 20-item scale had an a ¼ .95 at T1. A pilot study (N ¼ 44) indicatedthat this scale had a 1-month test-retest coefficient of .83.

Body DissatisfactionItems adapted from the Body Esteem Scale (Franzoi & Shields, 1984) were used to

assess body dissatisfaction. This scale asks participants to indicate their level of satisfac-tion with 21 body parts (e.g., waist, thighs, muscle tone) using a 5-point response formatranging from extremely satisfied to extremely dissatisfied. This scale has acceptableinternal consistency (a ¼ .94), test-retest reliability (r ¼ .90), and predictive validity(Franzoi & Shields, 1984; Stice & Bearman, 2001). This scale had an a ¼ .96 at T1 andan a ¼ .97 at T2.

RESULTS

Preliminary Analyses

Attrition analyses indicated that participants who dropped out differed significantlyfrom those who provided data at both assessments on parental education (a proxy forSES) and on several of the variables considered in this study at T1 (body satisfaction,negative affect, thin-ideal internalization, and pressure to be thin). These results suggestthat attrition may have introduced systematic bias, which suggests that findings shouldbe generalized with caution. The bivariate correlations between the putative risk factorsand outcomes are presented in Table 1.

The mean body dissatisfaction scores for girls were 3.2 at T1 and 3.1 at T2, whichcorrespond to the neutral anchor for this scale (neither satisfied nor dissatisfied). Themean body dissatisfaction scores for boys were 2.5 at T1 and 2.4 at T2, which correspondto the midpoint between the anchors moderately satisfied and neutral. If body dissatis-faction is defined as a score that corresponds to an average response of dissatisfied orextremely dissatisfied, the rates of body dissatisfaction were 43% (T1) and 36% (T2) forgirls and 9% (T1) and 12% (T2) for boys. This is consistent with the relatively higherlevels of body dissatisfaction among girls than boys found in other studies (e.g., Keelet al., 1997) and similar to the rates of body dissatisfaction among girls found in otherstudies (Stice & Whitenton, 2002). Although the rates of body dissatisfaction decreasedsomewhat for girls at T2, this may have occurred because of chance fluctuations, selectiveattrition, or a measurement artifact reflecting pretest sensitization.

394 Presnell et al.

Independent t tests were performed to determine any gender differences in bodydissatisfaction and the risk factors at baseline. Results indicated that boys and girlsdiffered significantly on T1 body dissatisfaction and on each of the risk factors at base-line. Girls reported higher body dissatisfaction, parental social support, negative affect,and perceived pressure to be thin, whereas boys had greater initial body mass and thin-ideal internalization. The means and standard deviations for each baseline variable bygender is presented in Table 2.

Risk Factors for Increases in Body Dissatisfaction

The univariate relations between each of the T1 putative risk factors and increases inbody dissatisfaction were first investigated in individual multiple regression models togain an understanding of these relations that was not complicated by multicollinearity.These models examined the univariate relation between each T1 risk factor and T2 bodydissatisfaction, controlling for the effects of T1 body dissatisfaction in the combinedsample of boys and girls. The unstandardized parameter estimates, confidence intervals,standardized parameters, correlation coefficients, and p values from the univariate

Table 1. Correlations among the T1 putative risk factors and T1 and T2 body dissatisfaction,along with means and standard deviation

2 3 4 5 6 7 8 9 10 11 M SD

1. Pressure-family .55 .61 .48 .10 .05 �.04 .27 .34 .36 .31 3.52 1.762. Pressure-peers .52 .40 .09 .17 �.06 .25 .41 .40 .31 3.33 2.043. Pressure-dating .43 .12 .06 �.05 .27 .35 .29 .29 3.21 1.934. Pressure-media .13 .09 �.06 .29 .38 .36 .41 5.26 2.895. Thin-ideal intern. �.00 �.05 .02 .12 .13 �.11 3.55 0.656. Body mass .03 .10 .16 .20 �.28 21.77 3.387. Social support �.19 �.10 �.12 .03 3.78 0.828. Negative affect .36 .37 .24 2.43 0.689. T1 body dissatisfaction .75 .36 2.87 1.0810. T2 body dissatisfaction .31 2.80 0.9611. Gender

Note: Absolute correlations greater than .08 are significant at p < .05. T1/2 ¼ Time 1/Time 2.

