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The Interactive Role of Gender, BMI, and Exercise Habits on Social Physique Anxiety

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Title: The Interactive Role of Gender, BMI, and Exercise Habits on Social Physique Anxiety
Language: English
Authors: Burkhart J. Hahn (ORCID 0000-0003-4583-2276), DeMond M. Grant, Kaitlyn M. Nagel, Danielle E. Deros, Ebony A. Walker, Jacob D. Kraft
Source: Journal of American College Health. 2025 73(5):2002-2009.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 8
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Anxiety, Social Influences, Human Body, Aesthetics, Gender Differences, Body Composition, Body Weight, Exercise, College Students, Obesity
DOI: 10.1080/07448481.2025.2510695
ISSN: 0744-8481
1940-3208
Abstract: Objective: Social physique anxiety (SPA) is characterized by concerns of evaluation focused on one's physical appearance. Past work suggests factors such as gender, body mass index (BMI), and exercise habits uniquely contribute to SPA. However, no study has examined the interactions between these three variables. The current study sought to investigate the linked impact of gender, BMI, and exercise habits on SPA. Participants: Participants (N = 360) from a large Midwestern university completed questionnaires assessing relevant variables. Method: SPA was elevated for women, individuals with higher BMI, and those who do not exercise. Results: A significant interaction indicated that women who were classified as overweight and obese reported elevated SPA, but the same effect did not hold for men. A marginally significant interaction revealed that men who engage in exercise reported lower SPA scores than women who exercise. Conclusions: These data depict both protective and maintenance factors of SPA for college populations. Other clinical implications are discussed.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1476950
Database: ERIC
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  Value: <anid>AN0186641454;acl01may.25;2025Jul17.02:51;v2.2.500</anid> <title id="AN0186641454-1">The interactive role of gender, BMI, and exercise habits on social physique anxiety </title> <p>Objective: Social physique anxiety (SPA) is characterized by concerns of evaluation focused on one's physical appearance. Past work suggests factors such as gender, body mass index (BMI), and exercise habits uniquely contribute to SPA. However, no study has examined the interactions between these three variables. The current study sought to investigate the linked impact of gender, BMI, and exercise habits on SPA. Participants: Participants (N = 360) from a large Midwestern university completed questionnaires assessing relevant variables. Method: SPA was elevated for women, individuals with higher BMI, and those who do not exercise. Results: A significant interaction indicated that women who were classified as overweight and obese reported elevated SPA, but the same effect did not hold for men. A marginally significant interaction revealed that men who engage in exercise reported lower SPA scores than women who exercise. Conclusions: These data depict both protective and maintenance factors of SPA for college populations. Other clinical implications are discussed.</p> <p>Keywords: Anxiety; BMI; gender; exercise; social physique anxiety</p> <p>Body dissatisfaction permeates throughout college-age populations, such that roughly 87% of college-aged women at a healthy body mass index (BMI) have a desire to weigh less and 38-63% of men reported dissatisfaction with various parts of their body (e.g., abdomen, muscle tone).[<reflink idref="bib1" id="ref1">1</reflink>]<sups>,</sups>[<reflink idref="bib2" id="ref2">2</reflink>] Furthermore, previous studies using BMI categories from the World Health Organization found that 38.3% of women with BMI in the health range perceived themselves as overweight, whereas 32.8% of men with overweight BMI described themselves as underweight.[<reflink idref="bib3" id="ref3">3</reflink>] Body dissatisfaction primarily relates to the difference between current and desired weight and shape, yet studies typically fail to include two critical components: social comparison and evaluation. Social physique anxiety (SPA), a form of social anxiety, incorporates social evaluative components and is described as a fear of evaluation regarding one's physical appearance.[<reflink idref="bib4" id="ref4">4</reflink>] SPA is related to a variety of maladaptive factors including negative self-perception of body image, decreased physical self-worth, lower perception of attractiveness and strength, negative perfectionism and disordered eating, and lower motivation to engage in physical exercise.[[<reflink idref="bib5" id="ref5">5</reflink>], [<reflink idref="bib7" id="ref6">7</reflink>]] Although the literature reports a plethora of detrimental effects related to SPA, it is not clear how relevant individual differences such as gender, BMI, and exercise habits predict SPA.</p> <p>Although a growing literature is documenting the negative impacts of SPA, few theories have been developed to further understand SPA. Thus, given that SPA is considered a subset of social anxiety, cognitive models of social anxiety can provide clarity to the cognitive mechanisms of SPA.[<reflink idref="bib9" id="ref7">9</reflink>]<sups>,</sups>[<reflink idref="bib10" id="ref8">10</reflink>] To avoid negative evaluation, those with SPA dedicate attentional resources toward a mental image of themselves which they believe will be evaluated by an audience (e.g., other gym-goers).[[<reflink idref="bib11" id="ref9">11</reflink>], [<reflink idref="bib13" id="ref10">13</reflink>]] This mental image is compared with perceived audience expectations of their physical appearance.