Prevalence of body dissatisfaction among preadolescents and the influence of social media: a cross-sectional study

INTRODUCTION

The term body image refers to the mental representation that individuals have of their own bodies. It is a multifaceted construct that encompasses perceptions, attitudes, and emotions regarding physical appearance.¹ It starts to develop from birth and depends on both objective aspects (body shape or size) and psychological, social, and cultural factors.²

Body dissatisfaction stems from the discrepancy between a person’s subjective evaluation of their actual body and their ideal body, and manifests as negative thoughts and emotions about the body, with an impact on psychological and physical wellbeing.² Various studies show that concerns and distorted perceptions about one’s body can develop even from early ages in relation to the internalization of esthetic ideals reinforced by family, peers and mass media.^3-5 Body dissatisfaction is associated with low self-esteem, anxiety, depression and maladaptive eating behaviors.^3,6,7

The extensive use of digital technologies, especially social media, has increased exposure to contents that promote unrealistic beauty standards, which is associated with higher levels of body dissatisfaction.^6,8,9 The use of digital media has become an integral part of daily life, especially among youth.^10,11 In Spain, 98% of adolescents have access to the internet, and use of social media is the main online activity of 80% of them, in some cases starting before age 10 years. One out of three underage individuals engages in problematic internet use.^12,13

Social media platforms do not only facilitate social interaction but also disseminate beauty ideals and promote constant comparison.¹⁴ Algorithms, filters, and the pursuit of validation through “likes” contribute to distorting body image and beauty standards.^15,16

Preadolescence, marked by physical and social changes, is a particularly vulnerable stage for the development of negative body image perceptions under the influence of biological, cultural and social factors.^2,3 The immaturity of critical thinking skills facilitates the internalization of unrealistic beauty standards and social comparison, increasing the probability of certain behaviors, such as restrictive eating or social withdrawal.¹¹ The sensitivity to the opinion of others at a time when identity is developing makes preadolescents particularly vulnerable to external influences, like social media.⁹ In spite of this, few studies to date have focused on this population.

Since there is evidence of an association between greater exposure to social media and high levels of body dissatisfaction in both adolescents and adults,^14-16 our study considers the possibility of a similar pattern occurring in the preadolescent population. Understanding this association will allow the development of educational, family-based and community-based interventions to promote a positive body image from the early stages of development.

The objectives of the study were to determine the prevalence of body dissatisfaction among preadolescents in Biscay, to identify their digital technology usage habits, and to analyze the association between their use of these technologies and body image perception.

MATERIAL AND METHODS

We conducted an observational, analytical, and cross-sectional study at the Munguía primary care center in Mungialdea county (Biscay).

The data were collected in March and April 2025. The sample included preadolescents aged 9 to 12 years enrolled in schools in Mungialdea. We excluded children with physical disabilities, eating disorders or a psychiatric diagnosis.

We estimated that a random sample of 168 participants would be sufficient to estimate, with a 95% confidence level and a margin of error of ±7 percentage points, a population percentage with an expected value of approximately 57%.⁴

The sample was selected using one-stage cluster sampling. Of the eight selected schools, two agreed to participate, and we included all students enrolled in years 4 through 6 of primary education and year 1 of compulsory secondary education (ESO). The fact that only two schools participated may have limited the representativeness of the sample and should be taken into account when interpreting and generalizing the results.

The study was approved by the Clinical Research Ethics Committee of the Basque Country. We obtained informed consent from the legal guardians and assent from the minors. The data collection took place during school hours in guided sessions lasting up to 60 minutes.

We collected sociodemographic and anthropometric data: age, sex, number of siblings, weight and height (direct measurement), and body mass index (BMI) calculated according to standardized protocols. Body image and body dissatisfaction were assessed using the Collins Figure-Rating Scale, which has been validated in children, to compare their perceived body shape with their ideal body shape.^4,17 Digital habits and social media use were assessed using two questionnaires: the Survey on Social Media Usage Habits developed by the Official Board of Psychology of Castilla y León¹⁸ and the Social Media Use Questionnaire, designed and validated for preadolescents in the Principality of Asturias.¹⁹

The statistical analysis was performed with the R software package (v 4.4.0). We obtained descriptive statistics and performed the χ² test, Student t test, ANOVA or Kruskal-Wallis test according to the nature and distribution of the variables. We calculated effect sizes (Cliff δ, ϵ², phi and Cramer V) and coefficients of agreement (weighted kappa and Krippendorff α), which we interpreted with the thresholds detailed in Table 1. Statistical significance was defined as a p value of less than 0.05 (95% confidence interval [95 CI]).

The study adhered to the principles of the Declaration of Helsinki and the General Data Protection Regulation, safeguarding the anonymity and confidentiality of participants.

RESULTS

The final sample consisted of 171 preadolescents. The main characteristics of the participants are summarized in Table 2.

