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"There's No Separating My View of My Body from My Autism": A qualitative study of positive body image in autistic individuals

Longhurst P, Aspell J, Todd J, Swami V

Body Image, 2024 Mar;48:101655.
PMID: 38042087 DOI: 10.1016/j.bodyim.2023.101655

While scholars have investigated positive body image across diverse populations, extant theory largely excludes those with differing socio-cognitive experiences, such as autistic individuals. Using constructivist grounded theory, this study sought to develop a grounded theory of positive body image in autistic individuals. One-to-one interviews with photo-elicitation were conducted with 20 autistic adults (7 women, 8 men, 5 non-binary/agender; aged 18-53 years) from the United Kingdom. Through a process of open, axial, and focused coding, a grounded theory was developed around a core category of positive body image in autistic adults and was found to comprise six themes: body connection, body acceptance, appreciating body functionality and neurodivergent strengths, having a body-positive protective filter, taking care of the body, and body and appearance neutrality. Our findings suggest that some aspects of positive body image in autistic individuals are consistent with those found in neurotypical adults. However, positive body image in autistic individuals further encompasses both the sensory (i.e., how the body is felt) and aesthetic (i.e., how the body is seen) body. These findings may stimulate research aimed at improving positive body image in autistic populations.
Greek adaptation of the Teruel Orthorexia Scale (TOS) in adults from the Republic of Cyprus: A bidimensional model may not be universal

Argyrides M, Anastasiades E, Maïano C, Swami V

Appetite, 2024 Mar 01;194:107180.
PMID: 38145878 DOI: 10.1016/j.appet.2023.107180

The Teruel Orthorexia Scale (TOS) is a 17-item instrument designed to assess distinct facets of Orthorexia Nervosa (ON) and Healthy Orthorexia (HO). While a bidimensional model of TOS scores has been supported in diverse national and linguistic groups, the psychometric properties of the TOS have not been previously assessed in Greek-speaking populations. To rectify this, we assessed the psychometric properties of a novel Greek translation of the TOS in a sample of adults from Cyprus. A total of 1248 respondents (710 women, 538 men) completed the Greek TOS, as well as previously validated measures of perfectionism, obsessive-compulsive symptomatology, eating restriction, negative affect, and appearance evaluation. Our results showed that a bidimensional model of the TOS had less-than-adequate fit when modelled using both confirmatory factor analysis and exploratory structural equation modeling (ESEM). Conversely, both exploratory factor analysis and ESEM supported extraction of a 3-factor model consisting of a HO facet and separate components of emotional orthorexia and cognitive-social orthorexia. This 3-factor model showed a lack of measurement bias (measurement invariance across gender identity and lack of differential item functioning as function of age and body mass index), but there were differences in latent factor means as function of respondent age and body mass index. The 3-factor model showed adequate evidence of construct validity, with the latent emotional orthorexia and cognitive-social orthorexia facets showing significant and moderate associations with the additional constructs measured in the survey. Broadly speaking, these findings support the psychometric properties of a 3-factor model of the Greek TOS, but also suggest that the bidimensional model of the TOS may not have universal applicability. We encourage further assessments of factorial validity in other national and linguistic contexts.
Fulltext Associations Between Negative Body Image and Sexual Health Practices in Emerging Adults from Malaysia

Goh PH, Luginbuehl T, Swami V

Arch Sex Behav, 2024 Apr;53(4):1473-1486.
PMID: 38321341 DOI: 10.1007/s10508-024-02810-y

