|Ahead of print
|Wounded healers? Exploring body image perceptions and the need for psychosocial intervention among undergraduate medical students
Miriam Archana Simon1, Chhaya Akshay Divecha2, Hassan Tayyab3, Alhassan Ali Asaad3
1 Assistant Professor, Department of Psychiatry and Behavioral Science, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
2 Assistant Professor, Department of Pediatrics, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
3 College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
Click here for correspondence address and email
|Date of Submission||18-Feb-2021|
|Date of Acceptance||25-Jun-2021|
|Date of Web Publication||23-Nov-2021|
Background: Body image issues are on the rise and affect people of all ages. It is one of the top-ranked issues of concern for young people. The present study aims to explore the body image perceptions and concerns of medical students, in particular their body esteem.
Materials and Methods: The present study was conducted among the medical students at the College of Medicine and Health Sciences, National University of Science and Technology, Sultanate of Oman. Students across the 6 years in the medical program were invited to be part of the study. Self-report of body mass index and body weight satisfaction were obtained. Participants were also required to complete items corresponding to the Appearance and Attribution sub-scales of the Body Esteem Scale for Adolescents and Adults.
Results: Results from 351 participants indicate that medical students in Oman experience low body esteem, especially related to the self-perception of their appearance and evaluations of others. Bodyweight dissatisfaction and behavioral attempts to change weight, though associated, are not very strong predictors for body esteem.
Conclusions: Results indicate that psychosocial and cultural factors may play a major contributory role in body image perceptions. Exposure to medical training that instills knowledge and awareness of body composition, eating habits and eating disorders does not seem to positively impact higher body esteem in students. It is recommended that awareness modules and psychoeducation sessions focusing on body image issues be planned and initiated for medical students in Oman.
Keywords: Body dissatisfaction, body esteem, body image, medical students, Oman
|How to cite this URL:|
Simon MA, Divecha CA, Tayyab H, Asaad AA. Wounded healers? Exploring body image perceptions and the need for psychosocial intervention among undergraduate medical students. Arch Ment Health [Epub ahead of print] [cited 2021 Dec 7]. Available from: https://www.amhonline.org/preprintarticle.asp?id=330924
| Introduction|| |
Body image is a person's perception of their physical self and the thoughts and feelings-positive, negative, or both, which result from that perception. This is one of the top-ranked issues of concern for young people. Body image is conceptualized as a multidimensional construct, which encompasses a behavioral component involving body-related behaviors (e.g., checking behaviors), a perceptual component involving the perception of body characteristics (e.g., estimation of one's body size or weight), and a cognitive-affective component involving cognitions, attitudes, and feelings toward one's body. Body esteem is considered how an individual likes or dislikes one's body. Body image dissatisfaction is defined as the negative attitude toward one's own body resulting from a perceived discrepancy between the actual body image (i.e., perceptions, thoughts, and feelings concerning one's actual physical appearance) and the ideal body image (i.e., internalized ideas about one's physical appearance).
The psychosocial influence on body dissatisfaction and the consequences is significant. Females reported more body dissatisfaction and disordered eating than males. A study reported that both males and females reported a positive, significant relationship between overall body image and self-esteem. Meta-analysis of around 26 studies revealed that personality was found to relate with body dissatisfaction. Body image perceptions are associated with anxiety, smoking behavior, the absence of parental support, negative affectivity, self-reported dietary restraint and physical exercise, and health-related behaviors.
Body image concerns are also reported globally among young adults in India, the United States of America, Europe, and Asia. Body dissatisfaction is also reported among adolescents and young adults in the Middle East region. A study conducted in the United Arab Emirates reports that around 74.8% of participants were dissatisfied with their current body image and that disordered eating attitudes were positively correlated with body image dissatisfaction. Body image concerns among students were also reported in Egypt, Kuwait, Iran, and Lebanon. Data from universities in five Arab countries-Bahrain, Egypt, Jordan, Oman, and Syria reported that body weight concern are highly prevalent among young Arab women.
