Body Image 33 (2020) 90–100

Contents lists available at ScienceDirect

Body Image
journal homepage: www.elsevier.com/locate/bodyimage

Meta-analysis of gender differences in body appreciation

Jinbo He a , Shaojing Sun b,∗ , Hana F. Zickgraf c , Zhicheng Lin a,∗ , Xitao Fan a
a
School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, China
b
School of Journalism, Fudan University, Shanghai, China
c
Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States

a r t i c l e i n f o a b s t r a c t

Article history: There are a number of studies that have conducted comparisons of body appreciation between males
Received 25 June 2019 and females. However, findings are largely inconsistent, making it unclear whether there are actual
Received in revised form 22 February 2020 gender differences in body appreciation. With a meta-analytic approach, the current study quantitatively
Accepted 22 February 2020
reviewed and synthesized previous findings, published up to May 2019, on gender differences in body
Available online 6 March 2020
appreciation. After searching and screening potential studies in four databases (i.e., PubMed, PsycINFO,
Web of Science, and ProQuest Dissertations & Theses Global), we identified 40 relevant articles published
Keywords:
from 2008 to 2019. A random-effects model reveals an overall estimate of gender difference in body
Body appreciation
Gender difference
appreciation of d = 0.27 (95 % CI: 0.21, 0.33; p < .001); that is, males generally have a higher level of body
Meta-analysis appreciation than females, with a small effect size. Survey method, type of sample (cohorts), and age
Systematic review were identified as significant moderators that have contributed to the variability in previous findings.
Future research and interventions in body appreciation may consider gender differences in their designs.
© 2020 Elsevier Ltd. All rights reserved.

1. Introduction studies have shown that body appreciation is closely associated

with well-being after controlling for other body image constructs
Historically, research on body image largely focused on the (e.g., body dissatisfaction and body esteem; Avalos et al., 2005;
negative or pathological aspects of body image (e.g., body dissatis- Davis, Fowler, Best, & Both, 2019; Swami, Tran, Stieger, & Voracek,
faction, body shame, and body preoccupation). In contrast, positive 2015; Tylka & Kroon Van Diest, 2013). Moreover, numerous stud-
body image has received less research attention. Positive body ies have shown body appreciation to be inversely related to various
image is considered not just the inverse of negative body image negative mental and physical health outcomes (e.g., Gillen, 2015;
but a distinct construct with its own unique components (Tylka, Marta-Simões, Ferreira, & Mendes, 2017; Ramseyer Winter, Gillen,
2011). These include: favorable opinions (e.g., “I feel good about Cahill, Jones, & Ward, 2019; Ramseyer Winter, O’Neill, & Omary,
my body.”), acceptance (e.g., “despite its flaws, I accept my body 2017). Existing research tends to show that positive body image
for what it is.”), respect of one’s body (“I’m attentive to my body’s is related to key variables (e.g., self-esteem, life satisfaction) asso-
needs.”), as well as protective cognitive styles that reject unreal- ciated with positive psychological and health outcomes for both
istic body appearance ideals (e.g., idealized media imagery). These men and women (Tiggemann, 2015). These correlates of positive
key components have been incorporated into the Body Appreci- body image, however, may manifest and function differently across
ation Scale (BAS; Avalos, Tylka, & Wood-Barcalow, 2005) as well gender. For instance, Kling, Hyde, Showers, and Buswell’s (1999)
as its follow-up version (BAS-2; Tylka & Wood-Barcalow, 2015). meta-analysis concluded with a small, but statistically significant,
However, the literature on body appreciation is relatively small, effect size of gender difference in global self-esteem connoting
reflecting only 14 years of empirical study. body satisfaction, with males scoring higher than females. Thus,
Ample evidence has suggested that body dissatisfaction and it is plausible to reason that the relationship between positive
body appreciation, though inversely correlated with one another, body image and its correlates may vary by gender. Such a specula-
are distinct constructs: Body appreciation is not just the absence tion, though contingent on specific correlates, echoes Calogero and
of body dissatisfaction (Tiggemann & McCourt, 2013). Previous Thompson’s call for further attention to gender differences in body
image, as such differences account for a variety of psychological dis-
orders and other health consequences. For example, Gillen (2015)
found that positive body image was significantly associated with
∗ Corresponding authors.
E-mail addresses: shaojingsun@gmail.com (S. Sun), zclin@cuhk.edu.cn (Z. Lin).

https://doi.org/10.1016/j.bodyim.2020.02.011
1740-1445/© 2020 Elsevier Ltd. All rights reserved.
 J. He et al. / Body Image 33 (2020) 90–100 91

