Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used

Abstract

This study aimed to review the findings on body image (BI) dissatisfaction and muscle dysmorphia (MD) in Brazilian RT practitioners and the differences in the assessment tools used. A critical review of studies with searches in PubMed, Brazilian Virtual Health Library, SciELO, PsycInfo, and SPORTDiscus databases was conducted. A total of 23 studies were included. Nine tools were used to assess BI dissatisfaction or MD: three questionnaires and six visual scales. The overall mean BI dissatisfaction was 56.5% (59.2% in men vs 57.3% in women). The mean MD was 42.4% (45.1% in women vs 38.5% in men). BI dissatisfaction and MD are related to women seeking slimness and men wanting to increase muscle mass. In conclusion, the frequency of BI was high in both sexes, and MD, when identified, was higher in women. The scales and questionnaires used differ significantly in depth and scope for the same purpose.

Keywords

body dissatisfaction body dysmorphic disorder body image resistance training

Introduction

Resistance training (RT), performed with weights or bodyweight specific exercises, is a term used to describe a type of exercise that requires the muscles of the body to move against an opposing force (Fleck and Kraemer, 2017). RT is one of the most practiced types of exercise by people of different age groups, of both sexes, and with different levels of physical fitness (Dias et al., 2005). This fact can be explained by the benefits arising from this practice, which include important morphological, neuromuscular, and physiological changes in the body (Hornsby et al., 2018; Taber et al., 2019).

One of the main effects of RT is increased strength, muscular endurance, and lean body mass (Suchomel et al., 2018). The muscle contraction process and adaptations resulting from RT can produce and release protective factors in the body. These metabolic responses can change body composition, decrease inflammation, improve mitochondria function, normalize blood glucose and blood pressure levels, and regulate lipid metabolism. Furthermore, RT can serve as a complementary method for the prevention and treatment of noncommunicable, neurological, and psychiatric chronic diseases (Maestroni et al., 2020).

Physical exercises aimed at health promotion are associated with a more consistent eating routine and with a greater acceptance of body image (BI) (Panão and Carraça, 2020). BI can be defined as a person’s perception of their own body size and shape, including their feelings toward these characteristics (Bassett-Gunter et al., 2017). The increasing emphasis on physical appearance in recent years called the “cult of the body” (Iriart et al., 2009), is associated with the establishment of beauty standards stimulated by the media and, in a way, demanded by society (Freitas et al., 2010; Oliveira and Machado, 2021). Thus, many people seek RT because they want muscle definition and body fat loss, and their BI is one of the main reasons for this search (Bassett-Gunter et al., 2017). However, these motivations can make the experience of physical exercise less pleasant, which may lead to greater BI dissatisfaction (Panão and Carraça, 2020).

Dissatisfaction with BI is characterized by the difference between the person’s current body and the one they consider ideal. This dissatisfaction can be severe and persistent, bringing social, psychological, and physical damages (Alvarenga et al., 2011). Such dissatisfaction is strongly influenced by the esthetic standards imposed by the media and is often understood as synonymous with success or greater personal value (Souza and Alvarenga, 2016). In addition, the person may become addicted to physical exercise and develop extreme concern with body shape (Costa et al., 2015; Panão and Carraça, 2020). Such factors may be related to the disorder known as muscle dysmorphia (MD). Also called bigorexia or reverse anorexia, MD involves a person’s concern about not being strong and muscular enough. Even with muscle levels above the population average, persons with MD describe themselves as “weak and small,” characterizing a distortion of their BI (Mitchell et al., 2017). As a consequence, people with MD tend to isolate themselves socially, train excessively, eat highly restrictive diets, and use anabolic steroids constantly (Camargo et al., 2008; Mitchell et al., 2017).

In another way, the systematic review of SantaBarbara et al. (2017) suggested that practicing RT 2–3 times a week, for 30–60 minutes, can significantly improve multiple dimensions of body image. These conclusions were made based on studies involving subjects from North America and Europe, primarily women, comparing RT to aerobic training or no exercise. Different assessment tools have been used in the studies, investigating variations of the same theme. However, review studies report little information on this subject and do not investigate the presence of MD.