Body dissatisfaction is an early predictor of weight change among medical students. Significant relationships were also observed between eating attitudes, body shape concern, social anxiety, and depression. Similar trends were also reported among medical students in the Middle Eastern region, most commonly among female students. In a study, conducted at Taibah University, most students were dissatisfied, over-estimating their weight, and desired to be thinner.
There is very limited literature available on body image concerns in the Sultanate of Oman. One study conducted among Omani adolescents reported disturbed eating attitudes. There is a lacuna of literature on body dissatisfaction among young adults and college students in Oman. The psychological construct of body image has recently gained interest in clinical and scientific research, as body image disturbance is a core diagnostic feature and therefore a predictor for eating disorders. Having a medical degree does not seem to be contributing to protect future health professionals from the risk of eating disorders and probably practicing in the future as “wounded healers.” It is therefore vital to assess medical students for body image concerns and provide adequate psychological support, thereby controlling the risk of developing eating disorders in the future.
The present study aims to explore the body image perceptions and concerns of medical students, in particular their body esteem. Medical students are future healthcare providers. Focus on their mental health and psychological well-being is crucial in preparing them for this role. Existing body image issues may impact their overall mental health and eventually stress coping skills and if left unaddressed may increase the risk of the development of eating disorders. This study also draws attention to the issue that even though students are exposed to the importance of healthy eating habits, nutritional aspects and eating disorders as part of their medical curriculum, body image issues continue to exist, and adequate intervention in this regard is required. The results of this study will thereby enable targeted planning and implementation of awareness programs and relevant intervention modules focused on student mental health and well-being.
| Materials and Methods|| |
The present study was conducted among medical students at the College of Medicine and Health Sciences, National University of Science and Technology, Sultanate of Oman. The MD degree offered at the CoMHS is a 6-year undergraduate medical program. Students undergo three phases of training: Premedical (2 years); Preclinical (2 years) and Clinical (2 years).
A cross-sectional research design, using the survey-based method was used. Approval from the institution's Ethics and Biosafety Committee was obtained before the commencement of the study. All students across the 6 years in the medical program were invited to be part of the study. Three hundred and fifty-one students consented to be part of the study. Written informed consent was obtained from participants.
Participants were required to provide basic demographic details. They were also asked to report their height and current body weight to enable the calculation of body mass index (BMI). A self-report of body weight satisfaction was obtained. Participants were asked to indicate “Yes” or “No” to the question “Are you satisfied with your current body weight?”
The Body Esteem Scale for Adolescents and Adults (BESAA) was used in this study. Two sub-scales of the BESAA-Appearance (10 items, maximum score: 50) and Attribution (5 items, maximum score: 25) were included in this study. The appearance subscale assesses general feelings and perceptions of one's appearance (e.g., “I like what I see in pictures”). The attribution subscale measures evaluations attributed to others about one's appearance (e. g., “Other people consider me good-looking”). Each item was rated on a five-point scale. Higher scores indicate higher body esteem.
Data obtained were analyzed using IBM's Statistical Package for Social Sciences version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp). Descriptive statistics were employed to analyze demographic data. Reliability analysis was carried out using Cronbach's alpha to assess internal consistency. Analysis of Variance, One-Sample t-test, and Correlation methods were employed to interpret data. Linear regression analysis was carried out to explore the strength of association.
| Results|| |
Results obtained from participants are presented in this section. Of the 351 participants, 308 were female and 43 were male as most students enrolled in CoMHS are female. The mean age of participants was 21.5 years. About 36.6% of students were in the premedical years (MD year 1 and 2), 31.8% were in the preclinical years (MD year 3 and 4), and 31.3% of students were undergoing clinical training (MD year 5 and 6).
Self-reported BMI obtained from participants was categorized based on guidelines by the World Health Organization. As shown in [Figure 1], 64.5% (227) of participants reported normal BMI. About 11.9% (42) were underweight, 17.9% (63) were overweight, and 5.4% (19) were obese.
Results also indicated that 68.5% of students were satisfied with their present body weight, 31.5% were dissatisfied, and that a majority of them (95.2%) had attempted to change their weight.