a host of health indicators (e.g., less depression, high self-esteem, moderate gender differences (e.g., cohort effects, socio-economic
fewer unhealthy dieting behaviors). status, and ethnicity; Kertechian & Swami, 2017). Indeed, as noted
Gender differences in body image, especially negative body by Tiggemann (2015), the development and formation of posi-
image, have been well documented in extant literature, showing tive body image may be modulated by diverse factors, particularly
that males and females tend to possess different perceptions of, social identities, one of which is gender. Since individuals often are
beliefs about, and behaviors toward their own bodies (Calogero embedded in multiple social identities (e.g., ethnicity, gender), gen-
& Thompson, 2010). For example, in contrast to the finding that der differences in positive body image could be moderated by other
the most consistent appearance ideal for females is thinness, there identity-related factors. For example, Tylka and Wood-Barcalow
is a culture-conditioned preference for a lean and muscular body (2015) reported smaller gender differences in community samples
type for males (Grogan, 2016). Media is an important contribu- than in college samples, and suggested that cohort effects might
tor to the gender differences in ideal body type, with idealized contribute to the inconsistency in prior research. Therefore, it is
images of females as unrealistically slim and males as not only prudent to investigate gender differences not in isolation but along
slender but also muscular (Franchina & Coco, 2018). In contrast with potential moderators.
to females, therefore, males could be dissatisfied with their own In sum, the inconsistencies in prior research present a great
bodies because of a drive for thinness, as in anorexia nervosa, or a obstacle in understanding gender differences in body appreciation.
drive for muscularity, as in muscle dysmorphia (Murray & Touyz, The important question we address here is whether, and to what
2012). extent, males and females differ in body appreciation, and what
Moreover, females, compared with males, are more frequently factors may moderate, amplify, attenuate, or conceal the potential
exposed to idealized body images in daily life, with the images gender differences. Meta-analysis is an ideal method for synthesiz-
being more homogenous, featuring primarily young, thin, and ing group differences, as well as identifying potential factors that
attractive ideals, compared with the less well-defined and more may contribute to the inconsistency or heterogeneity in previous
heterogeneous images for males (Buote, Wilson, Strahan, Gazzola, findings (Borenstein, Hedges, Higgins, & Rothstein, 2011). Thus, the
& Papps, 2011). With the nearly single-standard ideal, females are current study adopted a meta-analytic approach and attempted to
more likely than males to engage in upward social comparison. synthesize the magnitude and direction of potential gender differ-
Such upward social comparison has been shown to lead to body ences in body appreciation, and to identify potential moderators of
dissatisfaction, with the effect being stronger for females than for gender differences.
males (Myers & Crowther, 2009). Recently, upward social com-
parisons have been shown to be inversely associated with body 1.1. Potential factors related to inconsistent findings
appreciation among females, particularly while being exposed to
images of thin ideals (Watson, Murnen, & College, 2019). The neg- 1.1.1. Region
ative effect that upward social comparisons may have on body Different regions may have distinct cultures, which may affect
appreciation could be stronger for females than for males, if we what body ideals one is exposed to, how one attends to and
assume that the aforementioned differential norms and evalua- absorbs media information, and consequently how one evaluates
tive mechanisms about body dissatisfaction apply to the scenario her/his own body (Calogero & Thompson, 2010). For example, Asian
of body appreciation. culture values interdependence, and those with Asian culture back-
A potential gender difference in body appreciation has also been ground appear to be highly aware of the social norms pertaining
implicated in intervention research. Guest et al. (2019) reviewed 15 to body ideal and, furthermore, to embark on social comparisons
studies and concluded that existing interventions using intuitive in reference to those norms (White & Lehman, 2005). Such social
eating, cognitive behavioral therapy, self-compassion, and exer- comparisons can affect one’s perception and satisfaction of body
cise are effective in promoting positive body image for women, image (Myers & Crowther, 2009). Therefore, we explore whether
but not for men. A similar gender difference was found for ado- region (e.g., Americas, Europe, or Asia) moderates the relationship
lescents. For example, in a school-based intervention to improve between gender and body appreciation.
body image (“In Favor of Myself”), Golan, Hagay, and Tamir (2014)
observed that girls were more responsive to the intervention than 1.1.2. Type of sample
boys. In other words, there may be gender differences in sensitivity Different sample features may be related to conflicting find-
to interventions that aim to enhance positive body image. Address- ings on gender differences in body appreciation. For instance,
ing this difference in sensitivity requires a better understanding of with an adolescent sample, Lunde et al. (2013) found a large gen-
whether and how positive body image forms differently in males der difference in body appreciation. With a community sample
and in females. For example, one reason for this gender disparity of adults, however, Swami, Barron, Weis, and Furnham (2016))
in sensitivity to intervention could be that females may have lower did not detect a significant gender difference. Moreover, Tylka
body appreciation than males to begin with and, therefore, have and Wood-Barcalow (2015) showed that gender differences in
more room to improve in response to interventions. Furthermore, body appreciation were smaller in community samples than in
studying gender differences in body appreciation may inform inter- college samples. Sample characteristics (e.g., college vs. commu-
ventions aimed at improving body image by targeting males and nity sample) speak to the strictness of a participant’s immediate
females differently. situation—such as the behavioral restriction within the living
So far, research on gender differences in body appreciation is community—which may affect social comparison (Baldwin &
not consistent. A number of studies have reported that males have Mussweiler, 2018) and moderate the relation between gender and
a higher level of body appreciation than females (e.g., Alcaraz- body appreciation. Thus, it is important to explore whether the type
Ibanez, Cren Chiminazzo, Sicilia, & Teixeira Fernandes, 2017; Atari, of sample or cohort may moderate the relationship between gender
2016; Gillen & Dunaev, 2017), with a comparable number of stud- and body appreciation.
ies showing that males and females have similar levels of body
appreciation (e.g., Brown, 2009; Marta-Simões, Ferreira, & Mendes, 1.1.3. Measure of body appreciation
2016; Meneses, Torres, Miller, & Barbosa, 2019), and still one recent The BAS and the BAS-2 are the two major scales used to mea-
study reporting a higher level of body appreciation in females sure body appreciation. The BAS is the first psychometrically sound
than in males (Jovic, Sforza, Jovanovic, & Jovic, 2017). Some of measure of body appreciation. The BAS-2 improves upon the first
the variability in prior findings may be explained by factors that version by eliminating sex-specific items and body-dissatisfaction
92 J. He et al. / Body Image 33 (2020) 90–100

