The impact of body image on low mood: Insights from 154,183 adolescents across 43 countries

To explore the association between body image (BI) and feeling low mood using extensive and representative samples of school-aged adolescents from 43 countries.

A total of 154,183 participants (age 13.6 ± 1.6 years; 51.5 % girls) from these 43 countries from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey were included in the study. The BI, feeling low mood, physical activity (PA) and diet were self-reported.

Overall, 31.8 % of participants reported higher levels of feel low mood, while 68.2 % reported lower levels. Adolescents who perceived themselves as "much too fat" reported the highest rates of feeling low mood (59.4 %), compared to those who viewed themselves as "about the right size" (26.5 %). Generalized linear mixed models indicated that perceiving oneself as "much too fat" (estimate = 0.703, p = 0.001) significantly increased the likelihood of feeling low mood. Be active and daily consumption of fruits and vegetables was linked to lower odds of feeling low mood, while frequent consumption of sweets (estimate = 0.272) raised these odds. Country-specific variations were evident, with higher rates of feeling low mood in Turkey (estimate = 1.612, p < 0.001) and Italy (estimate = 1.207, p < 0.001), and lower rates in the Netherlands and Serbia.

Overall, BI, especially perceiving oneself as "much too fat," is closely related to feelings of low mood in adolescents. This study underscores the multifaceted factors affecting adolescents' mood, including BI, diet, PA, age, sex, and country-specific contexts.