EISSN 1676-5133

ANALYSIS OF THE BODY IMAGE EVALUATION INSTRUMENTS

Fabiane Frota da Rocha Morgado1 fabi.frm@hotmail.com Maria Elisa Caputo Ferreira1 caputoferreira@terra.com.br Mnica Rodrigues Maia Andrade1 monicarmaia@hotmail.com Ktia Josiany Segheto1 kjosy@ig.com.br doi:10.3900/fpj.8.3.204.e

Morgado FFR, Ferreira MEC, Andrade MRM, Segheto KJ. Analysis of the Body Image Evaluation Instruments. Fit Perf J. 2009 May-Jun;8(3):204-11.

ABSTRACT
Introduction: In the last few decades, there has been an increase as well as a diversication of the methodologies which seek to assess self body image. For the health professionals, it is of foremost importance to diagnose the image disorder in his/her students as well as in athletes or patients, for further referring them to therapy. This study aims to identify, quantify and collect the body image evaluation instruments that have been used in academic and scientic studies in Brazil, from 1992 to 2007, highlighting the most widely used. Materials and Methods: Bibliographic research performed based upon data from USP , Bireme, Google, databases, where one can nd data from Medline, Lilacs, and SciELO, among others. The descriptors were: body image, evaluation protocols, self image and evaluation instruments. Results: 130 protocols were used in 80 scientic and academic studies. The instruments were gathered in six groups: Questionnaires, 27.7%; Interviews, 25.4%; Drawings, 15.4%; Anthropometric Variables, 15.4%; Scales, 10%; and Silhouettes, 6.1%. Discussion: It was evident that the scholars restlessly searched for a non limited methodology which could be better suited for the group of people being studied. As a result, a wide variety of optional instruments to evaluate body image were found.

KEYWORDS
Questionnaires, Interview, Body Image.
1

Universidade Federal de Juiz de Fora - UFJF - Faculdade de Educao Fsica - Laboratrio de Estudos do Corpo - LABESC - Juiz de Fora - Brazil

Copyright 2009 por Colgio Brasileiro de Atividade Fsica, Sade e Esporte

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ANLISE

DOS

INSTRUMENTOS

DE

AVALIAO

DA

IMAGEM CORPORAL

RESUMO
Introduo: Nas ltimas dcadas, houve um aumento e uma diversificao das metodologias que buscaram avaliar a auto-imagem corporal. Para os profissionais da rea de sade imprescindvel o diagnstico do distrbio de imagem em seus alunos, atletas ou pacientes, para posterior encaminhamento destes a uma terapia. Este estudo visa identificar, quantificar e reunir os instrumentos de avaliao da imagem corporal que tm sido utilizados nas produes acadmicas e cientficas, no Brasil, de 1992 at 2007, destacando os mais utilizados. Materiais e Mtodos: Pesquisa bibliogrfica realizada nas bases de dados da USP , Bireme, Google, onde esto bases, como Medline, Lilacs, SciELO, entre outras. Os descritores adotados foram: imagem corporal, protocolos de avaliao, auto-imagem, instrumentos de avaliao e body image. Resultados: Foram analisados 130 protocolos utilizados em 80 produes cientficas e acadmicas. Os instrumentos foram reunidos em seis grupos: Questionrios, 27,7%; Entrevistas, 25,4%; Desenhos, 15,4%; Variveis Antropomtricas, 15,4%; Escalas, 10%; e Silhuetas, 6,1%. Discusso: Percebeu-se uma busca dos estudiosos por uma metodologia no-limitada, que melhor se aplique ao seu grupo pesquisado, o que resultou num emaranhado de opes de instrumentos para avaliar a imagem corporal.

PALAVRAS-CHAVE
Questionrios, Entrevista, Imagem Corporal.