Past findings on the association between negative body image and sexual health behaviors have been mixed and mostly derived from Western samples. The aim of the current study was to examine associations between indices of negative body image and sexual health practices that reduce the risk of disease transmission in emerging adults, and whether these associations are moderated by gender. Using an online survey, a convenience sample of 584 Malaysian adults aged 18-30 years (230 men, 354 women) completed measures of satisfaction with overall appearance, body size dissatisfaction, weight satisfaction, height satisfaction, and genital image evaluation. They also reported if they ever had partnered sex, condomless sex, and been screened for human immunodeficiency virus (HIV), as well as their lifetime number of penetrative sex partners. Hierarchical logistic and ordinal regression analyses indicated that more positive genital image evaluation, but not the other body image indices, was significantly associated with having had partnered sex and fewer lifetime penetrative sex partners. None of the body image indices were significantly associated with condomless sex. All associations were consistent across men and women. For HIV testing, a significant interaction between genital image evaluation and gender emerged. However, this was reduced to non-significance after controlling for the number of penetrative sex partners. Overall, our findings underline the importance of promoting improved genital image in interventions aimed at increasing positive sexual health behaviors.
Fulltext Nature Exposure and Positive Body Image: A Cross-Sectional Study Examining the Mediating Roles of Physical Activity, Autonomous Motivation, Connectedness to Nature, and Perceived Restorativeness

Baceviciene M, Jankauskiene R, Swami V

Int J Environ Res Public Health, 2021 Nov 22;18(22).
PMID: 34832003 DOI: 10.3390/ijerph182212246

Research shows that nature exposure is directly and indirectly associated with more positive body image, which is an important facet of well-being more generally. In this study, we tested the mediating roles of physical activity in nature, perceived restoration in nature, autonomous motivation, and connectedness to nature in explaining the association between nature exposure and positive body image. An online sample of 924 Lithuanian adults (age M = 40.0 years, 73.6% women) completed a survey that included the Nature Exposure (NE) Scale, the Body Appreciation Scale-2, a measure of frequency of physical activity in nature (PAN), the Behavioral Regulation in Exercise Questionnaire-2, the Restoration Outcome Scale, and the Connectedness to Nature Scale. Path analysis was conducted to examine hypothesized direct and indirect effects. Results showed that both greater NE (B = 0.564, SE = 0.057, p < 0.001) and autonomy in exercise motivation (B = 0.039, SE = 0.006, p < 0.001) were associated with more frequent PAN. Direct effects from exercise autonomy to nature restorativeness (B = 0.017, SE = 0.006, p = 0.004) and body appreciation (B = 0.041, SE = 0.004, p < 0.001) were observed. Associations were also found between connectedness to nature and body appreciation (B = 0.166, SE = 0.040, p < 0.001), nature restorativeness and body appreciation (B = 0.075, SE = 0.019, p < 0.001), and frequency of PAN and body appreciation (B = 0.064, SE = 0.019, p < 0.001). PAN mediated the relationship between NE and body appreciation. The final model was invariant across place of residence (urban vs. rural) and gender. Including self-determined physical activity in nature may increase the effectiveness of intervention programs aimed at promoting more positive body image.
Fulltext Examination of the factor structure of the Schizotypal Personality Questionnaire among British and Trinidadian adults

Barron D, Swami V, Towell T, Hutchinson G, Morgan KD

Biomed Res Int, 2015;2015:258275.
PMID: 25699263 DOI: 10.1155/2015/258275

Much debate in schizotypal research has centred on the factor structure of the Schizotypal Personality Questionnaire (SPQ), with research variously showing higher-order dimensionality consisting of two to seven dimensions. In addition, cross-cultural support for the stability of those factors remains limited. Here, we examined the factor structure of the SPQ among British and Trinidadian adults. Participants from a White British subsample (n = 351) resident in the UK and from an African Caribbean subsample (n = 284) resident in Trinidad completed the SPQ. The higher-order factor structure of the SPQ was analysed through confirmatory factor analysis, followed by multiple-group analysis for the model of best fit. Between-group differences for sex and ethnicity were investigated using multivariate analysis of variance in relation to the higher-order domains. The model of best-fit was the four-factor structure, which demonstrated measurement invariance across groups. Additionally, these data had an adequate fit for two alternative models: (a) 3-factor and (b) modified 4-factor model. The British subsample had significantly higher scores across all domains than the Trinidadian group, and men scored significantly higher on the disorganised domain than women. The four-factor structure received confirmatory support and, importantly, support for use with populations varying in ethnicity and culture.
Sociocultural adjustment among sojourning Malaysian students in Britain: a replication and path analytic extension

