Psychometric investigation of the Attention to Body Shape Scale in Brazilian adults

Investigação Psicométrica da Escala de Atenção à Forma Corporal em adultos brasileiros

Patrícia Angélica Teixeira Wanderson Roberto da Silva Lucas Arrais de Campos João Marôco Juliana Alvares Duarte Bonini Campos About the authors

Abstract

The objectives of the study were to develop a Portuguese version of Attention to Body Shape Scale (ABS), estimate the psychometric properties of the ABS for Brazilian data, and compare the ABS scores between the sexes and the different sample characteristics. The Portuguese version was developed following a standardized protocol. The factorial and convergent validity were evaluated using goodness-of-fit parameters and average variance extracted. Composite reliability and ordinal coefficient alpha were calculated. The invariance of the fitted model was investigated across independent subsamples using multigroup analysis. The scores were compared between variables using two-way ANOVA. A total of 1,056 individuals (71% female) with a mean age of 26.1 (SD=6.4) years participated in the study. Item 3 was removed due to low factor loading. The refined model presented good psychometric properties for the data. Different characteristics contributed to greater attention to body shape. The Portuguese version of the ABS will be useful to investigate attention to body shape in Brazil. The validity and reliability of the data supported the adequacy of the refined model. Specific characteristics influenced attention to body shape, and therefore, should be considered in future protocols.

Key words:
Body image; Validation study; Attention; Scale; Psychometry

Resumo

Os objetivos do estudo foram desenvolver a versão em português da Attention to Body Shape Scale (ABS); estimar as propriedades psicométricas da ABS para dados brasileiros; comparar os escores da ABS entre os sexos e diferentes características amostrais. A versão em português foi desenvolvida seguindo protocolo padronizado. As validades fatorial e convergente foram avaliadas por índices de ajustamento e variância extraída média. A confiabilidade composta e o coeficiente alfa ordinal foram calculados. A invariância do modelo ajustado foi investigada em subamostras independentes por análise multigrupos. Os escores médios da ABS foram comparados entre as variáveis usando ANOVA two-way. Participaram 1.056 indivíduos (71% mulheres) com média de idade de 26,1 (DP=6,4) anos. O item 3 foi excluído da escala devido ao baixo peso fatorial. O modelo refinado apresentou boas propriedades psicométricas aos dados. Diferentes características contribuíram para a maior atenção com a forma corporal. A versão em português da ABS será útil para investigar a atenção com a forma corporal no Brasil. A validade e a confiabilidade dos dados sustentaram a adequação do modelo refinado. Características específicas foram relevantes para investigar a atenção com a forma corporal, portanto, serão úteis para futuros protocolos.

Palavras-chave:
Imagem corporal; Estudo de validação; Atenção; Escala; Psicometria

Introduction

Body image is the mental representation that a person builds of his or her own body. The concept is multifactorial and involves perception, thoughts, feelings, and actions in relation to the body11 Tiggemann M, Hage K. Religion and spirituality: Pathways to positive body image. Body Image 2019; 28:135-141.,22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980.. Experts33 Cash T, Pruzinsky T. Body Image: a handbook of theory, research and clinical practice. New York: Guilford Press; 2002.,44 Thompson JK. The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes. Body Image 2004; 1(1):7-14. suggest that body image can be studied through a perceptual or attitudinal dimension. The perceptual dimension is the subject’s own visual image, which implies a visual memory of one’s size and proportions or an imagery reconstruction of the body made from sensations and impressions. The attitudinal dimension refers to the mental construction of the body image considering affective, cognitive, and behavioral aspects, and the subjective overall body satisfaction of a person55 Cash T, Smolak L. Body Image: A Handbook of Science, Practice, and Prevention. New York: Guilford Press; 2011.,66 Irvine KR, McCarty K, McKenzie KJ, Pollet TV, Cornelissen KK, Tovée MJ, Cornelissen PL. Distorted body image influences body schema in individuals with negative bodily attitudes. Neuropsychologia 2019; 122:38-50.. The cognitive component involves the perceptions and beliefs of individuals regarding body image, which can be investigated measuring attention to body shape22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980.,77 Silva WR, Campos JADB, Marôco J. Impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students. PLoS One 2018; 13(6):e0199480..