Considering that: (1) there are some controversies in the literature involving RT and BI; (2) it is essential to know more about RT practitioners’ self-perception to elucidate these individuals’ relationship with their bodies; and (3) knowing that culture, habits, lifestyle, and physical exercise can influence a person’s relationship with their BI (Freire et al., 2020), this study aimed to review the findings on BI dissatisfaction and MD in Brazilian RT practitioners and the differences in the assessment tools used.

Materials and methods

The present study is a critical review of the literature, with a search conducted in PubMed, Brazilian Virtual Health Library (Biblioteca Virtual em Saúde, BVS), SciELO, PsycInfo, and SPORTDiscus databases.

The descriptor search terms used or its synonyms, in a combined way, were as follows: “Body Image” OR “Body Dissatisfaction” AND “Resistance Training.”

The inclusion criteria were any Brazilian studies that assessed the perception of BI, in healthy adult individuals who were RT practitioners and presented frequency/prevalence of body dissatisfaction and/or characterization of body dissatisfaction. Studies that do not meet the established criteria were excluded. Also, resistance band training was not considered an eligible type of exercise in this investigation. Likewise, abstracts and conference proceedings were not included. There was no restriction on language or year of publication.

Title and abstract of the selected studies were read by two reviewers (AF and CGS) before including them in the study. Then, the following data were extracted and tabulated as follows: author, sample characterization, evaluated outcomes, assessment tools used, and main results.

A total of 135 records were identified from consulted databases. After duplicate records were removed, 128 were screened and only 30 were assessed for eligibility. Figure 1 shows the detailed flowchart of the search, selection, and analysis of studies included in this review.

Figure 1.

Flowchart of literature search and studies selection.

Results

Only 23 of the references found were eligible for inclusion in the study, with 19 studies assessing BI perception and dissatisfaction and four assessing MD or body image distortion. Of the studies analyzed, 13 included participants of both sexes, seven included women only, and three included men only. These findings can be seen in Table 1, which summarizes all information about the 23 studies. The selected articles were published between 2009 and 2020 and only studies written in English and Portuguese were found. For a better presentation of the results, they are divided into three topics as follows.

Table 1.

Summary of all studies included in the review.