[<reflink idref="bib4" id="ref11">4</reflink>]<sups>,</sups>[<reflink idref="bib14" id="ref12">14</reflink>] An individual with high SPA may dedicate attentional resources to imagining a distorted body image including thoughts that their body is not attractive enough, increasing anxiety toward potential evaluation and comparison to others.[<reflink idref="bib15" id="ref13">15</reflink>]<sups>,</sups>[<reflink idref="bib16" id="ref14">16</reflink>] Recently, Pawijit and colleagues (2019) found a moderate relationship between fear of negative evaluation and body image satisfaction, highlighting the importance of uncovering other associations and negative outcomes of SPA.</p> <p>Physical activity and exercise are two factors which have demonstrated close relationships with SPA.[<reflink idref="bib5" id="ref15">5</reflink>] To better assess these relationships, researchers have begun to examine social and cultural factors which may impact SPA individually and any potential interactions.[<reflink idref="bib5" id="ref16">5</reflink>]<sups>,</sups>[<reflink idref="bib17" id="ref17">17</reflink>] For example, Auster-Gussman and colleagues (2021) explain that SPA serves as a mediator in the relationship between BMI and exercise habits, such that higher BMI leads to higher SPA, and higher SPA leads to a decrease in exercise.[<reflink idref="bib18" id="ref18">18</reflink>] Additionally, previous literature has described possible gender differences in exercise duration, intensity, and type, leading to another interactive role influencing SPA.[<reflink idref="bib19" id="ref19">19</reflink>] To further this literature, the present study seeks to examine the interactions between gender, BMI, and exercise habits as they are known contributors to SPA.</p> <p>One such abundantly studied factor is body-mass index (BMI), a common medical tool used to measure one's body mass in relation to their height (calculated by using kg/m<sups>2</sups>). The World Health Organization and the National Institute of Health define BMI categories as underweight (< 18.5 kg/m<sups>2</sups>), normal weight (18.5–24.9 kg/m<sups>2</sups>), overweight (25–29.9 kg/m<sups>2</sups>), and obese (> 30 kg/m<sups>2</sups>).[<reflink idref="bib20" id="ref20">20</reflink>] BMI is highly correlated with various health outcomes (e.g., cardiovascular disease, body composition), widely available, and commonly used.[<reflink idref="bib21" id="ref21">21</reflink>]<sups>,</sups>[<reflink idref="bib22" id="ref22">22</reflink>] Despite this, BMI is not immune to bias, especially within certain populations (e.g., those with high muscle mass) and when measured by self-report. Although these limitations are relevant, previous literature has described limited to no self-reporting bias in weight and height based on gender, indicating BMI maintains its utility for the current study.[<reflink idref="bib23" id="ref23">23</reflink>] Among many, one challenge that those in the overweight or obese BMI ranges face is a decrease in exercise frequency.[<reflink idref="bib24" id="ref24">24</reflink>] It has been hypothesized that this relationship is a cycle which includes multiple interacting variables, rather than a monodirectional, one-dimensional relationship (e.g., inactivity causes weight gain).[<reflink idref="bib18" id="ref25">18</reflink>]<sups>,</sups>[<reflink idref="bib25" id="ref26">25</reflink>]<sups>,</sups>[<reflink idref="bib26" id="ref27">26</reflink>] For instance, it is common to attribute dispositional characteristics such as laziness and impulsivity to decreased exercise behaviors and high BMI. However, considerable data suggests other factors (e.g., BMI) influence a person's exercise habits, such that those with higher BMI feel negatively evaluated or even unwelcome in a gym environment (i.e., heightened SPA).[<reflink idref="bib26" id="ref28">26</reflink>]<sups>,</sups>[<reflink idref="bib27" id="ref29">27</reflink>] These barriers to healthy physical activity describe a vicious cycle of inactivity and increases in BMI. Thus, it is critical to understand the complex relationship of BMI, exercise habits, and SPA.</p> <p>The SPA literature describes a trend in gender differences, particularly that women experience higher SPA prevalence and intensity compared to men.[<reflink idref="bib5" id="ref30">5</reflink>]<sups>,</sups>[<reflink idref="bib15" id="ref31">15</reflink>] Unfortunately, very few studies have sought to identify the factors associated with these differences. A proposed explanation involves unrealistic media portrayal of body expectations for women, often accompanied by professionally edited photographs and advertisements for unhealthy or extreme weight loss measures. These body expectations for women include small and slender body types, whereas men are expected to display a larger, more muscular physique.[<reflink idref="bib28" id="ref32">28</reflink>]<sups>,</sups>[<reflink idref="bib29" id="ref33">29</reflink>] Further, racial and ethnic differences, both in media portrayal and body shape preferences across ethnicities, may also impact expectations and pressures.[<reflink idref="bib30" id="ref34">30</reflink>] Internalization of body standards, and subsequent comparison of the self to such body standards, leads to body dissatisfaction, decreased self-esteem, disordered eating behaviors, and avoidance of physical activity.