Attention is the process of investing energy on a specific subject. Thus, attention can be understood as a selective mental concentration to relevant or irrelevant stimuli, and may be temporary, subject to focus change, or depleted in a short time88 Memória CM, Muela H, Moraes NC, Costa-Hong VA, Machado MF, Nitrini R, Bortolotto LA, Yassuda MS. Applicability of the Test of Variables of Attention-TOVA in Brazilian adults. Dementia Neuropsychol 2018; 12(4):394-401.,99 Luria A. Fundamentos de neuropsicologia. Rio de Janeiro: Livros Técnicos e Científicos Edusp; 1981.. Selective attention refers to the differential processing of simultaneous sources of information. These sources can be internal as well as external1010 Johnston WA, Dark VJ. Selective attention. Ann Rev Psychol 1986; 37(1):43-75., and thus, selective attention can encompass several facets of the individual’s life, including attention paid to the body. Body attention usually relates to awareness of physical and emotional sensations. The degree of attention paid to the body is variable, as the direction of attention is different among individuals and may play different and important roles in people’s lives1111 Stephen ID, Hunter K, Sturman D, Mond J, Stevenson RJ, Brooks KR. Experimental manipulation of visual attention affects body size adaptation but not body dissatisfaction. Int J Eat Disord 2019; 52(1):79-87.,1212 Fan J, Gan J, Liu W, Zhong M, Liao H, Zhang H, Yi J, Chan RCK, Tan C, Zhu X. Resting-state Default Mode Network Related Functional Connectivity is Associated with Sustained Attention Deficits in Schizophrenia and Obsessive-compulsive Disorder. Front Behav Neurosci 2018; 12:319.. Beebe1313 Beebe DW. The attention to body shape scale: a new measure of body focus. J Pers Assess 1995; 65(3):486-501. reports that when the level of attention to body shape is excessive, body dissatisfaction and eating disorders may develop, especially in women, since they are more vulnerable to cultural and aesthetic issues1414 Silva WR, Dias JCR, Pimenta F, Campos JADB. Assessment of the Body Shape Concern: A Challenge. Psychol Comm Health 2014; 3(2):103-119..

Assessing the level of attention to body shape is important to raise data that may be used in clinical and epidemiological studies and educational, preventive, or treatment protocols aiming to minimize the onset of eating or body dysmorphic disorders and maintain people’s quality of life. For such assessment, psychometric instruments are commonly used66 Irvine KR, McCarty K, McKenzie KJ, Pollet TV, Cornelissen KK, Tovée MJ, Cornelissen PL. Distorted body image influences body schema in individuals with negative bodily attitudes. Neuropsychologia 2019; 122:38-50., however, the selection of the tool should be based on the research objective, context of application, and ability of the tool to provide valid and reliable data1414 Silva WR, Dias JCR, Pimenta F, Campos JADB. Assessment of the Body Shape Concern: A Challenge. Psychol Comm Health 2014; 3(2):103-119.

15 Schroderus-Salo T, Hirvonen L, Henner A, Ahonen S, Kääriäinen M, Miettunen J, Mikkonen K.. Development and validation of a psychometric scale for assessing healthcare professionals' knowledge in radiation protection. Radiography (Lond) 2019; 25(2):136-142.
-1616 Campos JADB, Marôco J. Modelagem de Equaçoes Estrurais: Aplicações à Validação de Intrumentos Psicométricos. In: Damásio BF, Borsa JC, editores. Manual de desenvolver de instrumentos psicológicos. Cubatão: Vetor; 2017. p. 323-345.. Despite the importance of attention to body image, few psychometric instruments are available in the literature to investigate this specific concept. These include the Objectified Body Consciousness Scale (OBCS) developed by McKinley and Hyde1717 McKinley NM, Hyde JS. The Objectified Body Consciousness Scale: Development and Validation. Psychol Women Quart 1996; 20(2):181-215., and the Attention to Body Shape Scale (ABS) proposed by Beebe1313 Beebe DW. The attention to body shape scale: a new measure of body focus. J Pers Assess 1995; 65(3):486-501., the latter being the only one that specifically assesses attention to body shape. The OBCS has shown poor psychometric properties1818 Moradi B, Varnes JR. Structure of the objectified body consciousness scale: Reevaluated 20 years later. Sex Roles 2017; 77(5-6):325-337. and is much longer (24 items) in relation to the ABS (7 items), making the ABS a preferable tool.