BI perception and dissatisfaction
Study	Sample	Outcome assessed and tools	Results found
Anversa et al. (2019)	n = 120 women bodybuilding or gymnastics practitioners, or both, aged between 20 and 40 years	BI dissatisfaction (BSQ)	No dissatisfaction was identified in gymnastics practitioners; those who did weight training or both showed mild dissatisfaction.
Damasceno et al. (2011)	n = 276 gym-goers, 168 men and 108 women, mean age 23.9 years	BI dissatisfaction (Body Silhouette scale adapted from Frederick et al., 2007)	Discrepancies between current and ideal silhouettes were related to the desire for increased muscle mass in men and slimness in women.
Dominski et al. (2019)	n = 54 weight training practitioners, 32 men and 22 women, mean age 30 years	BI perception (Silhouette Scale of Stunkard et al., 1983)	High dissatisfaction with BI in bodybuilders, specially about overweight
Duarte et al. (2014)	n = 45 gym-goers, 28 men and 17 women, mean age 27.9 years	BI satisfaction (SMT)	71.1% of the participants showed BI dissatisfaction, most in women. Women showed a greater oscillation between current and desirable silhouette markings.
Fermino et al. (2010)	n = 90 people who do weight training, ergometry, indoor cycling, and toning workout, 45 men and 45 women, aged between 20 and 40 years	BI satisfaction (Silhouette Scale of Stunkard et al., 1983)	Higher dissatisfaction score in women, as well as individuals with a higher percentage of fat or overweight.
Freitas et al. (2019)	n = 20 women weight training practitioners, aged between 20 and 40 years	BI dissatisfaction (BSQ)	60% showed no dissatisfaction with their BI, 20% mild dissatisfaction, and 15% moderate dissatisfaction.
Maciel et al. (2019)	n = 72 women RT practitioners, aged between 18 and 50 years	BI perception (BSQ)	66.2% showed dissatisfaction with their BI, most of them mild (39.4%).
Mariz et al. (2020)	n = 20 male bodybuilders, mean age 25.8 years	BI dissatisfaction (BSQ and Silhouette Scale of Castro et al., 2011)	90% of dissatisfaction with their current silhouette and wanted less body fat and greater muscle mass. According to the BSQ, they showed no dissatisfaction with their body shape.
Monteiro et al. (2018)	n = 110 women circuit training practitioners, mean age 36 years	BI perception and satisfaction (Silhouette Scale of Stunkard et al., 1983)	94% were dissatisfied with their BI and wanted slimmer silhouettes, even normal-weight women.
Oliveira et al. (2018)	n = 174 older adult RT practitioners, 70 men and 104 women, mean age 65 years	BI dissatisfaction (BSQ)	Absence of body dissatisfaction in 82.2% of the older adults
Petry and Junior (2019)	n = 138 weight training practitioners, 73 men and 65 women, mean age 30.2 years	BI perception (Body Silhouette Scale of Kakeshita et al., 2009)	78.5% of women and 69.9% of men were dissatisfied with BI; the highest percentage of dissatisfaction was in relation to the desire to decrease body size.
Reis et al. (2018)	n = 100 weight training practitioners, 36 women and 64 men, over 18 years old	BI perception (Silhouette Scale of Stunkard et al., 1983)	Most women wanted to have a slimmer silhouette. The men identified their current body as the ideal.
Rica et al. (2018)	n = 40 women aged >60 years, divided into RT practitioners (n = 20) and non-practitioners (n = 20)	BI perception and satisfaction (Silhouette Scale of Stunkard et al., 1983)	90% of satisfaction with BI in those who trained and 10% in those who did not. The discrepancy between ideal and current BI was much greater in those who did not train.
Rossi and Tirapegui (2018)	n = 227 gym-goers, 116 men and 111 women, mean age 32.2 years	BI satisfaction (Body Silhouette Scale of Harris et al., 2008)	23% of men and 9.6% of women was satisfied with their BI, regardless of nutritional status.
Silva et al. (2010)	n = 100 weight training practitioners, 50 men and 50 women, mean age 21.3 years	BI perception and dissatisfaction (BSQ and Silhouette Scale of Stunkard et al., 1983)	52% of the women and 12% of the men showed moderate or severe BI dissatisfaction. Women were also more dissatisfied than men according to the Silhouette Scale.
Silva et al. (2015)	n = 301 men weight training practitioners, mean age 25.2 years	BI dissatisfaction (Body Silhouette Scale adapted from Frederick et al., 2007)	The mean body score was negative, indicating that men wanted to have larger silhouettes than their current ones, especially those older than 30 years old.
Sousa et al. (2018)	n = 77 women, mean age 29.8 years	BI dissatisfaction (BSQ)	87% of women were satisfied with BI; the percentage of dissatisfied women trained to control body mass.
Souza and Ceni (2014)	n = 56 weight training practitioners, 43 men and 13 women, mean age 23.7 and 24 years, respectively	BI perception and satisfaction (Silhouette Scale of Stunkard et al., 1983)	77% of women and 70% of men were dissatisfied with their BI.
Theodoro et al. (2009)	n = 87 men weight training practitioners, mean age 22.3 years	BI perception and dissatisfaction (Silhouette Scale of Stunkard et al., 1983)	63.2% were satisfied with their physical appearance, but the majority wanted a larger silhouette than their current one and 65.5% wanted to have a larger silhouette than that represented by a person with normal weight.
Muscle dysmorphia and body image distortion
Study	Sample	Outcome assessed and tools	Results found
Baum et al. (2020)	n = 320 weight training practitioners, 185 men and 135 women, mean age 32.8 years	MD (MASS)	The average score of the evaluation showed the absence of MD.
Cortez et al. (2020)	n = 306 weight training practitioners, 157 men and 149 women, over 18 years	MD (ACQ)	49.6% of women and 39.6% of men showed mild to moderate MD.
Vargas et al. (2013)	n = 37 women gym-goers, mean age 29.05 years	MD (ACQ)	43.2% of the sample showed mild to moderate MD.
Nunes-Filho et al. (2020)	n = 370 RT practitioners, 226 men and 144 women, mean age 34.6 years	MD (ACQ)	37.5% of men and 42.5% of women scored for moderate or severe MD.

BI: body image; BSQ: Body Shape Questionnaire; SMT: Silhouette Matching Task; MD: muscle dysmorphia; ACQ: Adonis Complex Questionnaire; MASS: Muscle Appearance Satisfaction Scale; RT: resistance training.

