The body is the most prominent feature of a person. That is why one’s perception of their own body has a significant role in forming general self-esteem. Furthermore, today’s societies promote the importance of attractive physical appearance. Given the overwhelming prevalence of thin and lean female and strong and lean male images in social media common to all westernized societies, body image concerns have become widespread among adolescents. Moreover, statements on what is acceptable when it comes to physical appearance permeate post-industrial cultures (10). As beauty industry grows, there are numerous possibilities and methods to form one’s body to fit the promoted ideas of physical beauty. Furthermore, in many parts of the world, fitting into these ideal measures is rewarded (i.e. these people are treated better, they are given more opportunities and are considered healthier, smarter, happier, more successful and socially more competent), while those who do not fit those measures are stigmatized (11). Young people also need to be aware of the power of the media and learn how to view media with a critical eye. It is so because, once young people learn about overt media tactics, they will be empowered and experience media in a different way later in life (12). This cross-sectional study has been conducted among 278 participants, where 159 are students in medical vocational schools and 119 are students in a grammar school. When it comes to gender, the majority of the participants are females. Median age is 18 years for both schools and only a few students are 20 years old (Table 1). The majority students from medical vocational schools come from villages and the majority in grammar school are from towns (Table 2). In relation to that fact, it is noticed that medical students are less concerned about their physical appearance than the participants in the grammar school. Going through puberty can amplify body image concerns among boys and girls (13). Puberty for boys brings characteristics typically admired by society: strength, height, broadness. Puberty for girls, on the other hand, brings with it characteristics often perceived as less laudable, as girls generally get rounder and have increased body fat (14). Apart from gender differences, there are evidence that body image dissatisfaction grows during adolescent years what confirms our results. When it comes to gender, female participants are more concerned about their physical appearance than male participants in both schools, which is supported by general experience and statements in literature related to this topic (Table 3, 4). The fact that there is only a small number of female participants who are worried about their physical appearance can be explained with the results on students’ normal BMI. There is only a small number of overweight or underweight students (Fig. 1, Fig. 2). These results implify that most of adolescents live in a traditional environment, where young people live with their families and still consume traditional „mothers’ everyday foodfood“, so that BMI value is not so severely impaired.
In addition, the majority of students live in functional families (Table 6) which can affect the way they eat and amount of stress they experience. Individuals who have a positive attitude towards their physical appearance cannot be influenced by media, peer pressure or family (15). However, this does not mean that these individuals are not exposed to negative information from those sources. Nevertheless, they have tendencies not to take seriously these comments (15). When it comes to female participants who are worried about their physical appearance, it is important not to neglect their presence. It is possible that these individuals apply some methods for losing weight. In addition to increasing risk for negative consequences such as eating disorders, other cross-sectional and longitudinal research suggested that weight maintenance and dieting attempts are associated with other health-compromising behaviors, including poor nutrition, smoking and drinking (16, 17). All participants show low self-esteem (Table 6, Table 7) what can be explained by their adolescent youth, which is a time to search for personal identity and developing their own image about themselves. This is related to the fact that one’s body image is related to their self-esteem and psychological and physical wellbeing. Therefore, a negative body image is related to low self-esteem, anxiety and depression (18). Low self-esteem thus seems to be a unique factor that makes adolescents susceptible to depression. The association between self-esteem and depressive symptoms is interesting to examine during adolescence, as self-esteem affects many of the developmental challenges adolescents have to deal with, such as identity formation and reshaping social relations (19, 20).
Despite the exhibited low self-esteem, there is no confirmed association between body image dissatisfaction and low self-esteem (Table 6).
In addition, there are some conflicted research results. Some research indicate that boys and girls will continue to experience body image dissatisfaction during adolescent years (21). On the other hand, others suggest that, during adolescent period, boys and girls become gradually satisfied with their physical appearance. Finally, there are those who suggest different developmental paths for adolescents where females become less satisfied and males more and more satisfied with their physical appearance (23). This indicates that it is necessary to investigate further the association between low self-esteem and body image satisfaction. This association could exist only in particular groups of young people and not necessarily in every adolescent group. In relation to this, results in this research do not show difference in particular sociodemographic characteristics, gender or type of school.
