Anthropometric status and body image perception among Moroccan university students

Revue d’E´pide´miologie et de Sante´ Publique 67 (2019) 311–317

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Original article

Anthropometric status and body image perception among Moroccan university students Statut anthropome´trique et perception de l’image corporelle chez des e´tudiants universitaires marocains K. Boutahar *, A. Chetoui, K. Kaoutar, M. Najimi, F. Chigr Laboratory of Biological Engineering, Faculty of Science and Technology, Sultan Moulay Slimane University, Beni Mellal, Morocco

A R T I C L E I N F O

A B S T R A C T

Article history: Received 28 June 2018 Accepted 25 April 2019 Available online 16 July 2019

Background. – University students aged between 18 and 25 undergo several physical changes as a result of transition from adolescence to adulthood. Students do not always accept those changes and sometimes develop dissatisfaction towards their figures. In such cases, it is still not clear how actual body weight status can be affected by socio-cultural factors such as body image perception. The objective of this study was to determine the link between anthropometric status and body image perception among university students. Methods. – Two hundred and forty six (246) university students from the Faculty of Sciences and Technologies within the Beni Mellal-Khenifra region in Morocco, aged 20–24 years were interviewed using face-to-face questionnaires. Anthropometric measurements and Body Mass Index were collected. Body image perception was assessed by Figure Rating Scale, and body size dissatisfaction was calculated as Feel minus Ideal Discrepancy (FID). Data were described using means and proportions. The Student ttest and the chi-square test have been used to assess the statistical significance of group differences. Results. – Underweight students represented 16.7% of the investigated sample, while 11.4% suffered from overweight and obesity, higher in females students (14.4%) than in males (7.9%). Regarding body image perception, 43.9% of participants considered themselves underweight; whereas only 4.2% considered themselves overweight with no significant differences related to gender. Of note, the total prevalence of body image dissatisfaction was around 69.8%. Finally, among overweight/obese students, 88.9% of females and 71.4% of males expressed the wish to become thinner while 28.6% of the overweight/obese males wanted to get heavier. Conclusion. – The results of this study indicate a high rate of body image dissatisfaction and a tendency of participants to underestimate their body weight. This behavior may be a reflection of a real influence of social and psychological factors occurring during this critical period and may make university students vulnerable to many risk-taking behaviors. Thus, there is a need for suitable interventional programs and innovative strategies to ensure the understanding of the health consequences of overweight and obesity and to prevent associated comorbidities.

C 2019 Elsevier Masson SAS. All rights reserved.

Keywords: Anthropometric status Body image University students Morocco

R E´ S U M E´

Mots cle´s : Statut corporel L’image corporelle E´tudiants universitaires Maroc

Position du proble`me. – Les e´tudiants universitaires aˆge´s de 18 a` 25 ans subissent plusieurs modifications corporelles en raison de leurs habitudes alimentaires. Ils n’acceptent pas toujours ces changements et de´veloppent parfois une insatisfaction vis-a`-vis de leurs silhouettes. Dans de tels contextes, il n’est pas encore clair comment le statut re´el du poids corporel peut eˆtre influence´ par des facteurs socioculturels tels que la perception de l’image corporelle. L’objectif de cette e´tude e´tait de de´terminer le lien entre le statut anthropome´trique et la perception de l’image corporelle chez les e´tudiants universitaires.

* Auteur correspondant: N814, rue Rommane Lotissement Saint-Margarite, Khemisset, Morocco. E-mail address: [email protected] (K. Boutahar). https://doi.org/10.1016/j.respe.2019.04.057 C 2019 Elsevier Masson SAS. All rights reserved. 0398-7620/