BI perception and satisfaction assessment tools

The studies included in this review analyzed similar outcomes using nine different assessment tools, ranging from visual scales with scores corresponding to the images presented to scales/questionnaires with multiple-choice questions, in which each answer had a respective score. Those instruments are (1) the Silhouette Scale of Stunkard, Sorenson, and Schlusinger, (2) the Body Silhouette Scale adapted from Frederick et al., (3) the Silhouette Matching Task, (4) the Silhouette Scale of Castro et al., (5) the Body Silhouette Scale of Kakeshita et al., (6) the Body Silhouette Scale of Harris et al., (7) the Muscle Appearance Satisfaction Scale, (8) the Body Shape Questionnaire, and (9) the Adonis Complex Questionnaire. Most of these instruments were validated in Brazil. However, the Adonis Complex Questionnaire, which is widely used in several studies, could not be found in a study with the validation of this instrument, nor in the Portuguese language or for the Brazilian population. The same thing happened to the Body Silhouette Scale adapted from Frederick et al. and the Silhouette Matching Task. The Supplemental Material of this study presents each of these scales.

The body silhouette scale proposed by Stunkard et al. (1983) was the most used tool, appearing in eight of the 23 studies reviewed. This tool has the objective of assessing BI dissatisfaction using a schematic visual series of nine images, ranging from thin to obese bodies, where the participant must choose two images. The first image should represent what the person believes their current body shape is; the second represents what they believe to be the ideal body. The discrepancy between the two choices measures dissatisfaction with BI. If the variation is equal to zero, the person is considered satisfied with their BI. If the result is negative, they are classified as dissatisfied (Scagliusi et al., 2006).

The Body Shape Questionnaire (BSQ) assessment tool was the second most used, present in seven studies (Anversa et al., 2019; Freitas et al., 2019; Maciel et al., 2019; Mariz et al., 2020; Oliveira et al., 2018; Silva et al., 2010; Sousa et al., 2018). The BSQ seeks to identify body shape concerns and fitness-related self-deprecation. It has 34 questions related to BI, with scores from 1 to 6, where 1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = very often, and 6 = always. The result is obtained by the sum of all scores. A total score below 110 points indicates that the person shows absence of dissatisfaction; that between 111 and 138, mild dissatisfaction; that between 139 and 167, moderate dissatisfaction; and that exceeding 167, severe dissatisfaction (Di Pietro and Silveira, 2009).

The body silhouette scale developed by Frederick et al. (2007) was used in two studies (Damasceno et al., 2011; Silva et al., 2015). This tool seeks to assess satisfaction with BI. It presents, for both sexes, images representing silhouettes and their appropriate scores that range from an obese body (−7 points) to an extremely muscular body (+7 points). Participants must choose the image that best represents their current silhouette and the silhouette they think is ideal. Body dissatisfaction is measured by the difference in points between the chosen silhouettes and categorized into three levels: “low dissatisfaction” (<1 point), “mild dissatisfaction” (between 2 and 4 points), and “high dissatisfaction” (>5 points).

The study of Duarte et al. (2014) was the only one to use the Silhouette Matching Task (SMT) assessment tool, which aims at determining self-esteem from the perception of the person’s current and ideal images. This tool consists of a scale with nine silhouette images, based on the scale by Stunkard et al. (1983), used for six questions: What is your current size and shape? What was your size and shape 6 months ago? What would be your size and shape if you exercised regularly? What would be your size and shape if you followed a healthy diet? What would be your size and shape if you followed a healthy diet and exercised regularly? What would be your size and shape if you were completely free to choose? The percentage of satisfaction is measured based on the images chosen using the questions, where positive and negative values reflected a desire to have slimmer and larger silhouettes, respectively (Marsh and Roche, 1996).

Also one study (Mariz et al., 2020) used the body silhouette scale developed by Castro et al. (2011), which was designed to assess and interpret body size and shape, specifically for muscle mass. The tool presents seven images of male silhouettes, with their respective scores ranging from a lean body to an extremely muscular body. The participant should choose the images that represent their current and ideal silhouettes. If the difference between the choices results in a zero score, the individual is satisfied. If the result is negative, the person considers themselves weaker than they would like to be. Meanwhile, a positive score indicates that the participant believes themselves to be stronger than they would like.

