body image is a multidimensional issue comprising cognitive , perceptual , and behavioral aspects , which begins early in life . there are different theories for the explanation of body image disturbances . based on the objectification theory , children , like adults , internalize the social values and schema of attractiveness , success , and power . these schemas are advertised by the western media , such as action figures , and toys include which thin women and masculine men . the mass media influences children 's beliefs , attitudes , and behaviors . cognitive  behavioral theories explain how feelings and behaviors can affect body image disturbances . however , it seems that the bio - psychosocial model can provide a better explanation . based on this model , body mass index ( bmi ) is considered as an important predictive factor in body satisfaction and related behaviors such as dieting . one of the most important psychological determinants for body image dissatisfaction is self - esteem and negative affect about body . a number of social contributing factors , such as role models and pressure from external sources , can influence body image disturbance . researches argue that these models can explain the body image concerns and body dissatisfaction ( bd ) experienced by children as well as adults . body image concerns and a desire for an ideal body ( thinness for women and masculinity for men ) began as a predominately western phenomenon . thinness is perceived as the ideal and thin individuals are considered to be smart , successful , and attractive . research shows that children aged between 7 and 11 years believe that obese children are lazier and unhappier than thin children . also , they believe that obese children are less liked by others including their parents . in another study , approximately 40% of children aged between 7 and 10 years believe being thin is important for both genders . the preference for thinness is an important variable in the development of self - esteem and body satisfaction . different studies focusing on children reveal that weight gain is associated with higher negative body image . body image dissatisfaction and concerns about having the ideal body is recognized as a health problem . body image dissatisfaction can be harmful to people of all age groups ; however , it can be especially harmful during childhood . bd can result in eating disorders , low self - steam , depression and anxiety , poor interpersonal skills during childhood , unhealthy body change activities , and susceptibility to suicide . bd has been reported as a serious risk factor for unsafe weight reduction methods , severe exercise , and use of drugs for weight reduction or muscle enhancement . the side effects of these methods may be more harmful during childhood than other ages as they may impact growth . several studies argue that the foundation of one 's body image and the ideal body is developed during childhood . this body concern , at this age , could be due to increasing awareness about body , weight status , and desire for attractiveness . these factors , in addition to external pressure from family , peer groups , or the media could induce bd . found that thin boys desire to be larger , but only 44% of thin girls desire to be larger . other studies also emphasize that more boys than girls harbor a desire to be larger . therefore , in order to achieve the ideal body , weight management strategies differ between boys and girls . girls follow strict diets and use weight reduction pills , while boys prefer to use muscle enhancing products such , as steroids and creatine , increase their food intake , and engage in heavy exercise . the majority of research about asian children focuses on immigrant children such as asian - americans . in iran , limited research exists about body image and associated issues , especially during childhood and adolescence . this study has been designed on account of the serious health consequences of bd , and the fact that this phenomenon begins in early childhood . this study evaluates antifat attitudes and body weight concerns and their relationship with gender , age , academic grades , parental education , and bmi in elementary ( preadolescent ) school children . this cross sectional study was undertaken in kerman , one of the largest cities in iran . five - hundred elementary school students , including 242 girls and 248 boys , participated in this study . assessment of body image ( shape ) was done using children 's collins body figure rating scale ( bfrs , 1999 ) . children were asked to select one of the pictures that they think more suitable for these statements : ( 1 ) which one is like you ? ( current body image ) ( 2 ) which one do you look like ? ( desired or ideal body image ) . the subjects were classified into three groups based on absolute number : no bd ( bd = 0 ) , mild dissatisfaction ( bd = 1 ) , and moderate ( notable ) dissatisfaction ( bd > 1 ) . . cut off 1 was selected to ensure adequate sample size in mild and moderate bd groups . in this study bd bmi was divided to four categories underweight ( < 5 percentiles ) , normal weight ( 5 and 85 percentiles ) , overweight ( 85 and 95 percentiles ) and obese ( > 95 percentiles ) for girls and boys . one national study had showed that these cutoff points are appropriate to be used for iranian children and adolescents . two additional questions about desire for friends were asked ( using children 's bfrs ) : ( a ) which one do you think has more friends ? ( b ) which one do you like to be a friend with ? other demographic variables were included gender , age , educational grade , and parental education . statistical analysis was done using spss 16 ( statistical package for social sciences ) , and significance considered 0.05 level . for descriptive analysis , we used central tendency and dispersion ( mean  standards deviation ) . chi - square tests , one - way analysis of variance , t - test , pearson and spearman correlations ad nonparametric tests were used for additional analysis . assessment of body image ( shape ) was done using children 's collins body figure rating scale ( bfrs , 1999 ) . children were asked to select one of the pictures that they think more suitable for these statements : ( 1 ) which