[<reflink idref="bib31" id="ref35">31</reflink>]<sups>,</sups>[<reflink idref="bib32" id="ref36">32</reflink>] However, this media portrayal theory seems to explain a gender difference in physique expectations, rather than differences in SPA prevalence. A study by Barron and colleagues[<reflink idref="bib33" id="ref37">33</reflink>] found that college students exposed to fitness-related Instagram posts experienced a decrease in body satisfaction, results which held for both men and women. Indeed, it has been hypothesized both women and men are exposed and socialized to strive for the "ideal" physique, which leads to a developmental increase in physique scrutiny and body dissatisfaction.[<reflink idref="bib34" id="ref38">34</reflink>] The primary difference relates to the type of ideal physique, with women experiencing pressure to conform to a thin ideal and thus expressing weight concerns whereas men experience pressure to conform to a muscular ideal and thus expressing muscularity concerns.[<reflink idref="bib35" id="ref39">35</reflink>] Despite this theory, there is a dearth in the literature regarding relevant variables which might affect this relationship, such as BMI and exercise habits.</p> <p>Few studies in this literature examine interactions between the factors which contribute to the development and maintenance of social physique anxiety. In particular, it is rare that psychopathology and physical health literatures are combined in this fashion, despite a large body of research indicating that mental and physical health are highly related.[<reflink idref="bib36" id="ref40">36</reflink>] Further, the interactions between exercise, gender, and BMI present nuanced interpretations of SPA mechanisms. As discussed previously, each of these variables contribute to SPA alone. However, together, they could uncover novel contributions to the SPA literature. Specifically, the interactions may reveal how exercise differentially impacts SPA based on gender identification, and how SPA presents in those with varying BMI levels during exercise. This lack of an integrated approach may lead to a failure to understand SPA and its underlying factors, and thus discrepant findings (e.g., samples with high exercise frequency versus low exercise frequency). In conjunction with the lack of integrated research, much of the SPA literature is over a decade old.[<reflink idref="bib1" id="ref41">1</reflink>]<sups>,</sups>[<reflink idref="bib3" id="ref42">3</reflink>]<sups>,</sups>[<reflink idref="bib15" id="ref43">15</reflink>]<sups>,</sups>[<reflink idref="bib37" id="ref44">37</reflink>] Thus, this research seeks to provide an updated, nuanced view into the impact of biopsychosocial factors on SPA, especially within a college population. The present work aims to expand on prior work by examining the influence of physical and social factors on psychological outcomes among college students. More specifically, this study will examine how BMI, exercise habits, and gender impact SPA. This will broaden our current understanding by assessing replicability of previous findings (e.g., BMI differences in SPA) and clarifying unknowns in the literature (e.g., how exercise influences SPA based on gender).</p> <p>The purpose of this study is to examine the interactions between gender identity, BMI, and exercise habits on SPA, as they are all independently associated with SPA. This study has three primary hypotheses. First, it is predicted that gender identity, BMI, and exercise habits would be related to social physique anxiety. Next, it is hypothesized that those with low social physique anxiety would engage in more workouts per week than those with high social physique anxiety. Regarding the third hypothesis, a significant interaction is predicted such that those with BMI in the overweight or obese range and who identify as a woman will display even greater social physique anxiety than men with overweight or obese BMI. This is supported by previous research describing gender differences in SPA presentation, impact of societal pressure, and conflicting results regarding prevalence across men and women. Use of cross-sectional methods does not allow for causal inferences; however, the knowledge gained by answering these questions may inform treatment models for those with distress related to physique (e.g., SPA, body dysmorphia, depression) and increase cultural humility and awareness (e.g., body expectations for one's gender) during treatment of physique-related psychological concerns.</p> <hd id="AN0186641454-2">Methods</hd> <p></p> <hd id="AN0186641454-3">Participants</hd> <p>Three hundred and sixty participants were recruited <emph>via</emph> an online research platform at a large Midwestern university. Participants were primarily female (77.2%) with an average age of 20.15 (SD = 3.83; Range = 18-31). Participants identified as White (75.6%), American Indian/Alaska Native (8.8%), Latinx (5.6%), African American (3.5%), Asian (2.4%), Middle Eastern (.5%), Pacific Islander (.3%), other (3.2%), and prefer not to answer (1.1%). Twenty-two participants were excluded due to missing data. Six participants were excluded due to insufficient gender group sizes (i.e., 2 participants identified as transgender and 4 preferred to not report their gender identity), which resulted in a final sample of 332.</p> <hd id="AN0186641454-4">Measures</hd> <p></p> <hd id="AN0186641454-5">Primary outcome variable</hd> <p></p> <hd id="AN0186641454-6">Social physique anxiety scale (SPAS) 38</hd> <p>The SPAS is a 12-item measure of anxiety related to body image and appearance. Items are rated on a 5-point Likert type scale ranging from 1 (<emph>definitely disagree</emph>) to 5 (<emph>definitely agree</emph>). Total scores are calculated from a sum of all 12 items, with higher scores indicating greater appearance anxiety. The SPAS demonstrates high internal consistency (α =.90) and test-retest reliability (<emph>r</emph> =.82).[<reflink idref="bib4" id="ref45">4</reflink>] In this sample, the SPAS demonstrated high internal consistency (α =.89).