Swami V, Arteche A, Chamorro-Premuzic T, Furnham A

Soc Psychiatry Psychiatr Epidemiol, 2010 Jan;45(1):57-65.
PMID: 19337675 DOI: 10.1007/s00127-009-0042-4

The present study examined the sociocultural adjustment of 249 sojourning Malaysian undergraduates in Britain. One-hundred and ten Malay and 139 Chinese students enrolled in various courses answered a self-report questionnaire that examined various aspects of sociocultural adjustment and socio-demographics. Overall, Malay students reported significantly poorer sociocultural adjustment than Chinese students, as well as more negative outcomes on a range of predictors. Path analysis for the total sample showed that higher family income led to greater sociocultural adjustment, but partially because it led to more contact with host and conationals, better language proficiency, lower perceived cultural differences and less perceived discrimination. Moreover, participants with higher English proficiency were better adapted, but partially because they perceived less cultural differences as well as having more contact with host nationals. Additionally, individuals reporting better sociocultural adjustment also reported better health statuses. The same model was equally useful at predicting sociocultural adjustment for both Malay and Chinese participants. These results are discussed in terms of the role played by income in buffering against the negative aspects of sociocultural adjustment.
Beliefs in genetic determinism and attitudes towards psychiatric genetic research: psychometric scale properties, construct associations, demographic correlates, and cross-cultural comparisons

Voracek M, Swami V, Loibl LM, Furnham A

Psychol Rep, 2007 Dec;101(3 Pt 1):979-86.
PMID: 18232457

Using two new scales, this study examined beliefs in genetic determinism and attitudes towards psychiatric genetic research in student samples from Austria, Malaysia, Romania, and the United Kingdom. For both constructs, effects of culture were detectable, whereas those related to key demographics were either small and inconsistent across samples (political orientation and religiosity) or zero (sex and age). Judged from factorial dimensionality and internal consistency, the psychometric properties of both scales were satisfactory. Belief in genetic determinism had lower prevalence and corresponded only modestly to positive attitudes towards psychiatric genetic research which had higher prevalence. The correlations of both constructs with a preference of inequality among social groups (social dominance orientation) were modest and inconsistent across samples. Both scales appear appropriate for cross-cultural applications, in particular for research into lay theories and public perceptions regarding genetic vs environmental effects on human behavior, mental disorders, and behavioral and psychiatric genetic research related to these.
Psychometric properties of the Drive for Muscularity Scale in Malay men

Swami V, Barron D, Lau PL, Jaafar JL

Body Image, 2016 Jun;17:111-6.
PMID: 27037873 DOI: 10.1016/j.bodyim.2016.03.004

The Drive for Muscularity Scale (DMS) is a widely used measure in studies of men's body image, but few studies have examined its psychometric properties outside English-speaking samples. Here, we assessed the factor structure of a Malay translation of the DMS. A community sample of 159 Malay men from Kuala Lumpur, Malaysia, completed the DMS, along with measures of self-esteem, body appreciation, and muscle discrepancy. Exploratory factor analysis led to the extraction of two factors, differentiating attitudes from behaviours, which mirrors the parent scale. Both factors also loaded on to a higher-order drive for muscularity factor. The subscales of the Malay DMS had adequate internal consistencies and good convergent validity, insofar as significant relationships were reported with self-esteem, body appreciation, muscle discrepancy, and body mass index. These results indicate that the Malay DMS has acceptable psychometric properties and can be used to assess body image concerns in Malay men.
Correlates of appearance and weight satisfaction in a U.S. National Sample: Personality, attachment style, television viewing, self-esteem, and life satisfaction

