Abstracts

INTRODUCTION

Internationally, research on body image dates back to the 1900s, with studies of “ghost limbs” by neurologists who described the subject as “body scheme.” In 1935, Schilder used a biopsychosocial approach to investigate body image, with emphasis on the need to consider the neurological, psychological, and sociocultural aspects of the construct. Recently, studies in several areas of this field have advanced, mainly in psychology.¹⁶16 . Cash TF, Smolak L. Understanding body image: historical and contemporary perspectives. In: Cash TF, Smolak L, editors. Body image: a handbook of science, practice, and prevention. New York: Guilford Press; 2011. p. 3-11.

In Brazil, the issue of body image has received attention in the past three decades, with changes in the sociopolitical, cultural, and epidemiological contexts.

Goldenberg⁵⁰50 . Goldenberg M. The body as capital: understanding Brazilian culture. Vibrant. 2010;7(1):220-38. (2010) stated that the Brazilian population glorifies the body, which must be in conformity with certain aesthetic standards. In Brazil, the body plays a fundamental role in people’s lives to achieve social ascension and develop successful relationships. Brownell¹²12 . Brownell KD. Foreword. In: Cash TF, editor. Encyclopedia of body image and human appearance. Oxford: Elsevier; 2012. p. xxi-xii. (2012), in the foreword to the Encyclopedia of Body Image and Human Appearance, reported that billions of dollars are invested and spent on physical appearance worldwide. This book includes articles that discuss such costs by mentioning the pharmaceutical and cosmetic industries, gyms, food products, and nutritional supplements. The relationship between these investments and health improvements is also discussed.

These facts are especially true in Brazil, and global research conducted with 3,200 women from 10 different countries attests to this affirmation.^aa Etcoff N, Orbach S, Scott J, D’Agostino H. The real truth about beauty: a global report. Findings of the global study on women, beauty and well-being. Toronto: Unilever Canada; 2004 [cited 2013 May 5]. Available from: http://www.campaignforrealbeauty.ca/uploadedFiles/dove_white_paper_final.pdf In this study, Brazilians had the highest prevalence of stating that beauty increases opportunities in life (66.0%). Additionally, more than a half of all women in Brazil have already considered having cosmetic surgery, and 7.0% reported having undergone some kind of cosmetic procedure – the highest of all countries surveyed. Brazil was also the world’s largest consumer of weight-loss medications per capita.

In the present sociocultural context, in which physical appearance is highly valued and investments have increased at all levels, studying and understanding body image issues, such as what body image represents, what its perception means, and the magnitude of its effects on people’s behavior is essential.

The aim of this study was to analyze the Brazilian literature on body image and the theoretical and methodological advances achieved.

METHODS

A detailed review was undertaken of the literature on body image in Brazil, guided by two key questions: what is the current situation of body image research in Brazil in theoretical and methodological terms? And what form do advances in knowledge of the area take?

Conceptualization of the body image construct

Body image today is recognized as “how people experience their own embodiment, especially, but not exclusively, their physical appearance characteristics, including their physical functional competencies and biological integrity.”¹⁷17 . Cash TF. Cognitive-behavioral perspectives on body image. In: Cash TF, editor. Encyclopedia of body image and human appearance. Oxford: Elsevier; 2012. p. 334-42. It integrates components related to physical appearance, such as the mental representation of one’s own size, shape, and facial features, and attitudes about appearance, such as cognition, feelings, and behaviors. The attitudinal component has been approached in two dimensions: one dimension that assesses body image relative to body satisfaction or dissatisfaction and beliefs about the body and another dimension regarding the cognitive, behavioral, and emotional importance that one places on their own body.

Considering the cognitive-behavioral model that is assumed to be the body image concept presented above, determining which body image component, perceptual or attitudinal, will be assessed is essential to the choice and use of suitable instruments.

Methodological considerations about body image research

Experts have drawn attention to the importance of a strict research methodology for reliable advances of knowledge and published several recommendations.¹⁷17 . Cash TF. Cognitive-behavioral perspectives on body image. In: Cash TF, editor. Encyclopedia of body image and human appearance. Oxford: Elsevier; 2012. p. 334-42. ^{, 18}18 . Cash TF. Crucial considerations in the assessment of body image. In: Cash TF, Smolak L, editors. Body image: a handbook of science, practice, and prevention. New York: Guilford Press; 2011. p. 129-37. ^{, 48}48 . Gardner RM, Brown DL. Body image assessment: a review of figural drawing scales. Pers Individ Dif. 2010;48(2):107-11. DOI:10.1016/j.paid.2009.08.017
https://doi.org/10.1016/j.paid.2009.08.0... ^{, 49}49 . Gardner RM, Friedman BN, Jackson NA. Methodological concerns when using silhouettes to measure body image. Percept Mot Skills. 1998;86(2):387-95. DOI:10.2466/pms.1998.86.2.387
https://doi.org/10.2466/pms.1998.86.2.38... ^{, 104}104 . 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. DOI:10.1016/S1740-1445(03)00004-4
https://doi.org/10.1016/S1740-1445(03)00... Thompson¹⁰⁴104 . 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. DOI:10.1016/S1740-1445(03)00004-4
https://doi.org/10.1016/S1740-1445(03)00... (2004) highlighted not only the determination of the specific body image component to be investigated and its suitable instrument but also several other recommendations, such as (1) the use of several measurements (especially in exploratory studies), (2) the use of tools that have had their reliability and validation tested for the studied sample, (3) evaluation of the reliability and validation for the studied sample, (4) adapting measurement tools to the objectives of the study with authorization from the authors of the original work, (5) determination of whether the use of such tools is recommended to measure an aspect or feature of body image, such as body image exposition in the media or immediate body image state (experience), and (6) indications for clinical contexts with prior and post use and a particular intervention. Another recommendation refers to carefully determining the application protocol because it may have affective or cognitive (i.e., rational or intellectual) features or characteristics that should comply with the aim of the study. Finally, Thompson recommended considering the participants’ peculiarities for the analysis and interpretation of the results by evaluating the data using normal and clinical statistical tests. With regard to body image evaluation, Gardner & Brown⁴⁸48 . Gardner RM, Brown DL. Body image assessment: a review of figural drawing scales. Pers Individ Dif. 2010;48(2):107-11. DOI:10.1016/j.paid.2009.08.017
https://doi.org/10.1016/j.paid.2009.08.0... (2010) and Gardner et al⁴⁹49 . Gardner RM, Friedman BN, Jackson NA. Methodological concerns when using silhouettes to measure body image. Percept Mot Skills. 1998;86(2):387-95. DOI:10.2466/pms.1998.86.2.387
https://doi.org/10.2466/pms.1998.86.2.38... (1998) suggested using methodological caution in such studies, especially when using silhouette scales, because numerous problems continue to be identified with their use.

