Journal List > J Nutr Health > v.47(4) > 1081348

J Nutr Health. 2014 Aug;47(4):287-299. Korean.
Published online August 31, 2014.
© 2014 The Korean Nutrition Society
4th-grade elementary-school children's body image and dietary habits according to body mass index
Eugene Shim, and Yoon Kyoung Yang
Department of Food and Nutrition, Soongeui Women's College, Seoul 100-751, Korea.

To whom correspondence should be addressed. tel: +82-2-3708-9263, Email:
Received April 15, 2014; Revised April 30, 2014; Accepted July 22, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The goal of this study was to examine body image satisfaction and perception according to weight status, and to investigate those associations with dietary habits and nutritional status among preadolescent children.


Body image and dietary habits and intake were assessed in 134 elementary school students in grade 4. Children were categorized according to normal and overweight or obese groups. Figure rating scales were used to assess body image perception (identification of perceived current body size) and dissatisfaction (difference between perceived current body size and ideal body image).


There were sex differences in body image perceptions. Normal-weight girls, overweight or obese girls and boys were more likely to desire a leaner body size than their perceived body size compared with normal-weight boys. Body image satisfaction and perception showed an association with weight status. More overweight or obese children indicated dissatisfaction or underestimation of body image than normal-weight children. Children with body image dissatisfaction due to heavier perceived body size than ideal body image showed lower frequencies of consumption of meals and vegetables, compared to those who were satisfied with their body image. Children who underestimated their body image were more likely to have a lower frequency of breakfast and meal regularity and a higher frequency of eating out of home or food deliveries than those with accurate body image perception. In addition, body image underestimation showed an association with lower intakes of protein, dietary fiber and calcium, and the higher percentage of calories derived from fat.


Body image dissatisfaction as well as underestimation in children before puberty showed an association with overweight or obesity, and was also related to unhealthy dietary habits. These findings highlight the importance of accurate perception and satisfaction with body image in preadolescent children in order to prevent development of obesity in adolescents and adults.

Keywords: body image; satisfaction; underestimation; obesity; dietary habits


Table 1
General characteristics of subjects
Click for larger image

Table 2
Body images according to BMI and sex
Click for larger image

Table 3
Body image satisfaction and perception according to BMI and sex
Click for larger image