Frederick DA, Sandhu G, Morse PJ, Swami V

Body Image, 2016 Jun;17:191-203.
PMID: 27172812 DOI: 10.1016/j.bodyim.2016.04.001

We examined the prevalence and correlates of satisfaction with appearance and weight. Participants (N=12,176) completed an online survey posted on the NBCNews.com and Today.com websites. Few men and women were very to extremely dissatisfied with their physical appearances (6%; 9%), but feeling very to extremely dissatisfied with weight was more common (15%; 20%). Only about one-fourth of men and women felt very to extremely satisfied with their appearances (28%; 26%) and weights (24%; 20%). Men and women with higher body masses reported higher appearance and weight dissatisfaction. Dissatisfied people had higher Neuroticism, more preoccupied and fearful attachment styles, and spent more hours watching television. In contrast, satisfied people had higher Openness, Conscientious, and Extraversion, were more secure in attachment style, and had higher self-esteem and life satisfaction. These findings highlight the high prevalence of body dissatisfaction and the factors linked to dissatisfaction among U.S. adults.
Associations between belief in conspiracy theories and the maladaptive personality traits of the personality inventory for DSM-5

Swami V, Weis L, Lay A, Barron D, Furnham A

Psychiatry Res, 2016 Feb 28;236:86-90.
PMID: 26776299 DOI: 10.1016/j.psychres.2015.12.027

Conspiracy theories can be treated as both rational narratives of the world as well as outcomes of underlying maladaptive traits. Here, we examined associations between belief in conspiracy theories and individual differences in personality disorders. An Internet-based sample (N=259) completed measures of belief in conspiracy theories and the 25 facets of the Personality Inventory for DSM-5 (PID-5). Preliminary analyses showed no significant differences in belief in conspiracy theories across participant sex, ethnicity, and education. Regression analyses showed that the PID-5 facets of Unusual Beliefs and Experiences and, to a lesser extent, Suspiciousness, significantly predicted belief in conspiracy theories. These findings highlight a role for maladaptive personality traits in understanding belief in conspiracy theories, but require further investigation.
The Breast Size Rating Scale: Development and psychometric evaluation

Swami V, Cavelti S, Taylor D, Tovée MJ

Body Image, 2015 Jun;14:29-38.
PMID: 25828842 DOI: 10.1016/j.bodyim.2015.02.004

Existing measures of breast size dissatisfaction have poor ecological validity or have not been fully evaluated in terms of psychometric properties. Here, we report on the development of the Breast Size Rating Scale (BSRS), a novel measure of breast size dissatisfaction consisting of 14 computer-generated images varying in breast size alone. Study 1 (N=107) supported the scale's construct validity, insofar as participants were able to correctly order the images in terms of breast size. Study 2 (N=234) provided evidence of the test-retest reliability of BSRS-derived scores after 3 months. Studies 3 (N=730) and 4 (N=234) provided evidence of the convergent validity of BSRS-derived breast size dissatisfaction scores, which were significantly associated with a range of measures of body image. The BSRS provides a useful tool for researchers examining women's breast size dissatisfaction.
The Body Acceptance by Others Scale: An assessment of its factorial validity in adults from the United Kingdom

Swami V, Todd J, Stieger S, Tylka TL

Body Image, 2020 Dec;35:71-74.
PMID: 32947248 DOI: 10.1016/j.bodyim.2020.08.006

The construct of body acceptance by others (i.e., the degree to which an individual perceives acceptance for their appearance by others) is central to conceptual models of positive body image and adaptive eating styles. It is typically measured using the 10-item Body Acceptance by Others Scale (BAOS; Avalos & Tylka, 2006), but emerging research has suggested that a unidimensional model of BAOS scores may be unstable. Here, we examined the factor structure of BAOS scores in a sample of adults from the United Kingdom (N = 1148). Exploratory factor analyses indicated that BAOS scores reduced to two dimensions in women, of which only a primary 6-item factor was stable. In men, all 10 items loaded onto a primary factor. However, the results of confirmatory factor analyses indicated that both models of BAOS scores had poor fit. Although both the unidimensional 10-item and 6-item models had adequate internal consistency, our results are suggestive of factor structure instability. We conclude by suggesting ways in which future research could revise the BAOS to improve its factorial stability and validity.
Psychometric properties of an Italian translation of the Functionality Appreciation Scale (FAS)