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Me´thode. – Deux cent quarante-six (246) e´tudiants de la Faculte´ des sciences et techniques dans la re´gion de Beni Mellal-Khenifra au Maroc, aˆge´s de 20 a` 24 ans, ont e´te´ interroge´s a` l’aide d’un questionnaire en face-a`-face. Des mesures anthropome´triques ont e´te´ effectue´es et l’indice de masse corporelle a e´te´ calcule´. La perception de l’image corporelle a e´te´ e´value´e a` l’aide d’une e´chelle de figures compose´e de neuf images allant du mince a` l’obe`se. Les donne´es ont e´te´ de´crites a` l’aide de moyennes et de proportions. Le test t de Student et le test du Chi2 ont e´te´ utilise´s pour e´valuer la signification statistique des diffe´rences entre groupes. Re´sultats. – L’insuffisance ponde´rale e´tait pre´sente chez 16,7 % de l’e´chantillon, tandis que 11,4 % souffraient de surpoids et d’obe´site´, plus fre´quents chez les femmes (14,4 %) que chez les hommes (7,9 %). En ce qui concerne la perception de l’image corporelle, 43,9 % des participants se conside´raient en insuffisance ponde´rale, alors que seulement 4,2 % se conside´raient en surpoids, sans diffe´rence significative entre les deux sexes. La pre´valence totale d’insatisfaction vis-a`-vis de l’image corporelle e´tait de 69,8 %. Parmi les e´tudiants en surpoids/obe´site´, 88,9 % des femmes et 71,4 % des hommes souhaitaient maigrir, tandis que 28,6 % des hommes souhaitaient devenir plus lourds. Conclusion. – Les re´sultats de cette e´tude indiquent un taux e´leve´ d’insatisfaction vis-a`-vis de l’image corporelle et une tendance des participants a` sous-estimer leur poids. Ce comportement pourrait refle´ter une influence re´elle des facteurs sociaux et psychologiques intervenant au cours de cette pe´riode critique, ce qui pourrait les rendre vulne´rables a` de nombreux comportements a` risque. Il est donc indispensable de mettre au point des programmes d’intervention approprie´s et des strate´gies novatrices pour bien comprendre les conse´quences du surpoids et de l’obe´site´ sur la sante´ et pour pre´venir les comorbidite´s associe´es.

C 2019 Elsevier Masson SAS. Tous droits re ´ serve´s.

1. Introduction Young adults aged 18–25 are considered to be in a period of ‘transition’ from adolescence to adulthood. It is known that the interaction of social, psychological and biological factors that happen during this period may make them vulnerable to many risk-taking behaviors [1]. One of the most important vulnerabilities young adults have to face is the one related to predominant social models and representations commonly observed in this stage which tends to predispose this population to the development of body image dissatisfaction [2]. It is defined as ‘‘a person’s negative thoughts and feelings about his or her body’’ [3] and usually involves a perceived discrepancy between a person’s evaluation of his or her body and his or her ideal body [4]. A high prevalence of body dissatisfaction has been observed, mainly among university students [5,6] due to the bio-psychosocial instability, taken together with the insertion into the academic community, leaving home, developing relationships and possibly cohabiting [7]. This imposes a new social reality that makes the students vulnerable to societal pressure with regard to body aspects [2]. Body weight perception plays a significant role in weight management [8,9] and persons who have weight misperception are more likely than their counterparts with accurate perception to develop some physical (hypertension, hyperlipidemia, diabetes mellitus type 2, metabolic syndrome) [10,11] and psychological (distress, depression, self-abasement, anxiety, agrypnia) [12,13] problems. Nevertheless, it is not yet clear how actual body weight status may be influenced by changes in socio-cultural factors such as body image perception, especially among young students who have been neglected both in terms of research and policy [14]. Morocco, like other developing countries enduring several transitions, have intricate matters concerning body mass index and public health, as a significant underweight population coexists with an increasing overweight population. The prevalence of underweight has decreased over the past years, being more frequent among men than among women. In parallel, the prevalence of obesity has increased, being more frequent among women than among men [15]. In absence of specific data on nutritional status of young Moroccan adults living in Morocco, the only data available were on adults aged more than 20 years [16]. In 2000, a recent

survey reported obesity among 13.3% of individuals aged 20 years and more (22% among women and 8% among men) [16]. Hence, the aim of the present study was to examine the association between the anthropometric status and the body image perception, in a sample of university students within the Beni Mellal-Khenifra region in Morocco. Findings from this study may enhance our understanding of the complex relationships among these key study variables, in order to design effective programs to improve young adults’ quality of life and physical and mental health.