The ABS was developed in English in the American context1313 Beebe DW. The attention to body shape scale: a new measure of body focus. J Pers Assess 1995; 65(3):486-501. and only a Japanese version is available1919 Kagawa M, Uchida H, Uenishi K, Binns CW, Hills AP. Applicability of the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) and the Attention to Body Shape scale (ABS) in Japanese males and females. Eat Behav 2007; 8(3):277-284.. The items that make up the scale were adapted from the Appearance Orientation Subscale of the Multidimensional Body-Self Relations Questionnaire2020 Cash T, Winstead BA, Janda LH. Your body, yourself: A Psychology Today reader survey. Psychol Today 1985; 19(7):22-26., but with a focus on body shape. The one-factor structure composed of seven items with a 5-point Likert-type response scale (1=strongly disagree to 5=strongly agree) was reported in the original study. Furthermore, item three was formulated with a reverse score in relation to the others. To date, only five studies1919 Kagawa M, Uchida H, Uenishi K, Binns CW, Hills AP. Applicability of the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) and the Attention to Body Shape scale (ABS) in Japanese males and females. Eat Behav 2007; 8(3):277-284.,2121 Lokken K, Ferraro FR, Kirchner T, Bowling M. Gender differences in body size dissatisfaction among individuals with low, medium, or high levels of body focus. J Gen Psychol 2003; 130(3):305-310.

22 Maltby J, Giles DC, Barber L, McCutcheon LE. Intense-personal celebrity worship and body image: Evidence of a link among female adolescents. Br J Health Psychol 2005; 10(1):17-32.

23 MacLaren VV, Best LA. Disagreeable narcissism mediates an effect of BAS on addictive behaviors. Pers Indiv Diff 2013; 55(2):101-105.
-2424 Beebe DW, Holmbeck GN, Grzeskiewicz C. Normative and Psychometric Data on the Body Image Assessment-Revised. J Pers Assess 1999; 73(3):374-394. used the ABS, but none performed a confirmatory analysis to verify the construct validity of the instrument.

Despite being an instrument that assesses an important aspect of body image with a reduced number of items, the ABS is still rarely used in scientific and clinical contexts. The use of the ABS can help understand the degree of attention that people pay to their body shape. Brazil is a country that strongly values body aesthetics and it is one of the world leaders in plastic surgery and aesthetic procedures2525 Laus MF, Kakeshita IS, Costa TMB, Ferreira MEC, Fortes LS, Almeida SS. Body image in Brazil: recent advances in the state of knowledge and methodological issues. Rev Saude Publica 2014; 48:331-346.

26 Goldenberg M. The Body as Capital. Understanding Brazilian Culture. VIBRANT 2010; 7(1):220-238.
-2727 Ferrari CKB. High prevalence of trading mode and discussion of division in Brazilian adolescents and women. Publishing Director: Archive Euromedica; 2019.. Furthermore, previous studies2828 Silva WR, Souza SM, Marôco J, Maloa BFS, Campos JADB. Body weight concerns: Cross-national study and identification of factors related to eating disorders. PloS One 2017; 12(7):e0180125.

29 Junqueira ACP, Laus MF, Almeida SS, Costa TMB, Todd J, Swami V. Translation and validation of a Brazilian Portuguese version of the Body Appreciation Scale-2 in Brazilian adults. Body Image 2019; 31:160-170.
-3030 Silva WR, Pimenta F, Zaffaroni L, Castelnuovo G, Pietrabissa G, Marôco J, et al. Body Image Quality of Life Inventory: cross-national study in college students from four different countries. Eat Weight Disord 2020; 25(4):1079-1088. have shown that Brazilians are highly concerned with body shape and eating habits. Therefore, having a tool to assess the degree of attention to the body shape of Brazilians can help in the development of strategies to reduce risk behaviors, such as body dissatisfaction and disordered eating.

In addition, when assessing attention to body shape, the literature highlights the need to investigate demographic and dietary characteristics and the practice of physical exercise, as these factors can influence aspects related to body image3131 Robbins LB, Ling J, Resnicow K. Demographic differences in and correlates of perceived body image discrepancy among urban adolescent girls: a cross-sectional study. BMC Pediatrics 2017; 17(1):201.

