**4. Methodological aspects in the study of dissatisfaction with body image**

People who are extremely worried with their physical appearance are also susceptible to a negative or distorted body image (Castilho, 2001). Recent studies show that dissatisfaction with the body has reached alarming levels and has affected people in several age brackets (Conti, 2008; Coqueiro et al., 2008; Tribess et al., 2010; Triches & Giugliani, 2007).

Leonhard and Barry (1998) remark that the very first studies on body image were restricted to and underscored body measurements, or rather, they focused on subjects classified as obese according to the BMI. The ideal current standard of feminine beauty corresponds to extreme slimness, whereas obesity is a negative factor in people's life. A high BMI is also related to discontent with one's body (Robinson et al., 2001).

Several analyses have shown that overweight school children and adolescents manifest low self-esteem and dissatisfaction with their body image when they compare themselves to eutrophic schoolmates (Gleaves et al., 1995; Pinheiro & Giugliani, 2006a; Stice et al., 1996; Tiggemann, 1994). An investigation among students in the USA showed that body dissatisfaction featuring weight concern is highly prevalent among both sexes, in different ethnic groups and in social and economical classes. In fact, high BMI rates were always related to body dissatisfaction (Robinson et al., 2001).

It has been verified in current study that most eutrophic girls desire to be slimmer in contrast to boys' ideal for a bigger body or a bigger body form (Robinson et al., 2001) From the feminine point of view the ideal beauty stereotype is basically a lean and slim body, similar to the Barbie® doll which represents the ideal feminine slimness (Norton et al., 1996), whereas the male's point of view focuses on the robust and muscular body shape as the ideal of beauty, very similar to the super-heroes dolls male children play with (Pope et al., 1999).

A study among Brazilian adolescents in the state of Paraná, aged 15 – 19 years, verified that 48.6% of female adolescents with negative body image were eutrophic; only 2.6% of adolescents classified with malnutrition or on the malnutrition border had such disturbances; 14.5% of adolescents who had body image disturbance were actually overweight or obese. In the case of male adolescents, only 10% of the eutrophic group had body image disturbances and 8.6% were overweight or obese (Souza-Kaneshima et al., 2006; Souza-Kaneshima et al., 2008).

Bulimia Nervosa and Dissatisfaction of Adolescent's Body Shape 95

alternative receives marks from 0 to 3, namely, 3 = most of the time; 2 = frequently; 1 = rarely; 0 = never. The test is subdivided into 3 sub-scales: (1) dissatisfaction with body image and food restriction, with 22 items; (2) compulsive eating behaviour, with 15 items; (3) 4 items for compensation behaviour associated to feeding disorders indicated by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). First and second scales are

Due to their practical application and correction, the Body Shape Questionnaire (BSQ) and the Body Silhouette Figure method are currently the most quoted in the literature dealing with the evaluation of body image distortion in population studies (Mendelson et al., 2002). The Body Shape Questionnaire (BSQ) has been developed by Cooper et al. (1987) and incorporates the influence of the social milieu. It also provides an underlying evaluation of body image disorders in clinical and non-clinical populations and may be employed to evaluate the influence of body image disorders in the development, maintenance and in treatment response to feeding disturbances (Branco et al., 2006; Lemes et al., 2001; Oliveira et al., 2003). The questionnaire is composed of 34 points, each with six alternative answers, varying between "always" and "never". Marks from 1 to 6 (always = 6; very frequent = 5; frequent = 4; sometimes = 3; rarely = 2; never = 1) are given to each answer. Test result is the sum of the 34 items in the questionnaire. Result classification features levels of concern with body image, or rather, less than 70 marks means normal standard and no concern with body image distortion; marks between 70 and 90 demonstrate a mild concern on body image distortion; marks between 91 and 110 mean a moderate concern with distortion; above 110

grouped for a total score and the items of the third scale are individually evaluated.

marks means a marked concern with body image distortion (Assunção et al., 2002).

(Cooper et al., 1987; Freitas et al., 2002).

Kaneshima et al., 2006; Souza-Kaneshima et al., 2008).

(Ferrando et al., 2002).