The silhouette scale by Kakeshita et al. (2009) was used on the study of Petry and Junior (2019). This scale uses 15 silhouettes for each sex, with BMI ranging from 12.5 to 47.5 kg/m², to assess BI perception and satisfaction in both Brazilian adults and children. Participants are instructed to choose the silhouettes that indicate their current size and the size they wish to be. The result is expressed as the difference between the BMI of the chosen figures, with positive values indicating a desire to increase body size, and negative values indicating a desire to decrease body size. If the difference is zero, the participant is considered satisfied with their BI.

Also only one study (Rossi and Tirapegui, 2018) used the silhouette scale by Harris et al. (2008). The scale is based on 10 photographs of both sexes, with BMI ranging from 18.5 to 40 kg/m², and aims at assessing BI satisfaction. Participants choose the image that best represents their current and ideal physique. The differences between the choices are classified into “desire to be smaller” (>0 point), “desire to be larger” (<0 point), or “body satisfaction” (=0 point).

Muscular dysmorphia assessment tools

The studies of Cortez et al. (2020), Vargas et al. (2013), and Nunes-Filho et al. (2020) assessed MD using the Adonis Complex Questionnaire (ACQ), composed of 13 multiple-choice questions with alternatives A (0 point), B (1 point), and C (3 points), and whose objective is to identify signs and symptoms related to MD. The final score can range from 0 to 39 points. The result determines the severity of BI concerns and can be divided into “no concern” (0–9 points), “mild to moderate concern” (10–19 points), “serious concern” (20–29 points), or “severe concern” (30–39 points).

The study of Baum et al. (2020) used the Muscle Appearance Satisfaction Scale (MASS), which presents items related to the practice of RT to identify MD. This scale consists of 19 questions with alternatives that add up to between 1 and 5 points, distributed in four factors: training addiction, checking, satisfaction, and substance use. Global scores >52 points are indicative of MD (Mayville et al., 2002).

The Supplemental Material of this study also presents the two aforementioned questionnaires.

BI perception and dissatisfaction

The studies that analyzed BI perception and satisfaction included 2107 people (52.06% men), with a mean age of 29.8 ± 6.9 years. All 23 studies found some level of body dissatisfaction in people who practiced RT, ranging from 10% to 94% of the sample, according to the tool used for evaluation in each study. The overall mean BI dissatisfaction was 56.5%, and the percentage of men was similar to that of women (59.2% vs 57.3%, respectively), which is considered a high frequency.

Although BI values were similar between sexes, the reasons that affect BI between them were distinct, and literature already shows some studies about it. Women seek slimness; they want to have smaller silhouettes (Damasceno et al., 2011; Monteiro et al., 2018; Reis et al., 2018; Sousa et al., 2018). Men aim at increasing muscle mass (Damasceno et al., 2011; Mariz et al., 2020; Silva et al., 2015; Theodoro et al., 2009).

From all reviewed studies, only Anversa et al. (2019) compared RT and other sport concerning the presence of BI dissatisfaction. They found that women who did only gymnastics did not present BI dissatisfaction, whereas participants who did weight training or both activities together showed mild BI dissatisfaction.

Few studies were found on this subject that included older people. Oliveira et al. (2018) and Rica et al. (2018) reported a percentage of body satisfaction in 82.2% and 90% of the population studied (age higher than 60 and 65 years), respectively, suggesting that age is another factor that can affect BI.

It is essential to record that the prevalence of BI varies around the globe according to the population and age group studied, making it difficult to say if RT has more BI dissatisfaction than non-practitioners in general.

MD and BI distortion

The studies that analyzed MD and BI distortion (Baum et al., 2020; Cortez et al., 2020; Nunes-Filho et al., 2020; Vargas et al., 2013) included 1033 people (52.9% men), with a mean age of 32.1 ± 8.3 years. Vargas et al. (2013) analyzed only women, and the other three analyzed people of both sexes.

MD was assessed in three studies (Cortez et al., 2020; Nunes-Filho et al., 2020; Vargas et al., 2013) using the Adonis Complex Questionnaire (ACQ) as the assessment instrument. The mean MD was 42.4%, and it was higher in women than in men (45.1% vs 38.5%, respectively). Women saw themselves as having a larger physical shape, whereas men saw themselves as having less muscular bodies. Only Baum et al. (2020) used the Muscle Appearance Satisfaction Scale (MASS) assessment tool, and no MD was found.

