Philippine Journal of Science

138 (1): 67-74, June 2009

ISSN 0031 - 7683

Correlates of Body Image Satisfaction Among

Economically Depressed Urban Filipino Women

Mildred T. Aquino*, Consuelo L. Orense, Celeste C. Tanchoco,

Sofia V. Amarra, Merlyn G. Tajan, and Evelyn O. Dela Cruz

Food and Nutrition Research Institute

Department of Science and Technology, General Santos Avenue,
Bicutan, Taguig City, Philippines

The study assessed body image satisfaction with diet, body mass index (BMI), waist circumference
(WC), waist-hip ratio (WHR), age, income, and education among 251 women in a depressed
urban barangay. Results showed that most women were younger, had low education, and had
no occupation. Using BMI, 28.7% were overweight and obese, and 11.6% were underweight.
Using WHR and WC, 59% and 13.5%, respectively, were at risk. Six out of ten women were
not satisfied with their body image. Nutrient intake and adequacy between women who
were satisfied and those who were not satisfied with their body image were not significantly
different. Adequacy of intake was below the Recommend Energy and Nutrient Intake (RENI)
for most nutrients except niacin. Women satisfied with their body image had lower BMI, WC,
and WHR. Body image satisfaction was associated with BMI, WC, and WHR but WHR was
the only significant variable affecting image satisfaction. Android or central body adiposity
affects body image satisfaction among women because of the change in body shape brought
by fat deposition.

Key Words: body image, body mass index, nutrient intake-adequacy, urban Filipino women,
waist-hip ratio, waste circumference

INTRODUCTION be remarkably stable across the entire female lifespan.