Therefore, BSQ measures concerns with body form, with self-disparaging due to physical appearance and with the feeling of being 'fat'. Since it evaluates the body image's affective aspect, it is a very promising and helpful tool for the clinical follow-up of patients with eating disorders, such a bulimia nervosa (Conti, 2008; Kakeshita, 2004). Although BSQ initially evaluated the body image distortion in women with eating disorders, some studies show that it may also be used to measure concern on body form, weight and, in particular, the frequency people of both sexes, with or without eating disorder, feel that they are "fat"

Other investigations evaluated BSQ in different populations without any eating disorders. Good discriminating indexes in the test's validity and reliability and its repetition, coupled to internal consistency, have been reported (Rosen et al., 1996) Although different studies may highly diverge in their dissatisfaction index with the body image, most authors agree on a high body dissatisfaction index during adolescence, mainly with the female sex, which influences the emotional (dissatisfaction) and the perceptive (high estimation) dimensions

Almost 75% of adolescent high school students in the state of Paraná, Brazil, aged 15 – 19, reveal a normal BMI and therefore are eutrophic subjects. Nevertheless, the BSQ questionnaire revealed that half of them had body image disorders. Moreover, a comparative analysis between the sexes verified that only 34.2% of female adolescents failed to manifest any body image disturbances. The other interviewed adolescents manifested the following degrees in image: 23.9% with mild disorders; 31.6% with moderate disorders; 10.3% with marked disorders. On the other hand, body image disorders in male adolescents were lower, featuring 11.4 and 7.2% with mild and moderate disorders respectively (Souza-

When body weight awareness is higher than the body mass, the introduction of important changes in eating behaviour is enhanced. In fact, the discussion of the theme in different population segments is mandatory so that the significance of the phenomenon could be acknowledged and strategies to tackle the problem planned (Nunes et al., 2001). The development of tools to detect possible body image distortions in different population groups and the choice of such instruments are essential for the validity of the results.

Gender and ethnic groups manifest different types and degrees of body dissatisfaction. For instance, females have a higher propensity to develop body image discontent. This is due to the fact that they are constantly evaluated by society, especially with regard to their physical appearance. Even males may demonstrate body image distortions for the same reasons (Alvarez-Rayon et al., 2009; Costa et al., 2008; Cordas, 2004; Mond et al., 2004; Nunes et al., 2001).

Ethnicity-related physical characteristics also affect the adolescents' body satisfaction. A study in the state of Minnesota, USA, showed that Afro-American and mixed-race adolescents had a high body image satisfaction amounting to almost three times that in whites. On the other hand, Hispanics and Asians had the least satisfaction degree within the analyzed group (Kelly et al., 2005).

The age bracket also affects the evaluation of the body image. Young women show a higher rate of dissatisfaction as from their 13th or 15th year, while the male has a high degree of body image satisfaction at the same age. This is due to the fact that an increase in height and muscular mass occurs in male adolescents at this age, which brings them close to the ideal social and cultural image of the male body (Kelly et al., 2005; Raudenbush & Zellner, 1997). Male adolescents may later have difficulties in the maintenance of their physical profile and consequently a lowering of body satisfaction levels occurs (McCabe & Ricciardelli, 2004a).

The very first studies on this issue underscored body measurements even though social and behavioural aspects which may affect body image distortion were not taken into account. This occurred in spite of the fact that authors related gender, ethnic background and age bracket as factors that could affect body dissatisfaction.

The Body Cathexis Scale (Secord & Jourard, 1953) was one of the first self-evaluation ratings. In 1973, Berscheid et al. developed the Body Image Questionnaire and in 1984, Winstead & Cash introduced the Body-Self Relations Questionnaire (BSRQ). This questionnaire contains 140 items which the patients answer on a 5-point scale. Items deal with patients' attitudes and activities in three body areas: physical appearance, physical form and physical health.

The Body Attitudes Questionnaire (BAQ) (Ben-Tovim & Walker, 1994) is a self-report questionnaire with 44 items, developed for those with concerns for body appearance, and deals with the measurement of several attitudes related to the body. Answers may be grouped into six sub-scales which describe (1) overall fatness ("Feeling fat"); (2) selfdisparagement ("Depreciation"); strength ("Strength and Physical Fitness"); (4) salience of weight ("Salience"); (5) feelings of attractiveness especially with people of the opposite sex ("Physical attraction"); (6) consciousness of lower body ("Lower limbs fatness"). High scores in the subscales "Feeling fat", "Depreciation", "Salience" and "Lower limbs fatness" produce negative attitudes with regard to the body. High scores in "Strength and Physical Fitness" and "Physical Attraction" cause positive attitudes with regard to the body.