</p> <hd id="AN0186641454-7">Primary explanatory variables</hd> <p></p> <hd id="AN0186641454-8">Gender</hd> <p>Participants self-reported their gender identity <emph>via</emph> a demographics questionnaire. Participants self-selected their gender. This variable refers to gender identity and not sex assigned at birth.</p> <hd id="AN0186641454-9">Body mass index (BMI)</hd> <p>Participants self-reported weight in pounds and height in feet and inches. Weight was then converted to kilograms (pounds multiplied by 0.454) and height to meters (inches multiplied by 0.025). BMI was then calculated <emph>via</emph> kilograms divided by height in meters squared. BMI was categorized as underweight (<18.5), normal weight (18.5 − 24.9), overweight (25.0 − 29.9) and obese (< 30.0).[<reflink idref="bib39" id="ref46">39</reflink>]</p> <hd id="AN0186641454-10">Exercise habits</hd> <p>Participants self-reported days exercised per week on average. Based on prior research, exercise habits were dichotomized into exercise versus no exercise groups to maintain similar sample size across groups. Participants who reported exactly zero exercise sessions per week were sorted into the no exercise group. Participants who reported minimum of one exercise session per week were sorted into the exercise group.[<reflink idref="bib40" id="ref47">40</reflink>]<sups>,</sups>[<reflink idref="bib41" id="ref48">41</reflink>] Although it was used as a statistical control and not a grouping variable, participants also reported the number of hours they spent at the gym per workout.</p> <hd id="AN0186641454-11">Statistical control variables</hd> <p></p> <hd id="AN0186641454-12">Sexual orientation</hd> <p>Participants self-reported their sexual orientation <emph>via</emph> a demographics questionnaire. Participants self-selected their sexual orientation.</p> <hd id="AN0186641454-13">Race</hd> <p>Participants self-reported their racial identity <emph>via</emph> a demographics questionnaire. Participants self-selected their race.</p> <hd id="AN0186641454-14">Workout length</hd> <p>Participants self-reported workout length <emph>via</emph> a demographics questionnaire. Participants reported the average length of their workouts in hours.</p> <hd id="AN0186641454-15">Procedures</hd> <p>All procedures were approved by the IRB at the university at which the study was conducted. Participants were recruited <emph>via</emph> the institution's online recruitment system and compensated with course credit. Participants provided informed consent prior to completing an online questionnaire battery which included demographics, height and weight information, reports of exercise habits, and the SPAS.</p> <hd id="AN0186641454-16">Analytic plan</hd> <p>A 2 gender identification (men; women) by 2 exercise group (no exercise; exercise) by 4 BMI Range (underweight; healthy; overweight; obese) between-subjects ANOVA was conducted to evaluate differences in reported levels of social physique anxiety across these groups. Prior to these analyses, data were assessed for assumptions of normality, homogeneity of variance, and sphericity, in line with recommendations from past research.[<reflink idref="bib42" id="ref49">42</reflink>] Normality was assessed through skewness and kurtosis metrics. Homogeneity of variance across groups was assessed using Levene's Test of Equality of Error Variances. Significant interaction effects were probed using post-hoc Tukey tests using Bonferroni-correct α criteria to assess for differences between factors within the model. For brevity, only significant (<emph>p</emph> <.05) effects and marginally significant effects are included. All statistical analyses were conducted with SPSS version 27.0.</p> <hd id="AN0186641454-17">Results</hd> <p></p> <hd id="AN0186641454-18">Statistical assumption tests</hd> <p>Data across all continuous variables used in primary analyses fell within acceptable ranges of both skewness (all variables ranging from −1.30 to 0.99) and kurtosis (all variables ranging from −1.60 to 0.10) according to established thresholds (i.e., under an absolute value of 2 and 4, respectively).[<reflink idref="bib43" id="ref50">43</reflink>] Levene's Test of Equality of Error Variances also demonstrated homogeneity of variance of SPA across all other analytic variables, <emph>F</emph>(<reflink idref="bib14" id="ref51">14</reflink>, 345) = 0.60, <emph>p</emph> =.862.</p> <hd id="AN0186641454-19">Primary analyses</hd> <p>Results indicated several significant main effects, including gender, exercise group, and BMI Range. Those who identified as a woman endorsed significantly higher levels of SPA (<emph>M</emph> = 38.62, <emph>SE</emph> = 1.11) relative to those who identified as a man (<emph>M</emph> = 31.65, <emph>SE</emph> = 1.51), <emph>F</emph>(<reflink idref="bib1" id="ref52">1</reflink>, 339) = 4.26, <emph>p</emph> <.001. Those within a healthy BMI range (<emph>M</emph> = 33.97, <emph>SE</emph> = 0.81) reported significantly lower levels of social physique anxiety relative to those within overweight (<emph>M</emph> = 37.27, <emph>SE</emph> = 1.40, <emph>p</emph> <.05) or obese (<emph>M</emph> = 38.28, <emph>SE</emph> = 1.72, <emph>p</emph> <.05) BMI Ranges, <emph>F</emph>(<reflink idref="bib2" id="ref53">2</reflink>, 339) = 3.85, <emph>p</emph> <.05. Those who reported engaging in exercise (<emph>M</emph> = 32.97, <emph>SE</emph> = 1.25) reported significantly lower levels of social physique anxiety relative to those who reported engaging in no exercise (<emph>M</emph> = 38.11, <emph>SE</emph> = 1.36), <emph>F</emph>(<reflink idref="bib1" id="ref54">1</reflink>,<reflink idref="bib339" id="ref55">339</reflink>) = 6.52, <emph>p</emph> <.05. See Table 1 for a summary of these results.