based language. Furthermore, unlike the BAS, the BAS-2 is shown to publication bias (Ferguson & Brannick, 2012). We therefore exam-
be unidimentional and invariant across sample types and, impor- ine whether type of publication may moderate the relation between
tantly, also between genders. Therefore, it is possible that gender gender and body appreciation.
differences as measured using the BAS might result from differen-
tial item performance, which reflects the quality of the instrument
2. Method
but not actual gender differences. We therefore include measures
of body appreciation as a potential moderator.
2.1. Selection of studies
1.1.4. Survey method
A literature search was conducted for studies that had exam-
The increasing popular implementation of online research has
ined gender differences in body appreciation published up to May
raised questions about the equivalence of survey modes (e.g.,
2019. A computer-based search was conducted using PubMed,
paper-and-pencil vs. online) as well as the characteristics of the
PsycINFO, Web of Science, and ProQuest Dissertations & Theses
sample (e.g., from MTurk). Indeed, survey modes—web-based
Global. Records containing the term “body appreciation” in their
questionnaires vs. paper-based questionnaires—can influence par-
titles or abstracts were located. Studies were included in the meta-
ticipants’ responses to certain body-image related items, such as
analysis if they met the following criteria: (1) was written in
self-report of being fat or thin (Denscombe, 2006). Similarly, Myers
English, as previous studies showed that there was nearly no evi-
and Crowther (2009) found that the effect of social comparison on
dence of a systematic bias from English language restriction in
body dissatisfaction was more pronounced when social compari-
meta-analyses (e.g., Morrison et al., 2012); (2) was published in
son was measured through self-report survey than other methods.
peer-reviewed journals or unpublished dissertations; (3) included
Simply speaking, survey method can influence the measurement
comparisons between males and females in body appreciation, and
and study of social comparison. Furthermore, considering the cen-
effect size (Cohen’s d) was reported or could be computed based on
tral role social comparison plays in body appreciation (Callan, Kim,
the information provided in the article.
& Matthews, 2015; Duffy, Smith, Terhanian, & Bremer, 2005), we
Of note, since we only aimed to generalize our results to the gen-
deem it important to explore whether survey method (e.g., Inter-
eral population, but not clinical populations, we decided to exclude
net vs. in-person survey administration) may moderate the relation
studies using samples with physical/medical conditions. Moreover,
between gender and body appreciation.
the two identified studies using clinical samples to study body
appreciation had different physical conditions (amputation vs. aes-
1.1.5. Age
thetic rhinoplasty) in their samples (Farhat-ul-Ain & Fatima, 2016;
Existing research has shown that the magnitude and direction
Naraghi & Atari, 2015); thus, it might be questionable to combine
of gender differences in body dissatisfaction may change across
the two studies and compare the pooled result with that derived
adolescence, young adulthood, and middle age. For example, in
from general samples. Therefore, in line with Karazsia, Murnen, and
a 20-year longitudinal study, the percentage of males expressing
Tylka (2017), we excluded these two studies using samples with
body dissatisfaction (specifically weight dissatisfaction) increased
physical/medical conditions.
slightly from late adolescence to midlife, whereas the percentage
We did not include unpublished findings except for disserta-
of females with body dissatisfaction did not show a clear change
tions for the following reasons. Schmucker et al. (2017) reviewed
during the same time interval (Keel, Baxter, Heatherton, & Joiner,
past systematic reviews and meta-analyses and found that very
2007). In another 3-wave longitudinal study, Bearman, Presnell,
few of them suffered from overestimating treatment effects when
Martinez, and Stice (2006) found a significant interaction between
excluding unpublished literature. Therefore, they suggested that
age and gender on adolescents’ body dissatisfaction. Specifically,
meta-analysts consider “time, effort and cost” when adding unpub-
girls tended to undergo an increase in body dissatisfaction across
lished literature to a meta-analysis. On the other hand, according to
time, whereas boys tended to experience the highest dissatisfaction
Moyer Schneider, Knapp-Oliver, and Sohl (2010), unpublished doc-
in early adolescence. Therefore, age may also moderate the relation
toral dissertations, as compared with other forms of unpublished
between gender and body appreciation.
or gray literature, are more worthy of being included in systematic
reviews because of their relatively easy access, low bias, and thor-
1.1.6. BMI
ough presentation of findings. Ferguson and Brannick (2012), after
For both men and women, BMI is negatively associated with
systematically researching publication bias in psychological sci-
body appreciation (e.g., Gillen & Dunaev, 2017; Razmus & Razmus,
ence, found that dissertations, as indexed unpublished studies, may
2017; Swami, Hwang, & Jung, 2012). However, there is no consen-
better represent the missing studies than nonindexed unpublished
sus on the direction and magnitude of the gender difference in this
studies. Thus, as in a previous meta-analysis on body dissatisfaction
association; some studies found a stronger association between
(Karazsia et al., 2017), we included dissertations as the only unpub-
BMI and body appreciation in men than in women (e.g., Swami,
lished data source. In addition, in the current meta-analysis, when
Weis, Barron, & Furnham, 2018), whereas other studies found the
the same data set was reported in two publications (e.g., Halliwell,
opposite (e.g., Ng, Barron, & Swami, 2015). A recent meta-analysis
Jarman, Tylka, & Slater, 2017; Halliwell, Jarman, Tylka, & Slater,
revealed a negative association between body appreciation and BMI
2018), we compared the two publications and chose the one that
with a small effect size in males but a moderate one in females
provided gender differences in body appreciation and/or reported
(He, Sun, Lin, & Fan, 2020 under review); that is, compared with
more detailed information about the sample characteristics.
females, males’ body appreciation might be less negatively affected
by increasing BMI. Therefore, it seems possible that the gender dif-
ference in body appreciation might be more pronounced for higher 2.2. Coding of studies
BMI than lower BMI.
Two trained research assistants independently coded all stud-
1.1.7. Type of publication ies. Before starting formal coding, the two coders were trained by
The present meta-analysis included both journal articles and learning to code a set of articles that had already been expert-
unpublished dissertations. Previous studies showed that effect coded for another study. After becoming familiar with coding
sizes reported in unpublished dissertations tend to be smaller than articles for meta-analysis, the coders began the formal coding. The
those reported in published journal articles, potentially reflecting final intercoder reliability ranged from .89 to 1.00 (Krippendorff’s
 J. He et al. / Body Image 33 (2020) 90–100 93

alpha). Discrepancies between the raters were resolved through

discussions with the first and second authors. The following infor-
mation was extracted from each of the included studies: author
(s) and publication year; type of publication (journal or disserta-
tion); region (America, Europe, or Asia); survey method (online or
paper–pencil); type of sample (primary/middle/high school, col-
lege, or community); sample size; mean age of participants; mean
body mass index (BMI) of participants; measure of body apprecia-
tion (BAS or BAS-2); and Cohen’s d or the information for computing
Cohen’s d. For included studies that did not directly report Cohen’s
d, means and standard deviations of body appreciation for men and
women were extracted and used to calculate d. Where necessary,
we changed the sign of published d such that for all effect sizes, a
negative value of d reflected higher body appreciation in women,
and a positive value of d reflected higher body appreciation in men.