The translation and adaptation of psychometric instruments and their use have well-established guidelines in Brazil and abroad.^bb Beaton D, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the cross-cultural adaptation of health status measures. Rosemont: American Academy of Orthopedic Surgeons; 2002. ^{, c}c International Test Commission. Instituto Brasileiro de Avaliação Psicológica. Diretrizes para o uso de testes. Campinas: Laboratório de Avaliação e Medidas Psicológicas da PUCCAMP; 2003. According to the Standards for Educational and Psychological Tests,⁵⁵55 . Hambleton RK. Issues, designs, and technical guidelines for adapting test into multiple languages and cultures. In: Hambleton RK, Merenda PF, Spielberger CD, editors. Adapting educational and psychological tests for cross-cultural assessment. Mahwah: Lawrence Erlbaum; 2005. p. 3-38. ^{, 60}60 . Jorge MR. Adaptação transcultural de instrumentos de pesquisa em saúde mental. In: Gorenstein C, Andrade LHSG, Zuardi AW, editores. Escalas de avaliação clínica em psiquiatria e psicofarmacologia. São Paulo: Lemos Editorial; 2000. p. 53-61. ^{, 78}78 . Pasquali L. Princípios de elaboração de escalas psicológicas. In: Gorenstein C, Andrade LHSG, Zuardi AW, editores. Escalas de Avaliação Clínica em Psiquiatria e Psicofarmacologia. São Paulo: Lemos Editorial; 2001. p. 15-27. the adaptation process for an existing instrument must follow the same steps as for the development of new instruments. Adaptation implies accuracy, validation, and standardization or rules, including translation, equivalence to other sociocultural realities, and appropriate conventions.

Considering the present scenario of globalization and the growing importance of transcultural research, providing suitable adaptations or developing psychometric instruments for body image evaluation is essential in the Brazilian context so that the obtained results are consistent and ensure higher international visibility of body image research in Brazil.

Although a plethora of tools exist worldwide for the assessment of body image, researchers who are interested in this field of study in Brazil have faced difficulties because of the limited number of instruments available in the country. We performed extensive research to identify the tools that are being developed or adapted to our population using the following databases: SCOPUS, LILACS, SciELO, PubMed, Medline, and the CAPES thesis database. We also evaluated the publications that were available using Google Scholar. We used the keywords “body image” AND “Brazil” AND “scale(s)”; “body image” AND “Brazil” AND “questionnaire(s)”; and “body image” AND “Brazil” AND “instrument(s)”. The survey was conducted in January/February 2013, and we did not stipulate date limits in any of the databases consulted. The first tool was published in 2002, and the latest tool was published in 2013.

We selected only published/accepted studies (articles and theses/dissertations) and included three types of instruments: (1) those that were developed in Brazil, (2) those for which only translation was performed, and (3) those that were translated and had at least some psychometric characteristics tested.

The decision to describe not only the scales/questionnaires that presented good psychometric data was made based on the purpose of discussing recent advances in this field in Brazil. Although not all of the instruments cited herein were appropriate because of the poor results obtained in the validation process, in the past five years, researchers have been engaged in supplying measures that could be used in the Brazilian population. Additionally, this survey may serve as a reference for those interested in this topic because it described instruments that still needed to be tested or required reformulation.

The availability of instruments in the country is directly reflected by the number of studies conducted here and also by the type of investigation. To evaluate the current scenario of such research in Brazil, we performed a detailed survey of the following databases: SciELO (keyword: “body image” limited to Brazil), SCOPUS (keyword: “body image” limited to Brazil), and the CAPES thesis databases (keyword: “imagem corporal”). Again, we did not stipulate date limits in any of the databases consulted, so we used the full search range that the databases offered until 2012. The first publication found was in 1987.

RESULTS AND DISCUSSION

At the end of our search, we found 44 measures: 10 were developed in the country (Table 1), four were only translated to Brazilian Portuguese (Table 2), and 30 were both translated and tested (Table 3).^dd Four instruments were tested in distinct target populations and thus were considered to be different measures. The tables present the names of the instruments, the authors responsible for them, the components assessed, a brief description of their composition, the steps that were performed in the validation process, and the sample in which the instrument was applied. The psychometric results obtained from the tested measures are not presented herein because it was not our intention to characterize each of them but rather to indicate the attempts to provide assessment tools.

Three important considerations must be made with regard to the results. The first consideration is related to the availability of the measures for each sex. We found nine instruments that were to be used exclusively with men, 15 that were to be used only with women, and 20 that could be applied for both sexes. Notably, the instruments that were able to assess body image in men were published in the past five years. According to Thompson et al¹⁰³103 . Thompson JK, Burke NL, Krawczyk R. Measurement of body image in adolescence and adulthood. In: Cash TF, editor. Encyclopedia of body image and human appearance. Oxford: Elsevier; 2012. p. 512-20. (2012), when an instrument was not developed exclusively for males, its reliability and validity may be doubtful when used with men. Several measures that can theoretically be applied for both men and women include items that are more relevant to females (e.g., the Body Shape Questionnaire). Today, tools that were designed for men are available and take into account issues related to muscularity. Therefore, even when a measure is suitable for both sexes, using different instruments for males and females is necessary.