Body image is defined as “how a person feels about his
appearance.” Developing and nurturing a positive body
image is considered part of a healthy mental attitude and
is crucial to a person’s happiness and wellness. Body
image is a combination of how we perceive ourselves
about basic looks and how we react emotionally in
certain situations (Sloan 2006). Having a negative body
image may be a contributing factor to poor self-esteem,
feelings of perfectionalism, and negative eating attitudes
and behaviors which have been identified as predisposing
factors to eating disorders (Perez et al. 2003)
Women seem to be more dissatisfied or negative about
their bodies at all ages. Body dissatisfaction seems to
*Corresponding author: mildredaquino2003@yahoo.com
clo@fnri.dost.gov.ph
merlyntajan@yahoo.com
Women aged 30 to 75 yrs show potential levels of body
dissatisfaction just like younger women. Between 55% to
95% of women express dissatisfaction with their bodies,
and chronic dieting may pose a particular health risk for
women as they age (Tiggeman 1999).
Being overweight and obese are sources of dissatisfaction,
depression, and frustration which may lead to extreme
dieting and eating disorders such as Anorexia nervosa
and Bulimia. The most common assumption about the
link between depression and obesity is that overweight is
viewed negatively by the society resulting in discrimination
even among children in schools and adults in workplaces
(Margraf 2000). Females who perceived themselves to
be overweight prior to puberty scored significantly higher
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Philippine Journal of Science
Vol. 138 No. 1, June 2009
on measures of eating disorders, body dissatisfaction,
ascetism, drive for thinness, and perfectionism. It has
been acknowledged from the results of a longitudinal
study of the National Heart, Lung and Blood Institute
that weight concerns and a drive for thinness at ages 11
to12 are important risk factors leading to daily smoking
at ages 18 to19 years (NIH 2002).
Studies show that cultural diversity in body image exists.
Black and white women differed regarding their ethnic
group’s ideal body image and their perceptions of how
they compared with their ideal body image (Mciza et
al. 2005; Pan 2000; Perez et al. 2003). Women who
perceived themselves as bigger or smaller than the
ideal body size for their ethnic group showed bulimic
symptoms (Perez et al. 2003). Caucasian and Hispanic
Americans were found to exhibit more weight-related
body image disturbance than African-Americans and
Asian-Americans. Studies are needed to determine
whether the association between body dissatisfaction
and disordered eating attitude holds in various socio-
economic groups in developing countries.
Foreign studies have shown that poverty and food
insecurity without hunger may be contributing factors
to adult obesity. The study of Drewnowski and Specter
(2004) stated that the highest rates of obesity occur among
population groups with the highest poverty rates and
least education. He mentioned that energy-dense foods
are mostly composed of refined grains and added sugars,
and fats which may be the least costly foods available to
consumers. Moreover, these energy-dense foods which are
high in sugar and fats are the most palatable and can easily
satisfy hunger. Although poverty and food insecurity are
often associated with lower food expenditures, quality of
the diet is mostly affected, as there is lesser intake of fruits,
vegetables and other protein sources. In another study
done by Townsend et al. (2001), there was an association
between food insecurity and being overweight and obese
in women resulting in chronic diseases. However, aging
is also associated with alterations in body weight and may
have an important impact on health.
According to the 6th National Nutrition Survey
conducted by Food and Nutrition Research Institute
(FNRI) in 2003 (FNRI 2006), undernutrition among
Filipinos is still a problem; however, there has been an
increased prevalence of overweight and obesity from
1998 to 2003. Among adults, 24% are overweight
to obese. In addition, chronic diseases are becoming
number one problem of the country. To date, only a
handful of studies were conducted to determine if the
condition of being overweight or obese affects the
perception of body image of adult Filipino women.
68
Aquino et al.: Body Image Satisfaction
of Women and Correlates
One study conducted by Hawks et al. (2005) among
working women in Bacolod revealed that a significant
number of women were unnecessarily concerned about
reducing body size, and that this attitude was associated
with eating disorder attitudes and restrictive dieting
behaviors. Studies of this kind may contribute to better
understanding of the relationship between body image
satisfaction among economically depressed women with
their dietary intake, age, annual income, education and,
obesity indices. Moreover, there is a need to establish
if there is such an existing body image dissatisfaction
among depressed urban Filipino women, in order to
guide nutrition planners plan for appropriate programs
and intervention to alleviate conditions associated with
overweight and obesity.
The study generally aimed to assess the relationship of
body image satisfaction with dietary intake, obesity indices
such as body mass index (BMI), waist circumference
(WC), waist-hip ratio (WHR), and socio-demographic
factors (age and annual income) among economically
depressed urban Filipino women. Specifically, it aimed
to: (1) determine the socio-demographic characteristics
of the women; (2) determine intake of nutrients among
women who were satisfied and not satisfied with their
body image; (3) compare body mass index (BMI), waist
circumference (WC), and waist-hip ratio (WHR) of
respondents by body image satisfaction; and (4) determine
which of the factors (socio-demographic, obesity indices,
nutrient intake) relate to body image satisfaction.
METHODS
Data from this study was taken from a previous project on
body image satisfaction, dietary intake, and health outcomes
in urban Filipino women (Amarra et al. 2005 unpublished
report). The project was conducted in Barangay Bagong
Silang, Caloocan City which is located north of the City
of Manila. Bagong Silang is a relocation area where
most of the households are classified as social class C, D,
and E based on the classification system developed by the
Philippine Statistical Association (NSCB 1974).
A total of 251 women participated in the study from whom
data on socio-demographic, body image satisfaction,
dietary intake, weight, height, waist and hip ratio were
taken. Pre-tested questionnaires were used to collect socio-
demographic data and body image satisfaction. Two-day
24-hour food recall, done on a week-end and another
on a weekday, was used to gather data on food intake.
Detecto weighing scales and microtoise were used to take
weight and height, respectively, using standard methods
and techniques. A fiberglass tape measure was used to
Philippine Journal of Science Aquino et al.: Body Image Satisfaction
Vol. 138 No. 1, June 2009 of Women and Correlates