2.3. Assessment of study quality

Quality assessment for the included studies was conducted by

the first two authors of this paper independently. Discrepancies of
the quality scores were later resolved through discussion between
the two evaluators. Specifically, we adapted the tool that was used
in Chen, Cai, He, and Fan (2019) for assessing study quality for gen- Fig. 1. Study selection flowchart.
der differences in life satisfaction. This adapted tool includes four
questions to assess the quality of the selected studies in terms of
specification and definition of population, representativeness of the pairwise comparisons to examine the differences between the lev-
sample, validity of measuring instrument, and approach for assess- els within the moderator. To control for the Type 1 error rate, we
ing gender difference (see Table A1 in Appendix A). used Bonferroni corrections in post-hoc pairwise comparisons.
Publication bias was assessed by inspecting the symmetry of the
2.4. Data analyses funnel plot (Duval & Tweedie, 2000), as well as by using Egger’s lin-
ear regression test, which quantifies the estimated bias as reflected
All the data analyses were conducted via R 3.5.2 (R Core Team, in the funnel plot, with a non-significant p value (i.e., greater than
2018) with the package of metafor (Viechtbauer, 2010). We con- .050) indicating insufficient evidence for publication bias (Egger,
ducted three major sets of meta-analyses: (1) mean effect size Smith, Schneider, & Minder, 1997).
analyses, (2) heterogeneity tests, and (3) moderator analyses. First,
to estimate an overall mean effect size, we implemented a random-
3. Results
effects model because meaningful variation in effect sizes between
studies was anticipated (Lawson, Hook, & Farah, 2018). The inter-
3.1. Study selection
pretation of the effect-size of Cohen’s d was based on Cohen (1992):
0.20 as the cutoff for a small effect, 0.50 for a medium effect, and
The process of selecting the studies in this meta-analysis is
0.80 for a large effect.
graphically described in Fig. 1. The initial search identified 2805
Second, testing the presence or absence of unexplained hetero-
records from the four databases. After removing duplicates, 1769
geneity is a crucial step in meta-analysis. Both random sampling
studies remained. One hundred and forty-three studies were
error (i.e., within-study variability) and systematic study fea-
included in the full-text review after exclusion based on titles and
tures (e.g., characteristics of samples, selection of measurement
abstracts according to the criteria described in the Method sec-
instruments, publication type) could contribute to the hetero-
tion. Of the 143 full texts, 40 were identified as having met the
geneity among studies. The results of the heterogeneity test
selection criteria. Furthermore, the reference lists of all the selected
directly influence the selection of statistical models, fixed-effects
articles were checked for additional relevant studies, which yielded
vs. random-effects, as applied to the analysis of effect sizes. The
no additional records. Among the 40 articles, six contained multiple
Cochrane Q statistic and the I2 index are commonly used for
sub-studies with independent samples (Hill, Ogletree, & McCrary,
assessing the significance of unexplained heterogeneity (Higgins,
2016; Kertechian & Swami, 2017; Lemoine et al., 2018; Soulliard,
Thompson, Deeks, & Altman, 2003). The Q statistic informs the
Kauffman, Fitterman-Harris, Perry, & Ross, 2019; Swami, Weis et al.,
presence or absence of significant heterogeneity; I2 identifies
2018; Tylka & Wood-Barcalow, 2015), resulting in 51 independent
the extent of such heterogeneity (Huedo-Medina, Sánchez-Meca,
comparisons of body appreciation between males and females. The
Marín-Martínez, & Botella, 2006). According to Higgins et al. (2003),
details of the 40 articles included in this meta-analysis are pre-
I2 values of 25 %, 50 %, and 75 % indicate low, moderate, and high
sented in Table 1.
heterogeneity, respectively.
Third, moderator analyses were conducted to explore the fac-
tors that might have contributed to the heterogeneity in previous 3.2. Descriptive characteristics of the studies included
findings. The following potential moderators were examined: pub-
lication type, region, survey method, type of sample (cohort), The 40 selected articles involved a total of 21,257 participants
measures of body appreciation, publication year, mean age, and with their ages ranging from 9 to 91 years old (Halliwell et al., 2018;
mean BMI. The explained variance R2 was computed to assess the Meneses et al., 2019). The dates of publications ranged from 2008
proportion of heterogeneity explained by each moderator. When to 2019. The reported effect size (Cohen’s d) of gender differences
a statistically significant moderating effect was found for a cate- in body appreciation ranged from -0.20 (Jovic et al., 2017) to 1.08
gorical moderator with more than 2 levels, we turned to post-hoc (Soulliard et al., 2019), with a positive effect size indicating higher
 94
Table 1
Study characteristics.

Author (s) and year Publication type Region Survey method Type of sample Sample size Percent of White Mean age Mean BMI Measures Cohen’s d

Alcaraz-Ibanez et al., 2017 1 4 2 1 840 0.00% 15.50 21.87 2 0.48

Atari, 2016 1 4 2 2 1093 0.00% 25.87 23.69 2 0.12
Brown, 2009 2 1 2 2 228 59.20 % 22.07 n/a 1 0.03
Davis et al., 2019 1 1 1 n/a 448 86.40% 28.79 26.43 2 0.16
Dumitrescu et al., 2008 1 2 2 2 178 n/a 19.31 n/a 1 0.05
Ellis-Ordway, 2016 2 1 2 3 128 94.50 % 45.00 29.84 1 0.04
Gillen and Dunaev, 2017 1 1 2 2 261 44.00% 20.16 24.28 1 0.46
Gonzalez-Jimenez, 2016 1 2 1 2 320 n/a 26.91 n/a 2 0.18
Halliwell et al., 2017 1 2 2 1 344 n/a 9.98 n/a 2 0.22
Hill et al., 2016a1 1 1 2 2 132 54.00% n/a n/a 1 0.57
Hill et al., 2016a2 1 1 2 2 168 54.00% n/a n/a 1 0.28
Jáuregui-Lobera & Bolaños-Ríos, 2011 1 2 2 1 85 0.00% 17.40 n/a 1 0.59
Jáuregui-Lobera, Bolaños-Ríos, Santiago-Fernández, 1 2 2 1 312 0.00% 14.81 n/a 1 0.29
Garrido-Casals, & Sánchez, 2011
Jovic et al., 2016 1 2 2 3 622 100.00% 42.30 24.34 2 −0.20
Kertechian & Swami, 2017a1 1 2 2 2 326 n/a 21.33 21.82 2 0.29
Kertechian & Swami, 2017a2 1 2 2 2 326 n/a 21.33 21.82 2 0.22
Lemoine et al., 2018a1 1 2 1 1 129 n/a 14.40 19.61 2 0.47
Lemoine et al., 2018a2 1 2 1 1 513 n/a 15.00 20.89 2 0.66