2. Methods 2.1. Participants We have conducted a cross-sectional survey among 246 university students (132 females and 114 males) from the Faculty of Sciences and Technologies, Sultan Moulay Slimane University. The age range of the students was 20–24 years with mean age of 21.9  1.3 at the time of the survey. They were interviewed from January to June 2016 by the authors of this study using a pre- and posttested questionnaire. A face-to-face interview with participants was held to collect data, including, in addition to age and sex, anthropometric measurements and body image perception assessment. 2.2. Anthropometric measurements Weight and height measurements were reported for each participant. Weight was measured with a high precision mechanical scale ( 0.1 kg) and height was recorded using a wall-mounted stadiometer ( 0.1 cm). Measurements were taken for each participant in light clothing without shoes and Body Mass Index (BMI) was calculated as weight in kilograms divided by height in meter squared and categorized as underweight (< 18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese ( 30 kg/m2) [17]. 2.3. Body image perception assessment Body image perception was assessed by Figure Rating Scale (FRS) [18]. It consisted of nine schematic silhouettes presenting

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body shape images ranging from 1 to 9 where 1 was the thinnest body type and 9 the largest body type. The scale was used frequently as a measure of body dissatisfaction. Subjects were asked to mark the figure which they thought they resembled (perceived body size) and then the figure they wanted to look like (ideal body size). Body size dissatisfaction was calculated as Feel minus Ideal Discrepancy (FID), which was examined through the difference between perceived and ideal body size [19]. Scores of zero indicated body image satisfaction and negative or positive scores indicated body image dissatisfaction, with either a desire to gain or lose weight, respectively. The index Feel weight status minus Actual weight status Inconsistency (FAI) was also used to verify if there was a realistic weight status perception within subjects. The FAI was calculated as the difference between perceived body image and actual body size evaluated as BMI. Perceived body image was evaluated on a scale classified according to standard procedure [20,21] into four groups including underweight, normal-weight, overweight and obese shape. BMI was classified into four categories where code 1 was used for underweight status, code 2 for normal-weight status, code 3 for overweight status and code 4 for obese status. The FAI score of zero indicated a realistic body image perception, while negative and positive scores indicated weight status underestimation and overestimation, respectively [22]. To assess weight control attempts, students were invited to respond to the following question: ‘‘Do you think that you need to: lose weight, gain weight or maintain your weight’’.

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Table 1 Anthropometric characteristics of participants (n = 246). Males (n = 114)

Females (n = 132)

Age Weight (kg) Height (cm) Body mass index(kg/m)

Total

t-test

Mean

SD

Mean

SD

21.6 56.6 161.5 21.7

 1.1  10.4  5.2  3.6

22.1 65.3 173.4 21.8

 1.5  10.5  7.6  4.1

ns t = 6.56* t = 14.62* ns

Mean

SD

21.9 60.6 167.0 21.7

 1.3  11.3  8.7  3.8

*P < 0.0001; ns: not significant.

Table 2 Studied population classified according to BMI categories. Females

Underweight Normal-weight Overweight Obesity

Males

Total

n

%

n

%

n

%

24 89 14 05

18.2 67.4 10.6 3.8

17 88 06 03

14.9 77.2 5.3 2.6

41 177 20 08

16.7 72.0 8.1 3.2

BMI: Body Mass Index

77.2% of males). While 18.2% of females and 14.9% of males were underweight, overweight and obesity were higher among females (14.4%) compared to males (7.9%). 3.2. Weight perception

2.4. Ethics statement Written approval was obtained from the Sultan Moulay Slimane University before the initiation of this study. All the experiments were carried out according to the guidelines of the institutional ethical committee with the approval number of FST/LGB/2015/15JAN./012-JAN.2015-SEPT.2017. The participation was voluntary and anonymous. Participants were informed about the study objective and have red and signed a consent form. All data were confidential and protected at all stages of the study. 2.5. Data analysis Statistical analysis was carried out using Statistical Package for Social Sciences (Version 10.0, SPSS, Inc.) Software. Data were described using mean and standard deviation (SD) for continuous variables and proportions for categorical variables. Numerical variables were analyzed using the student t-test. The chi-square test was used to assess statistical significance between anthropometric status and body image perception. The test was considered significant when the P-value (degree of significance) was less than 0.05.