Self-reported BMI was associated to body weight satisfaction/dissatisfaction (P = 0.000) but not to attempts to change weight (P = 0.153). There was also no association between students' body weight satisfaction and attempts to change their weight (P = 0.784). Around 30% of participants who had normal BMI values experienced body image dissatisfaction. Around 63.8% of students with normal self-reported BMI had previous/current attempts to change weight. Around 93% of those who were underweight, all participants whose BMI category was “overweight” or “obese,” and 95% of students who were satisfied with their body weight had previous/current attempts to change their weight.
Results obtained from the subscales of the BESAA indicate adequate internal consistency. A Cronbach's alpha value of 0.747 was obtained for the Appearance subscale (10 items) and a value of 0.570 for the Attribution subscale (5 items).
The participant's mean score on the Appearance subscale was 25.98 (standard deviation [SD] =6.780). Results of ANOVA indicated that there was no significant difference in the scores on this subscale among students in the premedical, preclinical, and clinical years (P = 0.563). The mean score obtained by participants on the Attribution subscale was 15.24 (SD = 3.491). Results of ANOVA also indicated that there was no significant difference in the scores on this subscale among students in the premedical, preclinical, and clinical years (P = 0.798). [Figure 2] shows the distribution of participant's total scores on the Appearance.
|Figure 2: Indicates distribution of total scores on appearance and attribution subscales|
Click here to view
Item-wise responses of participants on the Appearance and Attribution subscales are presented in [Table 1].
|Table 1: Item-wise responses of participants on the appearance and Attribution Sub-Scales|
Click here to view
Results from [Table 1] indicate that a majority of participants wished they looked like someone else (72.3%), worry about the way they look (62.1%), and dislike how they look in pictures (69.2%). 77.4% of medical students felt that others did not consider them to be good-looking.
Results from [Table 2] indicate a moderate negative correlation between self-reported BMI and scores on the Appearance subscale (r = ‒0.348). A weak negative correlation was also seen between BMI scores and the Attribution subscale (r = ‒0.173). Body weight dissatisfaction was also negatively associated to body esteem dimensions, but the strength of the association was moderate. The participant's feelings about their appearance were mildly associated with attempts to change weight. Perceptions of others were not associated with attempts to change weight. This indicates that overall, students with higher BMI scores, increased body weight dissatisfaction, and those who had previous/current attempts to change weight experienced lower body esteem.
Linear regression analysis was carried out. Results are presented in [Table 3].
Results from [Table 3] indicate that though a relationship exists, BMI scores, body weight satisfaction/dissatisfaction, or attempts to change weight are not very strong predictors of body esteem. This highlights the consideration of other psychosocial and cultural factors that may contribute to body esteem.
The mean score of participants on the Appearance and Attribution subscales was compared to results of a similar study conducted among college students in Korea and the United States of America using the one-sample t-test to compare means. Results show that participants in the present study have significantly lower scores on the Appearance (P = 0.02) and Attribution (P = 0.02) subscales, indicating lower body esteem when compared to their global counterparts.
| Discussion|| |
Literature indicates that medical students experienced body dissatisfaction even though they reported a normal BMI. Results from the present study indicate that medical students experience body weight dissatisfaction and low body esteem despite reporting normal BMI scores. They also engage in frequent attempts to change weight. BMI, body weight dissatisfaction, and behavioral attempts to change weight, though associated, are not very strong predictors for body esteem. Exposure to medical training that instills knowledge and awareness of body composition/types, eating habits and eating disorders does not seem to positively impact higher body esteem in students. Results from the present study are similar to the analysis by Spigarelli et al., indicating that medical students, especially females have high body image dissatisfaction. It was also reported that medical students also report worsening body image concerns as they progress through the curriculum and have increased clinical training. Although in the current study, similar body issue concerns were reported by students across various years in medical training, the ramification of this crucial issue should be addressed proactively.
The contribution of possible socio-cultural influence is indicated by the study results. Body dissatisfaction is an internal process but can be influenced by several external factors. Conclusions by King et al. stated that the unique religious and cultural factors in the Middle Eastern region may affect body image and esteem. Abnormal eating habits and social pressure to be attractive, hugely influenced by the media was also reported among medical students. Littlewood reports that most inferences about the etiology of eating disorders recognize something “cultural” involving body imagery and social and family experience. The increasing contribution of socio-cultural factors in body image issues is, especially seen as anthropomorphic differences between ethnic and racial groups narrow, and the impact of globalization across all life aspects escalates.
