Body image assessment for obesity (BIA-O): development of a new procedure DA Williamson 1 *, LG Womble 1 , NL Zucker 1 , DL Reas 1 , MA White 1 , DC Blouin 1 and F Greenway 1 1 Louisiana State University, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA OBJECTIVE: A new measure of body image, named the body image assessment for obesity (BIA-O) was developed and tested for reliability and validity in a sample of 1209 adult men and women. Separate BIA-O procedures were developed for men and women. Current, ideal and reasonable body image estimates of Caucasian and African- American men and women were compared. METHOD: Figural stimuli of males and females were developed for body sizes ranging from very thin to very obese in 18 increments. Participants selected ®gures that represented estimates of current, ideal and reasonable (a body size that could be maintained over time) body size. Some participants (n  641) also completed two measures of body dissatisfaction in a test of the validity of the BIA-O as a measure of body dissatisfaction. A sample of 77 participants was administered the BIA-O on two occasions to test the test ± retest reliability of the BIA-O. RESULTS: The reliability of the BIA-O was supported by test ± retest reliability coef®cients which ranged from 0.65 to 0.93. Concurrent validity of the discrepancy between current and ideal and current and reasonable body size estimates was supported by positive correlations with two measures of body dissatisfaction. The BIA-O body size estimates of Caucasians and African-Americans, controlled for age and BMI, were compared. As BMI increased, Caucasian men and women were found to select larger current body size estimates in comparison to African-Americans. DISCUSSION: The reliability and validity of the BIA-O were supported. Greater body size dissatisfaction in obese Caucasians, relative to African-Americans of the same size, may be a function of biased estimates of current body size. International Journal of Obesity (2000) 24, 1326±1332 Keywords: body image; assessment; obesity Introduction Research on assessment of body image disturbances in obese men and women has lagged behind develop- ment of body image measures for normal weight people. 1 For example, of the 42 body image assess- ment procedures reviewed by Thompson, 2 only three methods were developed with samples that included overweight or obese persons. In response to this situation, obesity researchers have often relied upon methods that were developed for normal or under- weight people. Most measures of body image were originally designed for eating disorders. 1,2 This lim- itation has forced obesity researchers to rely upon questionnaire measures of body dissatisfaction. 2 Recent research has suggested that there may be racial differences in body image. 3,4 Much of this research has focused upon body size estimates and body size dissatisfaction in Caucasian and African- American women. These studies have generally found that Caucasian women are more dissatis®ed with their body size compared with African-American women. 4±6 Most of these studies have used question- naire measures of body dissatisfaction, and few stu- dies have compared Caucasian and African-American men on perceptual or attitudinal measures of body image. 4 Thus, there is considerable need for the development of body image assessment methods that can be used in ethnically diverse populations of both genders. The body image assessment (BIA) was developed by Williamson et al 7 as a ®gural stimulus method for assessing body image disturbances associated with eating disorders. The methodology of the BIA was based upon self-discrepancy theory. 8 Body size dis- satisfaction, as de®ned by the BIA, is the discrepancy between current (self) and ideal body size estimates. Most assessment measures of body image have been developed to measure either estimates of actual body size or dissatisfaction with body size and physical appearance. 2,9 The BIA measures the person's esti- mate of actual or current body size (CBS) and an estimate of the person's ideal body size (IBS). The discrepancy between CBS and IBS has been validated as a measure of dissatisfaction with body size. 10 The BIA uses silhouettes of nine female ®gures ranging from very thin to overweight as test stimuli. A series of studies has shown that women diagnosed with anorexia and bulimia nervosa overestimate actual *Correspondence: DA Williamson, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA. E-mail: Williada@pbrc.edu Received 16 November 1999; revised 3 April 2000; accepted 20 April 2000 International Journal of Obesity (2000) 24, 1326±1332 ß 2000 Macmillan Publishers Ltd All rights reserved 0307±0565/00 $15.00 www.nature.com/ijo