Candy & Fee (1998) developed the Eating Behaviours and Body Image Test (EBBIT) to identify feeding behaviour and body image in pre-adolescent girls. It is a 42-item self-report questionnaire with four answer alternatives in which eating behaviour for each reply receives different marks. Answers range from "Most of the time" to "Never", while each

When body weight awareness is higher than the body mass, the introduction of important changes in eating behaviour is enhanced. In fact, the discussion of the theme in different population segments is mandatory so that the significance of the phenomenon could be acknowledged and strategies to tackle the problem planned (Nunes et al., 2001). The development of tools to detect possible body image distortions in different population

Gender and ethnic groups manifest different types and degrees of body dissatisfaction. For instance, females have a higher propensity to develop body image discontent. This is due to the fact that they are constantly evaluated by society, especially with regard to their physical appearance. Even males may demonstrate body image distortions for the same reasons (Alvarez-Rayon et al., 2009; Costa et al., 2008; Cordas, 2004; Mond et al., 2004; Nunes et al.,

Ethnicity-related physical characteristics also affect the adolescents' body satisfaction. A study in the state of Minnesota, USA, showed that Afro-American and mixed-race adolescents had a high body image satisfaction amounting to almost three times that in whites. On the other hand, Hispanics and Asians had the least satisfaction degree within the

The age bracket also affects the evaluation of the body image. Young women show a higher rate of dissatisfaction as from their 13th or 15th year, while the male has a high degree of body image satisfaction at the same age. This is due to the fact that an increase in height and muscular mass occurs in male adolescents at this age, which brings them close to the ideal social and cultural image of the male body (Kelly et al., 2005; Raudenbush & Zellner, 1997). Male adolescents may later have difficulties in the maintenance of their physical profile and consequently a lowering of body satisfaction levels occurs (McCabe & Ricciardelli, 2004a). The very first studies on this issue underscored body measurements even though social and behavioural aspects which may affect body image distortion were not taken into account. This occurred in spite of the fact that authors related gender, ethnic background and age

The Body Cathexis Scale (Secord & Jourard, 1953) was one of the first self-evaluation ratings. In 1973, Berscheid et al. developed the Body Image Questionnaire and in 1984, Winstead & Cash introduced the Body-Self Relations Questionnaire (BSRQ). This questionnaire contains 140 items which the patients answer on a 5-point scale. Items deal with patients' attitudes and activities in three body areas: physical appearance, physical form and physical health. The Body Attitudes Questionnaire (BAQ) (Ben-Tovim & Walker, 1994) is a self-report questionnaire with 44 items, developed for those with concerns for body appearance, and deals with the measurement of several attitudes related to the body. Answers may be grouped into six sub-scales which describe (1) overall fatness ("Feeling fat"); (2) selfdisparagement ("Depreciation"); strength ("Strength and Physical Fitness"); (4) salience of weight ("Salience"); (5) feelings of attractiveness especially with people of the opposite sex ("Physical attraction"); (6) consciousness of lower body ("Lower limbs fatness"). High scores in the subscales "Feeling fat", "Depreciation", "Salience" and "Lower limbs fatness" produce negative attitudes with regard to the body. High scores in "Strength and Physical

Fitness" and "Physical Attraction" cause positive attitudes with regard to the body.

Candy & Fee (1998) developed the Eating Behaviours and Body Image Test (EBBIT) to identify feeding behaviour and body image in pre-adolescent girls. It is a 42-item self-report questionnaire with four answer alternatives in which eating behaviour for each reply receives different marks. Answers range from "Most of the time" to "Never", while each

groups and the choice of such instruments are essential for the validity of the results.