A preoccupation regarding attempts to change weight is also seen among medical students in this study. Participants also experienced significantly lower scores on body esteem dimensions in comparison to their counterparts in other regions that indicate negative self-evaluation. The impact of media consumption and internalization and culturally acceptable eating and exercise behaviors may be strong contributors to this. Preoccupation leading to distorted self-perception may also be associated with insecure attitude and seeking reassurance in other's opinions.
| Conclusions|| |
Results of the present study indicate that medical students in Oman experience low body esteem, especially related to the self-perception of their appearance and evaluations of others. It is also concluded that BMI levels, attempts to change weight and body dissatisfaction are mildly associated with, but are not strong predictors of body esteem dimensions. This indicates that other psychosocial and cultural factors may play a major contributory role in body image perceptions. This study shows that students in medical training are not immune to challenges in body image perceptions and experience poor body esteem due to existing socio-cultural influences. There is a possibility that as future medical professionals, if left unaddressed, this burden may result in them not only being wounded healers but also at greater risk of developing unhealthy eating habits and eating disorders.
It is therefore vital that a method of gatekeeper training be initiated for faculty members, student advisors, and student counselors in the CoMHS as a preventive strategy. It is recommended that awareness modules and psychoeducation sessions focusing on body image issues be planned and initiated for medical students in Oman. Planning and implementing Integrated Teaching sessions as part of the medical curriculum focusing on eating habits, eating disorders, and psychosocial awareness may also be helpful. Early intervention programs at the school level for adolescents are also recommended.
Limitations in this study include the utilization of self-reported BMI obtained from participants and excluding the use of the weight satisfaction subscale on BESAA, though this was covered as one self-reported item in the survey questionnaire administered to participants (“Are you satisfied with your current body weight?”).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Quittkat HL, Hartmann AS, Düsing R, Buhlmann U, Vocks S. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry 2019;10:864.
Rosa J, Garbarino E, Malter A. Keeping the body in mind: The influence of body esteem and body boundary aberration on consumer beliefs and purchase intentions. J Consum Psychol 2006;16:79-91.
Heider N, Spruyt A, De Houwer J. Body dissatisfaction revisited: On the importance of implicit beliefs about actual and ideal body image. Psychol Belg 2018;57:158-73.
MacNeill LP, Best LA, Davis LL. The role of personality in body image dissatisfaction and disordered eating: Discrepancies between men and women. J Eat Disord 2017;5:44.
Abell S, Richards M. The relationship between body shape satisfaction and self-esteem: An investigation of gender and class differences. J Youth Adolesc 1996;25:691-703.
Allen M, Robson D. Personality and body dissatisfaction: An updated systematic review with meta-analysis. Body Image 2020;33:77-89.
Okeke NL, Spitz MR, Forman MR, Wilkinson AV. The associations of body image, anxiety, and smoking among Mexican-origin youth. J Adolesc Health 2013;53:209-14.
Bearman SK, Martinez E, Stice E, Presnell K. The skinny on body dissatisfaction: A longitudinal study of adolescent girls and boys. J Youth Adolesc 2006;35:217-29.
Lowery S, Kurpius S, Befort C, Blanks E, Sollenberger S, Nicpon M, et al.
Body image, self-esteem, and health-related behaviors among male and female first year college students. J Coll Stud Dev 2005;46:612-23.
Shahi VK, Kohli N. Body image attitudes and perception among college students. IAHRW Int J Soc Sci 2019;7:1263-7.
Fiske L, Fallon EA, Blissmer B, Redding CA. Prevalence of body dissatisfaction among United States adults: Review and recommendations for future research. Eat Behav 2014;15:357-65.
Soh NL, Touyz S, Dobbins T, Surgenor L, Clarke S, Kohn M, et al.
Body image disturbance in young North European and East Asian women with and without eating disorders in Australia and in Singapore. Eur Eat Disord Rev 2008;16:287-96.