The second consideration refers to the number of instruments proposed or adapted to different age groups. Although the majority of assessment tools were intended to be used in college students, only two instruments were found for the evaluation of children, and three could be applied in middle-aged women. Notably, the adaptation of scales and questionnaires to be used in adolescents has grown fast in the last five years. Importantly, assessments must be sex- and age-appropriate for the intended sample.¹⁸18 . Cash TF. Crucial considerations in the assessment of body image. In: Cash TF, Smolak L, editors. Body image: a handbook of science, practice, and prevention. New York: Guilford Press; 2011. p. 129-37. Therefore, measures that were developed for certain groups may not be appropriate for use in other samples.¹⁰³103 . Thompson JK, Burke NL, Krawczyk R. Measurement of body image in adolescence and adulthood. In: Cash TF, editor. Encyclopedia of body image and human appearance. Oxford: Elsevier; 2012. p. 512-20. With regard to that reservation, studies with older men, for example, still cannot be conducted in Brazil. This is important because many researchers have been testing specific samples using measures that were adapted or validated for different groups. This strategy assuredly produces doubtful results that should be analyzed with caution. Body image is largely known to change over the years, so instruments designed to assess it in different age groups must consider important aspects of the construct within several stages of life. Moreover, the cognitive skills and ability to understand what is being asked vary with age and should be considered in studies of body image.

The third consideration is related to the great discrepancy in the number of measures available to assess different components of body image. Half of them (n = 22) were able to evaluate satisfaction/dissatisfaction with the whole body or parts of it. Seven could be used to examine body image perception (of these, only two were exclusively perceptive measures). Eight assessed the cognitive component. Six evaluated the behavioral component, and four assessed affective aspects of the construct. Notably, the great majority of instruments that assess these last dimension/components have appeared in the Brazilian context during the last five years, a fact that could have caused difficulty in studying them.

Nevertheless, despite the disparities mentioned above, progress is undeniably being made in providing tools to assess body image in the Brazilian population. Since 2002, the number of instruments proposed in the country increased from two to 41, showing the advances that are occurring in this area of study.

Current scenario of research on body image in Brazil

Figure A describes the results of this survey and the course of the research in the past decades in the country. The number of academic investigations was five-times higher between 2001 and 2011 (387 dissertations/theses) compared with 1987-2000 (71). Similarly, the number of papers published in peer-reviewed journals indexed in SciELO (Figure B) increased from three (1990-2000) to 152 (2001-2012), and the number of papers in SCOPUS (Figure C) increased from 13 to 308 during the same time.

Although the amount of research has increased rapidly, disparities still exist with regard to sex, age, and the component or dimension assessed. Although some of these discrepancies may be explained by the availability of measures for specific groups in Brazil, others contradict this reality. First, the majority of investigators target the female population, irrespective of age.⁴4 . Alvarenga MDS, Philippi ST, Lourenço BH, Sato PDM, Scagliusi FB. Insatisfação com a imagem corporal em universitárias brasileiras. J Bras Psiquiatr. 2010;59(1):44-51. DOI:10.1590/S0047-20852010000100007
https://doi.org/10.1590/S0047-2085201000... ^{, 5}5 . Alves E, Vasconcelos FAG, Calvo MCM, Neves J. Prevalência de sintomas de anorexia nervosa e insatisfação com a imagem corporal em adolescentes do sexo feminino do Município de Florianópolis, Santa Catarina, Brasil. Cad Saude Publica. 2008;24(3):503-12. DOI:10.1590/S0102-311X2008000300004
https://doi.org/10.1590/S0102-311X200800... ^{, 10}10 . Bosi MLM, Luiz RR, Uchimura KY, Oliveira FP. Comportamento alimentar e imagem corporal entre estudantes de educação física. J Bras Psiquiatr. 2008;57(1):28-33. DOI:10.1590/S0047-20852008000100006
https://doi.org/10.1590/S0047-2085200800... ^{, 32}32 . Costa LDCF, Vasconcelos FDAGD. Influência de fatores socioeconômicos, comportamentais e nutricionais na insatisfação com a imagem corporal de universitárias em Florianópolis, SC. Rev Bras Epidemiol. 2010;13(4):665-76. DOI:10.1590/S1415-790X2010000400011
https://doi.org/10.1590/S1415-790X201000... ^{, 38}38 . Dunker KLL, Fernandes CPB, Carreira Filho D. Influência do nível socioeconômico sobre comportamentos de risco para transtornos alimentares em adolescentes. J Bras Psiquiatr. 2009;58(3):156-61. DOI:10.1590/S0047-20852009000300003
https://doi.org/10.1590/S0047-2085200900... ^{, 81}81 . Pereira EF, Graup S, Lopes AS, Borgatto AF, Daronco LSE. Percepção da imagem corporal de crianças e adolescentes com diferentes níveis socio-econômicos na cidade de Florianópolis, Santa Catarina, Brasil. Rev Bras Saude Mater Infant. 2009;9(3):253-62. DOI:10.1590/S1519-38292009000300004
https://doi.org/10.1590/S1519-3829200900... ^{, 105}105 . Tribess S, Virtuoso Jr JS, Petroski EL. Estado nutricional e percepção da imagem corporal de mulheres idosas residentes no nordeste do Brasil. Cienc Saude Coletiva. 2010;15(1):31-8. DOI:10.1590/S1413-81232010000100008
https://doi.org/10.1590/S1413-8123201000... In all of the databases consulted, the number of studies that explored the female sex was almost twice as large than those that included men.³⁰30 . Coqueiro RS, Petroski EL, Pelegrini A, Barbosa AR. Insatisfação com a imagem corporal: avaliação comparativa da associação com o estado nutricional em universitários. Rev Psiquiatr Rio Gd Sul. 2008;30(1):31-8. DOI:10.1590/S0101-81082008000100009
https://doi.org/10.1590/S0101-8108200800... ^{, 35}35 . Damasceno VO, Lima JRP, Vianna JM, Vianna VRA, Novaes JS. Tipo físico ideal e satisfação com a imagem corporal de praticantes de caminhada. Rev Bras Med Esporte. 2005;11(3):181-6. DOI:10.1590/S1517-86922005000300006
https://doi.org/10.1590/S1517-8692200500... ^{, 66}66 . Kakeshita IS, Almeida SS. Relationship between body mass index and self-perception among university students. Rev Saude Publica. 2006;40(3):497-504. DOI:10.1590/S0034-89102006000300019
https://doi.org/10.1590/S0034-8910200600... ^{, 75}75 . Nicoli MG, Liberatore RDRL. Binge eating disorder and body image perception among university students. Eat Behav. 2011;12(4):284-8. DOI:10.1016/j.eatbeh.2011.07.004
https://doi.org/10.1016/j.eatbeh.2011.07... ^{, 88}88 . Quadros TMB, Gordia AP, Martins CR, Silva DAS, Ferrari EP, Petroski EL. Imagem corporal em universitários: associação com estado nutricional e sexo. Motriz Rev Educ Fis (Impr). 2010;16(1):78-85. DOI:10.5016/1980-6574.2010v16n1p78
https://doi.org/10.5016/1980-6574.2010v1... As mentioned above, only during the last five years have researchers concentrated their efforts on creating or adapting measures that can be used with men; however, even recent publications continued to have women as the object of study.