J. He et al. / Body Image 33 (2020) 90–100

Lemoine et al., 2018a3 1 2 1 1 370 n/a 15.50 21.68 2 0.68
Lunde, 2013 1 2 2 1 110 100.00% 16.90 n/a 1 0.75
Luu, 2014 2 1 1 3 289 30.40% 18.87 23.59 1 0.31
Marta-Simoes et al., 2016 1 2 2 3 155 n/a 21.60 22.63 2 0.17
Menesses et al., 2019 1 2 2 3 202 n/a 70.70 26.98 2 0.11
Mutale, Dunn, Stiller, & Larkin, 2016 1 1 2 2 190 76.90 % n/a 23.42 1 0.16
Ng et al., 2015 1 3 2 2 2403 0.00% 23.52 20.75 1 0.15
Razmus and Razmus, 2017 1 2 2 3 385 100.00% 35.38 23.91 2 0.00
Soulliard et al., 2019a1 1 1 1 2 79 81.00% 19.51 23.63 2 1.08
Soulliard et al., 2019a2 1 1 1 2 175 82.30 % 19.51 24.17 2 0.40
Swami et al., 2012 1 3 2 2 267 0.00% 22.35 20.27 1 0.38
Swami, Henry, Peacock, Roberts-Dunn, & Porter, 2013 1 2 2 3 1200 54.00% 24.23 n/a 1 0.27
Swami and Ng, 2015 1 3 2 2 874 0.00% 19.97 20.35 2 0.18
Swami, Barron et al., 2016a 1 1 1 3 399 81.70% 34.55 26.62 2 −0.01
Swami, 2016b 1 2 2 3 138 73.20 % 38.57 n/a 2 0.42
Swami, Ng, & Barron, 2016c 1 2 1 3 380 84.30 % 36.90 n/a 1 0.29
Swami, von Nordheim et al., 2016d 1 3 2 3 345 0.00% 22.41 21.00 2 0.16
Swami et al., 2017 1 2 1 3 1148 88.00% 34.87 25.95 2 0.32
Swami, Barron, & Furnham, 2018a1 1 2 1 2 52 82.10% 20.92 20.67 2 0.31
Swami, Barron et al., 2018a2 1 2 1 2 54 82.10% 20.92 20.67 2 0.52
Swami, Barron et al., 2018a3 1 2 2 3 61 92.60% 33.52 25.02 2 0.05
Swami, Barron et al., 20188a4 1 2 2 3 63 92.60% 33.52 25.02 2 −0.43
Swami, Barron et al., 2018a 1 3 1 3 629 0.00% 32.81 24.74 1 0.09
Swami, Todd et al., 2019b 1 3 2 3 475 0.00% 23.52 23.52 2 0.09
Todd, Aspell, Barron, & Swami, 2019 1 2 1 3 646 92.40% 38.92 27.25 2 0.47
Tylka and Kroon Van Diest, 2013 1 1 1 2 1200 81.70% 20.45 24.61 1 0.36
Tylka & Homan, 2015a 1 1 1 2 406 88.50 % 19.62 23.03 1 0.49
Tylka & Wood-Barcalow, 2015b1 1 1 1 2 675 79.10% 20.34 24.58 2 0.27
Tylka & Wood-Barcalow, 2015b2 1 1 1 2 263 81.00% 20.43 24.67 2 0.58
Tylka & Wood-Barcalow, 2015b3 1 1 1 3 317 79.80% 32.89 26.86 2 −0.11
Tylka & Wood-Barcalow, 2015b4 1 1 1 3 382 71.90 % 33.38 26.68 2 0.26
Van Diest and Tylka, 2010 1 1 2 2 238 91.60% 20.87 24.81 1 0.42
Watson et al., 2019 1 1 1 3 195 72.30 % 28.48 25.89 2 0.31

Notes: Author (s) and year: a, b, c, d denote that same author(s) published different articles in the same year; a1, a2, b1, b2, b3, and b4 denote that multiple independent samples (or studies) were reported in the same article;
Publication type: 1 = journal, 2 = dissertation; Region: 1 = America, 2 = Europe, 3 = Asia; Survey method: 1 = Online, 2 = Paper-pencil; Type of sample: 1 = primary, secondary or high school; 2 = college; 3 = community; Measure:
1 = Body Appreciation Scale, 2 = Body Appreciation Scale-2; n/a = not available.
 J. He et al. / Body Image 33 (2020) 90–100 95

Fig. 2. Forest Plot of the studies included.

levels of body appreciation in males than females. The descriptive accounting for 11.64 %; and mean age (Q = 13.10, p < .001) explain-
characteristics of the studies are shown in Table 1. ing 29.11 %.
Specifically, for survey method, the pooled d from online surveys
3.3. Assessment of study quality (d = 0.34, 95 % CI: 0.25, 0.43, p < .001) was larger than that from
paper–pencil surveys (d = 0.21, 95 % CI: 0.13, 0.29, p < .001). For
Based on the adapted tool from Chen et al. (2019), most studies type of sample (cohort), the pooled d from primary/middle/high
(90 %) had adequate definitions of their study populations, a small school samples (d = 0.50, 95 % CI: 0.36, 0.64, p < .001) was the largest,
number of studies (12.5 %) used representative samples, nearly all followed by that from college samples (d = 0.30, 95 % CI: 0.22, 0.38,
studies (97.5 %) used tools with at least validity or reliability infor- p < .001), with the pooled d from community samples being the
mation reported, and all studies (100 %) used the same tool (BAS or lowest (d = 0.15, 95 % CI: 0.07, 0.23, p < .001)1 . Mean age negatively
BAS-2) to assess body appreciation in males and females. The details predicted gender differences (B = -0.01, 95 % CI: -0.02, -0.01, p <
of the quality assessment are presented in Table A1 in Appendix A. 0.001). Other moderators were not significant (see Table 2).