Cerea S, Todd J, Ghisi M, Mancin P, Swami V

Body Image, 2021 Sep;38:210-218.
PMID: 33962221 DOI: 10.1016/j.bodyim.2021.04.007

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) is a widely used instrument for the measurement of individual's appreciation of their body for what it can do and is capable of doing (i.e., functionality appreciation). Here, we examined the psychometric properties of a novel Italian translation of the FAS. A sample of 950 Italian adults completed the FAS, as well as previously validated measures of body image (body appreciation, body esteem, body surveillance), disordered eating symptoms, and psychological well-being (self-esteem, general distress). Exploratory and confirmatory factor analyses supported a 1-dimensional model of FAS scores, with all 7 items retained. Scores achieved scalar invariance across gender, and the gender difference in latent FAS scores was not significant. FAS scores were found to have adequate internal consistency, test-retest reliability up to three weeks, and convergent and criterion-related validity through significant correlations with all additional constructs. However, evidence of incremental validity was weak, and likely reflected high nomological and conceptual similarity between functionality and body appreciation in this national context. Overall, these results provide strong evidence that scores on the Italian FAS are psychometrically valid, which may aid future development of interventions to promote more positive body image in Italian-speaking samples.
Psychometric properties of the Malay Schizotypal Personality Questionnaire: Measurement invariance and latent mean comparisons in Malaysian adults

Barron D, Morgan KD, Towell T, Jaafar JL, Swami V

Asia Pac Psychiatry, 2018 Mar;10(1).
PMID: 28677341 DOI: 10.1111/appy.12293

INTRODUCTION: The Schizotypal Personality Questionnaire (SPQ) is a widely used self-report measurement instrument for the assessment of schizotypal personality traits. However, the factor structure of the SPQ has been a matter of some debate. As a contribution to this debate, we examined the factor structure of the SPQ in Malaysian adults.
METHOD: A total of 382 Malaysian adults completed a Malay translation of the SPQ. Confirmatory factory analysis was used to examine the fit of 3- and 4-factor solutions for the higher-order dimensionality of the SPQ. Ethnic invariance for the best-fitting model was tested at the configural, metric, and scalar levels, and a multivariate analysis of variance was used to examine sex and ethnicity differences in domain scores.
RESULTS: The 4-factor model provided a better fit to the data than did the 3-factor model. The 4-factor model also demonstrated partial measurement invariance across ethnic groups. Latent mean comparisons for sex and ethnicity revealed a number of significant differences for both factors, but effect sizes were small.
DISCUSSION: The 4-factor structure of the SPQ received confirmatory support and can be used in Malay-speaking populations.
An exploration of the associations between facets of interoceptive awareness and body image in adolescents

Todd J, Aspell JE, Barron D, Swami V

Body Image, 2019 Dec;31:171-180.
PMID: 31654981 DOI: 10.1016/j.bodyim.2019.10.004