ANLISIS

DE LOS INSTRUMENTOS PARA LA

EVALUACIN

DE LA

IMAGEN CORPORAL

RESUMEN
Introduccin: En las ltimas dcadas, hubo un aumento y una diversificacin de las metodologas que buscaron evaluar la auto-imagen. Para los profesionales en el mbito de la salud es fundamental para diagnosticar el trastorno de la imagen en sus estudiantes, atletas o pacientes para su posterior envo de una terapia. Este estudio pretende identificar, cuantificar y recoger los protocolos de evaluacin de la imagen corporal que viene siendo utilizados en las producciones cientficas y acadmicas en Brasil, desde 1992 hasta 2007, destacando el ms utilizado. Materiales y Mtodos: Bsqueda de literatura celebrado en bases de datos de la USP , Bireme, Google, dnde estn las bases y Medline, Lilacs, SciELO, entre otros. Los descriptores se aprob: imagen corporal, protocolos para evaluacin, auto-imagen, herramientas de evaluacin y body image. Resultados: Fueron analizados 130 protocolos utilizados en 80 producciones, que se reunieron en seis grupos: Cuestionarios, el 27,7%; Encuestas, 25,4%; Dibujos, 15,4%; Variables Antropomtricas, 15,4%; Escalas, 10%; Siluetas, el 6,1%. Discusin: Fue notada una bsqueda inquietante de los estudiosos por una metodologa no limitada, que mejor se aplique a su grupo investigado, lo que result en un enmaraado de opciones de instrumentos para evaluarse la imagen corporal.

PALABRAS CLAVE
Cuestionario, Entrevista, Imagen Corporal.

INTRODUCTION
The history of body image began in the sixteenth century in France, with the doctor and surgeon Ambroise Par1. But the biggest contribution in this area was from Paul Schilder2, starting from 1935. However, it appears that from the 90s, the issue was addressed in an expressive way by researchers and scholars, resulting in a network of methodological options for evaluating the body image. It is understood by human body image the guration of our body formed in our mind, or the way the body appears to us2. The referred presentation mode is inuenced by physiological, libidinous and sociological factors. Therefore, in addition to the anatomical and physiological structure genetically dened and the libidinous aspects, we experience the body image of others2. Accordingly, the bodies that constitute the culture of a people inuence in the shaping of the individuals body image. In postmodern society, the cultural ideal of body is that athletic, muscular, lean and beautiful. This ideal permeates the collective imagination. We live in an incessant search for a perfect body. Therefore, sold, alienated, widespread and shaped according to the interests of a cultural industry. Consequently, many people are involved, even unwittingly, in body dysmorphic disorders. Thus, the ideal target for completeness and perfection, propagated in post-modernity, the body seems to serve as a privileged way, through the recovery of thinness, good shape and perfect health, as a standard from an era3. The society seeks ways to adapt to that standard. In this context, the physical activities, the plastic surgeries, the aesthetic treatments, among others, emerge as responsible for shaping the body according to the beauty standards of today.

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We are pressured in many circumstances to achieve, in our body, the ideal body from our culture. We are pressed for such representation by punishment (contempt, criticism, etc.) and gratications (money, power, admiration) 4. It is fact that culture interferes with the formulation of body image. Therefore, it is perceived the existence of cultural codes of beauty and aesthetics that guide the social relations. In this context, the individual is alienated and fragmented in a constant search for the ideal body of his/her culture. The men want a body stronger and more voluminous and with low body fat percentage, and for the women the ideal physical type is a leaner and less voluminous body5. To Bosi the thin body ideal imposed by society prevails, because women with adequate weight showed dissatisfaction with their body image, want to change it to t the social standards6. The dissatisfaction with body image can be perceived in todays society, given the exaggerated increase of eating disorders and a pathological search for physical activities and plastic surgeries, which aim to shape the body according to pre-established social standards, providing the much idealized perfect body. Another factor that conrms the dissatisfaction with the real body, that the individual born with, is the frantic search for places where the body is worked/shaped, such as tness centers, beauty salons and aesthetics clinics. Nowadays, it is understood that the real body is far from being the ideal body. The unattainable aspect of this ideal is in the eternal dissatisfaction with the real body, given the physiological difculties of maintaining a body that is not yours, which is from the cultural industry, which is from the TV, which responds to the capitalist interests. These referred interests are forming a cultural industry that sells ideologies, and with them, fuel the market. It should be emphasized that to maintain a perfect body it is necessary a nancial venture. Facing a notorious dictatorship from the ideal body, some image disorders and, consequently, some eating disorders, are part of the routine of many people in the postmodern society. To the extent that the person demonstrates constant dissatisfaction with the real body, he/she will tend to search the ideal body at the expense of compromising his/her health. An unhealthy food restriction result of eating disorders along with a frantic search for physical activity is one of the factors that affect the biopsychosocial welfare. As the multifactorial aspects are responsible for the etiopathogenesis of the eating disorders, a proper evaluation should include methods of measurement of psychopathological aspects as body image7. So, as the disorders with body image endanger the health of the individual, it becomes relevant to identify the types of protocols (methods or instruments) used for a proper evaluation of the self-image, especially in practitioners of physical acti-