32 Panão I, Carraça EV. Effects of exercise motivations on body image and eating habits/behaviours: A systematic review. Nutrition Dietetics 2020; 77(1):41-59.
-3333 Ishikawa M, Yokoyama T, Nishi N, Miura H. Study of the Relationship between Body Mass Index, Body Image, and Lifestyle Behaviors: A Community Survey in Fiji. JMA J 2020; 3(1):41-50.. Authors report a significant relationship between aspects of body image and anthropometric nutritional status, as overweight/obese individuals have been shown to feel higher pressure from society regarding the adequacy of body shape. Previous studies3434 Santos A, Silva WR, Santana MS, Campos JADB. Distortion and dissatisfaction with body size per the demographic and academic characteristics and the nutritional status of university students. Rev Cien Farm Basi Apli 2020; 41:1-12.

35 Yiu A, Murray SM, Arlt JM, Eneva KT, Chen EY. The importance of body image concerns in overweight and normal weight individuals with binge eating disorder. Body Image 2017; 22:6-12.
-3636 Rosewall JK, Gleaves DH, Latner JD. Psychopathology factors that affect the relationship between body size and body dissatisfaction and the relationship between body dissatisfaction and eating pathology. Front Psychol 2019; 9:2768. reported that young women are more dissatisfied with their bodies given the possible changes in society regarding the definition of an ideal weight. Moreover, people who have greater body dissatisfaction pay more attention to body exposure, do more physical exercise3737 Sabiston CM, Pila E, Vani M, Thogersen-Ntoumani C. Body image, physical activity, and sport: a scoping review. Psychol Sport Exerc 2019; 42:48-57., as well as make greater use of weight control substances and supplements3838 Murray SB, Griffiths S, Mond JM, Kean J, Blashill AJ. Anabolic steroid use and body image psychopathology in men: delineating between appearance-versus performance-driven motivations. Drug Alcohol Depend 2016; 165:198-202., and go on a diet more often3939 García CS, Zauder R, Sánchez GFL. Analysis of body composition and physical fitness of futsal players at school age according to their level of physical activity, diet and body image. Atena J Sports Sci 2019; 1:4. to try to ease discomfort with their body.

Thus, given the growing interest of the scientific and clinical community in Brazil regarding the study of body image and the impact that it has in people’s quality of life, this study was performed with three objectives: (i) to develop the Portuguese version of the ABS; (ii) to estimate the psychometric properties of the tool in adults; and (iii) to compare the scores of attention to body shape between the sexes and the sample characteristics. The hypothesis were that the Portuguese version of the ABS will be well understood in the Brazilian population, the factorial model of the ABS will present adequate psychometric properties when tested in Brazilians, and that specific sample characteristics will affect attention to body shape.

Methods

Study design

This was a cross-sectional study. The calculation of the minimum sample size was performed considering the need for 15 respondents for each parameter evaluated in the study [ABS: 7 items, 7 residues, and 9 independent variables (sex, age, nutritional status, dieting, self-perception of diet quality, use of substances and supplements for body change, economic level, and physical activity)]4040 Hair JF, Black WC, Babin B, Anderson RE, Tatham RL. Multivariate data analysis. Upper Saddle River: Prentice Hall; 2009.. Thus, the minimum sample size calculated was of 345 individuals. However, we used a sample size larger than the one calculated in order to increase the power of the psychometric analyses.

Participants

The sample consisted of young adults (18 to 40 years old) from the Araraquara community (normative sample) of both sexes. Exclusion criteria were: pregnancy or lactation, visual impairment, and being under treatment for eating disorders at the time of data collection.

Data for sex, age, use of substances and dietary supplements for body change, dieting for weight loss, self-perceived diet quality, physical activity, and the economic class of the participants were collected. Weight (kg) and height (m) were self-reported by the participants to calculate the body mass index (BMI) and establish the anthropometric nutritional status4141 World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Geneva: WHO; 2000.. The economic class was estimated using the Brazil Criterion42Associação Brasileira de EMpresas de Pesquisa (ABEP). Critério de Classificação Econômica Brasil Brazilian Criteria 2018 [Internet]. [acessado 2019 maio 18]. Disponível em: http://www.abep.org/criterio-brasil.. Level of attention to body shape was estimated using the ABS. IBM SPSS Statistics for Windows, version 22.0 (Armonk, NY: IBM Corp.) was used to perform the descriptive analyses.

Measuring instrument

The ABS was originally developed with 7 items, 5-point Likert-type responses, and a single-factor model1313 Beebe DW. The attention to body shape scale: a new measure of body focus. J Pers Assess 1995; 65(3):486-501.. The tool was tested initially in three different samples and demonstrated high internal consistency (Cronbach’s alpha=0.70-0.82) and test-retest reliability (r=0.76-0.87; p<0.001). The ABS also showed an adequate ability to discriminate groups of men and women (t [57]=2.63, p<0.01).