Discussion

In this review of Brazilian studies on perception and dissatisfaction with BI in RT practitioners, body dissatisfaction was found in all analyzed studies with a similar frequency in both sexes. The presence of MD varied according to the assessment tool used and, when identified, was higher in women. One of the divergent points between the sexes was the reasons that lead the individual to present both dissatisfaction and dysmorphia: women seek slimness, and men aim at gaining muscle mass. Although few studies are found with older people, a high satisfaction with BI was identified in this group. Regarding the assessment tools used for these measurements, we observed a heterogeneity of scales, some of which were similar, although they differed greatly in terms of the depth of the questions encompassed in the three questionnaires used (BSQ, ACQ, and MASS). BSQ was used in almost one-third of the studies.

BI can be defined as the person’s perception of their own body shape. RT is one of the ways to modify body composition and the motivations for joining this type of exercise are different for men and women. According to our findings, men seek a more muscular physique, whereas women want a slimmer body with smaller silhouettes. Such information is in line with a reality that has been present in society for years. However, RT seems to contribute to self-image acceptance, according to a systematic review that showed an improvement in BI in several aspects in RT practitioners. Training could improve the person’s relationship with BI in subjective, affective, perceptual, behavioral, and cognitive ways. According to some researchers, RT practice two to three times a week would be enough for such benefits. Nonetheless, the effects may differ between the sexes. Satisfaction with BI seems to increase in men when they see improvement in their body composition, whereas for women, this effect is seen when progress happens in strength and endurance (SantaBarbara et al., 2017). However, RT and the search for the ideal of beauty imposed by society can induce people who are already dissatisfied with their bodies to develop even more dysfunctional behaviors. The choice of exercise type and the motivation for performing it can strongly influence these issues.

Another systematic review of studies involving individuals of both sexes (Panão and Carraça, 2020) found differences and consequences in the reported motivations for the practice of physical activity. According to the authors, exercise can improve BI when done for health or well-being reasons. However, when the activity is performed with a focus on appearance or body weight, the association with image seems to be negative. These reasons could favor changes in the person’s eating pattern, with increased restrictions, rigidity in food choice, and risk for developing eating disorders (ED). The focus of interventions should be the achievements and progress throughout the sport practice and not physical appearance or comparison with other bodies (Panão and Carraça, 2020).

A higher prevalence of MD was observed in women. However, we found few studies that analyzed this outcome. MD is characterized by an excessive concern about not being strong or muscular enough, which can lead to various physical and psychological consequences. Nevertheless, the literature on this subject with women is scarce, and this outcome is more studied in men (Baum et al., 2020; Vargas et al., 2013). A study analyzing only women found no difference in the prevalence of MD between professional bodybuilders and beginners in this type of training. Notably, nine out of 10 practitioners were at risk for physical exercise addiction. The attraction to pre-established body models may be enough to trigger the symptoms of the disorder (Hale et al., 2013). A study on weight training found that men are at greater risk for MD than women. Furthermore, the way training is conducted and planned seems to influence the development of symptoms, again suggesting that those who train for fitness and esthetics are at greater risk than those who train for performance. Some researchers have also reported that both women and men demonstrated similarities in risk for ED (Skemp et al., 2013).

Indeed, one of the possible consequences of MD and BI dissatisfaction is the development of disturbed behaviors that can progress to an ED. A meta-analysis on the relation of MD and ED in men and women showed an association of MD and ED symptoms, such as following restrictive diets, compulsively exercising, using purgative methods for weight control, and using anabolic steroids. Some authors have reported the importance of conducting further studies on the subject focused on women, to elucidate possible differences between the sexes and determine the impact of cultural factors in this process, in view of the low gender diversity in research on the subject (Badenes-Ribera et al., 2019).