get the waist and hip circumference measures. Waist body image satisfaction. Logistic regression was used in
circumference was taken at the narrowest point between determining which of the factors influence body image
the lowest rib and iliac crest while hip circumference was satisfaction.
obtained at the widest circumference around the greater
trochanter.
Household measures of the 24-hour food intake of two
RESULTS AND DISCUSSION
non-consecutive days were recalled from the women
to estimate week-day and week-end intake, as studies
have shown differences of intake between these periods Respondents’ Profile
(Gibson 1990). Instruments such as measuring cups, ruler, Table 1 shows the distribution of the participants in
and portion size models were used as a way to prompt terms of age, education, and obesity classification.
and accurate recall of the food quantities. Household The findings reveal that majority of the respondents’
measures of the food items from the two-day food recall age were below 40 years, with the age group of 30-39
were translated into edible portion (EP) weights using years having the most number of participants. About
the standard weights and measures, Food Exchange List two-thirds of the women were non-working; one-tenth
(FEL) and actual weights.
Table 1. Profile of women respondents
The diet was evaluated for the nutritional content in Variables (N-251) No %
terms of energy, protein, fat, carbohydrates, dietary fiber, Age (yrs)
calcium, iron, vitamin A, thiamin, riboflavin, niacin, and 20-29 70 28
ascorbic acid using the Philippine Food Composition 30-39 80 32
Tables (FCT) (FNRI 1997) . A data base program was
40-49 51 20
used to compute the nutrient content of the diet on a daily
basis. Nutritional adequacy of the diet per respondent per 50-59 45 18
day was assessed using the 2002 Recommended Energy 60 & over 5 2
and Nutrient Intakes (FNRI 2002). Education
Elementary 37 15
BMI was calculated from the weight in kilograms divided
High School 56 22
by the square of the height in meters. From the calculated
BMI, the women were categorized into four classes based HighSchool graduate 83 33
on the World Health Classification (WHO) classification: College 47 19
underweight for BMI <18.5; normal, for BMI 18.5 - 24.9, College graduate 10 4
overweight for BMI 25.0 – 29.9, and obese for BMI ≥ Vocational 18 7
30.0. Waist-Hip Ratio (WHR) was obtained from the Occupation
measurement of the waist over the circumference of the None 159 63
hips. WHR of less than 1.0 for men and less than 0.85 for
Employee 5 2
women, and WC of less than 102 cm in men and 88 cm in
Sales/Service 23 9
women were considered to be of low risk in metabolic and
cardiovascular diseases, while levels above these cut off Sari-sari store owner 20 8
points considered the person at risk (WHO 1998). Vendor 28 11
Others 16 6

Data Analysis BMI

Means and standard deviations for absolute variables Underweight (<18.5) 29 12
such as age, income and nutrient intake were generated, Normal (18.5-24.9) 150 60
while frequencies and percentages were computed for Overweight(25.0–29.9) 57 23
categorical variables such as level of schooling, category Obese (≥30.0) 15 6
of obesity indices, and body image satisfaction. Data were Waist Circumference
also tested for normality using Kolmogorov-Smirnov
No Risk (<88 cm) 217 87
test. Comparison of means between women who were
At Risk (≥88 cm) 34 14
satisfied and not satisfied with their body image was
done using t-test for normal data and Mann-Whitney test Waist Hip Ratio (WHR)
for non-normal data. Chi square test (χ2) test was used to No Risk (<0.85) 103 41
determine the association between obesity indices and At Risk (≥0.85) 148 59

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Philippine Journal of Science Aquino et al.: Body Image Satisfaction
Vol. 138 No. 1, June 2009 of Women and Correlates

were engaged in selling either as sari-sari store owner, in this sample was lower than the national prevalence
vendor, or buy and sell businesswoman; the rest were (17%) while for WHR, the proportion of at risk (59%)
engaged in service activities such as manicure or laundry, is slightly higher (54.8%) by about 4 percentage points
and very few (2%) were employed. Their mean income (FNRI 2006).
was Php 97,800.13 (SD ± 79,654.57) per annum (not
shown in table). The classification by BMI was normal in
Mean nutrient intake by body image satisfaction
almost half of respondents, while almost one third were
Table 2a shows the mean intake of macro and micronutrients
either overweight or obese and the rest (11.6%) were
by body image satisfaction category. The means showed
underweight. The proportion of overweight and obese
no significant differences between women in the satisfied
in this sample is similar to the national prevalence for
and not satisfied groups using the Mann-Whitney test.
Filipinos (27.3%), while for underweight, the proportion
Similarly, the means of percent nutrient adequacy (Table
of underweight is smaller (FNRI 2006). Almost 90% of
2b) were not significantly different between the two
the respondents had a WC of less than 88 cm, and, thus,
groups of respondents. Among the nutrients, only niacin
were classified as having no risk. Considering WHR,
reached a mean adequacy higher than the RENI. The mean
there were more (59.0%) at risk among women (≥ 0.85)
adequacy in most nutrients was less than 50% except for
but four out of ten respondents (41%) were classified as
protein and niacin. Nutrient intake is not directly related
having no risk. The proportion of at risk using WC (13.5%)
to body image satisfaction, but it affects body weight,