Cross-cultural adaptation

The ABS was first independently translated to Portuguese by 3 bilingual translators (two Brazilian and one Portuguese) with knowledge of the English language and American cultural context. The three versions were compared, and a single Portuguese version (intermediate version) was obtained. This version was back-translated into English by one North American translator with knowledge of Portuguese language, and this version was compared with the original one to assess the similarity of the content4343 Góes PSA, Fernandes LMA, Lucena LBS. Validação de instrumentos de coleta de dados. Epidemiologia da saúde bucal. Rio de Janeiro: Guanabara Koogan; 2006.,4444 Beaton D, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the cross-cultural adaptation of health status measures. Am Academy Ortho Surg 2002; 12:1-9.. The translators and back-translators were not familiar with the ABS. After verifying the idiomatic and semantic equivalences, the Portuguese version of the ABS was evaluated by two Portuguese language specialists that attested the grammatical adequacy. In addition, two researchers from the field of psychology and body image analyzed the Portuguese version to assess conceptual and cultural equivalences.

Considering that item three (“I am not self-conscious about my body shape”) is the only item with a reverse score in relation to the others and this could cause confusion, the regular and inverted sentences were tested in a pilot study for the best formulation. The language experts also had difficulty in agreeing about the translation of the term “self-conscious” in item three. As there was no consensus, the pilot study was also used to test two words for “self-conscious” in Portuguese: “insecure” (“inseguro”) and “aware” (“consciente”) and identify which was clearer. Thus, the Portuguese version of the ABS was pretested - using different sentences for item three - to verify the misunderstanding index [MI] of the items, which evaluates if participants adequately understand the instructions and the item’s words and expressions. An MI≤20% was considered adequate. The pretest included 58 individuals (female=81%; mean age 28.4 [SD=5.5] years). The minority (1.7%) were from the lower income classes (D/E), 20.7% were from the medium class (C), and 77.6% from the higher income classes (B: 65.5% and A: 12.1%). The use of the inverted item (i.e., “I am not self-conscious…”) and the use of the word “aware” were considered confusing by participants (MI>20%); therefore, item three was translated as “I am aware...” (in Portuguese: “Eu sou consciente…”). After this adjustment, all the ABS items had MI=0 and the mean filling time was 84 (SD=31) seconds. Thus, the Portuguese version of the ABS was considered appropriate for use (Chart 1).

Chart 1
Original English version and Portuguese version of the Attention to Body Shape Scale (ABS).

Procedures and ethical aspects

The study was announced (i.e., objectives, criteria for participation and contact of researchers) to employees, students, and professors of the São Paulo State University (UNESP, Araraquara campus) through different means of communication (e.g., e-mails, personal invitations, social network). Therefore, the sample obtained was non-probabilistic for convenience. Data collection was carried out by four trained researchers. Individuals interested in participating in the research received verbal information about the objectives of the project. All individuals who voluntarily agreed to participate in the study and met the eligibility criteria signed the consent form and were asked to complete a demographic questionnaire and the ABS in paper version individually or in groups of five maximum in a reserved room of the university. Participants were encouraged to respond honestly to the items of the questionnaire and were reminded that all responses were anonymous and results would be kept confidential. Participants were asked to tell their friends, colleagues and family about the survey to recruit more people for the study in a snowball sampling process. Data collection was carried out from March of 2018 to May of 2019 on working days (Monday to Friday) between 9 am to 9 pm.

The project was approved by the Human Research Ethics Committee of the Araraquara School of Dentistry (UNESP) (C.A.A.E. 88600318.3.0000.5416).

Data Analysis

Psychometric sensitivity of items - Summary statistics (means, medians, and standard deviations) and data distribution (skewness [Sk] and kurtosis [Ku]) were calculated using the IBM SPSS Statistics software. Absolute values of Sk<3 and Ku<7 were considered indicative of adequate psychometric sensitivity of the items (i.e., data normality was assumed).