vities5,8,9,10,11,12, athletes from certain sport13,14, bulimics7, obese15,16,17,18,19,20,21 and anorexics7,22,23. It can be perceived that these protocols have been diversied in the last decades, perhaps in consequence of the gradual increase of productions that relate to body image and the need to adequate a tool for evaluation of certain groups, such as in addition to the above mentioned, the laryngectomized24,25, the burned ones26, the children16,27,28,29,30,31,32,33,34, among others. To the health professionals, especially to the teachers of Physical Education, who work frequently with people who show dissatisfaction with the actual body, or with those who are in the omnipotent search for the perfect body, it is relevant to recognize a possible disturbance of image for the conduction to a therapy. In this case, the protocols for evaluation of body image are considered a scientic instrument in the quest to illuminate the individuals perception about the image he has of himself, which helps in the investigation of the existence of body-dysmorphic disorders. For a satisfactory investigation of image disorders it is needed to choose a protocol that best applies to the researched group, and being essential the knowledge of a signicant diversity of methodologies used for the analysis of perception and satisfaction with the self-image. This research, bibliographic in nature, aimed to identify and quantify and meet the protocols for evaluation of body image that have been used in academic and scientic production in Brazil in the last 15 years, highlighting the most used by researchers.

MATERIALS AND METHODS

This research, bibliographic and descriptive in nature, seeks the state-of-the-art surrounding the theme Analysis of the evaluation protocols of body image. It has as a strategy for documental analysis, because it guides the researches that gather and classify the academic and scientic production essentially written. Moreover, the research aims to represent the content of a document in a different way from the original in order to facilitate, in a subsequent study, its consultation and differentiation. As object of analysis the research focused 80 academic and scientic productions, available for free in the online databases from USP , Bireme, Google, where there are the bases as Medline, Lilacs, SciELO, among others. In total, were evaluated 130 protocols found in 66 scientic articles, a course conclusion work, seven masters dissertations, three doctoral theses, a post-doctoral thesis, a publication in congress and one in a symposium. On the bases the English and Portuguese idioms were selected. The choice was made after a selection from those which relate to the area of Health Sciences. The descrip-

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tors used were body image, protocols for evaluation, self-image, instruments of evaluation. The descriptor used in English was body image. In this study were included the scientic and academic productions published in Brazil, between January 1992 and December 2007, which aimed to evaluate body image, and that used an instrument of evaluation clearly demonstrated. Among these, stand out the studies that had as sample a group of practitioners of physical activities5,8,9,10,11,12, athletes from certain sport 13,14, bulimics 7, obese 15,16,17,18,19,20,21, anorexics7,22,23, laryngectomized24,25, the burned ones26, the children16,27,28,29,30,31,32,33,34 and people in the post plastic surgery period35. Were excluded from the study the researches that did not clearly describe the used protocol in the evaluation of body self-image. This study aimed to bring together the protocols for evaluation of body image in groups with common characteristics. For this, the methodologies used by the authors of each work, to measure and evaluate the self-image, were studied and grouped according to their specicities. Were used the following criteria for grouping the protocols: the studies that adopted a questionnaire as an instrument for evaluation were constituents of the Questionnaires block, and those studies using questions as an interview, such as those structured, semi-structured, open and closed, individual , workshops, discussions, among others, were grouped in the Interviews block, the Drawings block consisted of all the studies that adopted any form of graphic and traces made by the subject of research to measure the self-body image. For the block of Anthropometric Variables, the criterion for grouping was the requirement that the analyzed production had the measurement of several variables, such as height, weight, oxygen consumption, exibility, strength of handgrip, absolute and relative maximum muscle power, predominant location of body fat and reference weight, among others, that aimed to complement the main protocol used in the study. It is noteworthy that the variables from this block appear in the studies as complements of a main protocol adopted. Were grouped in the Scales block, the researches that adopted a protocol that had the name Scale or the same terminology in English, but that was not in the form of a Questionnaire. Finally, in the Silhouettes block, were included the articles that used a model of human Silhouettes for the individual to choose the one that was most similar to his/her real and ideal image.

