The World Health Organization (WHO) defines adolescents as individuals aged between 10 to 19 years [1]. The term adolescent is derived from the Latin word ‘adolescere’ meaning ‘to grow up’[2,3]. This group of young individuals, who are often thought to be healthy, are sadly the most neglected, as they are neither children nor adults [4]. Adolescents experience a variety of health and social problems like anxiety, depression, eating disorders, drug abuse, tobacco and alcohol abuse, learning disabilities and malnutrition.

There is growing literature that shows girls as young as 8 years old already show higher concern towards body image perception and weight [5, 6]. If left unchecked these problems might have a potentially devastating effect on their health as adults tomorrow [4].

Body image is considered a multi-dimensional concept that includes perceptual, attitudinal, affective, and behavioural dimensions [7]. It is the mentalpicture we have in our minds of the size, shape and form of our bodies and our feelings concerning these characteristics [8].

Body image perception is the way a person feels about his/her body and these feelings can be positive, negative or both. It is ever changing, and is influenced by individual and environmental factors. It can be both self-perceived or as perceived by others like family, friends, peer group, teachers etc.

Positive body image occurs when a person is able to accept, appreciate and respect their body and is one of the protective factors which can make them resilient to eating disorders, depression and anxiety [7].

When a person has dissatisfaction, negative thoughts and feelings about his or her own body it is called negative body image. It is an internal process but can be influenced by several external factors like media, magazines, internet and advertising [7].

These often promote unrealistic, unobtainable and highly stylised appearance ideals. Many adolescents with normal weight compare themselves to images of very thin men and women presented by the media and perceive themselves as being fat and overweight [9].

Data was entered using MS Excel. Statistical analysis was done using SPSS Version 20. Operational definition: Body image is a mental picture we have in our minds of the size, shape and form of our bodies and our feelings concerning these characteristics and one's body parts [12].

Majority of the study subjects were in the middle adolescence. The proportion of girls (49.7%) and boys (50.3%) were almost equal. There were 90 males and 89 females. The proportion of subjects studying in 9^th (26.8%), 10th (22.9%), 11th (25.7%) and 12^th (24.6%) were almost equal.

A large proportion of the study subjects were Christians (56.4%) and then followed by Hindus (32.4%) and Muslims (10.6%). Most of the subjects were day scholars (74.9%) and only few were hostellers (25.1%).

Table-1: Distribution by stage of adolescence.

Most of the adolescents were having normal BMI for their age (65.4%).26.2% of the subjects had overweight and 8.4% of the subjects were undernourished.

Table-2: Nutritional status according to BMI for Age.

Table-3: Negative Body Image Perception among Adolescents.

(40.4%) compared to males (23.4%) wanted to become thinner. This was found to be statistically significant.

A larger proportion of the males (63.3%) wished to become taller as compared to females (52.8%).

Of all the undernourished subjects 20% perceived themselves to be normal and 6.67% to be fat. 52.3% of the normally nourished subjects had correct perception of their body size. Of the normally nourished subjects 1.7% thought they were too thin, 22.2% thin, 9.4% fat, 0.85% too fat.

46.8% of the over nourished subjects perceived themselves to be normal. None of the over nourished perceived themselves to be too thin or thin. Erroneous body size perception was seen among 36.8% of the subjects. This was statistically significant.

The information for parents’ and peers’ perception is available only for 171 and 155 subjects respectively as the rest didn’t know about how their parents felt about their body size.

Rates of over estimation and under estimation of body size by parents were 6.25% and 37.17% and by peers were 4.34% and 21.83% respectively.

significantly higher in those who were not satisfied with their body size and those who had tried to lose weight in their past.

Table-8: Body image perception and academic performance.

Negative correlation was observed between body image perception and academic performance of the students.

A total of 179 adolescents aged from 13 to 18 years were part of this study. In this study65.4% of the adolescents were having normal BMI for their age. About 26.2% had overweight and 8.4% were undernourished. A study done by Praveen Kulkarni et al among both urban and rural adolescents in South India, showed that prevalence of undernutrition was 28.3%.

Our study shows a much lower prevalence of undernutrition, this may be due to the fact that only urban adolescents were studied [13]. A study done by M Shashidhar Kotian et al in South Karnataka showed that overall prevalence of overweight and obesity was 11.4% and 4% respectively [14].

The present study shows a much higher prevalence of over nutrition may be due to the fact that the study was done in urban population. 84.91% of the study population had negative body image perception. In a study done in Trinidad by Ramberan et al, 51% of the participants had a negative body image perception.

The largely higher proportion observed in our study may be due to the different ethnic and cultural setting [11]. 63.2% of the subjects correctly identified the body size. A study done by D.T Simeonamong multi-ethnic adolescents in the Caribbean showed that 68% correctly identified their body size, which is almost similar to our study findings [15].

Erroneous body size perception was seen among 36.8% of the subjects.K Ramesh et al in their study based in adolescents in Kerala, showed than 82.8% had a false perception of their body weight [16]. Self-body size perception was seen to be better in our study. The most common mode of trying to lose

studies.

On the other hand, our prevalence is lower than that found by Pallan et al., who showed that more than 80% of South Asian children aged 5e7 years old were not satisfied with their body image [23].

Similarly, another study using the figure rating scale and involving 1530 children aged 7e10 also showed higher prevalence in body image dissatisfaction, at 82.9% among their students,of whom 59.9% desired a smaller body size and 23.0% desired a larger body size [24].

These findings indicate that the problem of body image dissatisfaction is not isolated to certain ethnicities or regions but has become a global phenomenon, and the fact that it is also high among younger adolescents may indicate that interventions should be undertaken seriously to curb its spread.

In a study conducted in Malaysia, more than half of the students were dissatisfied with their body image (60.1%). Overweight and obese students had higher body image dissatisfaction (79.6%) compared to students with normal weight (51.7%) or underweight students (57.6%).

Among the students with normal BMI, only 48.3% were satisfied with their current body image. Female students had higher body image dissatisfaction (66.1%) compared to male students (52.0%).

The proportion of body image dissatisfaction was higher than satisfaction for all students, regardless of their academic performance, parental education level or their family income [25]. But in our study a negative correlation was obtained between body image perception and academic performance.

Varying degrees of negative body image perception was seen among the subjects with a larger proportion of females with body size dissatisfaction.

Recommendations

The findings and conclusions drawn from this study have paved way for the following recommendations:

1. Educate adolescents, their peers, teachers and parents about body image perception and the immediate and long term effects it can have on the health of an adolescent.
2. Screen for negative body image perceptions in the adolescents. Provide counselling for those