Construct validity - To verify the fitting of the proposed theoretical model to the study sample, a confirmatory factor analysis (CFA) was performed. Weighted least square mean and variance adjusted estimator (WLSMV) method was used. The chi-square by degrees of freedom ratio (χ22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980./df), comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA) were used to assess the fit of the model to the data4545 Byrne BM. Structural equation modeling with AMOS: Basic concepts, applications, and programming. New Jersey: Routledge; 2001.,4646 Marôco J. Análise de Equações Estruturais: Fundamentos teóricos, Software & Aplicações. Lisboa: Report Number; 2014.. The fit was considered acceptable when χ22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980./df≤5.0, CFI and TLI≥0.90, and RMSEA≤0.104646 Marôco J. Análise de Equações Estruturais: Fundamentos teóricos, Software & Aplicações. Lisboa: Report Number; 2014.. The factor loadings (λ)≥0.50 were considered adequate. When the fit was not acceptable, modification indices were calculated using the Lagrange multiplier (LM) method. LM values >11 were inspected. Convergent validity was assessed using the average variance extracted (AVE) to verify whether items associated with the factor are strongly saturated within the factor4646 Marôco J. Análise de Equações Estruturais: Fundamentos teóricos, Software & Aplicações. Lisboa: Report Number; 2014.. The AVE was estimated using Fornell and Larcker4747 Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Marketing Res 1981; 18(1):39-50. proposal and considered adequate if ≥0.50. The analyses were performed using the MPLUS software, Version 7.2 (Muthén and Muthén, Los Angeles, CA).

Factorial invariance - The invariance was evaluated by multiple groups analysis, performed in MPLUS, to evaluate if the factor mean is maintained in independent samples. The model obtained for the study sample (“Test Sample”) was compared with the model fitted to an independent sample (“Validation Sample”) from the same population. The CFI difference test (ΔCFI) was used to compare factor loading (λ), thresholds (t), and residual variance/covariance (Cov/Res). CFI values of the configural model (M0), the factor loading model (M1), the thresholds model (M2), and the residuals model (M3) were considered. Invariance was confirmed when the difference in CFI (ΔCFI) was less than -0.014848 Cheung GW, Rensvold RB. Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling 2002; 9(2):233-255..

Reliability - The composite reliability (CR)4747 Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Marketing Res 1981; 18(1):39-50. and the ordinal coefficient alpha (α) were used. Values ≥0.70 were considered adequate4646 Marôco J. Análise de Equações Estruturais: Fundamentos teóricos, Software & Aplicações. Lisboa: Report Number; 2014.. To calculate α, the R program (R Core Team) was used.

Comparison of the ABS scores - Scores were calculated using the arithmetic mean of the responses given to the items of the ABS model fitted to the data. Sex (male vs. female) and sample characteristics of interest (weight loss diet, substances use, and dietary supplements use: never vs. once in life/sometimes/often; economic stratum: low [C/D-E] vs. high [A/B]; self-perceived quality of eating habits: poor/fair vs. normal/good/excellent; age: younger [<30 years old] vs. older [≥30 years old]; practice of physical exercise: no vs. yes; and nutritional status: eutrophic [BMI: 18.4 kg/m²-24.9 kg/m²] vs. overweight/obesity (BMI≥25.0 kg/m²) were considered as independent variables. Due to the large sample size, normality was assessed from psychometric sensitivity of the items4949 Kline RB. Principles and practice of structural equation modeling. New York: Guilford publications; 2015.. Homoscedasticity of the data was verified using Levene’s test (p=0.150-0.939). The scores were compared using two-way analysis of variance (ANOVA; Factor 1: sex; Factor 2: sample characteristic) implemented in SPSS Statistics. The effect size was estimated from η²p. The significance level adopted was 5%.

Results

A total of 1,170 people participated in the study. However, 114 individuals were excluded because they did not answer one or more ABS items. Thus, the final sample was composed of 1,056 individuals. Missing data was not imputed because the sample was large enough. Table 1 shows the sample characterization.

Table 1
Participants Characteristics (mean ± standard deviation or n (%)).

Most participants reported never taking substances or supplements for weight loss, practicing physical activity, considering their eating habit as having normal/good quality, and belonging to the A and B economic class. Table 2 presents the descriptive statistics of the answers to the ABS items. The psychometric sensitivity of the items was considered adequate and the data was normally distributed.

Table 2
Descriptive statistics of the answers to the Attention to Body Shape Scale (ABS) by the participants of the Total Sample (n=1,054), Male Sample (n=304), and Female Sample (n=752).