RESULTS
By bringing together the 130 protocols for evaluation of body image, it was veried the formation of six major blocks or groups, which are: Questionnaires, Interviews,

Drawings, Anthropometric Variables, Scales and Silhouettes. Then, it was illustrated the formation of these groups and the classication, quantication and appointment of the subgroups. The methodologies characterized as members of the block of Questionnaires were thus subdivided: test of body image for pre-adolescents (Adapted from Fee & Candy34), body image test36, Body Image from the Female High Performance Handball Athletes questionnaire (based on Doudlah13), afrmative sentences (adapted from the instrument of Gamba et al.37), questionnaire proposed by Steglich9, Body Cathexis Scale (Secord & Jourard7), BodySelf Relations Questionnaire (Winstead & Cash)7, Body Dissatisfaction (Garner et al.7), questionnaire in pregnant adolescents38, questionnaires on body dissatisfaction and self-esteem39, questionnaire of self perception from the participant on his/her weight40, My Body Image questionnaire8,41, Eating Behaviors and Body Image Test (Fee & Candy16,42), questionnaire with closed questions43,44, questionnaire for evaluating quality of life45,46,47, semistructured questionnaire35,48,49 and Body Shape Questionaire6,7,8,14,17,21,50,51,52,53,54,55,56. This instrument had an expressive use in the researches analyzed, appearing in 29% of them, what characterized it as the body image protocol most frequent in scientic and academic studies. The methods forming the Interviews block consisted of the following subgroups: interview using the mirror57, psychological interview58, open interview59, Rorschach Test30, reection workshop60,61, interview in deepness38,48, data survey script (based on Roys theory)62,63, autobiographic narrative23,64, individual interview15,31,65 and semi-structured interview19,20,24,25,28,29,30,57,63,66,67,68,69,70,71,72,73,74. It was noticed that the authors of 25% of productions, which is still considered an expressive percentage when compared to the others, favored method of Interviews. As for those methodologies constituents of the Drawings group, found in productions to evaluate the selfbody image, formed the following subgroups: graphic production66, symptoms graphic8, directed drawing31, Hammers Graphic Battery 75 , thematic drawing 30 , self-portrait drawing 27,28,38 and human figure drawing20,22,29,32,33,35,67,76,77,78,79,80. This method was found in 15% of productions. The protocols forming the block of Anthropometric Variables were subdivided into diverse variables 6,15,42,43,54,81,82,83 and Body Mass Index (BMI)5,6,12,17,18,34,43,53,73,74,79,83, which totaled in the appearance of this method in 15% of productions, equaling to the previous protocol. The instruments clustered in the block of the Scales formed the subgroups: Subscale of Dissatisfaction with Body Image of EBBIT34, burns specic health scale26, Self-Esteem Scale of Rosenberg26, Type Likert17 Scale,

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Body Dissatisfaction Scale50, Body Image Scale66, Flanagan45 Scale, semantic differential scale84, satisfaction scale of body areas18,81 and Piers-Harris Childrens SelfConcept16,77,79. It could be perceived that the referred instrument illuminated 10% of the scientic and academic studies. Finally, those forming the Silhouettes block had only two subdivisions: Silhouette Matching Task - SMT (adapted from Stunkard et al.10) and Set of Silhouettes from Sorensen and Stunkard5,11,12,17,53,56,74. In this context, it is illustrated that the Silhouettes have been adopted by only 6% of the analyzed studies. Such protocol was the least used in scientic and academic context. From the presentation of protocol groups for evaluating the body image, this study sought a relation between them and found, as noted, that the Questionnaire is the most used way to evaluate the issues related to self-image, while the Silhouettes are the less frequent, as shown in Image 1. In order to analyze only the group formed by the Questionnaires, the Body Shape Questionnaire (BSQ) stood out quantitatively. According to Cords7 the BSQ measures the concerns about the shape of the body, self-depreciation due to physical appearance and the feeling of being fat. To Freitas50, the instrument has demonstrated good levels of concurrent and discriminant validity and good test-retest reliability and adequate internal consistency. It seems that the referred instrument has been popularized among the researchers, given their high use in this group. The group for evaluation of body image formed with Interview presented a semi-structured interview as the protocol of preference among the analyzed authors. This method allows the use of guiding questions, according to the interest of the researcher, which may have favored the high quantitative relevance of this instrument. Furthermore, it allows the researchers to obtain answers that go beyond the anatomical and physiological measurements, that is, answers that reveal the history, culture, the corporeity,