Body dissatisfaction

Of the total participants, 43.9% reported being satisfied with their bodies, while 56.1% reported some degree of dissatisfaction. There were significant differences based on sex: body dissatisfaction was higher among girls than among boys (median −0.50 vs. 0.00; p = 0.003). The effect size, estimated using Cliff’s δ, was moderate (r = 0.25; 95% CI: 0.08 to 0.41)

We found no significant differences based on age (p = 0.086; ϵ² = 0.008) or type of school (p = 0.075). However, there were significant differences based on whether the child had siblings (p < 0.001): only children showed higher levels of body dissatisfaction, with a large effect size (r = −0.39; 95% CI: −0.57 to 0.19)

A majority of those who expressed body dissatisfaction (76.1%) said they wanted a slimmer body, compared to 23.9% who would prefer a more muscular body. This difference was statistically significant (p <0.001), with a large effect size that was clinically relevant (Cohen h = 1.10). Comparing by sex (Figure 1), a higher proportion of girls than of boys wanted a slimmer body (88,6% vs. 65,4%), a difference that was also significant (p = 0.016; Cliff δ = 0.25), with a medium effect size.

Most participants perceived their weight status as normal, which was generally consistent with the BMI classification, although the subjective and objective measures did not always agree (Figure 2). The concordance analysis yielded a kappa coefficient of 0.318 (p < 0.001), reflecting moderate and significant agreement between perceived and actual weight status. Overall, there was agreement between the two measures in 59.4% of the sample, although a degree of difference between perceived and actual status persisted at the individual level.

Digital media use habits

Table 3 summarizes the main digital media habits of the sample.

We found statistically significant differences in use patterns based on sex (Figure 3). Girls were more likely to have a tablet of their own (62.5% vs. 39.4%; p = 0.005) and reported going online to check email more frequently (69.4% vs. 39.4%; p < 0.001). They also consumed content related to fashion, health and beauty more often (p < 0.01). In contrast, boys were more likely to use gaming consoles (75.8% vs. 36.1%; p < 0.001) and play online games, both alone (79.8% vs. 34.7%; p <0.001) and with other people, either face-to-face (58.6% vs. 26,4%; p <0,001), online with people they knew (66.7% vs. 22.2%; p < 0.001) or online with strangers (46.5% vs. 5.6%; p < 0.001). They also consumed content related to sports and gaming more often than girls (p < 0.01), and were more likely to follow influencers.

With regard to usage according to age, we observed a gradual increase in the access to and use of certain technologies. The percentage of children who had a smartphone of their own increased significantly with age, from 20.6% at age 9 to 75.6% at age 12 (p < 0.001). Similarly, the use of WhatsApp and email was significantly more frequent in older children (p < 0.001). Figure 4 shows the trends in the use of digital media between ages 9 and 12 years, including only variables with statistically significant differences.

There were no significant differences in usage habits in relation to the type of school, having siblings, sleep duration, or level of physical activity.

Association between body dissatisfaction and social media use

We analyzed the association between body dissatisfaction and the use of several social media platforms (YouTube, Twitch, WhatsApp, Instagram, Twitter, Facebook, and other) using bivariate analyses and estimating the effect size with the Cliff δ. We did not find significant differences between users and non-users (p = 0.953; δ = −0.01; 95 CI: −0.36 to 0.34), which suggests the absence of a relevant association in the study sample.

When we considered specific social media platforms, only Instagram use was significantly associated with body dissatisfaction (p = 0.011), with a moderate effect size (δ = 0.27; 95 CI: 0.06 to 0.46). In contrast, the use of other platforms (YouTube, Twitch, WhatsApp, Twitter, Facebook, TikTok, other) was not significantly associated with body dissatisfaction (p > 0.3 for all), with null or very small effect sizes (Table 4).

DISCUSSION

We conducted this study with three main objectives. First, to analyze the prevalence of body dissatisfaction among preadolescents. More than half of the participants (56.1%) reported some degree of dissatisfaction with their appearance, indicating that this is a common phenomenon at this stage of development. This prevalence was consistent with previous studies that have reported body dissatisfaction as a widespread issue, even before adolescence.^4,20

Consistent with the existing literature, we observed significant differences between the sexes, with a higher prevalence of body dissatisfaction among girls compared to boys (p = 0.003, medium effect size). This finding confirms that girls are more vulnerable to socially-promoted ideals of thinness, which are internalized from an early age through various agents of socialization, particularly digital media.^9,14,20

We also identified a statistically significant association between being an only child and higher levels of body dissatisfaction (p < 0.001, large effect size). Although previous research has hardly addressed this factor, this finding could be explained by the lack of family references to compare oneself with or seek validation from, which could magnify the influence of external references, like those found in social media. Given the cross-sectional design of the study, further research is needed to confirm this potential association, which could be an interesting area to explore in future studies.