Table 2. Means and standard deviation for each variable by gender

Girls Boys

Variables M SD M SD

Pressure to be thinFamily 3.93a 2.27 2.67b 1.59Peers 4.10a 1.88 2.91b 1.44Dating partners 3.73a 2.20 2.65b 1.52Media 6.58a 2.76 4.19b 2.54

Thin-ideal internalization 3.49a 0.70 3.66b 0.58Body mass 20.65a 2.77 22.84b 3.61Social support 3.80a 0.87 3.81a 0.83Negative affect 2.59a 0.69 2.25b 0.63T1 body dissatisfaction 3.20a 1.07 2.51b 0.94T2 body dissatisfaction 3.08a 0.95 2.44b 0.90

Note: Means with different subscripts are significantly different at p < .01. T1/T2 ¼Time 1/Time 2.

Risk Factors for Body Dissatisfaction 395

models are reported in Table 3. As hypothesized, initial elevations in body mass, nega-tive affect, and perceived pressure to be thin from peers prospectively predicted increasesin body dissatisfaction over the 9-month study period. However, parental social support,thin-ideal internalization, and perceived pressure to be thin from family, dating partners,and media did not show significant prospective relations. It might be noted that we had apower of .99 to detect a medium effect (r ¼ .30) and a power of .70 to detect a small effect(r ¼ .10) in these univariate models (Cohen, 1988).

To test whether gender moderated any of the univariate effects of the risk factors,interaction terms were computed for gender and each of the T1 independent variablesand added to the models. All analyses controlled for baseline levels of body dissatisfac-tion. Results indicated a significant Gender � BMI interaction (B ¼ .05, p < .01) in theprediction of increases in body dissatisfaction. Post-hoc analyses indicated that BMI wasa significant predictor of increases in body dissatisfaction for girls (B ¼ .07, p < .001), butnot for boys (B ¼ .01, ns). We then tested for higher-order effects because previousresearch indicates that body mass may deviate from a linear relation, particularly forboys (Muth & Cash, 1997). An orthogonal polynomial analysis of the Gender � BMIeffect indicated a significant Gender � Quadratic interaction (B ¼ �.42, p < .05).A quadratic (U-shaped) model was supported for boys and indicated that boys’ bodydissatisfaction was highest when they were either underweight or overweight (B ¼ .39,p < .01). For girls, the quadratic component was nonsignificant (B ¼ �.03, ns), indicatingthat this relation did not deviate significantly from a linear association.

Results also indicated a significant Gender � Negative Affect interaction (B ¼ �.24,p < .02). Post-hoc analyses indicated that initial negative affect significantly predictedincreases in body dissatisfaction for boys (B ¼ .32, p < .001), but not for girls (B ¼ .06,ns). No other significant interactions with gender were found among the putative riskfactors.

Risk factors that showed significant univariate relations, along with the significantinteractions, were included in a multivariate regression model to assess the unique effectof each predictor controlling for the other predictors. This model tested whether T1 bodymass, perceived pressure to be thin from peers, negative affect, gender, the Gender �BMI interaction, and the Gender � Negative Affect interaction predicted T2 bodydissatisfaction, controlling for T1 body dissatisfaction. The unstandardized parameterestimates, confidence intervals, standardized parameters, correlation coefficients, and

Table 3. Parameter estimates and confidence intervals from the univariate multiple regressionmodels examining T1 risk factors and subsequent increases in body dissatisfaction

