Association between Body Image and Self Esteem Among Senior High School Female Students

Introduction. Many teenagers experience dissatisfaction with changes in body shape. Mismatched the reality of actual body shape and ideal body image perception triggers negative body image perception, which can cause a decrease in selfesteem. In terms of gender, women's self-esteem levels tend to be lower compared to men. Methods. This study was an observational analytic study with a cross-sectional approach, taken at Fons Vitae I Senior High School with stratified random sampling. The body image was measured by using Body Shape Questionnaire-34 (BSQ-34), and self-esteem was measured by using the Rosenberg Self Esteem Scale (RSES) questionnaire. Data are analyzed using chi-square. Results. The total respondents were 109 female students. In univariate analysis, there were 13.8% female students who had dissatisfaction with her body image and 86.2% female students who had satisfaction with her body image. Female students with low self-esteem were 19.3%, and high self-esteem was 80.7%. The bivariate analysis shows that there is a significant association between body image and the level of self-esteem among Senior High School female students (p = 0.039) with OR = 3.511. Conclusion. There is a significant association between body image and level of self-esteem.


INTRODUCTION
The World Health Organization (WHO) defines adolescence as someone who has an age range of 10 to 19 years. 1 Adolescence is a period of transition from childhood to adulthood, which begins to experience hormonal, physical, psychological, and social changes 2 which can cause related problems their body image. 3 Body image can be interpreted as a subjective evaluation of a person's appearance. 4 Access to mass media, social, cultural, and family environments can also influence body image by continuously identifying their body image against the perceived ideal body. 5,6 Appearance is an essential component of body image because it is a significant asset, especially for a woman. At puberty, women tend to experience additional fat tissue such as in the hips and breasts compared to men who generally experience a decrease in fat tissue, especially in the limb area. 7 These changes make women more worried because they are often used as a comparison with body image ideal that is slim like a model. 8 If the fact that the actual body shape and the perception of the ideal body image are not suitable, it will lead to the perception of a negative body image which in turn, can lead to a decrease in selfesteem. 9 Self-esteem is an individual's evaluation of himself as a whole, can be positive or negative.
Self-esteem is an essential determinant of mental health and adolescent development. 10 Low selfesteem is often associated with many psychological, physical, and social problems that can interfere with the transition from adolescence to adulthood. 11 Meanwhile, individuals with high self-esteem can view themselves more positively to produce a more open and optimistic mind to interact with their social environment. 12 In terms of gender, the level of self-esteem of women tends to be lower than that of men because men generally have a higher level of satisfaction with physical appearance and himself. 13.14 The purpose of this study was to determine whether there is a relationship between body image and self-esteem levels in SMA Fons Vitae, Jakarta. This research is expected to provide information for other researchers and to develop this research topic so that it can be widely used.

METHODS
This research is an observational analytic study with a cross sectional approach. Data were collected in September 2019. The target population in this study were all students of SMA Fons Vitae I in the 2019/2020 school year. The research sample was 109 respondents. Sampling was done by using stratified random sampling method.

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The dependent variable (dependent) from this study is the level of self-esteem. The independent variable (independent) of this study is body image. Data collection was carried out by researchers by asking respondents who had been randomly selected to fill in the informed consent form, then the researcher gave a questionnaire to respondents using the Body Shape Questionnaire-34 (BSQ-34) and Rosenberg Self Esteem Scale (RSES) questionnaires. The data is then processed and analyzed univariately and bivariately with the chi-square test.

RESULTS
The total number of students who were willing to become respondents and met the inclusion criteria and did not meet the exclusion criteria were 109 students. Demographic characteristics of respondents are divided by age and class. There were 7 people (6.4%) were at the age of 14 years, 36 people (33.0%) were at the age of 15 years, 33 people (30.3%) were at the age of 16 years, and 33 people (30.3%) %) are at the age of 17. For the data on the education level of respondents, it was obtained that 33 people (30.3%) were in high school class 1, 31 people (28.4%) sat in high school grade 2, and 45 people (41.3%) sat in high school grade 3 high school (Table 1).  Based on the analysis with the Fisher Exact Test, it was obtained a p-value of 0.039. This shows that there is a significant relationship between body image and self-esteem levels, meaning that students who have body image dissatisfaction will have a higher tendency to experience low selfesteem levels. The odds ratio obtained is 3.511, which means that students who experience body image dissatisfaction will have a 3.511 times higher chance of experiencing low self-esteem levels compared to students who have body image satisfaction (Table 4).  16 . This means that the majority of young women already have positive perceptions, feelings, and thoughts about their bodies which are often associated with body size estimation, evaluation of body attractiveness, and emotions related to body shape.
Body image is a physical image of the body that is subjective. Changes such as the addition of fat tissue that tend to be experienced by women 7 , the strong role of mass media factors, peers 8 , parents, gender, race / ethnicity, socioeconomic status, and body mass index 11 can affect a perception of body image which if not appropriate will cause concern . Adolescents who have a positive body image will appreciate their body more and believe in their abilities, resulting in satisfaction with their body image. 18 On the other hand, adolescents with negative body image will produce dissatisfaction with their body image, which can lead to adverse effects such as eating disorders.
Then, based on the data on the level of self-esteem, it was found that the majority of Self-esteem is an important variable in determining behavior created by social and cultural forces. 22 Self-esteem is influenced by various factors such as parenting, social environment, demographics, socioeconomic status, and self. 23 Adolescents with low self-esteem tend to have a more sensitive view, feelings that are vulnerable to themselves, are not easily loved, awkward, and feel inadequate. 24  which supports the theory that there is a correspondence between the actual body shape and the perception of ideal body image, so that it will trigger a positive body image perception that can increase the level of self-esteem higher.
Adolescents are particularly vulnerable to body shape dissatisfaction due to the physiological, psychological, and social changes they experience 27 . Dissatisfaction with weight and body shape is an obstacle that is often faced by adolescents, especially women and can reduce self-esteem levels.
However, this can be overcome if they have accepted their bodies in any condition, are in accordance with their ideal body image 28 , or have received high enough social support such as family, friends, and teachers who do not question the assessment of a teenager's negative body image. Because of this social support, they are able to increase self-esteem even though their subjective assessment of themselves is still negative. 26 According to Kitri Nour Hamidea, et al (2017) that someone who comes from a low level of socioeconomic status tends to have lower self-esteem. Even though a person has assessed his body image positively, if the role of the social and economic environment is not supportive, it can reduce one's self-esteem. 29 Thus, the concept of body image and self-esteem cannot stand alone. These two variables can be influenced by various factors that can affect the good or bad results of a person's body image and self-esteem.