|dc.description.abstract||The increase in body dissatisfaction (BD) in recent times for Western and non–Western women is a concerning public health issue given that BD has been associated with a myriad of negative health outcomes. While BD is often used interchangeably with other terms such as body image concerns, body image problems and negative body image, it can be broadly defined as describing an individual’s dissatisfaction with his or her body. BD is pervasive, and a strong predictor of problematic weight-related behaviours (WRBs), disordered eating, and eating disorders. BD is a predictor of lower quality of life (QoL) and unhealthy lifestyle behaviours such as smoking, alcohol consumption, risky sexual behaviours, drug use and psychopathology. Despite evidence of the pervasiveness of BD and its strong association with numerous negative health outcomes, most research has been conducted in Western cultures. Limited research is available in non-Western cultures. This warrants further cross-cultural comparison to investigate the extent to which findings from a Western context are applicable to a non-Western culture. This research uses a systematic literature review and a cross-sectional survey to cross-culturally explore the role of BD in predicting (a) problematic WRBs (specifically restrained eating and bulimic symptoms), (b) unhealthy lifestyle behaviours (specifically smoking, alcohol consumption, drug use and sexual behaviours) and (c) the four domains of QoL (physical, psychological, environmental and social relationships). In particular, the research explores the role of BD as a mediator in the relationship between sociocultural influences (peer, parent, media) through thin ideal internalisation to predict problematic WRBs (restrained eating and bulimic behaviours); its association with various unhealthy lifestyle behaviours, such as smoking, alcohol consumption, drug use and risky sexual behaviours; and how it predicts four domains of quality of life with culture as a moderator.
This thesis is comprised of a systematic review and a large cross-sectional study from which three manuscripts were derived. The systematic review of the literature synthesised evidence on the relationship between body image concerns and weight- related behaviours. Forty-five out of 46 studies found a positive association between body image concerns and WRBs. Adolescents and emerging adults who misperceived their weight or were dissatisfied with their body had a higher likelihood of engaging in unhealthy or extreme WRBs and developing eating disorders. The findings from the review confirmed that body image concerns play a significant role in adolescents and emerging adults engaging in WRBs. Findings from the systematic review (Manuscript 1) have been published in a peer-reviewed academic journal and informed the development of a large cross-sectional survey.
The large cross-sectional survey comprised 126 questions with 420 Malaysian and 488 Australian female emerging adults. It was administered online for Australian participants and both online and face-to-face for Malaysian participants. It led to the development of three manuscripts. Manuscript 2 aimed to investigate the mediating role of BD between sociocultural influences via thin internalisation in predicting problematic WRBs (restrained eating and bulimic behaviours) in Australian and Malaysian emerging adults, by testing a component of the Tripartite Influence Model. The results from Manuscript 2 found that in both cultures there were direct links between peers and body dissatisfaction, between internalisation of the thin ideal and restrained eating, and between internalisation of the thin ideal and bulimic behaviours. Although the two models were largely similar across both cultures, there were two distinct differences: family influence was found to have a significant association with thin internalisation for Malaysian females but not Australian females, and the association between BD and restrained eating was significant for Australian females (weak association) but not Malaysian females. The relationship between thin ideal internalisation and restrained eating was found to be stronger than the relationship between BD and restrained eating, suggesting that BD is not a necessary mediator for women of both cultures. That is, regardless of the level of BD, internalising the thin ideal alone is sufficient to elicit restrained eating and bulimic behaviours. These findings (Manuscript 2) are in press in a peer-reviewed academic journal.
Manuscript 3 cross-culturally investigated (a) similarities and differences of Australian and Malaysian emerging adults in terms of BD, sociocultural influences, thin ideal internalisation and lifestyle behaviours, and (b) the association between BD and unhealthy lifestyle behaviours, such as smoking, alcohol consumption, drug use and risky sexual behaviour in Australian and Malaysian emerging adults. The results found that Australian women had higher mean scores for BD, thin ideal internalisation, restrained eating, bulimic behaviours, family influence and media influence; while Malaysian women had a higher mean score for peer influence. With respect to the relationship between BD and lifestyle behaviours, BD was found to predict use of ‘other drugs’ (cocaine, methamphetamine, ecstasy, LSD and heroin), smoking and sexual behaviours for Malaysian women, and was not found to have an association with unhealthy lifestyle outcome variables for Australian women. Manuscript 3 is under review in a peer-reviewed academic journal.
Manuscript 4 cross culturally investigated (a) the role of BD in predicting four domains of QoL: physical, psychological, environmental and social relationships in Australian and Malaysian emerging adults, and (b) culture as a moderator in the relationship between BD and the four domains of QoL. The findings showed that BD had a direct relationship with all four domains of QoL. The relationship with psychological QoL was strongest. Across both cultures, the results suggest that women who are dissatisfied with their bodies are more likely to have lower QoL in all domains. Further, the moderating effect of culture was only significant for the relationship between BD and two aspects of QoL across cultures - physical QoL and environmental QoL. Manuscript 4 is under review in a peer-reviewed academic journal.
The overall findings of this PhD study suggest that BD is strongly associated with problematic WRBs, and due to increased Westernisation, modernisation, technological advancement and economic growth in recent years in Malaysia, Western ideals of body image (the thin ideal) have permeated the non-Western culture of Malaysia. Hence there are cross-cultural similarities in BD and how it predicts problematic WRBs. However, due to the strong relationship between internalisation and restrained eating, it can be said that internalisation of the thin ideal alone is sufficient to induce restrained eating and bulimic behaviours. Collectively, these four manuscripts highlight the significant role of BD as a public health problem found to predict problematic WRBs, unhealthy lifestyle behaviours and lower QoL across cultures. Therefore, addressing this problem requires greater attention be given to BD. This PhD thesis culminates with a series of recommendations for educational institutions, media, policy makers and governments to help emerging adults and young adults increase body satisfaction and form healthier dietary habits, in turn enhancing their quality of life and wellbeing. Recommendations are made for six key groups. The recommendations relate specifically to research, practice and policy.||