T1 Risk Factors B (95% CI) b R p Value

Pressure to be thinFamily �.03 �.01–.07 .05 .07 .151Peers �.04 .00–.07 .08 .11* .037Dating partners �.01 �.03–.05 .02 .03 .554Media �.02 �.01–.04 .06 .08 .123

Thin-ideal internalization �.01 �.12–.09 �.01 �.01 .811Body mass .02 .00–.04 .07 .11* .041Social support �.003 �.11–.05 �.03 .04 .412Negative affect .19 .09–.29 .13 .19** .0001

Note: B ¼ unstandardized parameter estimates; CI ¼ confidence interval; b ¼ standardized parameterestimates; r ¼ correlation coefficient; T1 ¼ Time 1. All analyses were controlled for T1 body dissatisfaction.*p < .05. **p < .0001.

396 Presnell et al.

p values from the multivariate model are reported in Table 4. The main effects ofBMI became nonsignificant in the multivariate model, but negative affect remainedsignificant. The Gender � BMI and Gender � Negative Affect interactions showedsignificant unique relations to subsequent increases in body dissatisfaction in the multi-variate model, but the unique effect for perceived pressure to be thin became nonsigni-ficant. It is noteworthy that girls who reported being extremely satisfied or moderatelysatisfied with their bodies had a significantly lower mean body mass (M ¼ 19.85) thanboys who reported being similarly satisfied (M ¼ 22.48; t ¼ �2.069, p < .04). Conversely,girls who reported being moderately or extremely dissatisfied were well within thenormal weight range (M ¼ 22.19), whereas dissatisfied boys approached being over-weight (M ¼ 24.93).

DISCUSSION

The aims of this study were to examine whether a set of risk factors predicted increases inbody dissatisfaction using prospective data from adolescent girls and boys and to exploregender differences in these predictors. Initial elevations in negative affect predicted subse-quent increases in body dissatisfaction for boys, but not for girls. In addition, initial eleva-tions in body mass predicted increases in body dissatisfaction for girls, but not for boys.There was a main effect for perceived pressure to be thin from peers in the combinedsample. Parental social support, thin-ideal internalization, and perceived pressure fromfamily, dating partners, and media did not significantly predict body dissatisfaction. Theprospective design provides some confidence that the effects were in the hypothesizeddirection because it establishes temporal precedence of the proposed risk factors.

Perceived pressure to be thin from peers emerged as a significant predictor of bodydissatisfaction in the univariate analyses, which is consistent with past findings (Fieldet al., 2001; Stice & Whitenton, 2002). However, this finding became nonsignificant whenentered into the multivariate model, indicating that it does not account for a significantamount of unique variance in the presence of the other predictors. Although the findingthat recurrent negative messages about one’s body foster body dissatisfaction appears tobe a robust effect in the literature, it likely overlaps with other predictor variables in themodel. Perceived pressure may be correlated with other risk factors, such as negative

Table 4. Parameter estimates and confidence intervals from the multivariate multiple regressionmodel examining the relations of T1 risk factors and subsequent increases in body dissatisfaction

Increases in Body Dissatisfaction from T1 to T2

T1 Risk Factors B (95% CI) � r p Value

Perceived pressure to be thinPeers .001 �.02–.05 .03 .04 .434

Body mass �.02 �.08–.03 �.08 �.05 .332Negative affect .72 .39–1.04 .51 .23** .000Gender .22 �.37–.81 .11 .04 .465Gender � BMI .04 .01–.07 .42 .13* .015Gender � Negative Affect �.35 �.54–.16 �.67 �.19** .000

Note: B ¼ unstandardized parameter estimates; CI ¼ confidence interval; � ¼ standardized parameterestimates; r ¼ correlation coefficient; T1 ¼ Time 1. All analyses controlled for T1 body dissatisfaction.*p < .01. **p < .0001.

Risk Factors for Body Dissatisfaction 397

affect, that accounted for a significant amount of variation in the model. If this is the case,then this collinearity could cause perceived pressure to be omitted from the multivariatemodel because it does not explain any unique variance.