Table 2a. Mean energy and nutrient intake by category of body image satisfaction
Intake by Body Image Satisfaction
Nutrient
Not Satisfied (n=176) Satisfied (n=75) Total (N=251) P-Value*
Energy (kcal) 1326 ± 512.32 1420 ± 563.51 1354 ± 28.78 0
Protein (g) 35.90 ± 15.10 38.71 ± 16.51 36.72 ± 5.55 0
Fat (g) 25.10 ± 15.67 28.61 ± 15.45 26.76 ± 5.62 0
Carbohydrates(g) 237.0 ± 94.35 252.2 ± 106.08 241.5 ± 8.04 0
Dietary Fiber (g) 8.4 ± 4.60 9.3 ± 5.06 8.6 ± 4.75 0
Iron (mg) 9.3 ± 4.79 9.8 ± 4.74 9.4 ± 4.77 0
Calcium (mg) 323 ± 229.51 349 ± 266.96 331 ± 41.07 0
Thiamin (mg) .57 ±.33 .62 ±.40 .58 ±.35 0
Riboflavin (mg) .50 ±.24 .53 ±.26 .50 ±.24 0
Niacin (mg) 15.4 ± 6.28 16.7 ± 7.30 15.7 ± 6.62 0
Vitamin A (RE) 200 ± 204.07 217 ± 211.83 206 ±206.13 0
Ascorbic (mg) 22 ± 21.66 23 ± 21.93 22 ± 21.71 0
*p-value of >0.05 indicates no significant difference in mean intake of nutrients between women in the satisfied and not satisfied group

Table 2b. Mean energy and nutrient adequacy by category of body image satisfaction
Intake Adequacy by Body Image Satisfaction
Nutrient Not Satisfied
Satisfied (n=75) Total (N=251) P-Value*
(n=176)
Energy (kcal) 74.0 ±27.75 79.6 ± 31.89 75.7 ±29.10 0
Protein (g) 61.3 ± 26.23 66.7 ±28.46 62.9 ±26.97 0
Iron (mg) 34.5 ± 17.74 36.0 ± 17.55 35.0 ± 17.66 0
Calcium (mg) 42.6 ± 30.51 45.9 ± 34.91 43.6 ± 31.86 0
Thiamin (mg) 51.4 ±30.26 56.9 ±36.37 53.1 ±32.23 0
Riboflavin (mg) 45.0 ±21.68 47.7 ±23.56 45.8 ±22.25 0
Niacin (mg) 109.1 ±44.83 119.1 ±52.14 112.1 ±47.25 0
Vitamin A (RE) 40.3 ±40.85 43.4 ±42.36 41.2 ±41.25 0
Ascorbic (mg) 30.7± 30.95 32.9 ±31.32 31.3 ±31.01 0
*p-value of >0.05 indicates no significant difference in mean intake of nutrients between women in the satisfied and not satisfied group