Second, disproportions were also observed concerning the age of the participants. In all of the databases consulted, adolescents were the target population most often evaluated,²2 . Adami F, Frainer DES, Santos JS, Fernandes TC, De-Oliveira FR. Insatisfação corporal e atividade física em adolescentes da região continental de Florianópolis. Psic Teor Pesq. 2008;24(2):143-9. DOI:10.1590/S0102-37722008000200003
https://doi.org/10.1590/S0102-3772200800... ^{, 11}11 . Branco LM, Hilário MOE, Cintra IP. Percepção e satisfação corporal em adolescentes e a relação com seu estado nutricional. Rev Psiquiatr Clin. 2006;33(6):292-6. DOI:10.1590/S0101-60832006000600001
https://doi.org/10.1590/S0101-6083200600... ^{, 20}20 . Castro IRR, Levy RB, Cardoso LO, Passos MD, Sardinha LMV, Tavares LF. Imagem corporal, estado nutricional e comportamento com relação ao peso entre adolescentes brasileiros. Cienc Saude Coletiva. 2010;15Suppl 2:3099-108. DOI:10.1590/S1413-81232010000800014
https://doi.org/10.1590/S1413-8123201000... ^{, 24}24 . Conti MA, Frutuoso MFP, Gambardella AMD. Excesso de peso e insatisfação corporal em adolescentes. Rev Nutr. 2005;18(4):491-7. DOI:10.1590/S1415-52732005000400005
https://doi.org/10.1590/S1415-5273200500... ^{, 31}31 . Corseuil MW, Pelegrini A, Beck C, Petroski EL. Prevalência de insatisfação com a imagem corporal e sua associação com a inadequação nutricional em adolescentes. Rev Educ Fis. 2009;20(1):25-31. ^{, 38}38 . Dunker KLL, Fernandes CPB, Carreira Filho D. Influência do nível socioeconômico sobre comportamentos de risco para transtornos alimentares em adolescentes. J Bras Psiquiatr. 2009;58(3):156-61. DOI:10.1590/S0047-20852009000300003
https://doi.org/10.1590/S0047-2085200900... ^{, 68}68 . Laus MF, Costa TMB, Almeida SS. Body image dissatisfaction and its relationship with physical activity and body mass index in Brazilian adolescents. J Bras Psiquiatr. 2011;60(4):315-20. DOI:10.1590/S0047-20852011000400013
https://doi.org/10.1590/S0047-2085201100... ^{, 73}73 . Martins CR, Pelegrini A, Matheus SC, Petroski EL. Insatisfação com a imagem corporal e a relação com estado nutricional, adiposidade corporal e sintomas de anorexia e bulimia em adolescentes. Rev Psiquiatr Rio Gd Sul. 2010;32(1):19-23. DOI:10.1590/S0101-81082010000100004
https://doi.org/10.1590/S0101-8108201000... ^{, e}e Fernandes AER. Avaliação da imagem corporal, hábitos de vida e alimentares em crianças e adolescentes de escolas públicas e particulares de Belo Horizonte [dissertação de mestrado]. Belo Horizonte: Universidade Federal de Minas Gerais; 2007. followed by undergraduates.⁴4 . Alvarenga MDS, Philippi ST, Lourenço BH, Sato PDM, Scagliusi FB. Insatisfação com a imagem corporal em universitárias brasileiras. J Bras Psiquiatr. 2010;59(1):44-51. DOI:10.1590/S0047-20852010000100007
https://doi.org/10.1590/S0047-2085201000... ^{, 51}51 . Gonçalves TD, Barbosa MP, Rosa LCLD, Rodrigues AM. Comportamento anoréxico e percepção corporal em universitários. J Bras Psiquiatr. 2008;57(3):166-70. DOI:10.1590/S0047-20852008000300002
https://doi.org/10.1590/S0047-2085200800... ^{, 66}66 . Kakeshita IS, Almeida SS. Relationship between body mass index and self-perception among university students. Rev Saude Publica. 2006;40(3):497-504. DOI:10.1590/S0034-89102006000300019
https://doi.org/10.1590/S0034-8910200600... ^{, 69}69 . Laus MF, Moreira RCM, Costa TMB. Diferenças na percepção da imagem corporal, no comportamento alimentar e no estado nutricional de universitárias das áreas de saúde e humanas. Rev Psiquiatr Rio Gd Sul. 2009;31(3):192-6. DOI:10.1590/S0101-81082009000300009
https://doi.org/10.1590/S0101-8108200900... ^{, 74}74 . Miranda VPN, Filgueiras JF, Mockdece CN, Teixeira PC, Ferreira MEC. Insatisfação corporal em universitários de diferentes áreas de conhecimento. J Bras Psiquiatr. 2012;61(1):25-32. DOI:10.1590/S0047-20852012000100006
https://doi.org/10.1590/S0047-2085201200... ^{, 87}87 . Pontieri FM, Lopes PF, Eça VB. Avaliação da presença de fatores de para o desenvolvimento de transtornos alimentares em acadêmicos de um curso de Educação Física. Ensaios Cienc. 2007;2(2):29-37. ^{, 96}96 . Silva DAS, Nahas MV, de Sousa TF, Del Duca GF, Peres KG. Prevalence and associated factors with body image dissatisfaction among adults in southern Brazil: a population-based study. Body Image. 2011;8(4):427-31. DOI:10.1016/j.bodyim.2011.05.009
https://doi.org/10.1016/j.bodyim.2011.05... Studies with children⁶6 . Alves TCHS, Santana MLP, Silva RCR, Pinto EJ, Assis AMO. Fatores associados a sintomas de transtornos alimentares entre escolares da rede pública da cidade do Salvador, Bahia. J Bras Psiquiatr. 2012;61(2):55-63. DOI:10.1590/S0047-20852012000200001
https://doi.org/10.1590/S0047-2085201200... ^{, 14}14 . Carvalho AMP, Cataneo C, Galindo EMC, Malfará CT. Auto conceito e imagem corporal em crianças obesas. Paideia (Ribeirao Preto). 2005;15(30):131-9. DOI:10.1590/S0103-863X2005000100014
https://doi.org/10.1590/S0103-863X200500... ^{, 53}53 . Graup S, Pereira EF, Lopes ADS, Araújo VCD, Legnani RFS, Borgatto AF. Associação entre a percepção da imagem corporale indicadores antropométricos de escolares. Rev Bras Educ Fis Esp. 2008;22(2):129-38. ^{, 81}81 . Pereira EF, Graup S, Lopes AS, Borgatto AF, Daronco LSE. Percepção da imagem corporal de crianças e adolescentes com diferentes níveis socio-econômicos na cidade de Florianópolis, Santa Catarina, Brasil. Rev Bras Saude Mater Infant. 2009;9(3):253-62. DOI:10.1590/S1519-38292009000300004
https://doi.org/10.1590/S1519-3829200900... ^{, 85}85 . Pinheiro AP, Giugliani ERJ. Who are the children with adequate weight who feel fat? J Pediatr (Rio J). 2006;82(3):232-5. DOI:10.2223/JPED.1477
https://doi.org/10.2223/JPED.1477... ^{, 86}86 . Pinheiro NP, Jiménez M. Percepção e insatisfação corporal: um estudo em crianças brasileiras. Psico. 2010;41(4):510-6. ^{, 106}106 . Triches RM, Giugliani ERJ. Insatisfação corporal em escolares de dois municípios da região Sul do Brasil. Rev Nutr. 2007;20(2):119-28. DOI:10.1590/S1415-52732007000200001
https://doi.org/10.1590/S1415-5273200700... and the older adults⁸8 . Benedetti TB, Petroski EL, Gonçalves LT. Exercícios físicos, auto-imagem e auto-estima em idosos asilados. Rev Bras Cineantropom Desempenho Hum. 2003;5(2):69-74. ^{, 21}21 . Chaim J, Izzo H, Sera CTN. Cuidar em saúde: satisfação com imagem corporal e autoestima de idosos. Mundo Saude. 2009;33(2):175-81. ^{, 41}41 . Fonseca CC, Gama EF, Thurm BE, Pereira ES, Limongelli AMA, Miranda MLJ. Benefícios da estimulação perceptual corporal no esquema corporal de idosos. Rev Bras Geriatr Gerontol. 2012;15(2):353-64. DOI:10.1590/S1809-98232012000200017
https://doi.org/10.1590/S1809-9823201200... ^{, 82}82 . Pereira EF, Teixeira CS, Borgatto AF, Daronco LSE. Relação entre diferentes indicadores antropométricos e a percepção da imagem corporal em idosas ativas. Rev Psiquiatr Clin. 2009;36(2):54-9. DOI:10.1590/S0101-60832009000200003
https://doi.org/10.1590/S0101-6083200900... ^{, 105}105 . Tribess S, Virtuoso Jr JS, Petroski EL. Estado nutricional e percepção da imagem corporal de mulheres idosas residentes no nordeste do Brasil. Cienc Saude Coletiva. 2010;15(1):31-8. DOI:10.1590/S1413-81232010000100008
https://doi.org/10.1590/S1413-8123201000... have also been conducted, but they were notably less frequent. This is important when we consider that measures that have this age group as the target population started to be adapted only in 2009. Thus, several studies published before this date had used non-validated instruments. Moreover, studies with children and older people were mostly conducted using non-validated instruments.