among other psychological aspects of the studied subjects, which allows greater deepness85. As for the group formed by the Drawings as a way to measure body image, the drawing of the human gure (DFH) had greater quantitative relevance. To Campagna67, the DFH allows the individual to search the image that makes from himself/herself and also from other people, these images that inhabit his/her mind. It may also reect idealized images, momentary emotions, attitudes to others, to life, to society. These characteristics summarize the design of Shilder about the breadth of the body image term - there are gurations and mental representations involved, but it is not a mere representation2. Thus, these conceptions of DFH may explain the high number of authors who used this methodology in this group. The group formed by the Anthropometric Variables was characterized in two ways: diverse variables (height, weight, maximum oxygen consumption, exibility, strength of handgrip, absolute and relative maximum muscle power, predominant location of body fat and weight of reference, among others) and BMI. In this case, it was perceived that these variables appeared in most productions as auxiliary to another protocol used, being the BMI the most used in this context. The Scales are another way to evaluate the body image. In this context, the Piers-Harris Childrens Scale of Self-Concept was the one with a small highlight among others. Unlike the other groups, this presented a quantitative balance between the formed subgroups. Opposed to that what was believed before starting this study, the group formed with the Silhouettes was the one that showed the lower quantitative importance compared with the others. Perhaps because, as Damasceno5 afrms, such instrument may have several limitations, not allowing the representation of the individual as a whole, the distribution of its mass of subcutaneous fat and other

Image 1 - Utilization of the body image assessment protocols

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important anthropometric aspects in the formation of body image. However, the set of Silhouettes from Sorensen and Stunkard86 was the most used protocol inside this block.

REFERENCES
1. Barros, DD. Imagem corporal: a descoberta de si mesmo. Hist. cienc. saude-Manguinhos. 2005;12:547-54. 2. Shilder P . A imagem do corpo: as energias construtivas da psique. 3 ed. So Paulo: Martins Fontes; 1999.

DISCUSSION
After a bibliographic review, it could be perceived that the most used protocols by the researchers in their studies on body image were the Questionnaires, followed by the Interviews. This nding suggests that the referred instruments may allow that the analyzed individual is considered in its complexity, with all its symbols and meanings. So they are not limited to anatomical and physiological measurements, but seek to understand the subjects body in a historical and cultural context. The body image encompasses all the ways a person experience and concepts his/her own body 4. It can be affirmed that the body image is the concept - and the experience - which is built on the body scheme, bringing along the human world of significations 64. Given this understanding, many authors searched methods to understand and measure the representations of the body to the subject. Freitas affirms that in the image are present the affections, values, personal history, marked in the gestures, the look, in the body that moves, which rests, which symbolizes 87. This understanding seemed to be clear among the researchers, so that the Questionnaire and Interview, which can be understood as instruments that consider the body, the culture and corporeality of the subject, were the most used. It should be highlighted the high number of subgroups within the formed groups. It is a fact that researchers are looking for an adaptation of the already existing protocols or the development of others, so that better ts the subject of their researches. Thus, science has evolved, which allowed increasing the reliability of the data listed in each study. Over 15 years, the simplicity and limitation of some methods associated with the need to adapt the evaluation protocol of body image to a specic group provided a tangle of options of instruments to evaluate the self-image. After reviewing the productions selected for this study, we concluded that the instrument most frequently used was the Questionnaire, while the Silhouette was the method least used by scientists. The other methods, such as Interview, Drawing, Anthropometric Variables and Scale, form a network of methodological options for the measurement of body image. It is suggested, from this study, an identication of the evaluation protocol of body image in an international context, for later comparison with those in vogue in Brazil.

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