Previous research suggests that lower interoceptive awareness is associated with more negative body image during adolescence. However, studies have not distinguished between adaptive and maladaptive modes of attention toward interoceptive signals, and relationships between interoceptive awareness and positive body image remain unexplored. To address these issues, a sample of 265 British adolescents (140 girls, 125 boys) aged 13-16 years completed measures of interoceptive awareness, body appreciation, functionality appreciation, body pride, body shame, and body surveillance. Correlational analyses broadly indicated that greater interoceptive awareness was significantly associated with more positive body image. Multiple regressions revealed significant predictive relationships between interoceptive awareness and all facets of body image in both girls and boys, except body surveillance, which was not statistically significant for girls. At the univariate level, the interoceptive awareness facets of Attention Regulation, Body Listening, Self-Regulation, and Trusting emerged as significant predictors for at least one facet of positive body image, whilst the Noticing and Emotional Awareness facets did not. These findings broadly align with previous research with adults, which has indicated that the way interoceptive stimuli are appraised and responded to might be more closely associated with facets of body image than the tendency to notice interoceptive stimuli.
Multiple dimensions of interoceptive awareness are associated with facets of body image in British adults

Todd J, Aspell JE, Barron D, Swami V

Body Image, 2019 Jun;29:6-16.
PMID: 30771695 DOI: 10.1016/j.bodyim.2019.02.003

Previous research has identified a relationship between interoception and body image, where lower interoceptive awareness (IA) is associated with negative body image. However, relationships between facets of interoception and positive body image remain unexplored, and men and older adults remain underrepresented. To overcome these limitations, we assessed relationships between multiple dimensions of interoceptive awareness (IA) and multiple facets of body image in community adults. An online sample of 646 British adults (447 women) aged 18-76 years completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), the Body Appreciation Scale-2, the Functionality Appreciation Scale, the Authentic Pride subscale from the Body and Appearance Self-Conscious Emotions Scale, and the Appearance Orientation and Overweight Preoccupation subscales from the Multidimensional Body-Self Relations Questionnaire. Hierarchical regressions revealed significant predictive relationships between IA and all five facets of body image after controlling for sex, body mass index, and age. In the final models, the MAIA subscales emerged as significant predictors for at least one facet of body image, with the exception of the MAIA Body Listening subscale. These findings extend previous work by demonstrating significant relationships between IA and previously unexplored facets of body image, which may hold promise for practitioner-based interventions.
Motherhood status moderates the relationship between perfectionistic self-presentation and breast size dissatisfaction

Lombardo C, Panasiti MS, Vacca M, Grano C, Swami V

Body Image, 2019 Sep;30:75-80.
PMID: 31200234 DOI: 10.1016/j.bodyim.2019.05.005

Perfectionistic self-presentation refers to a desire to create an image of flawlessness in the eyes of the others and has been associated with more negative body image. We extended previous research by examining associations between perfectionistic self-presentation and breast size dissatisfaction, and also examined whether motherhood status moderated this association. A total of 484 Italian women (age M = 40.39, SD = 13.73; mothers n = 53.9%) completed measures of perfectionistic self-presentation (perfectionistic self-promotion, nondisplay of imperfection, and nondisclosure of imperfection) and breast size dissatisfaction. Preliminary analyses indicated that a majority of the sample (69.2%) reported breast size dissatisfaction, with 44.4% and 24.4% desiring larger and smaller breasts, respectively, than they currently had. Only perfectionistic self-promotion and nondisplay of imperfection were significantly correlated with breast size dissatisfaction. Both associations were additionally moderated by motherhood status, with associations being significant in non-mothers but not in mothers. Our findings suggest that motherhood may help decouple the link between perfectionistic self-presentation and breast size dissatisfaction. Future studies should assess whether this effect is due to an enhanced maternal view of breasts that emphasises nurturing and biological functions or a result of weaker investment in sociocultural norms on physical appearance.
Weaker implicit interoception is associated with more negative body image: Evidence from gastric-alpha phase amplitude coupling and the heartbeat evoked potential