Concerning perception of body image related to BMI, the results presented in Table 3 show that overall 43.9% of participants considered themselves as underweight; whereas only 4.2% considered themselves overweight, while no participant considered himself obese. No significant gender differences in body image were noticed. According to BMI classifications, 41% of the students did not have a correct body image perception. This association was statistically significant (x2 = 102.32; P < 0.0001). Among students with normal BMI, 41.3% thought that they were underweight and among those with BMI  25 kg/m2, only 34.6% thought that they were overweight. Concerning overweight boys, 71.4% considered their body weight as normal and no one thought that he was underweight (x2 = 33.9; P < 0.0001). Among overweight girls, 36.8% considered themselves overweight against 63.1% considering themselves normal-weight and no girl thought she was underweight (x2 = 68.3; P < 0.001). Among students with BMI  30 kg/m2, 42.8% did not consider themselves overweight or obese (x2 = 114.82; P < 0.001). Most of the participants in the underweight (80.4%), normal-weight (85%), and overweight (80,7%) categories of BMI selected the normal figure [3,4] as their desirable or ideal body image, while no participant chose overweight or obese figures as ideals. No significant difference was reported between the two sexes (Table 4).

3. Results 3.3. Body dissatisfaction 3.1. Anthropometric status The details of collected data concerning the anthropometric characteristics and weight status of the sample are presented in Table 1 by gender. The participants mean age was 21.9 years (SD = 1.3) and 53.6% were girls. On average, females were significantly shorter (t = 14.6, P < 0.0001) and lighter than males (t = 6.5, P < 0.0001) while no significant gender difference in BMI was noticed. According to BMI classification (Table 2) a large proportion of the sample (72%) had normal-weight status (67.4% of females and

The total prevalence of body image dissatisfaction calculated by the FID was 69.8%. Positive scores were obtained among 20.7% of participants (expressing their desire to be thinner), while 49.1% had negative scores (desire to be heavier). There was no significant gender difference in body image dissatisfaction (x2 = 1.035; P = 0.59). Moreover, regarding body dissatisfaction (FID) according to the BMI of the subjects, 92% of students with BMI  25 expressed dissatisfaction (x2 = 76.45; P < 0.0001). Underweight males were more satisfied with regard to their body image (35.3%) than normal-weight males (27.7%); 64.7% of

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Table 3 Body image perception among participants according to BMI. BMI (kg/m2)

 18.5

18.5–24.9

25–29.9

 30

Sex

Females (n = 24) Males (n = 17) Total (n = 41) Females (n = 88) Males (n = 84) Total (n = 172) Females (n = 14) Males (n = 5) Total (n = 19) Females (n = 5) Males (n = 2) Total (n = 7)

Perceived body image Underweight

Normal-weight

Overweight

Obese

n (%)

n (%)

n (%)

n (%)

21 13 34 37 34 71 0 0 0 0 0 0

3 (12.5%) 4 (23.5%) 7 (17.1%) 51 (58.0%) 49 (58.3%) 100 (58.1%) 10 (71.4%) 4 (80.0%) 14 (73.7%) 2 (40.0%) 1 (50.0%) 3 (42.8%)

0 0 0 0 1 1 4 1 5 3 1 4

0 0 0 0 0 0 0 0 0 0 0 0

(87.5%) (76.5%) (82.9%) (42.0%) (40.5%) (41.3%)

(1.2%) (0.6%) (28.6%) (20.0%) (26.3%) (60.0%) (50%) (57.2%)

X2 = 114.82; P < 0.0001; BMI: Body Mass Index.