3.4. Overall analysis 3.6. Publication bias and sensitivity analysis

A random-effects model was used to estimate the average effect The funnel plot (see Fig. 3) was symmetric. Moreover, Egger’s
size and its 95 % confidence interval. Results indicated a small but linear regression test revealed that Z = 1.28, p = .201, which was
significant effect size, with the pooled d = 0.27 (95 % CI: 0.21, 0.33; not significant (i.e., greater than .050). Thus, there is little evidence
p < .001). The forest plot is described in Fig. 2. However, substantial that the current results are affected by publication bias.
heterogeneity was also identified, with Q(50) = 189.78 (p < .001) and Following the same procedure used in Chen et al. (2019), we
I 2 = 76.01 %; that is, 76.01 % of the total observed variability across compared the results by including and excluding the five studies
the studies could be attributed to between-study differences. with relatively low scores on quality assessment (i.e., a total score
of 2): the pooled d when including the five studies [d = 0.27 (95 %
CI: 0.21, 0.33; p < .001)] was nearly the same as the pooled d when
3.5. Moderator analyses
excluding the five studies [d = 0.28 (95 % CI: 0.21, 0.35; p < .001)].
The results of moderator analyses are shown in Table 2. Over-
all, results indicated that four variables contributed significantly to
1
the heterogeneity of effect sizes: survey method (Q = 4.45, p < .050) Post-hoc pairwise comparisons: For primary/middle/high school vs. college
samples, Q = 7.14 (p < .010); for college vs. community samples, Q = 6.69 (p < .010);
accounting for 9.20 % of the total heterogeneity; type of sample and for primary/middle/high school vs. college samples, Q = 16.96 (p < .010). All
(Q = 19.89, p < .001) accounting for 36.63 %; type of sample exclud- tests were statistically significant at the significance level of 0.02 with a Bonferroni
ing samples from primary/middle/high schools (Q = 6.69, p < .010) correction (0.05/3 ≈ 0.02).
96 J. He et al. / Body Image 33 (2020) 90–100

Table 2
Moderator analyses.

k Parameter Z 95 % CI Q df R2
SE
Lower limit Upper limit

Publication type 1.05 1 0.00%

Journal 49 d = 0.28*** 0.03 8.63 0.21 0.34
Dissertation 3 d = 0.14 0.13 1.02 −0.12 0.40
Region 2.78 2 3.38%
America 20 d = 0.31*** 0.49 6.20 0.21 0.40
Europe 24 d = 0.28*** 0.46 6.38 0.19 0.37
Asia 7 d = 0.16* 0.75 2.13 0.01 0.30
Survey method 4.45* 1 9.20 %
Online 22 d = 0.34*** 0.04 7.52 0.25 0.43
Paper-pencil 29 d = 0.21*** 0.04 5.26 0.13 0.29
Type of sample 19.89*** 2 36.63 %
Primary/middle/high school 8 d = 0.50*** 0.07 7.24 0.37 0.64
College 22 d = 0.30*** 0.04 7.25 0.22 0.38
Community 20 d = 0.15*** 0.04 3.54 0.07 0.23
Type of sample without primary/middle/high school # 6.69** 1 11.64 %
College 22 d = 0.30*** 0.04 7.28 0.22 0.38
Community 20 d = 0.15*** 0.04 3.55 0.07 0.23
Measure 0.49 1 0.00%
Body Appreciation Scale 19 d = 0.30 0.04 5.79 0.20 0.40
Body Appreciation Scale-2 32 d = 0.25 0.04 6.39 0.18 0.33
Publication year 51 B = 0.003 0.01 0.24 −0.02 0.03 0.06 1 0.00%
Mean age 48 B = -0.01*** 0.003 −3.62 −0.02 −0.005 13.10*** 1 29.11 %
Mean BMI 39 B = -0.03 0.02 −1.95 −0.063 0.0002 3.79 1 6.49%

Notes: * p < .05, ** p < .01, *** p < .001. # For analyzing the cohort effect with only colleges and communities, 8 studies from primary/middle/high schools were removed.