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which has been linked to body image in some studies
(Song et al. 1999; Monteath and McCabe 1997; Office
for Women 2003). Increase in BMI results from sustained
overconsumption of food, especially food rich in calories.
Underweight can result if a person consumes less calories
than what is needed for energy. Besides food intake, other
factors such as sedentary lifestyle increase weight and,
subsequently, BMI. The non-significant differences noted
between women who were satisfied and not satisfied with
their bodies suggest that other factors may have affected
the person’s BMI, but these were not covered in this paper.
Moreover, the possibility of capturing the usual intake
may be missed with the use of recall methods such as the
two-day 24-hour food recall. Related limitations inherent
with this tool is the ability of the individual to accurately
describe the dimensions of the food, deliberate refusal to
report intake, or memory lapse due to age or low education
(Gibson 1990).
Obesity indices, age and income of participants by
body image satisfaction
Table 3 presents the means of BMI, WC, WHR, age
and income of participants classified by body image
satisfaction. Age and annual income of women in the two
groups did not differ significantly; but, the means of BMI,
WC and WHR were significantly lower among women
who were satisfied with their body image.
The relationship between age and body image has been
mentioned by Katzmarzyk and Davis (2001) from the
data of the National Heart, Lung, and Blood Institute
of Growth and Health Study which said that even girls
nine to ten years were trying to lose weight. Zerbe and
Domnitei (2004) also reported that older women tend
to become more negative about their body image due to
weight gain associated with aging. The present data does
not agree with previous studies, but a similar result has
been noted in the report of Haartl et al.(2003) that revealed
no association of age and body image satisfaction. The
Table 3. Mean Age, Income, Body Mass Index (BMI), Waist Circumference (WC ), Waist-Hip Ratio (WHR) by body image
satisfaction
Annual Income
Body Image Satisfaction Age (yrs)
(PhP)
101,491.00 ±
Not Satisfied 37.66 ± 1.149
86,043.16
89,138.67 ±
Satisfied 38.33 ± 11.30
61,796.20
97,800.13 ±
Total (N=251) 37.86 ± 11.18
79,654.57
Mean Difference -0 12,352
P-value 0 0
* significant difference at α = 0.05
Aquino et al.: Body Image Satisfaction
of Women and Correlates
absence of a significant association between age and body
image satisfaction could mean that women in the study
might have a more tolerant attitude towards aging which
leads to better acceptance of their current body shape. In
the majority of the Filipino communities, people usually
accept the fact that women get bigger as they become
older. This acceptance in the immediate environment
of the woman makes her feel comfortable of whatever
body shape she has. In contrast to other societies, people
can become dissatisfied with their body shape as a result
of other factors such as ridicule or teasing by others,
especially among young people (Levine et al. 1994).
The average income which was not different between
the two groups indicate that body image satisfaction
does not discriminate between income levels, be it high
or low income bracket. Dissatisfaction with body image
can also occur even in women who belong to depressed
communities as noted from other studies (Drewnowski
and Specter 2004; Office for Women 2003).
The higher means of BMI, WC, and WHR from the
dissatisfied group of women was an indication that
higher body weights may be a factor for the women’s
dissatisfaction with their bodies. Obesity could affect the
shape of one’s body. With an increase in body fat, weight
also increases. When more fat is deposited in the body,
the distortion of the body shape becomes more evident,
leading to one’s dissatisfaction with his/her body image.
Dissatisfaction with one’s body image can also happen
when a person is too thin or underweight. Studies that
relate body image satisfaction and BMI have already
been reported by Song et al. (1999); and Monteath and
McCabe (1997); and in other publications ( Office for
Women 2003).
Table 4 shows that the levels of BMI, WC, and WHR
by body image satisfaction are significantly associated.
With BMI as indicator, higher proportion of women
dissatisfied with their body image were either overweight
Waist Circumference
BMI (kg/m2) Waist-Hip Ratio
(cm)
23.58 ± 4.18 78.21 ± 10.10 .87 ± .06
22.18 ± 3.06 74.9 ± 7.56 .85 ± .04
23.16 ± 3.93 77.22 ± 9.52 .86 ± .05
1 3 0
.016* .019* .005*
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Vol. 138 No. 1, June 2009 of Women and Correlates

Table 4. Distribution of Women by Obesity Indices and Body Image Satisfaction

Body Image satisfaction
Total X2 p-value
Obesity Indices Not Satisfied Satisfied
No % No %
BMI
Underweight (< 18.5 kg) 21 72 8 28 29
Normal (18.5 – 24.5 kg) 94 63 56 37 150 11 .003*
Overwt & Obese (≥25 kg) 61 85 11 15 72
Total 176 70 75 30 251
Waist Circumference
No Risk (< 88 cm) 147 68 70 32 217 4 .038*
At Risk ( ≥ 88 cm) 29 85 5 15 34
Total 176 70 75 30 251
Waist-Hip Ratio
No Risk (< 0.85) 65 63 38 37 103
At Risk (≥ 0.85) 111 75 37 25 148 4 .043*
Total 176 70 75 30 251
* Significant association at α =0.05