Thomas J, Khan S, Abdulrahman AA. Eating attitudes and body image concerns among female university students in the United Arab Emirates. Appetite 2010;54:595-8.
El Ansari W, Dibba E, Labeeb S, Stock C. Body image concern and its correlates among male and female undergraduate students at Assuit University in Egypt. Glob J Health Sci 2014;6:105-17.
Ebrahim M, Alkazemi D, Zafar TA, Kubow S. Disordered eating attitudes correlate with body dissatisfaction among Kuwaiti male college students. J Eat Disord 2019;7:37.
Garrusi B, Baneshi MR. Body dissatisfaction among Iranian youth and adults. Cad Saude Publica 2017;33:e00024516.
Haddad C, Zakhour M, Akel M, Honein K, Akiki M, Hallit S, et al.
Factors associated with body dissatisfaction among the Lebanese population. Eat Weight Disord 2019;24:507-19.
Musaiger A. Body weight concern among female university students in five Arab countries – a preliminary cross-cultural study. Ann Agric Environ Med 2015;22:349-52.
Pant B, Ahmad S, Shukla AK, Kiran C. Body image perception: An early predictor of weight change among medical students. Int J Soc Rehabil 2018;3:6-9. [Full text]
Liao Y, Knoesen NP, Castle DJ, Tang J, Deng Y, Bookun R, et al.
Symptoms of disordered eating, body shape, and mood concerns in male and female Chinese medical students. Compr Psychiatry 2010;51:516-23.
As-Sa'Edi E, Sheerah S, Al-Ayoubi R, Al-Jehani AA, Tajaddin W, Habeeb H. Body image dissatisfaction: Prevalence and relation to body mass index among female medical students in Taibah University, 2011. J Taibah Univ Med Sci 2013;8:126-33.
Kayano M, Yoshiuchi K, Al-Adawi S, Viernes N, Dorvlo AS, Kumano H, et al.
Eating attitudes and body dissatisfaction in adolescents: Cross-cultural study. Psychiatry Clin Neurosci 2008;62:17-25.
Bosi ML, Nogueira JA. Body image and eating behavior among medical students: Eating disorders among medical students. Epidemiol Open Access 2016;6:256.
Mendelson BK, Mendelson MJ, White DR. Body-esteem scale for adolescents and adults. J Pers Assess 2001;76:90-106.
Jung J, Forbes GB. Multidimensional assessment of body dissatisfaction and disordered eating in Korean and US college women: A comparative study. Sex Roles 2006;55:39-50.
Spigarelli MG, Haney SE, Butler K, Sotiriou EG. Assessing body dissatisfaction in medical students: Results of the BSQ 8C (Body Shape Questionnaire). J Adolesc Health 2013;52:S40.
King T, Morse BJ, Woofenden H, Copithorne M, Dunigan B, Sylvia Z. Middle East Meets West: A cross-national examination of body image and health behaviors in Jordan and the United States. Virtual Commons - Bridgewater State University. Available from: https://vc.bridgew.edu/psychology_fac/52/
. [Last accessed on 2020 Dec 31].
Sharma M, Singh SK, Tiwari P, Chauhan N. Body image perception, eating attitude and influence of media among undergraduate students of medical college in Delhi: A cross sectional study. Int J Res Med Sci 2019;7:4627.
Litllewood R. Commentary: Globalization, culture, body image, and eating disorders. Cult Med Psychiatry 2004;28:597-602.
Pop CL. Association between body mass index and self body image perception. Iran J Public Health 2017;46:1744-5.
Isaac M, Elias B, Katz LY, Belik SL, Deane FP, Enns MW, et al.
Gatekeeper training as a preventative intervention for suicide: A systematic review. Can J Psychiatry 2009;54:260-8.
Miriam Archana Simon,
Department of Psychiatry and Behavioral Science, College of Medicine and Health Sciences, National University of Science and Technology, PO Box 391, PC 321, Al Tareef, Sohar
Sultanate of Oman
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
| Article Access Statistics|
| Viewed||52 |
| PDF Downloaded||3 |