</p> <p>Table 1. Main and interaction effects.</p> <p> <ephtml> <table><thead><tr><td /><td><italic>df</italic></td><td><italic>F</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td>Social Physique Anxiety</td><td /><td /><td /></tr><tr><td> Exercise Group</td><td char=".">1</td><td char=".">6.524</td><td char=".">.011*</td></tr><tr><td> BMI Categories</td><td char=".">2</td><td char=".">3.849</td><td char=".">.022*</td></tr><tr><td> Gender</td><td char=".">1</td><td char=".">24.795</td><td char="."><.001*</td></tr><tr><td> Exercise Group x BMI Categories</td><td char=".">2</td><td char=".">0.404</td><td char=".">.668</td></tr><tr><td> Exercise Group x Gender</td><td char=".">1</td><td char=".">3.584</td><td char=".">.059</td></tr><tr><td> BMI Categories x Gender</td><td char=".">1</td><td char=".">4.263</td><td char=".">.015*</td></tr><tr><td> Exercise Group x BMI Categories x Gender</td><td char=".">1</td><td char=".">0.359</td><td char=".">.699</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Notes.</emph> *Denotes statistical significance at α =.05.</p> <p>Results also indicated a significant interaction between gender identification and BMI such that women who are within a healthy BMI Range (<emph>M</emph> = 35.29, <emph>SE</emph> = 0.75) reported significantly lower levels of social physique anxiety relative to women within the overweight (<emph>M</emph> = 42.72, <emph>SE</emph> = 1.48) and obese (<emph>M</emph> = 43.26, <emph>SE</emph> = 1.82) BMI ranges, <emph>F</emph>(<reflink idref="bib2" id="ref56">2</reflink>,<reflink idref="bib339" id="ref57">339</reflink>) = 4.26, <emph>p</emph> <.05. The means of SPA for men were not significantly different across BMI group. See Table 2 for a summary of these results.</p> <p>Table 2. EM means: exercise + gender.</p> <p> <ephtml> <table><thead><tr><td>BMI categories</td><td /><td /><td /><td>95% CI</td></tr></thead><tbody valign="top"><tr><td>Social physique anxiety</td><td>Gender</td><td char=".">Mean</td><td char=".">SE</td><td char=".">Lower bound</td><td char=".">Upper bound</td></tr><tr><td>No Exercise (<italic>n</italic> = 137)</td><td>Men</td><td char=".">36.087</td><td char=".">2.161</td><td char=".">31.837</td><td char=".">40.338</td></tr><tr><td /><td>Women</td><td char=".">39.622</td><td char=".">1.73</td><td char=".">36.22</td><td char=".">43.025</td></tr><tr><td>Exercise (<italic>n</italic> = 251)</td><td>Men</td><td char=".">28.32</td><td char=".">2.087</td><td char=".">24.215</td><td char=".">32.425</td></tr><tr><td /><td>Women</td><td char=".">37.614</td><td char=".">1.392</td><td char=".">34.875</td><td char=".">40.352</td></tr></tbody></table> </ephtml> </p> <p>No other significant interactions or main effects were observed. Notably, an interaction between gender -identification and exercise group trended toward -significance such that men who endorsed engaging in exercise reported lower levels of social physique anxiety (<emph>M</emph> = 28.32, <emph>SE</emph> = 2.09) relative to women who endorsed engaging in exercise (<emph>M</emph> = 37.61, <emph>SE</emph> = 1.39), <emph>F</emph>(<reflink idref="bib1" id="ref58">1</reflink>, 339) = 3.58, <emph>p</emph> = 0.059. Post hoc tests did not reveal significant effects for SPA in the no exercise group for both men and women. Further, these results still hold when controlling for sexual orientation, race, and amount of time spent in the gym per workout. See Table 3 for a summary of these results.</p> <p>Table 3. EM means: BMI categories + gender.</p> <p> <ephtml> <table><thead><tr><td>BMI categories</td><td /><td /><td /><td>95% CI</td></tr><tr><td>Social physique anxiety</td><td>Gender</td><td>Mean</td><td>SE</td><td>Lower bound</td><td>Upper bound</td></tr></thead><tbody valign="top"><tr><td>Underweight (<italic>n</italic> = 9)</td><td>Men</td><td char=".">26.000</td><td char=".">6.846</td><td char=".">12.534</td><td char=".">39.466</td></tr><tr><td /><td>Women</td><td char=".">33.208</td><td char=".">3.697</td><td char=".">25.936</td><td char=".">40.481</td></tr><tr><td>Healthy (<italic>n</italic> = 237)</td><td>Men</td><td char=".">32.651</td><td char=".">1.435</td><td char=".">29.829</td><td char=".">35.472</td></tr><tr><td /><td>Women</td><td char=".">35.287</td><td char=".">0.746</td><td char=".">33.819</td><td char=".">36.755</td></tr><tr><td>Overweight (<italic>n</italic> = 76)</td><td>Men</td><td char=".">31.814</td><td char=".">2.386</td><td char=".">27.122</td><td char=".">36.507</td></tr><tr><td /><td>Women</td><td char=".">42.720</td><td char=".">1.481</td><td char=".">39.806</td><td char=".">45.634</td></tr><tr><td>Obese (<italic>n</italic> = 47)</td><td>Men</td><td char=".">33.306</td><td char=".">2.909</td><td char=".">27.584</td><td char=".">39.027</td></tr><tr><td /><td>Women</td><td char=".">43.257</td><td char=".">1.817</td><td char=".">39.683</td><td char=".">46.831</td></tr></tbody></table> </ephtml> </p> <hd id="AN0186641454-20">Discussion</hd> <p>The aim of the current study was to investigate the primary and interacting effects of BMI, exercise habits, and gender on social physique anxiety. Results support a relationship between BMI and SPA such that individuals with a BMI in the healthy category report lower SPA than those with a BMI in the overweight and obese category. Two additional main effects suggest those who engage in regular exercise report lower SPA than those who do not exercise, and individuals who identify as a woman report higher SPA than those who identify as men. Previous studies report similar findings and theorize the reason for higher SPA is a result of women displaying increased SPA in environments in which they are uncomfortable (e.g., male-dominated spaces, pressure to wear revealing clothing), as evidenced by a preference for all-women or private environments and more obscuring exercise clothing.