(84.7%) or underweight (72.4%). This means that body
dissatisfaction does not only arise from excess weight
but also from inadequate body weight. BMI is highly
correlated with fat; thus, distortion of body shape due to
excess or lack of fat is evident in people with extremely
high or low body weight (Song et al. 1999; Monteath
and McCabe 1997). Similarly, using WC and WHR, a
greater proportion (85.3% and 75.1%, respectively) of
those considered at risk were not satisfied with their
body image. These indices considered as measures of
central body obesity are known risk factors to metabolic
syndrome and related diseases such as diabetes mellitus,
cardiovascular disease, and lipid disorders, among others
(Alberti & Zimmet 1998; Dobbelsteyn et al. 2001; Woo
et al. 2002).
The variables BMI, WC, and WHR which were found to
be associated with body image in the previous Chi square
test were entered in the logistic regression as shown in
Table 5. Out of these variables, only WHR emerged as
the significant factor that contribute to the variation in
Table 5. Factors Related to Body Image Satisfaction in the Logistic
Regression
B S.E. Sig. Exp.(B)/(95 % C.I. for Exp B)
WHRab -10 4 0 .000
WAIST a
0 0 0 1.056
BMIa -0 0 0 .845
Constant 8 3 0 2181
a
Variable(s) entered :BMI, WAIST, WHR
b
Significant factor affecting body image satisfaction
body image satisfaction (p-value = 0.35; 95% C.I. :
0.000 to 0.196). The negative value of WHR indicates
that an increase in WHR would correspond to decrease
the degree of satisfaction with body image of the women.
Between the obesity indices, WHR would give a more
obvious picture of the woman’s image based on the
silhouette given, from very thin, to ideal body shape
and to the extremely large physical shape. Thus, it is not
surprising that WHR appeared as the significant predictor
of the outcome variable in this group of women.
CONCLUSIONS AND RECOMMENDATIONS
The study assessed body image satisfaction among
urban women and examined the factors that influence
satisfaction, such as socio-demographic characteristics,
dietary intake, and obesity indices. In general, the findings
reveal that body image dissatisfaction exists in seven out
of ten women in this depressed urban community. The
conclusions specific to the objectives of the study are
the following:
• Majority of the sampled women are less than 40
years of age, have High School level of education,
( 0.000 - 0.196) and no occupation. By nutritional status using
( 0.965 – 1.55) BMI, 28.7% are overweight and obese and
(0.698 – 1.023)
11.6% are underweight while the rest are normal.
Android obesity based on WHR is noted in 59%
of the women while based on WC, 13.5% are
considered at risk.

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Vol. 138 No. 1, June 2009
• Mean nutrient intake and adequacy of intake among
women not satisfied are not significantly different
from those who are satisfied with their body image.
Adequacy of nutrient intake is below the RENI for
most nutrients except niacin. Mean intake adequacy
of most nutrients except protein and niacin are less
than 50% adequate.
• Mean BMI, WC and WHR were significantly lower
among women categorized as satisfied with their
body image. Age and income are not different
between the two groups of women. The association
between body image satisfaction and the obesity
indices : BMI, WC, and WHR are significant.
• Among the study variables, WHR emerged as
the only significant factor that influenced body
image satisfaction. Thus, having high WHR, an
indicator of central body or android obesity, affects
satisfaction of the women with their body image.
Based on the results of this study, it is recommended that :
• Programs on weight reduction to bring WHR measures
to normal could improve the body image of the women
and help reduce the possible negative effect of body
image dissatisfaction.
• Further studies be done on the causes of body image
dissatisfaction to identify other factors not included
in this study and consider these in planning health
programs. For example, if having an apple shaped
body deters one from joining exercise programs,
include workshops or seminars to boost self-esteem.
• The effect of body image dissatisfaction on various
psychological, biological and other conditions can
be studied in our local situation.
• Use other complementary methods of determining
food intake of individuals in addition to classic
methods to check on the validity of reported
intake by the participants, such as food record or
observation methods.
ACKNOWLEDGMENTS
The authors wish to thank the respondents from Barangay
Bagong Silang, Caloocan City and the barangay health
officers. Acknowledgments are also given to the following
researchers: Michael Angelo G. Lijauco, Ermelita N.
Bautista, Mildegarde C. Capitrano, Maureen C. Ugat,
and Ferdinand A. Bagunu. The authors would like to give
special thanks to Ma. Sofia V. Amarra, Ph.D., former
section head of LNS-NSTD, Ms. Elenita V. Castillo for
guiding us with the statistical analysis, and Maria Zorayda
A. Torres, Ph.D. for editing the article.
Aquino et al.: Body Image Satisfaction
of Women and Correlates
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