2001).

analyzed group (Kelly et al., 2005).

bracket as factors that could affect body dissatisfaction.

alternative receives marks from 0 to 3, namely, 3 = most of the time; 2 = frequently; 1 = rarely; 0 = never. The test is subdivided into 3 sub-scales: (1) dissatisfaction with body image and food restriction, with 22 items; (2) compulsive eating behaviour, with 15 items; (3) 4 items for compensation behaviour associated to feeding disorders indicated by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). First and second scales are grouped for a total score and the items of the third scale are individually evaluated.

Due to their practical application and correction, the Body Shape Questionnaire (BSQ) and the Body Silhouette Figure method are currently the most quoted in the literature dealing with the evaluation of body image distortion in population studies (Mendelson et al., 2002).

The Body Shape Questionnaire (BSQ) has been developed by Cooper et al. (1987) and incorporates the influence of the social milieu. It also provides an underlying evaluation of body image disorders in clinical and non-clinical populations and may be employed to evaluate the influence of body image disorders in the development, maintenance and in treatment response to feeding disturbances (Branco et al., 2006; Lemes et al., 2001; Oliveira et al., 2003). The questionnaire is composed of 34 points, each with six alternative answers, varying between "always" and "never". Marks from 1 to 6 (always = 6; very frequent = 5; frequent = 4; sometimes = 3; rarely = 2; never = 1) are given to each answer. Test result is the sum of the 34 items in the questionnaire. Result classification features levels of concern with body image, or rather, less than 70 marks means normal standard and no concern with body image distortion; marks between 70 and 90 demonstrate a mild concern on body image distortion; marks between 91 and 110 mean a moderate concern with distortion; above 110 marks means a marked concern with body image distortion (Assunção et al., 2002).

Therefore, BSQ measures concerns with body form, with self-disparaging due to physical appearance and with the feeling of being 'fat'. Since it evaluates the body image's affective aspect, it is a very promising and helpful tool for the clinical follow-up of patients with eating disorders, such a bulimia nervosa (Conti, 2008; Kakeshita, 2004). Although BSQ initially evaluated the body image distortion in women with eating disorders, some studies show that it may also be used to measure concern on body form, weight and, in particular, the frequency people of both sexes, with or without eating disorder, feel that they are "fat" (Cooper et al., 1987; Freitas et al., 2002).

Other investigations evaluated BSQ in different populations without any eating disorders. Good discriminating indexes in the test's validity and reliability and its repetition, coupled to internal consistency, have been reported (Rosen et al., 1996) Although different studies may highly diverge in their dissatisfaction index with the body image, most authors agree on a high body dissatisfaction index during adolescence, mainly with the female sex, which influences the emotional (dissatisfaction) and the perceptive (high estimation) dimensions (Ferrando et al., 2002).

Almost 75% of adolescent high school students in the state of Paraná, Brazil, aged 15 – 19, reveal a normal BMI and therefore are eutrophic subjects. Nevertheless, the BSQ questionnaire revealed that half of them had body image disorders. Moreover, a comparative analysis between the sexes verified that only 34.2% of female adolescents failed to manifest any body image disturbances. The other interviewed adolescents manifested the following degrees in image: 23.9% with mild disorders; 31.6% with moderate disorders; 10.3% with marked disorders. On the other hand, body image disorders in male adolescents were lower, featuring 11.4 and 7.2% with mild and moderate disorders respectively (Souza-Kaneshima et al., 2006; Souza-Kaneshima et al., 2008).

Bulimia Nervosa and Dissatisfaction of Adolescent's Body Shape 97

Fig. 1. Silhouette Figure Body Images developed by Stunkard et al. (1983) and modified by

et al., 2010). However, its main limitations are the contour figures designed in a linear bidimensional form which may reproduce shortcomings in body entireness and in fat distribution (O'Brien, et al., 2007). Further, the figures may be foregrounded on biotypes

Studies employing the Figure Body Images with children aged 6 – 12 years showed that in the case of girls the ideal body is substantially smaller that their own, whereas no difference in choice occurred in the case of boys (Williamson & Delin, 2001; McCabe & Ricciardelli, 2004a,b). Owing to a more critical stance by girls with regard to their body image, they manifest a high esteem for their body image which causes a self-awareness related to overweight and obesity. Thus, girls, albeit eutrophic, choose figures with the abovementioned contours. Boys show an inverse distortion of reality, or rather, overweight boys

The Figure Rating method (Stunkard et al., 1983), applied in several Brazilian studies, showed a prevalent 82% of school children dissatisfied with their body image (Erling & Hwang, 2004; Pinheiro & Giugliani, 2006b; Triches & Giugliane, 2007), coupled to 78.8% of university students and physically active adults (Coqueiro et al., 2008; O'Brien et al., 2007). All these analyses report that women desire a decrease in their body contour size, whereas men desire a stronger, more muscular body. Difference in the male's and female's preference of body

which do not correspond to the characteristics of the population under analysis.

choose figures with contours in eutrophic conditions (Branco et al., 2006)

Thompson & Gray (1995).