Third, Brazilian researchers have been concentrating their efforts on the evaluation of aspects related to global satisfaction. Indeed, the results from our survey showed that (dis)satisfaction is undeniably the most assessed component in all of the databases consulted, whereas the perceptual dimension and cognitive, behavioral, and emotional components of body image have been neglected. In this sense, data from studies within the Brazilian population are only able to provide evidence that dissatisfaction with the whole body or parts of it have become a common feature in the country, regardless of sex and age. These studies showed that dissatisfaction affected approximately 60.0%-83.0% of children,⁸⁴84 . Pinheiro AP, Giugliani ERJ. Body dissatisfaction in Brazilian schoolchildren: prevalence and associated factors. Rev Saude Publica. 2006;40(3):489-96. DOI:10.1590/S0034-89102006000300018
https://doi.org/10.1590/S0034-8910200600... ^{, 106}106 . Triches RM, Giugliani ERJ. Insatisfação corporal em escolares de dois municípios da região Sul do Brasil. Rev Nutr. 2007;20(2):119-28. DOI:10.1590/S1415-52732007000200001
https://doi.org/10.1590/S1415-5273200700... ^{, f}f Fernandes AER. Avaliação da imagem corporal, hábitos de vida e alimentares em crianças e adolescentes de escolas públicas e particulares de Belo Horizonte [dissertação de mestrado]. Belo Horizonte: Universidade Federal de Minas Gerais; 2007. 60.0%-80.0% of adolescents,²2 . Adami F, Frainer DES, Santos JS, Fernandes TC, De-Oliveira FR. Insatisfação corporal e atividade física em adolescentes da região continental de Florianópolis. Psic Teor Pesq. 2008;24(2):143-9. DOI:10.1590/S0102-37722008000200003
https://doi.org/10.1590/S0102-3772200800... ^{, 31}31 . Corseuil MW, Pelegrini A, Beck C, Petroski EL. Prevalência de insatisfação com a imagem corporal e sua associação com a inadequação nutricional em adolescentes. Rev Educ Fis. 2009;20(1):25-31. ^{, 80}80 . Pelegrini A, Petroski EL. Inatividade física e sua associação com estado nutricional, insatisfação com a imagem corporal e comportamentos sedentários em adolescentes de escolas públicas. Rev Paul Pediatr. 2009;27(4):366-73. DOI:10.1590/S0103-05822009000400004.
https://doi.org/10.1590/S0103-0582200900... 60.0%-87.0% of adults³⁰30 . Coqueiro RS, Petroski EL, Pelegrini A, Barbosa AR. Insatisfação com a imagem corporal: avaliação comparativa da associação com o estado nutricional em universitários. Rev Psiquiatr Rio Gd Sul. 2008;30(1):31-8. DOI:10.1590/S0101-81082008000100009
https://doi.org/10.1590/S0101-8108200800... ^{, 35}35 . Damasceno VO, Lima JRP, Vianna JM, Vianna VRA, Novaes JS. Tipo físico ideal e satisfação com a imagem corporal de praticantes de caminhada. Rev Bras Med Esporte. 2005;11(3):181-6. DOI:10.1590/S1517-86922005000300006
https://doi.org/10.1590/S1517-8692200500... ^{, 75}75 . Nicoli MG, Liberatore RDRL. Binge eating disorder and body image perception among university students. Eat Behav. 2011;12(4):284-8. DOI:10.1016/j.eatbeh.2011.07.004
https://doi.org/10.1016/j.eatbeh.2011.07... ^{, 88}88 . Quadros TMB, Gordia AP, Martins CR, Silva DAS, Ferrari EP, Petroski EL. Imagem corporal em universitários: associação com estado nutricional e sexo. Motriz Rev Educ Fis (Impr). 2010;16(1):78-85. DOI:10.5016/1980-6574.2010v16n1p78
https://doi.org/10.5016/1980-6574.2010v1... ^{, 92}92 . Rech CR, Araújo EDS, Vanat JR. Autopercepção da imagem corporal em estudantes de educação física. Rev Bras Educ Fis Esporte. 2010;24(2):285-92. DOI:10.1590/S1807-55092010000200011
https://doi.org/10.1590/S1807-5509201000... ^{, 96}96 . Silva DAS, Nahas MV, de Sousa TF, Del Duca GF, Peres KG. Prevalence and associated factors with body image dissatisfaction among adults in southern Brazil: a population-based study. Body Image. 2011;8(4):427-31. DOI:10.1016/j.bodyim.2011.05.009
https://doi.org/10.1016/j.bodyim.2011.05... and 55.0%-73.0% of the older adults.²¹21 . Chaim J, Izzo H, Sera CTN. Cuidar em saúde: satisfação com imagem corporal e autoestima de idosos. Mundo Saude. 2009;33(2):175-81. ^{, 82}82 . Pereira EF, Teixeira CS, Borgatto AF, Daronco LSE. Relação entre diferentes indicadores antropométricos e a percepção da imagem corporal em idosas ativas. Rev Psiquiatr Clin. 2009;36(2):54-9. DOI:10.1590/S0101-60832009000200003
https://doi.org/10.1590/S0101-6083200900... ^{, 105}105 . Tribess S, Virtuoso Jr JS, Petroski EL. Estado nutricional e percepção da imagem corporal de mulheres idosas residentes no nordeste do Brasil. Cienc Saude Coletiva. 2010;15(1):31-8. DOI:10.1590/S1413-81232010000100008
https://doi.org/10.1590/S1413-8123201000... Notably, the results have been consistent with regard to showing that body image disturbances are more frequent in females. Nevertheless, although this research was conducted with men, these studies utilized instruments that were not the most appropriate because they focused on thinness and body fat instead of muscularity, as recommended by Cash & Smolak¹⁶16 . Cash TF, Smolak L. Understanding body image: historical and contemporary perspectives. In: Cash TF, Smolak L, editors. Body image: a handbook of science, practice, and prevention. New York: Guilford Press; 2011. p. 3-11. (2011). In Brazil, few scales or questionnaires have been developed with such characteristics.