Among the nine instruments used to assess BI perception and satisfaction, only three were in the form of a questionnaire (BSQ, MASS, and ACQ), used in only 36.6% of the studies. The scope of the BSQ goes beyond the way the person sees their physical shape and how they would like their shape to be. This tool presents questions on how the person feels about their shape, if they are concerned about it, if they compare themselves with slim people, how they relate to food, if they feel the need to go on a diet, and if they make use of methods of purging or compensation through exercise, in addition to assessing the possibility of isolation or social restriction owing to all these aspects (Cooper et al., 1987). This entire spectrum of questions allows for a much more comprehensive assessment of body perception and relationship with the body, aiming at providing a better-founded interpretation of BI satisfaction. Two other tools with similar purposes, but not only these, are the MASS and ACQ, used to assess body dissatisfaction and MD. These assessment tools analyze exercise addiction, body satisfaction, restrictive dietary practices, excessive muscle checking, use of substances aimed at altering body composition, and presence of injuries (Mayville et al., 2002). Thus, thoughts, feelings, and behaviors in relation to the body that are not restricted to a visual perception, but are related to aspects of food, exercise, and the ingestion of non-recommended substances, can be analyzed together, providing a broader analysis of behaviors.

The other tools consist of visual scales, in which the participant must indicate the images that represent their current and ideal or desired body shapes, with a more specific and limited focus. Certainly, the discrepancies between what is seen and what is desired point to important issues to be worked on about BI and the relationship of a person with their own body, since these represent an unhealthy behavior. However, these tools may not be sensitive enough to identify more issues of dysfunction, such as the level of concern and dissatisfaction with their body, poor relationship with their image and with food, and use of harmful practices to health as possible mitigating factors (Souza and Alvarenga, 2016; Stice and Shaw, 2002).

Independent of the type of instrument used in the studies analyzed, the lack of validation of some of them to the Brazilian population or the Portuguese language is a fact that compromises the data validity and also can affect the extensive range of BI dissatisfaction founded in this study (10%–94% of the sample). This information inspires caution in future studies with evaluating BI dissatisfaction and MD about which instruments should or should not be used.

Some limitations of the present study were the lack of data on how long the participants had been practicing RT, which could reveal the association between practice time versus level of dissatisfaction or versus presence of MD or not. Likewise, the reason the person practiced RT had not been investigated in most studies. Thus, it was not possible to test these associations. Furthermore, the studies analyzed were cross-sectional. Therefore, we could not infer cause and effect between RT and BI dissatisfaction or MD.

In conclusion, the frequency of dissatisfaction with BI in Brazilian RT practitioners of both sexes was high, and the presence of MD, when identified, was higher in women. However, the heterogeneity of the tools and lack of validation of some indicates a crucial bias in the results obtained. Besides that, the several scales used for these assessments differ significantly in the depth and scope of the questionnaires developed for the same purpose, raising questions about how robust they really are to evaluate a matter so complex as the whole BI perception and its nuances.

Supplemental Material

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Supplemental material, sj-ris-5-hpq-10.1177_13591053231183593 for Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used by Vinícius Suedekum da Silva, Jeniffer Caroline Watte Martins, Annelise Fochesatto and Carolina Guerini de Souza in Journal of Health Psychology

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sj-ris-7-hpq-10.1177_13591053231183593 – Supplemental material for Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used

Supplemental material, sj-ris-7-hpq-10.1177_13591053231183593 for Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used by Vinícius Suedekum da Silva, Jeniffer Caroline Watte Martins, Annelise Fochesatto and Carolina Guerini de Souza in Journal of Health Psychology

Supplemental Material

sj-riss-8-hpq-10.1177_13591053231183593 – Supplemental material for Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used

Supplemental material, sj-riss-8-hpq-10.1177_13591053231183593 for Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used by Vinícius Suedekum da Silva, Jeniffer Caroline Watte Martins, Annelise Fochesatto and Carolina Guerini de Souza in Journal of Health Psychology

This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Footnotes

Acknowledgements

The authors would like to thank the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), and Universidade Federal do Rio Grande do Sul (UFRGS) for supporting this research.

Author contributions

CGS and JCWM designed the study. VSS, JCWM, and AF collected and analyzed data. VSS and CGS wrote the paper. VSS, JCWM, AF, and CGS read and approved the final version of the manuscript.

Data sharing statement

The current article is accompanied by the relevant raw data generated during and/or analysed during the study, including files detailing the analyses and either the complete database or other relevant raw data. These files are available in the Figshare repository and accessible as Supplemental Material via the Sage Journals platform. Ethics approval, participant permissions, and all other relevant approvals were granted for this data sharing.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by FAPERGS under grant number 21/2551-0000520-3.

ORCID iD

Carolina Guerini de Souza

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