There was no support for the assertion that thin-ideal internalization results inincreased body dissatisfaction. This null finding is inconsistent with previous research,which has found significant prospective effects (Stice & Bearman, 2001; Stice &Whitenton, 2002). Because gender did not moderate the effects, the null findings cannotbe attributed to a larger, muscular ideal espoused for boys. It should be noted that thescale used to assess thin-ideal internalization specifically measures adherence to the thinideal traditionally espoused for females, but does not measure the degree of subscriptionto the muscular ideal.1 This scale, moreover, asked male and female participants aboutthe degree to which they internalized thinness as an ideal for females, which represents asignificant weakness. Again, because gender did not moderate the effect, however, thisfinding cannot solely be attributed to a measurement artifact.

The Gender � BMI interaction indicates that adiposity functions differently for boysand girls. The significant quadratic component for boys illustrates that they are dissatis-fied with their bodies when they are either below or above average weight and mostsatisfied when they are of average weight. In contrast, girls show a positive linearrelation, such that their body dissatisfaction increases with body weight. This is consis-tent with previous research that found that body weight and body-image evaluation andaffect had a curvilinear relation for adult males but a linear relation for adult females(Muth & Cash, 1997). Previous research has also documented that although the majorityof girls with body dissatisfaction want to be thinner, boys’ dissatisfaction is rooted forsome in a desire to be thinner, whereas others wish to be bigger than their current size(Ricciardelli & McCabe, 2001). In fact, an average of 48% of normal-weight adolescentboys report either wanting or trying to gain weight (McCreary & Sasse, 2000). Ourfindings are also in accord with previous research indicating that although both boysand girls report the most dissatisfaction when they are overweight, girls are mostsatisfied with their bodies when they are underweight, whereas boys are most satisfiedwhen they are average weight (Richards et al., 1990). Similarly, these findings provideadditional support for the hypothesis that as girls deviate from the ultrathin ideal, thegreater body dissatisfaction they experience (Graber, Brooks-Gunn, Paikoff, & Warren,1994). To our knowledge, this study is the first to explicitly test for gender differences inhigher-order effects of body mass on body dissatisfaction in an adolescent sample.

Deficits in parental social support also did not predict increases in body dissatisfaction.This finding is contradictory to some previous research, which found that social supportdeficits were associated with increased body dissatisfaction (Stice & Whitenton, 2002).However, one previous study has produced null findings (Byely et al., 2000). The currentfindings may have resulted because the study utilized a high school sample and peersrather than parents may comprise the primary source of social support at this stage.Therefore, it is possible that acceptance into one’s immediate social network may over-ride any deficits experienced in parental support.

Negative affect emerged as one of the most potent predictors of body dissatisfaction.The interaction with gender revealed that this risk factor predicted increases in

1There was no evidence that the null finding in the current study was obscured by the use of a scale intendedprimarily for females with male participants as there was no main effect of thin-ideal internalization, even whenmales were excluded from the analyses (B ¼ .066, p > .10).

398 Presnell et al.

body dissatisfaction for boys, but not for girls. Despite findings from extant researchdemonstrating that acute inductions of negative mood produce acute body dissatisfac-tion in girls, the null findings reported in the current study are consistent with a previouslongitudinal study that found no predictive relation between depressive symptoms andfuture increases in body dissatisfaction among girls (Stice & Whitenton, 2002). Althoughthere may be acute effects of negative mood inductions on body dissatisfaction for girls,this effect might not persist over time. The evidence that negative affect did predict bodydissatisfaction for boys in our sample is novel, as to our knowledge this is the first studyto investigate these relations. Independent replication of this finding would be useful toincrease our confidence that negative affect is a differential risk factor for boys’ and girls’body dissatisfaction.