In the last decade, some specific groups have gained attention in the Brazilian context. One example is athletes. Several research groups have substantially increased their number of publications concerning this particular population.¹⁹19 . Castro APA, Damasceno VO, Miranda JA, Lima JRP, Vianna JM. Photo silhouettes for assessment of body image of bodybuilders. Rev Bras Med Esporte. 2011;17(4):250-3. DOI:10.1590/S1517-86922011000400007
https://doi.org/10.1590/S1517-8692201100... ^{, 39}39 . Ferreira A, Bergamin R, Gonzaga T. Correlação entre medidas antropométricas e aceitação pessoal da imagem corporal em bailarinas de dança moderna. Mov Percepçao. 2008;9(12):43-51. ^{, 42}42 . Fortes LS, Almeida SS, Ferreira MEC. Impacto de variáveis antropométricas sobre a insatisfação corporal e o comportamento alimentar em jovens atletas. J Bras Psiquiatr. 2012;61(4):235-41. DOI:10.1590/S0047-20852012000400007
https://doi.org/10.1590/S0047-2085201200... ^{, 43}43 . Fortes LS, Ferreira MEC. Comparação da insatisfação corporal e do comportamento alimentar inadequado em atletas adolescentes de diferentes modalidades esportivas. Rev Bras Educ Fis Esporte. 2011;25(4):707-16. DOI:10.1590/S1807-55092011000400014
https://doi.org/10.1590/S1807-5509201100... ^{, 44}44 . Fortes LS, Miranda VPN, Amaral ACS, Ferreira MEC. Insatisfação corporal de adolescentes atletas e não atletas. J Bras Psiquiatr. 2011;60(4):309-14. DOI:10.1590/S0047-20852011000400012
https://doi.org/10.1590/S0047-2085201100... ^{, 54}54 . Haas AN, Garcia ACD, Bertoletti J. Imagem corporal e bailarinas profissionais. Rev Bras Med Esporte. 2010;16(3):182-5. DOI:10.1590/S1517-86922010000300005
https://doi.org/10.1590/S1517-8692201000... ^{, 77}77 . Oliveira FP, Bosi MLM, Vigário PS, Vieira RS. Comportamento alimentar e imagem corporal em atletas. Rev Bras Med Esporte. 2003;9(6):348-56. DOI:10.1590/S1517-86922003000600002
https://doi.org/10.1590/S1517-8692200300... ^{, 83}83 . Perini TA, Vieira RS, Vigário PDS, Oliveira GLD, Ornellas JDS, Oliveira FPD. Transtorno do comportamento alimentar em atletas de elite de nado sincronizado. Rev Bras Med Esporte. 2009;15(1):54-7. DOI:10.1590/S1517-86922009000100012
https://doi.org/10.1590/S1517-8692200900... ^{, 107}107 . Vieira JLL, Oliveira LPD, Vieira LF, Vissoci JRN, Hoshino EF, Fernandes SL. Distúrbios de atitudes alimentares e sua relação com a distorção da auto-imagem corporal em atletas de judô do estado do Paraná. Rev Educ Fisica. 2006;17(2):177-84. ^{, 108}108 . Vieira LF, Amorim HZ, Amorim AC, Rocha PGM, Vieira JLL. Distúrbios de atitudes alimentares e sua relação com o crescimento físico de atletas paranaenses de ginástica rítmica. Motriz Rev Educ Fis (Impr). 2009;15(3):552-61. Moreover, individuals with various clinical conditions have also been investigated. Since the beginning of the 2000s, body image began to be explored in patients with rheumatoid arthritis,⁶¹61 . Jorge RTB, Brumini C, Jones A, Natour J. Body image in patients with rheumatoid arthritis. Mod Rheumatol. 2010;20(5):491-5. DOI:10.1007/s10165-010-0316-4
https://doi.org/10.1007/s10165-010-0316-... cancer,³3 . Almeida TR, Guerra MR, Filgueiras MST. Repercussões do câncer de mama na imagem corporal da mulher: uma revisão sistemática. Physis. 2012;22(3):1003-29. DOI:10.1590/S0103-73312012000300009
https://doi.org/10.1590/S0103-7331201200... ^{, 56}56 . Hannickel S, Zago MMF, Barbeira CB, Sawada NO. O comportamento dos laringectomizados frente à imagem corporal. Rev Bras Cancerol. 2002;48(3):333-9. ^{, 79}79 . Pedrolo FT, Zago MMF. A imagem corporal alterada do laringectomizado: resignação com a condição. Rev Bras Cancerol. 2000;46(4):407-15. ^{, 93}93 . Santos DB, Vieira EM. Imagem corporal de mulheres com câncer de mama: uma revisão sistemática da literatura. Cienc Saude Coletiva. 2011;16(5):2511-22. DOI:10.1590/S1413-81232011000500021