Regarding the desire for physical change, most of the participants who expressed dissatisfaction would prefer a slimmer body, a trend that was more prevalent in girls compared to boys (88.6% vs. 65.4%). Boys tended to prefer a more muscular body, reflecting the different body ideals internalized according to sex: thinness in women and muscle mass in men, in agreement with previous studies.⁴

When we assessed the strength of the correlation between participants’ subjective perceptions of their weight status and their actual BMI, we found that it was moderate (κ = 0.318). There was a tendency to underestimate body weight, with participants exhibiting perceptions that have been associated with body dissatisfaction and maladaptive eating behaviors in the previous literature.^9,21

There were no differences based on age or type of school, supporting the notion that factors such as puberty and relationships with peers or family have a stronger impact on self-image than fixed demographic variables. Therefore, preventive interventions should focus on biopsychosocial development milestones.⁵

The second objective was to analyze digital habits and social media use. The data showed widespread use of these platforms: 94.1% of participants reported using social media, similar to the prevalence reported in recent studies.¹⁹ However, only 28.6% had active user profiles, which could be due to the age restrictions set by the platforms. Still, this limitation does not keep preadolescents from being exposed to potentially harmful content, especially considering that influencers are the figures most frequently followed by minors.²²

As regards the type of content consumed, it most frequently involved music, gaming, or humor, while topics such as politics or gastronomy generated little interest. This finding poses significant challenges for media literacy, which must adapt to the current interests of this cohort in order to be effective. We identified sex-specific consumption patterns: boys consumed more sports- and gaming-related contents, while girls were more likely to consume contents related to fashion, art, music or health/beauty, which was consistent with previous studies.^19,23

With regard to internet use, recreational use outweighed academic use, with very prevalent use of platforms such as YouTube (93.5%) or TikTok (38%). One-third of preadolescents used screens before bedtime, which could affect their sleep. Most families (91%) set rules regarding the use of digital devices and media, although only 43.6% used monitoring tools. When it came to the schools, 99.4% of participants reported that there were rules in place, reflecting a growing concern that access should be supervised.

The third objective was to explore the association between body dissatisfaction and social media use. We found no significant association between overall social media use and body dissatisfaction in the sample, contrary to what has been reported in previous studies of adolescents and young adults.^8,21 These results suggest that the association between social media and body dissatisfaction may manifest differently during preadolescence—a stage characterized by widespread, but, in many cases, still moderate use that is supervised by the family. In addition, growing public awareness of the risks associated with screentime and social media (through school campaigns, and family- and community-based initiatives) may be driving more conscious consumption patterns and mitigating the influence of unrealistic, idealized content.

When we analyzed specific social media platforms, we identified a significant association with a moderate effect size between Instagram use and body dissatisfaction (p = 0.011, δ = 0.27), consistent with previous studies that have identified Instagram as one of the platforms with the greatest negative impact on body image.^6,21 The visual nature of the application and the exposure to idealized images foster social comparison, which can elicit or magnify concerns about one’s appearance and reduce self-esteem, particularly among young women.^24,25

In contrast, we did not find a significant association with other platforms (YouTube, TikTok, Twitch, WhatsApp, Facebook, and Twitter), which suggests that the impact of social media on self-image depends on the type of content, frequency of exposure, and dynamics of social interaction.⁶

These findings underscore the need for future research to investigate more thoroughly the effects of different types of social media, content, interactions, and family and social environments on body image among preadolescents.

There are several limitations to this study. Its cross-sectional design does not allow for establishing causality, and the small sample size, with participation of only two schools, limits the representativeness of the results. The information on digital habits was self-reported, which may have been a source of social desirability bias; furthermore, we did not consider the stage of pubertal development, a factor that could affect body image. In future research, it would be useful to include measures of pubertal development, for example, the Tanner scale, to control for this variable, as it is crucial in preadolescence. Nonetheless, our findings provide a solid foundation for future research and to guide preventive interventions adapted to this age group.

CONCLUSIONS

More than half of preadolescents reported body dissatisfaction, with a higher prevalence among girls and only children.

Although social media use was widespread, body dissatisfaction was only significantly associated with the use of Instagram.

Early exposure to the digital environment poses health care and education challenges. Despite the limitations of the study, its results provide a solid foundation for preventive interventions, such as media literacy workshops and efforts to promote body diversity in school and family settings. Findings such as  the specific impact of Instagram and the differences between boys and girls can guide the selection of contents and strategies for these interventions, adapting them to the needs of each target population. Longitudinal studies are required to investigate the mechanisms underlying the association between social media use and body image during preadolescence.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare in relation to the presentation and publication of this article.

AUTHORSHIP

All authors contributed equally to the published manuscript.

This study has been submitted to the 2026 Congress of the Asociación Española de Pediatría de Atención Primaria (AEPAP) for presentation of partial results . The present manuscript offers more detailed and complete information about the study.

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