[<reflink idref="bib5" id="ref59">5</reflink>]<sups>,</sups>[<reflink idref="bib44" id="ref60">44</reflink>] Research describes similar rationale for BMI, such that those in higher BMI ranges describe public gym cultures as places of judgment or feel as if women do not belong.[<reflink idref="bib18" id="ref61">18</reflink>]</p> <p>To further examine these protective and risk factors, interactions were evaluated. Results generally supported the hypotheses. First, SPA appeared to affect women significantly more than men, especially those within the overweight and obese category. In line with this analysis, data show a general trend toward lower SPA for women with lower BMI, even when comparing healthy to underweight (although this comparison is not significant). In contrast, men showed a trend toward the lowest SPA in the overweight category, indicating men feel less anxious at a higher BMI than women. Additionally, the largest SPA difference between men and women is in the overweight category, indicating that men who fall in the overweight category may be less anxious about their physiques than women with a similar BMI range. This effect may be related to societal expectations for body shape and physique pressure, such that women are generally pressured to be small, thin, and fit where men are generally pressured to be larger and more muscular.[<reflink idref="bib29" id="ref62">29</reflink>] Thus, women at a higher BMI may be more anxious about their physique than men. Secondly, although the interaction is only approaching significance, the interaction between exercise habits and gender portrayed interesting results. Men who exercise show significantly lower SPA values than women who exercise. Thus, exercise appears to be a more protective for men than for women. Previous research using semi-structured interviews assessing gym culture, training, and body image describes a similar effect, theorizing factors such as intimidation, implicit segregation (e.g., male-dominated free weight areas), equipment catering to the needs of men over women, and consistent display of physique <emph>via</emph> mirrors may present as gym attendance barriers for women.[<reflink idref="bib32" id="ref63">32</reflink>]<sups>,</sups>[<reflink idref="bib45" id="ref64">45</reflink>] These results are particularly notable, as it may not be the impact of BMI and exercise habits alone that influence social physique anxiety, but instead show the impact of societal expectations for body type, especially when those expectations are unrealistic.[<reflink idref="bib46" id="ref65">46</reflink>] As a final statistical check for these results, a statistical control was included for sexual orientation, race, and amount of time spent in the gym per workout. The analysis held significance, indicating these results maintain relevance across racial and sexual orientation groups. Further, the results were not impacted by time spent in the gym per workout, indicating lower SPA for those who exercise and for men, regardless of workout length.</p> <p>Despite being cross-sectional and not causal, these findings hold important implications for research on social physique anxiety, its maintaining factors, and future research methodology, especially related to college students. These data align with SPA's connection to social anxiety and respective attentional impairments.[<reflink idref="bib8" id="ref66">8</reflink>]<sups>,</sups>[<reflink idref="bib47" id="ref67">47</reflink>] Considering attentional control difficulties found in cognitive models of social anxiety, it is possible that the same attentional bias leads to the effects presented in this study. Previous literature supports a relationship between body image dissatisfaction and fear of negative evaluation.[<reflink idref="bib8" id="ref68">8</reflink>]<sups>,</sups>[<reflink idref="bib47" id="ref69">47</reflink>] The relation of overweight and obese BMI to higher SPA may indicate an increased attentional focus to their physical appearance (i.e., self-focus), leading to a comparison of body composition to the perceived expectations of the gym environment and subsequent negative thoughts about evaluation from others. Further, data describes an effect similar to previous research, such that lower SPA is associated with more exercise. For instance, Auster-Gussman and colleagues (2021) report that SPA is a barrier to exercise, especially for those within the overweight or obese BMI categories.[<reflink idref="bib18" id="ref70">18</reflink>] These previous results taken together with the present study describe SPA's relation to exercise behavior impairment in a college population. Specifically, those with SPA display increased negative thoughts about their bodies accompanied by fear of negative evaluation from others. These unpleasant experiences may increase gym avoidance and other impairments to exercise. As a result, college-aged individuals with higher SPA may experience additional barriers to exercising in a gym environment, thus putting them at higher risk of health challenges.[<reflink idref="bib14" id="ref71">14</reflink>]<sups>,</sups>[<reflink idref="bib18" id="ref72">18</reflink>]<sups>,</sups>[<reflink idref="bib48" id="ref73">48</reflink>] This is especially true for women, as women were shown in the current study to have a higher prevalence and intensity of SPA. Interestingly, this study examined general exercise, not simply gym workouts or running outside. Thus, it appears these results may apply across exercise dimensions. However, it may be important for future studies to examine this effect across exercise types (e.g., sport, resistance training, cardiovascular activity) and locations (e.g., gym, outside, home) to see if differences arise.