https://doi.org/10.1590/S1413-8123201100... ^{, 98}98 . Silva MS, Castro EK, Chem C. Qualidade de vida e auto-imagem de pacientes com câncer de cabeça e pescoço. Univ Psychol. 2012;11(1):13-23. visual disability,⁴⁵45 . França DNO, Azevedo EEDS. Imagem corporal e sexualidade de adolescentes com cegueira, alunos de uma escola pública especial em Feira de Santana, Bahia. Rev Cienc Med Biol. 2010;2(2):176-84. ^{, 59}59 . Interdonato GC, Greguol M. Auto-análise da imagem corporal de adolescentes com deficiência visual sedentários e fisicamente ativos. Conexoes. 2009;7(3):1-13. physical disability,⁹⁰90 . Rafael CBS, Gomes LF, Duarte ER, Barreto SMG, Ferreira MEC. Benefícios da atividade física em relação à imagem corporal da pessoa com deficiência física. Rev Sobama. 2012;13(2Suppl):9-12. human immunodeficiency virus/autoimmune deficiency syndrome,¹³13 . Campião W, Leite LHM, Vaz EM. Autopercepção da imagem corporal entre indivíduos portadores do vírus da imunodeficiência humana (HIV). Rev Bras Nutr Clin. 2010;25(3):177-81. ^{, 71}71 . Leite LHM, Papa A, Valentini RC. Insatisfação com imagem corporal e adesão à terapia antirretroviral entre indivíduos com HIV/AIDS. Rev Nutr. 2011;24(6): 873-82. DOI:10.1590/S1415-52732011000600008
https://doi.org/10.1590/S1415-5273201100... ^{, 89}89 . Silva QH, Pedro FL, Kirsten VR. Satisfação corporal e características de lipodistrofia em crianças e adolescentes com HIV/AIDS em uso de terapia antirretroviral de alta potência. Rev Paul Pediatr. 2011;29(3):357-63. DOI:10.1590/S0103-05822011000300009
https://doi.org/10.1590/S0103-0582201100... Parkinson’s disease,⁴⁷47 . Gamarra AHE, Molski CS, Hilbig A, Valentini CK, Striebel VLW, Rieder CRDM. Evaluation of body image and self-concept and their correlation with depressive symptoms in Parkinson’s disease. Arq Neuropsiquiatr. 2009;67(3A):585-90. DOI:10.1590/S0004-282X2009000400002
https://doi.org/10.1590/S0004-282X200900... obesity and bariatric surgery,¹⁴14 . Carvalho AMP, Cataneo C, Galindo EMC, Malfará CT. Auto conceito e imagem corporal em crianças obesas. Paideia (Ribeirao Preto). 2005;15(30):131-9. DOI:10.1590/S0103-863X2005000100014
https://doi.org/10.1590/S0103-863X200500... ^{, 34}34 . Costa RF, Machado SC, Cordás TA. Imagem corporal e comportamento sexual de mulheres obesas com e sem transtorno da compulsão alimentar periódica. Rev Psiquiatr Clin. 2010;37(1):27-31. DOI:10.1590/S0101-60832010000100006
https://doi.org/10.1590/S0101-6083201000... ^{, 67}67 . Kanno P, Rabelo M, Melo GFD, Giavoni A. Discrepâncias na imagem corporal e na dieta de obesos. Rev Nutr. 2008;21(4):423-30. DOI:10.1590/S1415-52732008000400006
https://doi.org/10.1590/S1415-5273200800... ^{, 76}76 . Nozaki VT, Rossi NM. Imagem corporal: cirurgia bariátrica. Saude Pesq. 2010;3(2):185-91. ^{, g}g Rezende FF. Percepção da imagem corporal, resiliência e estratégias de coping em pacientes submetidos à cirurgia bariátrica [dissertação de mestrado]. Ribeirão Preto: Universidade de São Paulo; 2011. burns,⁹9 . Bergamasco EC, Rossi LA, Amâncio CG, de Carvalho EC. Body image of patients with Burns sequellae: evaluation through the critical incident technique. Burns. 2002;28(1):47-52. DOI:10.1016/S0305-4179(01)00065-1
https://doi.org/10.1016/S0305-4179(01)00... ^{, 33}33 . Costa MCS, Rossi LA, Dantas RAS, Trigueros LF. Imagem corporal e satisfação no trabalho entre adultos em reabilitação de queimaduras. Cogitare Enferm. 2010;15(2):209-16. ^{, 63}63 . Júnior GFP, Vieira ACP, Alves GM. Avaliação da qualidade de vida de indivíduos queimados pós alta hospitalar. Rev Bras Queimaduras. 2010;9(4):140-5. and pregnancy.¹⁰²102 . Teixeira PC, Matsudo SM, de Almeida VS. Auto-estima e imagem corporal de gestantes de acordo com o nível de atividade física. Rev Bras Cienc Mov. 2009;16(1):53-60. ^{, h}h Cairolli PB. Avaliação da imagem corporal e da (in)satisfação com o corpo grávido pela escala de medida em imagem corporal em gestantes inscritas no programa de pré-natal da rede básica de saúde de Vinhedo - SP [dissertação de mestrado]. Campinas: Universidade Estadual de Campinas; 2009.