Predominance of body image dissatisfaction reached 15.3% among university students in Brazil (Luz, 2003). In some countries, such as Spain, body image dissatisfaction amounted to 22.1% among female adolescents (Ferrando et al., 2002), whereas an Australian study identified body frustration in most female adolescents, aged 14 – 16 years. Further, 57% of Australian young women practiced unhealthy diets and 36% ingested anorexigenous pills, diuretics and laxatives, smoked and practiced extremely restrictive diets. The above attitudes clearly show the relationship between body dissatisfaction and abnormal behaviour, suggestive of eating disorders (Grigg et al., 1996). Moreover, a longitudinal investigation among Norwegian young women showed that body image disturbances predispose towards restrictive diets (Friestad & Rise, 2004). Frequent diet practice may be a risk factor favouring the development of eating behaviour disorders, such as bulimia nervosa (Morgan et al., 2002).

Weight dissatisfaction in a group of female university students of the Nutrition Course in Rio de Janeiro, Brazil, was also investigated by BSQ. The slim body ideal imposed by society also prevailed in the group since 58.7% desired a decrease of two or more kilos even though their weight was adequate. A similar desire was shown by almost all the female university students with moderate and marked body image disturbances. The above result is highly relevant since body image distortion may be a risk factor for the development of eating behaviour disorders, such as bulimia nervosa. It should be emphasized that future professionals should take a different view of the patient especially in situations featuring eating disorders. Therefore, awareness of one's own body is part and parcel of the multidimensional character of eating behaviour disorders and should be discussed with future nutritionists so that society's influence in the construction process of ideas of beauty might be assessed. Consequently, their clinical attitudes would include the limits in which weight loss brings a positive impact on people's health (Bosi et al., 2006).

Silhouette Figure Body Images were introduced by Stunkard et al. (1983) with 15 silhouettes for each gender, later developed by Thompson & Gray (1995) with a new 9-silhouette figures (Fig. 1) in individual cards containing a male and a female figure with several silhouettes. Card 1 shows a very slim person (BMI = 12.5 kg/m2) and Card 9 a very obese one (IMC = 47.5 kg/m2). The subjects choose a card with a silhouette that is closest to their body's image, identified as I; another card representing a healthy person is then chosen, identified as HEALTHY; finally, a card is chosen which represents the desired silhouette, identified as IDEAL.

Rating has five variables: 1) the number which corresponds to the current figure; 2) the number which corresponds to the healthy figure; 3) the number that corresponds to the ideal figure; 4) discrepancy scores between the healthy and current figures; and 5) discrepancy scores between the ideal and current figures. Scores range between – 8 and + 8, or rather, the higher the difference, the higher the body discrepancy and, consequently, a greater dissatisfaction rate. Discrepancy scores between the healthy and current figures is a more objective rating for body dissatisfaction, whilst the discrepancy score between the ideal and current figures represents a more emotional stance (Scagliusi et al., 2006).

The Figure Body Images is a fast, easy and simple method, highly efficient in evaluating body distortion and dissatisfaction with weight and body dimensions rate. In fact, it is widely accepted and used by several researchers since it is a valid tool for quantitative studies for body image perception in both sexes (Coqueiro et al., 2008; Damasceno et al., 2005; Gardner et al., 1998; Gardner et al., 1999; Kakeshita, 2004; Madrigal et al., 2000; Tribess