It is important to consider the limitations of this study when interpreting the findings.First, the evidence of selective attrition raises concerns about the generalizability of thefindings. Second, the relatively short follow-up period might have constrained theamount of change that was observed in body dissatisfaction, which may have made itdifficult to detect predictors of this change. Third, this study relied solely on self-reportdata. Although adolescents are generally considered to be the best reporters of inter-nalizing symptoms (such as negative affect and body dissatisfaction), reports fromfriends or family members regarding the pressure to be thin could provide additionalinformation to assess whether individuals who report greater body dissatisfaction object-ively receive greater pressure to be thin or if they are merely perceiving more pressurethan their nondissatisfied counterparts. Another limitation is the homogeneity of thesample, which limits the generalizability of our results. Finally, whereas longitudinaldata provide information regarding temporal precedence, third-variable explanationscannot be ruled out with a nonexperimental design. Therefore, it is possible that someshared causal variable increases both the risk factors and body dissatisfaction.

Our data suggest that a substantial number of boys and girls experience body dis-satisfaction, but it may be useful for future research to parse out the particular aspects ofbody dissatisfaction that differ between boys and girls. For example, recent researchsuggests that boys’ dissatisfaction develops from a desire to gain weight and musclemass instead of, or in addition to, the drive for thinness that is observed in girls(McCreary & Sasse, 2000). Traditional scales used to assess body dissatisfaction in girlsmay be insensitive to such differences because reporting dissatisfaction with body partsalone does not yield information regarding how respondents would like their bodies tobe different (i.e., larger or smaller). Scales that ask specifically about the nature of thedissatisfaction would yield more useful information to determine gender differences.Future research should seek to make this distinction clearer and to investigate whetherthe risk factors differ for individuals desiring to be thinner versus larger and moremuscular. Such information has implications for interventions that help to mitigate theeffects of sociocultural pressures to reduce body dissatisfaction. Our data suggest thatthis goal needs to be approached differently for boys and girls.

Body dissatisfaction is multidetermined. Therefore, future research should investigatea broader range of risk factors for body dissatisfaction. It is also possible that the effects ofsome of the putative risk factors for body dissatisfaction may be moderated by other,unexamined risk factors. For example, the influence of sociocultural pressure to be thinon body dissatisfaction might differ depending on whether or not an adolescent believeshim or herself to be physically or athletically competent. In addition, focusing on ayounger age range may allow greater insight into how body dissatisfaction changeswith development. A more diverse sample would allow researchers to test whether

Risk Factors for Body Dissatisfaction 399

other factors, such as ethnicity or SES, moderate the effects of the putative risk factors onbody dissatisfaction. Future research should also examine the functional consequences ofbody dissatisfaction for both boys and girls to more clearly establish the significance ofthis outcome. Relatedly, the consequences of body dissatisfaction may differ for boyswho wish to gain weight versus those who wish to lose weight. For instance, the formermay be more likely to use steroids whereas the latter may result in dietary restriction.

Clearly, body dissatisfaction is prevalent among both boys and girls and the factorsthat predict body image concerns differ somewhat between them. Although this studyaddresses some neglected areas in this literature, etiologic understanding and preventionefforts would benefit from further prospective and experimental research to clarify thefactors that place adolescent boys and girls at risk for body dissatisfaction.

The authors thank the project research assistants Penny Flick, Michelle Kees, Joy Margolis, SharonOzer, and Chris Ziemba, as well as the research participants, who made this study possible.

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).Washington, DC: Author.

Baker, J.D., Williamson, D.A., & Sylve, C. (1995). Body image disturbance, memory bias, and body dysphoria:Effects of negative mood induction. Behavior Therapy, 26, 747–759.

Blyth, D.A., Simmons, R.G., Bulcroft, R., Felt, D., Van Cleave, E.F., & Bush, D.M. (1981). The effects of physicaldevelopment in self-image and satisfaction with body image for early adolescent males. Research in Com-munity and Mental Health, 2, 43–73.