Table 4 Ideal body size among participants according to BMI. BMI (kg/m2)

 18.5

18.5–24.9

25–29.9

 30

Sex

Females (n = 24) Males (n = 17) Total (n = 41) Females (n = 80) Males (n = 87) Total (n = 167) Females (n = 14) Males (n = 5) Total (n = 19) Females (n = 4) Males (n = 3) Total (n = 7)

Ideal body size Underweight

Normal-weight

Overweight

Obese

n (%)

n (%)

n (%)

n (%)

4 (16.7%) 4 (23.5%) 8 (19.5%) 16 (20.0%) 9 (10.3%) 25 (15.0%) 3 (21.4%) 1 (20%) 4 (21.1%) 0 1 (33.3%) 1 (14.3%)

20 (83.3%) 13 (76.5%) 33 (80.5%) 64 (80.0%) 78 (89.7%) 142 (85.0%) 11 (78.6%) 4 (80.0%) 15 (78.9%) 4 (100%) 2 (66.7%) 6 (85.7%)

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

BMI: Body Mass Index.

them expressed their desire to get heavier against half males with normal BMI. On the other hand, all overweight males were not satisfied with their weight, 71.4% wanted to get thinner while 28.6% wanted to get heavier (x2 = 15.89; P < 0.003). When females were considered, 41.3% of normal-weight ones were satisfied with their body image compared to 20.8% and 11.1% of underweight and overweight ones respectively. A total of 79.2% of underweight and 46.3% of normal-weight females wanted to get heavier, while 88.9% of overweight ones wanted to get thinner (x2 = 66.02; P < 0.0001). Females showed a significant preference for heavier bodies and the mean value of the perceived figure was significantly lower than the ideal figure (P < 0.001). The FAI scores ranged from 2 to +1 and the mean FAI value was negative in both sexes ( 0.39, SD = 0.56 in females and 0.33, SD = 0.58 in males) indicating a tendency to underestimate the weight status in a gender independent manner. No significant gender difference was found in realistic evaluation of body image perception (FAI = 0) (58.0% in females, 58.3% in males). In fact, 39.7% of females and 37.1% of males underestimated their weight status and only 2.3% and 4.6% of them overestimated it respectively.

Among those with BMI  25, only 50% reported that they tried to lose weight (x2 = 34.79; P < 0.0001) and this was significantly higher in females (x2 = 33.34; P < 0.001) than in males. On the other hand, among those with BMI < 25, 30.9% of females and 29.5% of males reported trying to gain weight, while 56.6% of females and 57.1% of males wanted to maintain their weight. Concerning weight control intentions in relation to perceived body image, 70% of students who perceived themselves as overweight wanted to lose weight while 30% of them wanted to maintain their weight (x2 = 50.79; P < 0.0001). Respectively, 85.7% of females and 33.3% of males who perceived themselves overweight wanted to lose weight; this association was statistically significant among females (x2 = 47.87; P < 0.0001). Regarding weight control intentions in relation to the FAI, no significant association was reported; only 25% of students who overestimated their body weight wanted to lose weight while 12.5% still wanted to gain weight against 25.9% of those who had a realistic perception.

3.4. Weight control intentions

This study evaluated the association between anthropometric status and body image self-perceptions, among a sample of university students in Beni Mellal-Khenifra region in Morocco. According to the literature, university populations may be considered as the convenient sample for the study of health in

Among all students, 16.8% reported on attempts to lose weight, against 27.6% who reported trying to gain weight, while 55.6% wanted to maintain their weight.