</p> <p>Results from this study present critical clinical applications. The trend of this data may inform gender-based cultural awareness in treatment with individuals who struggle with social physique anxiety. Considering gender differences in both SPA intensity and expression, these findings reinforce the necessity for collaborative empiricism, culturally competent assessment, and understanding of individual, group, and universal cultural expression for each client. More specifically, considering gender differences in body type, clinicians may aim to structure social physique anxiety treatment (e.g., exposure, cognitive restructuring) around those specific body expectations.[<reflink idref="bib28" id="ref74">28</reflink>]<sups>,</sups>[<reflink idref="bib29" id="ref75">29</reflink>] Regarding sociological body expectations, there is some evidence that social media use amongst college students, instead of provoking negative comparisons, can be beneficial for body image. For example, body positivity social media posts have been shown to increase body satisfaction for undergraduate university students.[<reflink idref="bib49" id="ref76">49</reflink>] Additionally, this work furthers the cyclical nature of body image dissatisfaction, undesirable health behaviors (e.g., inactivity, gym avoidance), and BMI, such that latent variables (e.g., SPA) may relate to gym avoidance, which, in turn, relates to further increases in BMI and SPA. Indeed, it is crucial for clinicians to explore deeper factors which may be preventing a client from engaging in behavior and/or cognitive change. This is especially true for medical professionals in frequent contact with individuals seeking assistance with weight loss and increasing healthy behaviors (e.g., medical doctors), as can be seen when applied <emph>via</emph> strategies such as motivational interviewing.[<reflink idref="bib50" id="ref77">50</reflink>] Further, considering these data are particularly relevant to a college population, and that previous research describes an increase in body dissatisfaction amongst college-aged individuals, these clinical applications may be critical for university mental health resources (e.g., university counseling centers).[<reflink idref="bib1" id="ref78">1</reflink>]</p> <p>This study is not without limitations. BMI is limited in its use as a marker of body composition. BMI may present misleading information based on factors such as race, muscle mass, and age.[<reflink idref="bib21" id="ref79">21</reflink>] However, considering our goal is to explore how BMI, exercise habits, gender, and respective interactions influence participants' SPA, we believe this analysis is a sensible furthering of the literature on social physique anxiety, exercise behavior, and gender. Additionally, this study measured self-report BMI, which may be vulnerable to a variety of self-report biases. Due to sample characteristics, only men and women were included. Future research should examine the effects of broader gender groups on SPA, as previous research suggests nonbinary and transgender individuals are uniquely at risk for body image concerns.[<reflink idref="bib51" id="ref80">51</reflink>] However, due to the low sample of non-binary and transgender participants, we were not able to include these data in the present analysis. Our research suggests that exercise reduces SPA symptoms, and there may be a trend which describes an increased effect for men than for women. We are not suggesting that women receive decreased benefits from exercise overall, but instead that gym environments may limit exercise's beneficial effect for women, specifically within a male-dominated gym culture.[<reflink idref="bib21" id="ref81">21</reflink>] Concretely, recent research has found that an increased community of women in resistance training environments normalizes this behavior and reduces social concerns for other women.[<reflink idref="bib52" id="ref82">52</reflink>]</p> <p>Future studies are encouraged to address the limitations and theoretical shortcomings of the present study. Considering the limited generalizability of the sample, it is critical to examine the replicability of these data. Additionally, future studies may desire to obtain a representative sample of non-binary and transgender individuals to examine the effect of SPA on a broader range of the gender identity continuum. Employment of objective measurements (e.g., weight and height) within an experimental design will help to limit self-report error and clarify possible spurious effects given self-report data. Moreover, the use of additional body composition measurement techniques may assist in gaining a more accurate assessment of body fat. Finally, future studies may desire to apply attention-related neurocognitive methodology (e.g., P3 ERP component, heartbeat-evoked potential) during exposure to SPA-related threatening stimuli (e.g., mirror), which will clarify factors that maintain these debilitating symptoms.</p> <p>This study sought to identify primary and moderating factors which impact social physique anxiety, including exercise habits, body mass index, and gender using self-report mass testing data. Based on our findings, those who identify as women, have high BMI, and who do not exercise experience more SPA. Further, women in the overweight and obese BMI categories displayed increased SPA, and exercise appeared to be a more protective factor for men than for women, although this effect was only marginally significant. The purpose of this analysis was to provide further insight into barriers surrounding exercise habits and suggest intervention options (e.g., reform to gym structure) for limiting said barriers. The present approach furthers the literature on contributing factors to social physique anxiety among college-aged participants and expands on options for improving the comfortability of gym environments and treatment of individuals who struggle with social physique anxiety.