Byely, L., Archibald, A.B., Graber, J., & Brooks-Gunn, J. (2000). A prospective study of familial and socialinfluences on girls’ body image and dieting. International Journal of Eating Disorders, 28, 155–164.

Carlat, D.J., Camargo, C.A., Jr., & Herzog, D.B. (1997). Eating disorders in males: A report on 135 patients.American Journal of Psychiatry, 154, 1127–1132.

Cattarin, J.A., & Thompson, J.K. (1994). A three-year longitudinal study of body image, eating disturbance, andgeneral psychological functioning in adolescent females. Eating Disorders: Journal of Treatment and Pre-vention, 2, 114–125.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Cohn, L.D., & Adler, N.E. (1992). Female and male perceptions of ideal body shapes: Distorted views among

Caucasian college students. Psychology of Women Quarterly, 16, 69–79.Crockett, L., Schulenberg, J., & Petersen, A. (1987). Congruence between objective and self-report data in a

sample of young adolescents. Journal of Adolescent Research, 2, 383–392.Fairburn, C.G., Cooper, Z., Doll, H.A., Norman, P.A., & O’Connor, M.E. (2000). The natural course of bulimia

nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57, 659–665.Field, A.E., Carmargo, C.A., Taylor, C.B., Berkey, C.S., Roberts, S.B., & Colditz, G.A. (2001). Peer, parent, and

media influences on the development of weight concerns and frequent dieting among preadolescent andadolescent girls and boys. Pediatrics, 107, 54–60.

Franzoi, S.L., & Shields, S.A. (1984). The body esteem scale: Multidimensional structure and sex differences in acollege population. Journal of Personality Assessment, 48, 173–178.

Furman, W. (1996). The measurement of friendship perceptions: Conceptual and methodological issues. InW.M. Bukowski, A.F. Newcomb, & W.W. Hartup (Eds.), The company we keep (pp. 41–65). New York:Cambridge University Press.

Furman, W., & Buhrmester, D. (1985). Children’s perceptions of the personal relations in their social networks.Developmental Psychology, 21, 1016–1024.

Galambos, N.L., Almedia, D.M., & Petersen, A.C. (1990). Masculinity, femininity, and sex role attitudes in earlyadolescence: Exploring gender intensification. Child Development, 61, 1905–1914.

Gotlib, I.H., Lewinsohn, P.M., & Seeley, J.R. (1998). Consequences of depression during adolescence: Maritalstatus and marital functioning in early adulthood. Journal of Abnormal Psychology, 107, 686–690.

Graber, J.A., Brooks-Gunn, J., Paikoff, R.L., & Warren, M.P. (1994). Prediction of eating problems: An 8-yearstudy of adolescent girls. Developmental Psychology, 30, 823–834.

Hoffman, J.M., & Brownell, K.D. (1997). Sex differences in the relationship of body fat distribution withpsychosocial variables. International Journal of Eating Disorders, 22, 139–145.

Keel, P.K., Fulkerson, J.A., & Leon, G.R. (1997). Disordered eating precursors in pre- and early adolescent girlsand boys. Journal of Youth and Adolescence, 26, 203–216.

400 Presnell et al.

McCabe, M.P., & Ricciardelli, L.A. (2001). Parent, peer, and media influences on body image and strategies toboth increase and decrease body size among adolescent boys and girls. Adolescence, 36, 225–240.

McCabe, M.P., & Ricciardelli, L.A. (2003). A longitudinal study of body change strategies among adolescentmales. Journal of Youth and Adolescence, 32, 105–113.

McCreary, D.R., & Sasse, D.K. (2000). An exploration of the drive for muscularity in adolescent boys and girls.Journal of American College Health, 48, 297–304.

Muth, J.L., & Cash, T.F. (1997). Body-image attitudes: What difference does gender make? Journal of AppliedSocial Psychology, 27, 1438–1452.