4. Discussion

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young adults [23]. Concerning anthropometric status assessed by BMI, our sample was divided into 16.7% of underweight, 72% of normal-weight, 8.1% of overweight and 3.2% of obesity with no significant difference between sexes. Our results were in concordance with literature in terms of obesity prevalence among young adults in developing countries as obesity prevalence ranged from 2.3 to 12% [24]. In absence of specific data on anthropometric status of young adults in Morocco, the latest data available were from the national survey of the year 2000 and concerned adults aged more than 20 years. Overweight and obesity were found to occur among 39.3% and 13.2% of individuals studied, respectively [16]. The lower prevalence of overweight and obesity in our sample compared with national data could be explained by increasing trends with age of weight gain, among young adults especially and adults in general, as reported in many studies [25,26]. Peixoto et al. in 2007 also mentioned that age was strongly associated with obesity in women [27]. Therefore, younger women, who were more likely to be educated, adopted lifestyles that were less prone to obesity as a consequence of the influence of lifestyle of developed countries [28]. Regarding body image perception, we found that 40.3% of students did not have an accurate perception of their own weight status. Our results were consistent with those of previous studies which have found that the actual weight differed significantly with weight perception among university students [29,30], but still less than the results of an Egyptian study among university student in Damanhour and Alexandria where all of the students had wrong perceptions of their weight compared to their BMI [31]. This result was also confirmed by body dissatisfaction (measured with the FID) expressed in our sample. Only 30.2% of participants were satisfied with their current body image which was in concordance with keshk’s et al. study in 2019 among university students in Cairo reporting a level of 30.7% of satisfaction [32]. The discrepancies between weight perception and measured weight status in our sample clearly indicated that both males and females underestimated their body weight (the mean FAI value was negative in both sexes ( 0.39, SD = 0.56 in females and 0.3, SD = 0.58 in males). Our results were also consistent with the results of Keshk’s et al. study in 2019 in which more than half of the participants (53.5%) underestimated their body weight [32]. According to gender, in our sample, 71.4% of overweight males and 63.1% of overweight females considered their body weight as normal. On the other hand, 40.9% of normal-weight males and 42% of normal-weight females thought they were underweight. A study among young students in Tunisia and Egypt showed similar results to our findings. Underestimation of body weight was expressed among respectively 39.5% and 43.5% of overweight and obese males against 22.4% and 26.8% of overweight and obese females [33]. Moreover, our data were in line with results the obtained from a study leaded in Saudi Arabia within university students as only 10.7% of overweight males and 9.4% of overweight and obese females were dissatisfied with their body shape [34]. Ideal standards of body sizes were always seen as culturally specific. In such setting, the females’ ideal body size varied across countries, with bigger sizes being more popular in less affluent and non-Western countries where fatness may be culturally valued as a welcomed sign of health, beauty, prestige, and prosperity [13,16]. In Arab societies, curvaceousness was traditionally considered as a characteristic of feminine beauty [35]. In a Moroccan context, misperception of body weight and preference for fat body size among females were reported in several investigations [36,38,39]. The review of Toselli et al. in 2016 within African residents and migrants in Europe concluded that Moroccan residents tended to prefer a heavier ideal figure [37]. The review

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included two studies conducted among Moroccan Saharoui women [38,39] and another one among women living in Casablanca [40] showing a high prevalence of overweight and obesity. However, participants were generally satisfied with their body weight and considered themselves normal-weight [38–40]. Similarly, High Atlas Amazigh Moroccan women underestimated their body mass and wished to gain weight [36]. In contrast, results of a study of Nicolau et al. in 2009 among north Moroccan women with mean age of 25.7 years, showed a personal preference for thin bodies. However women witnessed the persistence of traditional ideals regarding body weight, perceived social pressure to comply with these ideals, and their concern with avoiding the negative perceptions of others [41]. Our findings were in concordance with the fact that women in Arab and non-western countries, significantly preferred heavier bodies, supported by previous studies conducted in Saudi Arabia [42] and Egypt [43] among university female students showing that a high percentage of participants wanted to be heavier than their perceived body image. However, our results were in contrast with those of young Tunisian female students examined by Jaeger et al. in 2002 who preferred to be thinner [44]. This contrast may be explained by the fact that some developing countries were more aligned with Western values, and thus the preference of women for thin bodies [37]. Interestingly, the phenomenon of body dissatisfaction was at first thought of as a ‘golden girl problem’, implying that these types of feelings were restricted to white females in the Western world [45]. However in our sample, males were more dissatisfied with their body image than females (32.8% and 27.1% respectively), and 37% of men underestimated their weight status which was in concordance with the literature reporting the preference of males for a heavier and muscular body structure in both developed and developing countries [46–48]. Our results were also in concordance with the study of Lahmam et al. in 2006 among high atlas Moroccan men reporting that 48.5% of them underestimated their body weight [36]. In a study conducted among Egyptian university students, male students preferred heavier weight as muscularity [31]. Also, in a study among Italian university students male tended to underestimate their weight status [22] and in another study among Saudi students no obese males were dissatisfied with their body shape [34]. Many studies have shown that a negative body image was related to destructive behaviors [49]. Other studies have mentioned that a positive body image was related to better outcomes, such as happiness and life satisfaction [50]. Thus, normal-weight individuals who perceived themselves as being overweight may be prone to negative behaviors such as unnecessary dieting and binge eating [51]. On the other hand, overweight individuals who believed that they have normal-weight may not feel the need to control their weight and therefore were at risk of obesity [51]. To underline the importance of perceived body image in attempts of weight control in our sample, we have found that 50% of students who were actually overweight declared trying to lose weight while this percentage increased to 70% among students who perceived themselves as overweight. This correlation between the perceived weight and weight control intentions was demonstrated in several surveys among adults regardless of age group and gender supporting that weight control was positively associated with overweight perception [52]. Interestingly, in our sample, 30% of students who perceived themselves as overweight wanted to maintain their weight, supporting our findings of preference for heavier bodies, and only 33.3% of males who perceived themselves as overweight wanted to lose weight against 85.7% of females. This was supporting the notion of women being more likely than men to diet [22] and in concordance with results of other samples of university students, in which females were more interested in