results underscore females’ vulnerability to body-image related

psychopathology (Lewinsohn, Seeley, Moerk, & Striegel-Moore,
2002; Striegel-Moore et al., 2009). Since body appreciation has been
shown to protect females against body dissatisfaction (Andrew,
Tiggemann, & Clark, 2015; Halliwell, 2013), and since body image
disturbances are closely associated with various negative mental
and physical health outcomes (e.g., eating disorders), special atten-
tion should be paid to body appreciation in females. As noted in
the Introduction, body appreciation is a unique construct beyond
the mere absence of body dissatisfaction; females could simultane-
ously experience both body dissatisfaction and body appreciation
regarding their body (Tiggemann, 2015). Therefore, although avail-
able interventions for females’ body image generally concentrate
on either negative body image or, less often, positive body image,
we suggest that future interventions, in order to be more effective,
may consider focusing on both at the same time, that is, to reduce
body dissatisfaction and to improve body appreciation.
Gender differences in body appreciation were moderated by
survey method. Gender differences reported in online surveys were
greater that those from paper-pencil surveys. According to studies
Fig. 3. Funnel plot for checking publication bias. comparing these two survey methods (Gnambs & Kaspar, 2015;
Wood, Nosko, Desmarais, Ross, & Irvine, 2006), online surveys
Therefore, the five studies showed a minimal effect on the overall led to significantly less missing data than paper-pencil surveys,
integrated effect size. especially when the survey is relatively long or contains sen-
sitive questions. Past research also showed that the degree of
4. Discussion anonymity and response format influenced participants’ endorse-
ment of sensitive topics such as body dissatisfaction and disordered
This study quantitatively summarized the literature prior to May eating (Anderson, Simmons, Milnes, & Earleywine, 2007; Lavender
2019 on gender differences in body appreciation between males & Anderson, 2008). For example, Anderson et al. (2007) found
and females using meta-analytic techniques. Based on a random- that both males and females showed higher rates of reporting
effects model, our results suggested a small gender difference, with endorsement of certain sensitive items (e.g., purgative behav-
males showing a higher level of body appreciation than females. iors) on unmatched count questionnaires—which ensure true
Three significant moderators (survey method, type of sample, and anonymity—than on conventional standard questionnaires. Sim-
mean age) were found to have contributed to the heterogeneity ilarly, Lavender and Anderson (2008) observed that when being
across previous findings. assessed with unmatched count survey as opposed to traditional
The finding that females had a lower level of body appreci- standard survey, females tended to be more likely to endorse sen-
ation than males helps to reconcile previous conflicting results sitive items such as adopting strict dieting to lose weight. Likewise,
on gender differences in body appreciation. Together with the when ensured better anonymity, males were more likely to endorse
previous finding that females tend to show higher levels of neg- sensitive items such as using steroids to become muscular. Thus,
ative body image/body image dissatisfaction (Grogan, 2016), these there could be reason to believe that, for personally sensitive feel-
 J. He et al. / Body Image 33 (2020) 90–100 97

ing and information with regard to body appreciation, findings studies reported an association between age and body appreciation.
based on online survey could be more accurate than those with For example, Swami, von Nordheim, and Barron (2016) reported
paper-based survey. If so, the large gender difference revealed by that age was not correlated with men’s body appreciation. Thus,
the studies with online survey (d = 0.34) could be a more accu- it could be that body appreciation increases with age for females
rate reflection of gender difference in body appreciation than that but remains stable for males, so that the gender differences in body
(d = 0.21) from the studies with traditional paper-based survey. appreciation become smaller with increasing age. Whether this is
With regard to the type of sample pertaining to the cohort indeed the case warrants further examination in future studies with
effects (Tylka & Wood-Barcalow, 2015), we found that this mod- a longitudinal design.
erator explained about 37 % of the total heterogeneity across Additionally, it should be noted that there could be a confound-
previous findings. Specifically, samples from primary/middle/high ing effect between the moderators of the type of sample (cohort)
schools showed the largest gender difference, which is generally and mean age. Specifically, in the current meta-analysis, we com-
consistent with previous research on negative body image. That pared gender differences in primary/middle/high school samples,
is, although both boys and girls started to become dissatisfied college samples, and community samples. Clearly, the three types
with their bodies in preadolescence (Burgess, Grogan, & Burwitz, of sample also differ in age (the mean ages of the samples in pri-
2006; Grogan, 2016), the trajectories of body dissatisfaction are mary/middle/high schools, colleges, and communities were 14.94,
more stable for boys than for girls from adolescence to young 21.34, and 34.12 years, respectively). Consequently, even though
adulthood, with girls showing increased body image dissatisfaction both moderators were found to be significant, the effects could be
in later adolescence (Bucchianeri, Arikian, Hannan, Eisenberg, & confounded by the age effect (the mean age), the cohort effect (the
Neumark-Sztainer, 2013). The earlier onset of puberty in girls than type of sample), or both.
boys, combined with girls’ higher risk of precocious puberty, might The current meta-analysis synthesized findings up to May 2019.
contribute to the greater gender differences in body appreciation To be more up-to-date, we reviewed the literature one more time
in adolescents (Patton & Viner, 2007). Moreover, as exemplified at the end of the peer review process, around February 2020. We
by gendered toys and clothing, beginning in childhood, girls are were able to locate eight new studies on gender differences in body
already sexualized by the media and in online and in-person inter- appreciation (i.e., Góngora, Licea, Chams, & Thornborrow, 2020;
actions (American Psychological Association, 2008). The experience Junqueira et al., 2019; Namatame, Yashima, & Sawamiya, 2020;
of sexual objectification may contribute to greater gender dif- Quittkat, Hartmann, Düsing, Buhlmann, & Vocks, 2019; Soulliard
ferences in school-aged and adolescent children. The differences & Vander Wal, 2019; Swami, Barron et al., 2019; Vadivel, Kate, &
between school- and adult community samples might also be Zeba, 2019; Wang, Fardouly, Vartanian, & Lei, 2019). A majority
partially explained by pubertal development during adolescence, of these new studies (five in total) reported significantly higher
which heightens the impact of gender differences in sexual objec- levels of body appreciation in males than in females (d = 0.20 ∼
tification (e.g., Lindberg, Grabe, & Hyde, 2007). Indeed, adolescence 0.72; Góngora et al., 2020; Junqueira et al., 2019; Namatame et al.,
is a sensitive period; objectification experiences and sexual harass- 2020; Swami, Barron et al., 2019; Wang et al., 2019), with two stud-
ment have been found to contribute to the development of eating ies showing no significant gender differences (Soulliard & Vander
disorder symptoms in early adolescence. How objectification expe- Wal, 2019; Vadivel et al., 2019) and still one study reporting a
riences and sexual harassment directly affect body appreciation higher level of body appreciation in females than in males (d = -
remains an important question for future research (Petersen & 0.18; Quittkat et al., 2019). Thus, the effect size distribution of the
Hyde, 2013). newly published studies was generally in line with the previous
As already noted above, in line with the results presented studies as synthesized in this meta-analysis. Moreover, when these
in Tylka and Wood-Barcalow (2015), the present study found a eight studies were included in the overall effect size estimation, the
smaller gender difference in body appreciation in community sam- pooled d was 0.26 (95 % CI: 0.21, 0.32; p < .001), practically the same
ples than in college samples. The difference is likely, in part, due as that found in the current meta-analysis (i.e., without including
to age, as college samples are predominantly made up of young the eight new studies), d = 0.27 (95 % CI: 0.21, 0.33; p < .001). There-
adults. In particular, female college students, compared with their fore, the overall estimate of gender differences found in the current
male peers, are more likely to experience rape (Herbenick, Fu, meta-analysis is robust, barely affected by the eight new studies
Dodge, & Fortenberry, 2019) and other sexual assaults (Mellins published between May 2019 and February 2020.
et al., 2017), with an estimated 20 % of college women experienc- The present study has some limitations. First, as we did not
ing some form of sexual assault by their senior year (Muehlenhard, solicit ongoing studies or unpublished studies from researchers
Peterson, Humphreys, & Jozkowski, 2017). Gender differences in in body image, it is possible that some potential relevant stud-
sexual assaults are particularly pronounced in the college con- ies were missed because they were not included in the databases
text, which is conducive to sexual assault because of the higher searched. Second, although the current study identified three
rates of alcohol consumption by college students than non-students significant moderators, it is possible that we neglected some mod-
from the community context (Abbey, Zawacki, Buck, Clinton, & erators because they were not addressed in the coded studies.
McAuslan, 2004). Thus, gender and age differences in the expe- One such potential moderator is sexual orientation. For exam-
rience of sexual assault may help to explain the greater gender ple, Alleva, Paraskeva, Craddock, and Diedrichs (2018) found that
differences in body appreciation observed in college students than body appreciation was lower among sexual minority men com-
in community samples. pared with heterosexual men, whereas Ramseyer Winter, Satinsky,
Relatedly, the mean sample age emerged as a significant moder- and Jozkowski (2015) reported higher levels of body appreciation
ator, explaining about 30 % of the total heterogeneity across studies. among sexual minority women than heterosexual women. It seems
That is, gender difference in body appreciation decreased with the that sexual minority women and heterosexual men have higher
increase of age. A number of studies have explored the effect of age levels of body appreciation than heterosexual women and sex-
on positive body image among women. For example, Tiggemann ual minority men. Thus, sexual orientation can potentially interact
and McCourt (2013) reported that older women showed higher lev- with gender to affect body appreciation. Also of note, the current
els of body appreciation than younger women. Tiggemann (2015) meta-analysis only addressed the differences in body appreciation
reasoned that as they age, women are becoming less likely to attach between male and female identified samples, the majority of which
physical appearance to their self-worth, and more likely to appre- were likely cisgender. Therefore, gender minority status is another
ciate the health and functionality of their body. For men, only a few potential moderator that should be explored in future research.
98 J. He et al. / Body Image 33 (2020) 90–100