Despite adequate fit of the complete model (λ=0.257-0.826; χ22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980./df=7.09; CFI=0.98; TLI=0.98; RMSEA=0.08), item 3 presented unsatisfactory factor loading (λ=0.257). Thus, item 3 was excluded, which resulted in a refined model with adequate fit and factor loading (λ=0.524-0.821; χ22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980./df=7.75; CFI=0.99; TLI=0.98; RMSEA=0.08). Although the values of χ22 Schilder P. A Imagem do Corpo: as energias construtivas da psiquê. São Paulo: Martins Fontes; 1980./df were high, probably due to the large sample size, they should not be considered alone for accepting or rejecting the model fit4646 Marôco J. Análise de Equações Estruturais: Fundamentos teóricos, Software & Aplicações. Lisboa: Report Number; 2014.. Convergent validity (AVE=0.51) and reliability (α=0.81; CR=0.86) of the refined model were adequate. The multiple group analysis (Test: n=528 vs. Validation: n=528) resulted in small CFI difference (ΔCFIM1-M0=-0.003; ΔCFIM2-M1=0.002; ΔCFIM3-M2=0.001) indicating the strong invariance of the model.

Table 3 presents the comparison of the ABS scores between sexes and sample characteristics. Despite the significant interaction between sex and substance use and sex and supplement use, it was at the limit of significance (p=0.010-0.036) and the effect size was small (η²p=0.004-0.006). Therefore, this significance may be related to the sample size. Thus, it was decided to analyze the factors independently. Women and people who used substances and supplements for weight loss, who practice physical activity, and who reported having already been on a weight loss diet presented higher scores of attention to body shape.

Table 3
Comparison of the mean scores (± standard deviation) of to body shape according to sex and sample characteristics.

Discussion

The present study contributes to both researchers and professionals in the field of Health and Nutrition by providing the Portuguese version of the ABS. In addition, we verified that a refined model of the scale presented validity and reliability to Brazilian data. Finally, we found that different sample characteristics affect the ABS scores. These findings may be important for future clinical and epidemiological protocols that aim to develop educational and preventive strategies to treat or minimize the negative outcomes related to eating disorders and negative body image in the population.

During the process of transcultural adaptation of the ABS to Portuguese, the cultural adequacy of the term “self-conscious” (item 3) was challenging, which can have resulted in the low factor loading for this item. Further content analysis strategies are suggested in future studies to reevaluate the construction of this item and obtain semantic and idiomatic equivalence between the original and the Portuguese versions of the tool.

The refined factorial model of the ABS had a good fit to the data and was invariant in independent samples, confirming that its use is adequate in adult individuals. Comparing these findings with those of other studies is difficult, since no study has verified the fit of the ABS factorial model to other samples using a confirmatory strategy. The two studies that verified the factorial validity of the ABS used others strategies (e.g., correlations between the total scores of the ABS and other instruments). The study by Beebe1313 Beebe DW. The attention to body shape scale: a new measure of body focus. J Pers Assess 1995; 65(3):486-501. conducted in an American population sample, and by Kagawa, Uchida1919 Kagawa M, Uchida H, Uenishi K, Binns CW, Hills AP. Applicability of the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) and the Attention to Body Shape scale (ABS) in Japanese males and females. Eat Behav 2007; 8(3):277-284. in a Japanese population evaluated the reliability of the ABS and, as in our study, they also found good results. These studies indicated that the ABS is a valid and reliable tool to assess body shape attention in adults from different cultures and contexts.