Newman, D.L., Moffitt, T.E., Caspi, A., Magdol, L., Silva, P.A., & Stanton, W.R. (1996). Psychiatric disorder in abirth cohort of young adults: Prevalence, comorbidity, clinical significance, and new case incidence fromages 11 to 21. Journal of Consulting and Clinical Psychology, 64, 552–562.

Parks, P.S., & Read,M.H. (1997). Adolescentmale athletes: Body image, diet, and exercise. Adolescence, 32, 593–602.Pietrobelli, A., Faith, M., Allison, D., Gallagher, D., Chiumello, G., & Heymsfield, S. (1998). Body mass index as a

measure of adiposity among children and adolescents: A validation study. Journal of Pediatrics, 132, 204–210.Pope, H.G., Gruber, A.J., Mangweth, B., Bureau, B., deCol, C., Jouvent, R., & Hudson, J.I. (2000). Body image

perception among men in three countries. American Journal of Psychiatry, 157, 1297–1301.Raudenbush, B., & Zellner, D.A. (1997). Nobody’s satisfied: Effects of abnormal eating behaviors and actual and

perceived weight status on body image satisfaction in males and females. Journal of Social Clinical Psycho-logy, 16, 95–110.

Ricciardelli, L.A., & McCabe, M.P. (2001). Dietary restraint and negative affect as mediators of body dissatisfac-tion and bulimic behavior in adolescent girls and boys. Behaviour Research and Therapy, 39, 1317–1328.

Ricciardelli, L.A., & McCabe, M.P. (2003). Sociocultural influences on body image and body changes amongadolescent boys and girls. Journal of Social Psychology, 143, 5–26.

Richards, M.H., Boxer, A.M., Petersen, A.C., & Albrecht, R. (1990). Relation of weight to body image in pubertalgirls and boys from two communities. Developmental Psychology, 26, 313–321.

Schwartz, D.J., Phares, V., Tantleff-Dunn, S., & Thompson, J.K. (1999). Body image, psychological functioning,and parental feedback regarding physical appearance. International Journal of Eating Disorders, 25, 339–343.

Smolak, L., Levine, M., & Thompson, J.K. (2001). The use of the Sociocultural Attitudes Towards AppearanceQuestionnaire with middle school boys and girls. International Journal of Eating Disorders, 29, 216–223.

Stice, E., & Bearman, S.K. (2001). Body image and eating disturbances prospectively predict increases indepressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37, 597–607.

Stice, E., Mazotti, L., Weibel, D., & Agras, W.S. (2000). Dissonance prevention program decreases thin-idealinternalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experi-ment. International Journal of Eating Disorders, 27, 206–217.

Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eating onset: A prospective investigation.Health Psychology, 21, 131–138.

Stice, E., & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: A longitudinalinvestigation. Developmental Psychology, 38, 669–678.

Striegel-Moore, R.H., Silberstein, L.R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia.American Psychologist, 41, 246–263.

Taylor, M.J., & Cooper, P.J. (1992). An experimental study of the effects of mood on body size perception.Behaviour Research and Therapy, 30, 53–58.

Thompson, J.K., Heinberg, L.J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, andtreatment of body image disturbance. Washington, DC: American Psychological Association.

Watson, D., & Clark, L.A. (1992). On traits and temperament: General and specific factors of emotionalexperience and their relation to the five-factor model. Journal of Personality, 60, 441–476.

Watson, D., & Clark, L.A. (1993). Behavioral disinhibition versus constraint: A dispositional perspective. InD.M. Wegner & J.W. Pennebacker (Eds.), Handbook of mental control (pp. 506–527). New York: Prentice Hall.

Wiseman, C.V., Gray, J.J., Mosimann, J.E., & Ahrens, A.H. (1992). Cultural expectations of thinness in women:An update. International Journal of Eating Disorders, 11, 86–89.

Wood, K.C., Becker, J.A., & Thompson, J.K. (1996). Body image dissatisfaction in preadolescent children. Journalof Applied Developmental Psychology, 17, 85–100.

Risk Factors for Body Dissatisfaction 401