Predominance of body image dissatisfaction reached 15.3% among university students in Brazil (Luz, 2003). In some countries, such as Spain, body image dissatisfaction amounted to 22.1% among female adolescents (Ferrando et al., 2002), whereas an Australian study identified body frustration in most female adolescents, aged 14 – 16 years. Further, 57% of Australian young women practiced unhealthy diets and 36% ingested anorexigenous pills, diuretics and laxatives, smoked and practiced extremely restrictive diets. The above attitudes clearly show the relationship between body dissatisfaction and abnormal behaviour, suggestive of eating disorders (Grigg et al., 1996). Moreover, a longitudinal investigation among Norwegian young women showed that body image disturbances predispose towards restrictive diets (Friestad & Rise, 2004). Frequent diet practice may be a risk factor favouring the development of eating behaviour disorders, such as bulimia

Weight dissatisfaction in a group of female university students of the Nutrition Course in Rio de Janeiro, Brazil, was also investigated by BSQ. The slim body ideal imposed by society also prevailed in the group since 58.7% desired a decrease of two or more kilos even though their weight was adequate. A similar desire was shown by almost all the female university students with moderate and marked body image disturbances. The above result is highly relevant since body image distortion may be a risk factor for the development of eating behaviour disorders, such as bulimia nervosa. It should be emphasized that future professionals should take a different view of the patient especially in situations featuring eating disorders. Therefore, awareness of one's own body is part and parcel of the multidimensional character of eating behaviour disorders and should be discussed with future nutritionists so that society's influence in the construction process of ideas of beauty might be assessed. Consequently, their clinical attitudes would include the limits in which

Silhouette Figure Body Images were introduced by Stunkard et al. (1983) with 15 silhouettes for each gender, later developed by Thompson & Gray (1995) with a new 9-silhouette figures (Fig. 1) in individual cards containing a male and a female figure with several silhouettes. Card 1 shows a very slim person (BMI = 12.5 kg/m2) and Card 9 a very obese one (IMC = 47.5 kg/m2). The subjects choose a card with a silhouette that is closest to their body's image, identified as I; another card representing a healthy person is then chosen, identified as HEALTHY; finally, a card is chosen which represents the desired silhouette,

Rating has five variables: 1) the number which corresponds to the current figure; 2) the number which corresponds to the healthy figure; 3) the number that corresponds to the ideal figure; 4) discrepancy scores between the healthy and current figures; and 5) discrepancy scores between the ideal and current figures. Scores range between – 8 and + 8, or rather, the higher the difference, the higher the body discrepancy and, consequently, a greater dissatisfaction rate. Discrepancy scores between the healthy and current figures is a more objective rating for body dissatisfaction, whilst the discrepancy score between the

The Figure Body Images is a fast, easy and simple method, highly efficient in evaluating body distortion and dissatisfaction with weight and body dimensions rate. In fact, it is widely accepted and used by several researchers since it is a valid tool for quantitative studies for body image perception in both sexes (Coqueiro et al., 2008; Damasceno et al., 2005; Gardner et al., 1998; Gardner et al., 1999; Kakeshita, 2004; Madrigal et al., 2000; Tribess

ideal and current figures represents a more emotional stance (Scagliusi et al., 2006).

weight loss brings a positive impact on people's health (Bosi et al., 2006).

nervosa (Morgan et al., 2002).

identified as IDEAL.

Fig. 1. Silhouette Figure Body Images developed by Stunkard et al. (1983) and modified by Thompson & Gray (1995).

et al., 2010). However, its main limitations are the contour figures designed in a linear bidimensional form which may reproduce shortcomings in body entireness and in fat distribution (O'Brien, et al., 2007). Further, the figures may be foregrounded on biotypes which do not correspond to the characteristics of the population under analysis.

Studies employing the Figure Body Images with children aged 6 – 12 years showed that in the case of girls the ideal body is substantially smaller that their own, whereas no difference in choice occurred in the case of boys (Williamson & Delin, 2001; McCabe & Ricciardelli, 2004a,b). Owing to a more critical stance by girls with regard to their body image, they manifest a high esteem for their body image which causes a self-awareness related to overweight and obesity. Thus, girls, albeit eutrophic, choose figures with the abovementioned contours. Boys show an inverse distortion of reality, or rather, overweight boys choose figures with contours in eutrophic conditions (Branco et al., 2006)