Our results also showed that most individuals are aware of their body shape, which corroborates previous data2121 Lokken K, Ferraro FR, Kirchner T, Bowling M. Gender differences in body size dissatisfaction among individuals with low, medium, or high levels of body focus. J Gen Psychol 2003; 130(3):305-310.,2222 Maltby J, Giles DC, Barber L, McCutcheon LE. Intense-personal celebrity worship and body image: Evidence of a link among female adolescents. Br J Health Psychol 2005; 10(1):17-32.. The greater attention to body shape found among females in our results is supported by the literature. Lokken et al.2121 Lokken K, Ferraro FR, Kirchner T, Bowling M. Gender differences in body size dissatisfaction among individuals with low, medium, or high levels of body focus. J Gen Psychol 2003; 130(3):305-310., Beebe1313 Beebe DW. The attention to body shape scale: a new measure of body focus. J Pers Assess 1995; 65(3):486-501. and Lonergan et al.5050 Lonergan AR, Bussey K, Mond J, Brown O, Giffiths S, Muray SB, Mitchison D. Me, my selfie, and I: The relationship between editing and posting selfies and body dissatisfaction in men and women. Body Image 2019; 28:39-43. highlight that this finding might be related to the strong pressure women endure from culture and society to have a body in accordance to specific standards. The finding that individuals taking substances (e.g., medication) or supplements and dieting to improve their body shape have a higher body focus is in accordance with previous studies1919 Kagawa M, Uchida H, Uenishi K, Binns CW, Hills AP. Applicability of the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) and the Attention to Body Shape scale (ABS) in Japanese males and females. Eat Behav 2007; 8(3):277-284.,2828 Silva WR, Souza SM, Marôco J, Maloa BFS, Campos JADB. Body weight concerns: Cross-national study and identification of factors related to eating disorders. PloS One 2017; 12(7):e0180125.,5151 Corazza O, Simonato P, Demetrovics Z, Mooney R, Van de Ven K, Roman-Urrestarazu A, Rácmolnár L, De Luca I, Cinosi E, Santacroce R, Marini M, Wellsted D, Sullivan K, Bersani G, Martinotti G. The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: A cross sectional study. PloS One 2019; 14(4):e0213060.. People with an exaggerated concern with their body shape tend to seek ways to change how their bodies look based on what society considers ideal by using strategies such as the ones evaluated5252 Guzzo Junior CC, Mendes JL, Costa LP. Social Medias: A View of the Physical Educator About the Use of this Tool on the Prhysical Exercice Practice Guided by People Without Qualification on the Area. Podium Sport Leisure Tourism Rev 2018; 7(3):415-428.. The practice of physical activity was related to a greater attention to body shape, as supported by the literature5353 Prichard I, Tiggemann M. Relations among exercise type, self-objectification, and body image in the fitness centre environment: The role of reasons for exercise. Psychol Sport Exerc 2008; 9(6):855-866.. Exercise is related to an increased focus on the appearance of the body. As argued by Corazza et al.5151 Corazza O, Simonato P, Demetrovics Z, Mooney R, Van de Ven K, Roman-Urrestarazu A, Rácmolnár L, De Luca I, Cinosi E, Santacroce R, Marini M, Wellsted D, Sullivan K, Bersani G, Martinotti G. The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: A cross sectional study. PloS One 2019; 14(4):e0213060. individuals who aim a “perfect” body see the practice of physical activity as a way to achieve that wish, without necessarily considering aspects related to health and well-being.

Thus, the significant relationship between attention to body shape and the studied independent variables indicates the importance of such variables in later studies to broaden the scenario for tracking clinical conditions and body shape-related behavior. We believe that these results can assist in the identification of risk groups for dysfunctional behaviors in relation to body image and eating. However, despite the significant differences found, we suggest caution in interpreting the findings of this study since the effect size was small, giving a low practical significance to the results.

This study has some limitations. First, there was a difficulty in the cultural adaptation of item 3 to Portuguese language, which may have influenced its suitability for the ABS factorial model. Second, the cross-sectional study design does not allow establishing a temporal relationship of cause and effect; however, it allowed the identification of characteristics that should be considered in intervention studies. Third, the use of a convenience sample limits the generalizability of the results to populations with different characteristics from the sample used. In this way, we suggest that future studies replicate our research protocol in other contexts (e.g., in coastal regions where body exposure may be greater). Fourth, only people with eating disorders were excluded, which may have contributed to the inclusion of individuals with other conditions (e.g., anxiety disorder) that may influence attention to the shape of the body. Fifth, we did not evaluate the sexual orientation of the participants, which may be relevant in future studies. Despite these limitations, the ABS was shown to be a simple and fast tool to measure attention to body shape, producing valid and reliable data from a refined model. It is hoped that this study can increase the understanding about attention to body shape in the Brazilian population, which can be an important aspect in people’s lives.

Acknowledgments

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001 and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; Grant #2018/21467-8, #2017/20315-7, #2018/06739-1 and #2019/19590-9).

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Publication Dates

  • Publication in this collection
    22 Apr 2022
  • Date of issue
    Apr 2022

History

  • Received
    01 Oct 2020
  • Accepted
    17 Apr 2021
  • Published
    19 Apr 2021
ABRASCO - Associação Brasileira de Saúde Coletiva Rio de Janeiro - RJ - Brazil
E-mail: revscol@fiocruz.br