Table 4
Dietary habits according to BMI
Click for larger image

Table 5
Nutrient intake according to BMI
Click for larger image

Table 6
BMI according to body image
Click for larger image

Table 7
Dietary habits according to body image
Click for larger image

Table 8
Nutrient intake according to body image
Click for larger image

1. Edwards NM, Pettingell S, Borowsky IW. Where perception meets reality: self-perception of weight in overweight adolescents. Pediatrics 2010;125(3):e452–e458.
2. Brener ND, Eaton DK, Lowry R, McManus T. The association between weight perception and BMI among high school students. Obes Res 2004;12(11):1866–1874.
3. Standley R, Sullivan V, Wardle J. Self-perceived weight in adolescents: over-estimation or under-estimation? Body Image 2009;6(1):56–59.
4. Gray WN, Crawford MJ, Follansbee-Junger K, Dumont-Driscoll MC, Janicke DM. Associations between actual and perceived weight and psychosocial functioning in children: the importance of child perceptions. Child Obes 2012;8(2):147–154.
5. Eisenberg ME, Neumark-Sztainer D, Paxton SJ. Five-year change in body satisfaction among adolescents. J Psychosom Res 2006;61(4):521–527.
6. McCabe MP, Ricciardelli LA. Body image dissatisfaction among males across the lifespan: a review of past literature. J Psychosom Res 2004;56(6):675–685.
7. Calzo JP, Sonneville KR, Haines J, Blood EA, Field AE, Austin SB. The development of associations among body mass index, body dissatisfaction, and weight and shape concern in adolescent boys and girls. J Adolesc Health 2012;51(5):517–523.
8. Santana ML, Silva Rde C, Assis AM, Raich RM, Machado ME, de J Pinto E, de Moraes LT, Ribeiro Júnior Hda C. Factors associated with body image dissatisfaction among adolescents in public schools students in Salvador, Brazil. Nutr Hosp 2013;28(3):747–755.
9. Austin SB, Haines J, Veugelers PJ. Body satisfaction and body weight: gender differences and sociodemographic determinants. BMC Public Health 2009;9:313.
10. Kostanski M, Fisher A, Gullone E. Current conceptualisation of body image dissatisfaction: have we got it wrong? J Child Psychol Psychiatry 2004;45(7):1317–1325.
11. Parkinson KN, Tovée MJ, Cohen-Tovée EM. Body shape perceptions of preadolescent and young adolescent children. Eur Eat Disord Rev 1998;6(2):126–135.
12. Tremblay L, Limbos M. Body image disturbance and psychopathology in children: research evidence and implications for prevention and treatment. Curr Psychiatry Rev 2009;5(1):62–72.
13. Saxton J, Hill C, Chadwick P, Wardle J. Weight status and perceived body size in children. Arch Dis Child 2009;94(12):944–949.
14. Park E. Overestimation and underestimation: adolescents' weight perception in comparison to BMI-based weight status and how it varies across socio-demographic factors. J Sch Health 2011;81(2):57–64.
15. Magarey AM, Perry RA, Baur LA, Steinbeck KS, Sawyer M, Hills AP, Wilson G, Lee A, Daniels LA. A parent-led family-focused treatment program for overweight children aged 5 to 9 years: the PEACH RCT. Pediatrics 2011;127(2):214–222.
16. Kim JA. A study on the obese child's body image, food habit and food attitude. J Korean Soc Matern Child Health 1999;3(1):89–104.
17. Johnstone AM, Stewart AD, Benson PJ, Kalafati M, Rectenwald L, Horgan G. Assessment of body image in obesity using a digital morphing technique. J Hum Nutr Diet 2008;21(3):256–267.
18. Schwartz MB, Brownell KD. Obesity and body image. Body Image 2004;1(1):43–56.
19. Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999;23 Suppl 2:S2–S11.
20. Erickson SJ, Robinson TN, Haydel KF, Killen JD. Are overweight children unhappy?: body mass index, depressive symptoms, and overweight concerns in elementary school children. Arch Pediatr Adolesc Med 2000;154(9):931–935.
21. Pallan MJ, Hiam LC, Duda JL, Adab P. Body image, body dissatisfaction and weight status in South Asian children: a cross-sectional study. BMC Public Health 2011;11:21.
22. Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. J Adolesc Health 2006;39(2):244–251.
23. Blaesing S, Brockhaus J. The development of body image in the child. Nurs Clin North Am 1972;7(4):597–607.
24. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, Oh K, Jang MJ, Hwang SS, Yoo MH, Kim YT, Lee CG. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51(1):1–25.
25. Collins ME. Body figure perceptions and preferences among preadolescent children. Int J Eat Disord 1991;10(2):199–208.
26. Truby H, Paxton SJ. Development of the children's body image scale. Br J Clin Psychol 2002;41(Pt 2):185–203.
27. Jang YA, Lee HS, Kim BH, Lee Y, Lee HJ, Moon JJ, Kim CI. Revised dietary guidelines for Koreans. Asia Pac J Clin Nutr 2008;17 Suppl 1:55–58.
28. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2008: Korea National Health and Nutrition Examination Survey (KNHANES IV-2). Cheongwon: Korea Centers for Disease Control and Prevention; 2009.
29. Oh K, Jang MJ, Lee NY, Moon JS, Lee CG, Yoo MH, Kim YT. Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005. Korean J Pediatr 2008;51(9):950–955.
30. Ministry of Health and Welfare. Korea Centers for Disease Control and Prevention. Korea Health Statistics 2012: Korea National Health and Nutrition Examination Survey (KNHANES V-3). Cheongwon: Korea Centers for Disease Control and Prevention; 2013.
31. Davison KK, Markey CN, Birch LL. Etiology of body dissatisfaction and weight concerns among 5-year-old girls. Appetite 2000;35(2):143–151.
32. Tiggemann M, Lynch JE. Body image across the life span in adult women: the role of self-objectification. Dev Psychol 2001;37(2):243–253.
33. Presnell K, Bearman SK, Stice E. Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. Int J Eat Disord 2004;36(4):389–401.
34. Shunk JA, Birch LL. Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. J Am Diet Assoc 2004;104(7):1120–1126.
35. Toselli S, Brasili P, Spiga F. Body image, body dissatisfaction and weight status in children from Emilia-Romagna (Italy): comparison between immigrant and native-born. Ann Hum Biol 2014;41(1):23–28.
36. Stice E, Ng J, Shaw H. Risk factors and prodromal eating pathology. J Child Psychol Psychiatry 2010;51(4):518–525.
37. Haines J, Neumark-Sztainer D, Wall M, Story M. Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity (Silver Spring) 2007;15(11):2748–2760.
38. van den Berg P, Neumark-Sztainer D. Fat'n happy 5 years later: is it bad for overweight girls to like their bodies? J Adolesc Health 2007;41(4):415–417.
39. Choi TI, Rhee HJ, Ko KM, Yoo SM, Kim KN, Lee SY, Kang JH. The prevalence of obesity and obesity-related metabolic complications in Korean adolescents. J Korean Acad Fam Med 2006;27(3):175–181.
40. Cho JH, Han SN, Kim JH, Lee HM. Body image distortion in fifth and sixth grade students may lead to stress, depression, and undesirable dieting behavior. Nutr Res Pract 2012;6(2):175–181.
41. Lim H, Wang Y. Body weight misperception patterns and their association with health-related factors among adolescents in South Korea. Obesity (Silver Spring) 2013;21(12):2596–2603.
42. Viner RM, Haines MM, Taylor SJ, Head J, Booy R, Stansfeld S. Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents. Int J Obes (Lond) 2006;30(10):1514–1521.
43. Yao NL, Hillemeier MM. Weight status in Chinese children: maternal perceptions and child self-assessments. World J Pediatr 2012;8(2):129–135.
44. Rietmeijer-Mentink M, Paulis WD, van Middelkoop M, Bindels PJ, van der Wouden JC. Difference between parental perception and actual weight status of children: a systematic review. Matern Child Nutr 2013;9(1):3–22.
45. West DS, Raczynski JM, Phillips MM, Bursac Z, Heath Gauss C, Montgomery BE. Parental recognition of overweight in school-age children. Obesity (Silver Spring) 2008;16(3):630–636.
46. Pimenta AM, Sánchez-Villegas A, Bes-Rastrollo M, López CN, Martínez-González MA. Relationship between body image disturbance and incidence of depression: the SUN prospective cohort. BMC Public Health 2009;9:1.
47. Toschke AM, Küchenhoff H, Koletzko B, von Kries R. Meal frequency and childhood obesity. Obes Res 2005;13(11):1932–1938.
48. Cho KJ. The research study on the food habits according to obesity index of primary school children in Busan. Korean J Food Cult 2004;19(1):106–117.
49. Lee MS, Sung CJ, Sung MK, Choi MK, Lee YS, Cho KO. A comparative study on food habits and nutrient intakes among high school students with different obesity indexes residing in Seoul and Kyunggi-do. Korean J Community Nutr 2000;5(2):141–151.