The Figure Rating method (Stunkard et al., 1983), applied in several Brazilian studies, showed a prevalent 82% of school children dissatisfied with their body image (Erling & Hwang, 2004; Pinheiro & Giugliani, 2006b; Triches & Giugliane, 2007), coupled to 78.8% of university students and physically active adults (Coqueiro et al., 2008; O'Brien et al., 2007). All these analyses report that women desire a decrease in their body contour size, whereas men desire a stronger, more muscular body. Difference in the male's and female's preference of body

Bulimia Nervosa and Dissatisfaction of Adolescent's Body Shape 99

Since most adolescents are greatly affected by social pressures, the media, parents and friends, it is recommended that their convivial milieu be focused on healthy and physical activities rather than on body weight control. This will minimize the effects of enhancements of the slim body ideal in Western society and increase the probability that they will be

Several authors report that the practice of physical activity by adolescents is related to body satisfaction (Savage et al., 2009; Damasceno et al., 2005; Neumark-Sztainer et al., 2006). Parents, educators and health professionals should stimulate adolescents to adopt programs for the promotion of the healthy body and for a positive body image. This will inhibit potential damaging behaviour, such as unhealthy control in body weight and eating binges.

While the social media and social culture associate a beautiful body with slimness, they transmit a beauty standard unattainable by most people. The body image's distortion may be related to the thin body as the ideal body type. Since the distortion is normally linked to diseases such as depression, it may also be associated with eating disorders such as anorexia and bulimia nervosa. In fact, such diseases are difficult to deal with and perhaps the best type of prevention is an improvement of satisfaction with the body image, especially during childhood and adolescence which are the periods in which subjects are building their body

Educational campaigns focused on healthy social milieus which make possible an emotional well-being are highly recommended. Campaigns, physical activities and the intake of healthy food should be adopted by the community and broadcasted by all the social media. Results in the subjects' health will be visible in a short space of time. Therefore, parents, educational personnel and health agents should not merely increase their knowledge on the potential risks of overweight during childhood and its consequences in adulthood but provide practical and concrete alternatives, such as linking leisure with physical activities. It will surely improve children and adolescents' body image. The family may also provide a

wide variety of healthy food for children and the latter may choose their preferences.

of beauty, which is already being sustained by many experts in the field.

(October 2000), pp.(1157-1163), ISSN 0002-8223.

Children and young people will have healthy feelings with regard to themselves coupled to a solid self-esteem. They will never have their physical value tainted by the social impositions on beauty. Avoidance of eating disorders, such as bulimia nervosa, and an improvement in their body's image will be achieved when there is a change in current ideal

Abramovitz, B.A. & Birch, L.L. (2000). Five-year-old girls ideas about dieting are predicted

Ackard, D.M.; Crol, L, J.K. & Kearney-Cooke, A. (2002). Dieting frequency among college

by mothers dieting. *Journal of the American Dietetic Association*, Vol.100, N10,

female: association with disordered eating, body image, and related psychological problems. *Journal of Psychosomatic Research.* Vol.52, N3, (March 2002), pp.(129-136),

satisfied with their body (Kelly et al., 2005).

**6. Conclusion** 

image.

**7. References** 

ISSN 0022-3999.

contours is due to the fact that women overestimate the body image and men underestimate it (Almeida et al., 2006; Atalah et al., 2004; Coqueiro et al., 2008; Damasceno et al., 2005; Kakeshita & Almeida., 2006; Madrigal et al., 2000; Tanaka et al., 2002).

Although percentages of the body image dissatisfaction prevalence may be different in Australia, Croatia, UK, Mexico, Switzerland and the USA, it is very high in all countries and this lack of satisfaction is not merely found in overweight or obese subjects but also in eutrophic ones (Ricciardelli & McCabe, 2001).

Due to incidence increase in eating disorders, such as anorexia nervosa and bulimia, several researches are relating them to body image disorders (Almeida et al., 2005; Conti et al., 2010; Killen et al., 1994; Neumark-Sztainer et al., 2006; Smolak & Levine, 2001, Stein et al., 1998; Souza-Kaneshima et al., 2006; Souza-Kaneshima et al., 2008). It should also be underscored that during the last years body image disorders have been found in still younger eutrophic populations too (Souza-Kaneshima et al., 2006; Souza-Kaneshima et al., 2008).