</p> <hd id="AN0186641454-21">Acknowledgements</hd> <p>Authors appreciate the contributions of our research assistants and participants throughout data collection for this work.</p> <hd id="AN0186641454-22">Ethics approval</hd> <p>This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Oklahoma State University.</p> <hd id="AN0186641454-23">Consent</hd> <p>Informed consent was obtained from all individual participants included in the study.</p> <hd id="AN0186641454-24">Author contributions</hd> <p>BJH and DMG contributed to the study conception and design. BJH contributed to material preparation and data collection. BJH and DMG contributed to manuscript conceptualization and data analysis. All authors contributed to manuscript preparation, editing, and feedback.</p> <hd id="AN0186641454-25">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States of America and received approval from the Oklahoma State University Institutional Review Board.</p> <hd id="AN0186641454-26">Funding</hd> <p>No funding was received to assist with the preparation of this manuscript.</p> <hd id="AN0186641454-27">Data availability statement</hd> <p>The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.</p> <ref id="AN0186641454-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Neighbors LA, Sobal J. Prevalence and magnitude of body weight and shape dissatisfaction among university students. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Interactive Role of Gender, BMI, and Exercise Habits on Social Physique Anxiety
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Burkhart+J%2E+Hahn%22">Burkhart J. Hahn</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4583-2276">0000-0003-4583-2276</externalLink>)<br /><searchLink fieldCode="AR" term="%22DeMond+M%2E+Grant%22">DeMond M. Grant</searchLink><br /><searchLink fieldCode="AR" term="%22Kaitlyn+M%2E+Nagel%22">Kaitlyn M. Nagel</searchLink><br /><searchLink fieldCode="AR" term="%22Danielle+E%2E+Deros%22">Danielle E. Deros</searchLink><br /><searchLink fieldCode="AR" term="%22Ebony+A%2E+Walker%22">Ebony A. Walker</searchLink><br /><searchLink fieldCode="AR" term="%22Jacob+D%2E+Kraft%22">Jacob D. Kraft</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2025 73(5):2002-2009.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 8
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Influences%22">Social Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Human+Body%22">Human Body</searchLink><br /><searchLink fieldCode="DE" term="%22Aesthetics%22">Aesthetics</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Body+Composition%22">Body Composition</searchLink><br /><searchLink fieldCode="DE" term="%22Body+Weight%22">Body Weight</searchLink><br /><searchLink fieldCode="DE" term="%22Exercise%22">Exercise</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Obesity%22">Obesity</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2025.2510695
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Social physique anxiety (SPA) is characterized by concerns of evaluation focused on one's physical appearance. Past work suggests factors such as gender, body mass index (BMI), and exercise habits uniquely contribute to SPA. However, no study has examined the interactions between these three variables. The current study sought to investigate the linked impact of gender, BMI, and exercise habits on SPA. Participants: Participants (N = 360) from a large Midwestern university completed questionnaires assessing relevant variables. Method: SPA was elevated for women, individuals with higher BMI, and those who do not exercise. Results: A significant interaction indicated that women who were classified as overweight and obese reported elevated SPA, but the same effect did not hold for men. A marginally significant interaction revealed that men who engage in exercise reported lower SPA scores than women who exercise. Conclusions: These data depict both protective and maintenance factors of SPA for college populations. Other clinical implications are discussed.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1476950
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1476950
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2025.2510695
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 2002
    Subjects:
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Social Influences
        Type: general
      – SubjectFull: Human Body
        Type: general
      – SubjectFull: Aesthetics
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Body Composition
        Type: general
      – SubjectFull: Body Weight
        Type: general
      – SubjectFull: Exercise
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Obesity
        Type: general
    Titles:
      – TitleFull: The Interactive Role of Gender, BMI, and Exercise Habits on Social Physique Anxiety
        Type: main
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            NameFull: Ebony A. Walker
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            – D: 01
              M: 01
              Type: published
              Y: 2025
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            – Type: issn-print
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              Value: 1940-3208
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              Value: 73
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