After much reflection about the data obtained from this survey and in an attempt to understand the reasons for the lack of important information concerning certain groups, the most plausible explanation we found relies on the availability of instruments. As already exemplified in the case concerning studies conducted with men and women, researchers have faced difficulties assessing several aspects of body image in vast age ranges and physical and mental conditions because of the limited number of instruments available in the country. Moreover, a considerable number of the studies analyzed used tools that may not be entirely suitable for the target population.

Another necessary consideration is the common mistake made by Brazilian researchers with regard to the dimension/component assessed. When studying body image, researchers must acknowledge that this is a multidimensional construct. We noticed that much confusion still exists in the use of appropriate terms (e.g., studies that assessed body dissatisfaction but referred to it as body image perception). Knowledge of its definition and dimensions is essential when selecting appropriate measures. Thus, the results from several published studies should be analyzed with caution.

Future directions

Despite the progress that has been made in the past several years, the actual state of knowledge about body image in Brazil is still far from what is known in more developed countries, especially the United States, Australia, and some European countries. Researchers in these advanced centers of study are seeking to understand this theme in fairly diverse populations, develop several new assessment instruments, identify risk and protective factors in body image disturbances, and improve prevention and treatment strategies.²³23 . Conti MA, Ferreira MEC, Amaral ACS, Heasrt N, Cordás TA, Scagliusi FB. Equivalência Semântica da versão em português do “Body Change Inventory”. Cienc Saude Coletiva. 2012;17(9):2457-69. DOI:10.1590/S1413-81232012000900026
https://doi.org/10.1590/S1413-8123201200... Furthermore, in addition to the sociocultural elements that are already well known to influence the development of body image, several new perspectives are being proposed to understand this multidimensional construct. Behavioral and molecular genetic studies have been conducted to identify factors other than psychological ones related to increased susceptibility to poor body image. Similarly, neuroimaging techniques are being applied to explore specific areas of the brain that may be implicated in such disorders.¹¹⁸

In Brazil, the study of body image is still in its infancy, and the initiative that is most prominent is providing assessment tools that are essential to advancing research in this area. Importantly, we noted that some specific groups are being studied extensively, whereas others are being relatively overlooked. One might think that this may be attributable to the lack of instruments available, but the tools that have been developed or adapted do not focus on these ignored groups. Therefore, efforts must be made especially in this direction.

Appearance-related issues have pronounced importance in the Brazilian population. Body image has been taken into account in several surveys conducted by the Brazilian government (e.g., National Survey of Scholars Healthⁱi Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde do escolar 2009. Rio de Janeiro; 2009 [cited 2013 Apr 23]. Available from: http://www.ibge.gov.br/home/estatistica/populacao/pense/pense.pdf ), and the results have supported the Ministry of Health in planning and implementing health promotion because these evaluations have generated evidence to guide and estimate the impact of interventions to reduce the prevalence of risk factors.

CONCLUSIONS

By analyzing the current situation of body image research in Brazil, we may conclude that the majority of measures available are intended to be used in college students. Half of these instruments evaluate satisfaction/dissatisfaction with the whole body or parts of it. Females and adolescents of both sexes are the most studied population, and researchers have concentrated their efforts only on the assessment of body satisfaction. The advances that have been made in the field are mainly represented by the large increase in the number of available instruments. Nevertheless, many published studies have used non-validated instruments, with much confusion in the use of appropriate terms. In summary, much more is needed to understand body image in the Brazilian population, but interest in this theme is increasing, and important steps have been taken by scientists in the country.

REFERENCES

Publication Dates

History