Currently, it remains unclear whether, and how, body appreciation Table A1 (Continued)
differs between cis- and transgender men and women, or as com- Study names Q1 Q2 Q3 Q4 Total
pared with nonbinary individuals. Indeed, in the studies included
Razmus and Razmus, 2017 1 0 1 1 3
in the current meta-analysis, only one reported information about Soulliard et al., 2019 1 0 1 1 3
sexual orientation and/or gender identity (i.e., Watson et al., 2019), Swami et al., 2012 1 0 1 1 3
precluding us from analyzing their potential moderating effects on Swami et al., 2013 1 0 1 1 3
gender differences in body appreciation. We suggest future studies Swami and Ng, 2015 1 0 1 1 3
Swami, Barron et al., 2016a 0 0 1 1 2
to include information on sexual orientation and gender identity. A
Swami, 2016b 1 0 1 1 3
future update of the current meta-analysis can then be conducted Swami, Ng et al., 2016c 0 0 1 1 2
when more research collecting and reporting sexual orientation Swami, von Nordheim et al., 2016d 1 0 1 1 3
and gender identity becomes available. Swami et al.,2017 1 1 1 1 4
Swami, Weis et al., 2018 1 0 1 1 3
In conclusion, the current meta-analysis revealed that males had
Swami, Khatib et al., 2019a 1 0 1 1 3
a higher level of body appreciation than females, and this difference Swami, Todd et al., 2019b 1 0 1 1 3
was small in effect size. Gender differences in body appreciation Todd et al., 2019 1 1 1 1 4
were found to be moderated by survey method (online vs. paper Tylka and Kroon Van Diest, 2013 1 0 1 1 3
pencil), type of samples (primary/middle/high school vs. college Tylka & Homan, 2015a 1 0 1 1 3
Tylka & Wood-Barcalow, 2015b 1 0 1 1 3
vs. community samples), and age. Specifically, the gender differ-
Van Diest and Tylka, 2010 1 0 1 1 3
ence was larger in online than paper-and-pencil survey studies, Watson et al., 2019 0 0 1 1 2
larger in samples from primary/middle/high schools than from col-
Notes:
leges (with community samples being the smallest), and larger at Q1. Was the study population clearly specified and defined?
younger age. (a) yes* (Did the authors describe the group of people from which the study partic-
ipants were selected or recruited, using demographics, location, and time period?).
(b) no description.
Author statement Q2. Representativeness.
(a) truly representative or somewhat representative of the study population*.
Jinbo He: Conceptualization, Methodology, Writing, Funding. (b) potential for selection biases or not stated.
Q3. Validity of measuring instrument.
Shaojing Sun: Conceptualization, Writing. Hana F. Zickgraf: Writ-
(a) well developed with reporting validity and/or reliability*.
ing. Zhicheng Lin: Writing. Xitao Fan: Writing, Funding. (b) no description of validity and/or reliability.
Q4. Same method of assessment for males and females.
(a) yes*.
Declaration of Competing Interest (b) no.

All authors declare that they have no conflict of interest.

Appendix B. Supplementary data
Acknowledgements
Supplementary material related to this article can be found, in
the online version, at doi:https://doi.org/10.1016/j.bodyim.2020.
This research was partially supported by the Presidential Fund
02.011.
of the Chinese University of Hong Kong, Shenzhen, to Jinbo He
(Grant Number: PF.01.001428) and Xitao Fan (Grant Number:
PF.01.000670). References

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