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losing weight than males [31,53]. This also could be taken as indicator of occurring changes in lifestyles of young Moroccans especially those attending University. There were some limitations in our study. First, the research was cross-sectional so causality was not able to be determined. The sample could not be taken as a true radioscopy of the entire youth population of Morocco, especially the rural population as many of them did not have access to university education. Concerning BMI scale, a major limitation in measuring up male body was the fact that it did not consider increased muscle mass, which could have been a contributing factor of raised BMI in some males. Moreover it could be possible that these muscular males who ‘misperceived’ themselves as normal-weight would in fact not be misperceiving due to the BMI scale which wrongly classified them as overweight. Third, we only assessed the association between BMI and body weight perception by age and gender. Future studies should investigate associations among eating habits, weight dissatisfaction and concerns, physical activity, and psychological symptoms. 5. Conclusion Despite limitations, this study contributed towards the understanding of the complex relationship between anthropometric status and body image among university students in Morocco. The findings of the present study evidenced the dissatisfaction, the discrepancy and the underestimation of body weight with ideal body image in the examined sample and the correlation between body weight perception and weight control intentions. Therefore, motivational factors such as promotion of a healthy body image should be integrated across all interventions aimed to prevent and overcome obesity and other health-related concerns among young adults. Funding Fundings. A part of this study has been founded by ‘‘projet prioritaire de recherche’’ (ppr)-type B (.Pr M Najimi). Disclosure of interest The authors declare that they have no competing interest. References [1] Aucott L, Poobalan A, McCallum M, Smith WCS. Mental wellbeing related to lifestyle and risky behaviors in 18–25 year old: evidence from North East Scotland. Int J Pub Health Res 2014;4:431–40. [2] Franc¸a CB, Colares VA. Estudocomparativo de condutas de sau´de entre universita´rios no inı´cio e no final do curso. Rev SaudePublica 2008;42:420–7. [3] Grogon S. Body image: understanding body dissatisfaction in men, women, and children. East Sussex: Routledge; 2008. [4] Cash TF, Szymanski ML. The development and validation of the Body-Ideals Questionnaire. J Personality Assessment 1995;64:466–77. [5] Bosi M, Uchimura K. Eating behavior and body image among psychology students. J Bras Psiquiatr 2008;58(3):150–5. [6] Quadros TMB, Gordia AP, Martins CR, Silva DAS, Ferrari EP, Petroski EL. Imagem corporal em universita´rios: associac¸a˜o com estado nutricional e sexo. Motr 2010;16(1):78–85. [7] Burke V, Mori TA, Giangiulio N, Gillam HF, Beilin LJ, Houghton S, et al. An innovative program for changing health behaviours. Asia Pac J Clin Nutr 2002;11(Suppl3):586–97. [8] Xie B, Liu C, Chou CP, Xia J, Spruijt-Metz D, Gong J, et al. Weight perception and psychological factors in Chinese adolescents. J Adolesc Health 2003;33(3): 202–10. [9] Xie B, Chou CP, Spruijt-Metz D, Reynolds K, Clark F, Palmer PH, et al. Weight perception, academic performance, and psychological factors in Chinese adolescents. Am J Behav 2006;30(2):115–24. [10] Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101(3 Pt 2):518–25. [11] Gurnani M, Birken C, Hamilton J. Childhood obesity: Causes, consequences, and management. Pediatr Clin North Am 2015;62(4):821–40.

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