Todd J, Cardellicchio P, Swami V, Cardini F, Aspell JE

Cortex, 2021 10;143:254-266.
PMID: 34482968 DOI: 10.1016/j.cortex.2021.07.006

Interoception refers to the processing of internal bodily stimuli, while body image refers to appearance-related perceptions, affect, and cognitions. Previous research has found that body image is associated with self-reported and behavioural indices of interoception. Here, we extended this research by examining associations between measures of positive (i.e., body appreciation, functionality appreciation) and negative body image (i.e., body shame, weight preoccupation) and two electrophysiological indices of interoceptive processing, namely the heartbeat evoked potential (HEP) and gastric-alpha phase-amplitude coupling (PAC), in a sample of 36 adults. Significant negative associations were identified between the indices of negative body image and the interoception variables. Specifically, more negative HEP amplitude and lower gastric-alpha PAC were both associated with greater body shame and weight preoccupation. However, no significant associations were identified for the indices of positive body image. These findings extend previous work by demonstrating that there are significant associations between negative body image and previously unexplored components of cardiac and gastric interoception. This, in turn, could have important clinical applications, such as the HEP and gastric-alpha PAC both serving as biomarkers of negative body image.
Developing a model linking self-reported nature exposure and positive body image: A study protocol for the body image in nature survey (BINS)

Swami V, Tran US, Stieger S, Voracek M

Body Image, 2021 Nov 26;40:50-57.
PMID: 34844138 DOI: 10.1016/j.bodyim.2021.11.002

Exposure to natural environments has been shown to be associated with more positive body image, but much of the existing research is limited to Western European nations and little is known about the robustness of these associations in other national contexts. In this protocol paper, we present a conceptual model of the direct and indirect associations (i.e., via self-compassion, connectedness to nature, and restorative experiences in nature) between nature exposure and body appreciation. This model brings together conceptualisations from existing research, but also extends it in a number of important ways. The model will be tested through the Body Image in Nature Survey (BINS), a researcher-crowdsourced project involving researchers in multiple nations worldwide. Data collection began in December 2020 and is expected to be completed in February 2022. Data will be analysed to examine the extent to which our conceptual model is robust across nations, as well as other sociodemographic characteristics. We will also determine the extent to which key variables included in our survey are invariant across nations and associated with cultural, socioeconomic, and gender-related factors. The BINS will likely have important implications for the development of nature-based interventions to promote healthier body appreciation in diverse national contexts.
Associations between weight status, body satisfaction, ethnic identity and self-esteem in Oceanian adolescents

Frayon S, Swami V, Wattelez G, Todd J, Galy O

Pediatr Obes, 2021 12;16(12):e12824.
PMID: 34184838 DOI: 10.1111/ijpo.12824

BACKGROUND: Self-esteem has consistently been observed to be relatively low in adolescents with obesity. In the Pacific region, the prevalence of obesity in adolescence is high, but few studies have considered issues of self-esteem in this population.
OBJECTIVE: To examine associations between weight status, body dissatisfaction and self-esteem in a sample of New Caledonian adolescents and to test for moderation effects of ethnicity on predictors of self-esteem.
METHODS: Objective anthropometric measures (height, weight, waist circumference and thickness of skinfolds) were obtained in a multi-ethnic sample of New Caledonian adolescents. Body mass index (BMI), waist-to-height ratio and the sum of four skinfolds thickness were used as proxies of weight status. Indices of ethnic identity, self-esteem, socio-demographic data (socioeconomic status, ethnicity, gender, urbanicity of residence) and body dissatisfaction were obtained using survey methods.
RESULTS: Between-group analyses indicated that adolescents of European/white origin had significantly higher self-esteem than adolescents with Oceanian Non-European Non-Asian ancestry (ONENA). However, low self-esteem was significantly associated with weight status and body dissatisfactions in European/white adolescents but not ONENA adolescents. Ethnicity moderated the relationships of predictors (BMI z-score, body dissatisfaction, age, urbanicity and ethnic identity) on self-esteem, and the strongest predictors of self-esteem were ethnicity and ethnic identity.
CONCLUSIONS: While self-esteem has important consequences for adolescent well-being and health outcomes, these results highlight the importance of applying different steps to develop and maintain healthy self-esteem in the Pacific region.

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