Body Image Satisfaction, Food Consumption, Diet Quality, and Emotional Management in Adolescence: A Longitudinal Analysis from the SI! Program for Secondary Schools Trial

Background: Adolescence involves physical and psychological changes that often conflict with body ideals, potentially increasing body image (BI) dissatisfaction and unhealthy diet. The main objective was to analyze cross-sectional and longitudinal associations between BI satisfaction (BIS) and nutritional status, dietary habits (DH), and emotional management (EM) in adolescents. Methods: 1315 adolescents from the SI! Program for Secondary Schools trial reported their BIS, DH, and EM at ages 12, 14 and 16. Linear and logistic mixed models estimated the associations between BIS, food intake, diet quality, and EM. Linear and logistic mixed-effect models for repeated measures assessed mean change estimates from baseline to 2- and 4-year follow-up in food intake and EM, stratified by gender. Results: A large proportion of adolescents without excess weight were dissatisfied with their BI. BIS was significantly associated with DH, especially in boys. Body-satisfied adolescents at baseline tended to have healthier DH (diet quality index: boys 56.7 ± 13.0; girls 58.8 ± 12.7) and showed a greater improvement in diet quality at 16 years (boys 3.44 (1.50, 5.37); girls 1.85 (0.18, 3.52)). Adolescents who desired to lose weight decreased their intake of sugar-sweetened beverages, sweets, and snacks, whereas boys who desired to gain weight consumed more frequently fast food, sweets, snacks, and processed meat. Body-satisfied adolescents had higher self-esteem, and girls desiring to gain weight presented higher emotional eating. Conclusions: BIS was associated with nutritional status, and EM, showing gender differences. Overall, the desire to gain weight was associated with unhealthier DH. Educational interventions should promote self-esteem and BIS by focusing messages on healthy eating instead of body weight.