When it comes to self-evaluation of their nutritional status, medical students are not worried about their physical appearance and their estimation of their body matches the desired BMI. On the other hand, even dough not worried about their physical appearance, participants from grammar school have wrongly estimated their BMI to be lower than the desirable (Fig. 4). Moreover, lower body weight among the participants from grammar school could be the result of higher levels of stress due to school obligations (working harder to achieve better grades and continue to higher levels of education) and latter due to alcohol consumption (Table 8).
When it comes to gender and excess body weight, female outnumber male participants. This can be explained by the fact that females mature faster when it comes to physical characteristics and by increased feeding as a method of stress release. It is highly possible that females develop problems related to their bodies when entering adolescent period (24). Furthermore, females are exposed to high amounts of sociocultural pressures to look a certain way (25). For screening or for epidemiologic research, the BMI is used to assess weight status in adolescents as well as adults. Whereas in adults the BMI cut points that define obesity and overweight are not linked to age and do not differ for males and females, in growing children BMI varies with age and gender. Since the quarter of participants made a mistake estimating their BMI, it is important to conduct more research among larger number of participants to verify the possible reasons for that result. It is possible that such results are a reflection of local or traditional understanding of physical beauty, which entail curves. These mistakes in estimation were more frequent in medical vocational school whose students come from villages. Morris Rosenberg analyzed how social context forms one’s opinion of themselves. He claims that social comparison is related to a minority status and can have negative consequences on one’s self-evaluation (26). On the other hand, male participants from grammar school made more mistakes in their estimations. This can be related to the latest trend that promotes lean and muscular male body (27) and to the fact that grammar school students are more under the influence of the media (or more informed on trends).
It is evident that BMI measurements and BMI self-evaluation are not an adequate method for analyzing the participants because the participants, even those worried about their physical appearance, estimated their appearance in accordance with the desirable BMI. Body image dissatisfaction can be caused by other body characteristics apart from the body weight.
Previous studies indicated many scales that quantitatively assess the body image concerns, where every scale has their own validity, reliability, and cultural norms. Since there are few reliable tool to analyze nutritional status, Tayaba Moeen et al. have pointed out the need for further assessment of body image concerns and to define how individuals perceives or thinks about their physical appearance. Body Image Scale, containing 35 items, highlighted the three of the additional components of body image, namely; physical component, psychological component and strategies to use to maintain one’s body image which had not been discussed in previous scales (28).
When it comes to residency, majority of participants in medical vocational school come from villages and participants in grammar school come from both villages and town (Table 2). Traditional way of life can have impact on the idea how a perfect body should look. In that sense, it is noticed that children raised in such surrounding have a different understanding of the perfect boy measures than the one in the westernized cultures (29).
Furthermore, when it comes to family and its influence, living with both parents with a stable marriage can affect children in a positive sense when it comes to their body image concern. There are also some indications that body image could be affected by the parents’ education or socio-economic status although it is currently not thoroughly investigated (30). In addition, previous studies confirmed that living in a less populated area, or having parents with primary education, was uniquely related to a more negative body image, which comports with other studies of older children and adolescents (31). Nevertheless, it is very important to educate children on physical appearance and its changes during puberty. This means that at a very young age, children need to understand that each body is different in size and shape. It is a message that all need to understand and accept from the beginning of their lives. Young people need to understand both physical and emotional changes they experience in puberty and they need to be aware that those changes are a normal part of their development. In order to cultivate a healthy body image, adolescents need to obtain a set of skills that will help them go through the numerous ideas on how to look and how to eat.
Despite the fact that the results of this research indicate that majority of participants are not severely concerned about their body image, it is very important not to ignore those who do worry about their body image. Also, our results implify that traditonal parenting may be a protective factor in process of development. In those with low body image, it can be associated more with existential fear (study sucess) or with a preoccupation with one's own appearance.
According to the approach of social comparison, the risk of body image dissatisfaction is greater with those who compare themselves to others than with those who rarely compare themselves to others.
It is so because the negative body image they have could have repercussions for their psychological well-being, eating habits, nutritional status, and overall quality of life. Programs that educate adolescents on possible risks a negative body image have could contribute to adolescent health and well-being by promoting realistic and age-appropriate body images and promoting tolerance and diversity. There is currently no official service in Croatia where adolescents could find more information how to provide better control of self- esteem, which affects many of the developmental challenges.