one is like you ? ( current body image ) ( 2 ) which one do you look like ? ( desired or ideal body image ) . the subjects were classified into three groups based on absolute number : no bd ( bd = 0 ) , mild dissatisfaction ( bd = 1 ) , and moderate ( notable ) dissatisfaction ( bd > 1 ) . . cut off 1 was selected to ensure adequate sample size in mild and moderate bd groups . in this study bd bmi was divided to four categories underweight ( < 5 percentiles ) , normal weight ( 5 and 85 percentiles ) , overweight ( 85 and 95 percentiles ) and obese ( > 95 percentiles ) for girls and boys . one national study had showed that these cutoff points are appropriate to be used for iranian children and adolescents . two additional questions about desire for friends were asked ( using children 's bfrs ) : ( a ) which one do you think has more friends ? ( b ) which one do you like to be a friend with ? other demographic variables were included gender , age , educational grade , and parental education . statistical analysis was done using spss 16 ( statistical package for social sciences ) , and significance considered 0.05 level . for descriptive analysis , we used central tendency and dispersion ( mean  standards deviation ) . chi - square tests , one - way analysis of variance , t - test , pearson and spearman correlations ad nonparametric tests were used for additional analysis . the mean weight of participants was 32.40 ( 12.01 ) in girls and 31.78 ( 9.41 ) in boys ; there was no significant gender difference . in addition , there was no significant gender difference in terms of height ( girls = 135 cm  18.44 , boys = 134 cm  15.72 [ p > 0.05 ] ) . selected characteristics of respondents there was a significant difference in bmi ( categorized ) between boys and girls ( p < 0.05 ) . although there was a significant relationship between bmi and age ( p < 0.05 ) and academic grades ( p < 0.05 ) for both genders , there was a significant relationship between bmi and maternal education ( p < 0.05 ) for girls . there was a significant difference in the current body image score for girls ( 3.79  1.45 ) and boys ( 4.31  1.31 ) ( p < 0.05 ) . in addition , there was a significant gender difference related to ideal body images ( 3.45  1.45 for girls and 4.32  1.36 for boys [ p < 0.05 ] ) . further , there was a significant difference in bd ( subtracting the ideal body from the current body ) between boys and girls ( p < 0.05 ) . there was no relationship between bd and education of parents , age , or academic grades . however , there was a significant relationship between bd and bmi ( df = 2 , p < 0.05 ) . categorization of bd based on gender antifat attitudes were assessed by two additional questions relating to selecting friends :  who do you think has more friends ?  ( s3 ) and  who would you like to be friends with ? tables 3 and 4 summarize the images that were selected by both boys and girls . results demonstrate a significant difference in the manner in which boys and girls answered these questions ( p < 0.05 ) . responses to the question  which one do you think has more friend ?  the selection of figures ( antifat attitudes ) had no relationship with boys bmi , however , thinner girls ( lower bmi ) selected images of thinner children . correlation between some of variables was shown in table 5 . according to the results , boys with higher bd assessed obese children as being more friendly ( r = 0.141 , p < 0.01 ) ; however , they preferred to be friends with thinner children ( r = 0.21 , p < 0.01 ) . although girls with higher bd preferred to be friends with thinner children ( r = 0.208 , p < 0.01 ) , there was no correlation between girls bd and their selection of friends ( r = 0.125 , p > 0.05 ) . in some of the studies , 60% of girls expressed a desire to be thin versus 38% of boys . also , studies focusing on asian children highlight the same gender difference . one national study in iran , highlights children 's desire to be thin , especially girls . in a survey conducted as part of the aforementioned study , approximately 25% of children and adolescents believed they were of normal weight , while 50% of children and adolescents believed they were obese . socio - cultural messages about manhood are associated with a strong and muscular body especially , in asian cultures . in iranian culture , men are expected to be brave and protect women ; therefore , it is not surprising that boys desire to be larger . some studies argue that gender differences in perception of body size based on the figure rating scale may be due to boy 's desire for masculinity . as these figures are designed to represent silhouettes ranging from thin to obese ( small versus large ) , masculinity is ignored in this scale ; consequently , boys select silhouettes with larger bodies . body mass index is introduced as a risk factor of bd in adolescents and adults , especially for women . research undertaken by davison et al . demonstrates a correlation between bmi and bd in preschool girls . in this study , nearly 27% of children were underweight , and 13% of children were obese . in a previous study , approximately 17.3% of iranian children and adolescents were underweight , and 17.7% were overweight or obese . this difference may be due to the younger age group and smaller sample size of this study . given the high rates of childhood obesity and its impact on bd and eating disorders , serious preventive planning is required which encompass school - based programs . messages about the ideal body affect individuals , especially children , via the media , their family , and peer groups . the desire to be accepted by family and friends can cause body concerns and a preoccupation with achieving an ideal body . parental reactions and attitudes toward the appearance of their children can lead to bd among children . the opinions of parents have a greater impact on elementary school children than younger children . researches argue that children have negative opinions regarding their overweight peers ( antifat attitudes ) . understanding the reasons children harbor antifat attitudes is important to ensuring the success of interventional programs . children that are exposed to negative messages about weight are prone to developing negative attitudes toward obese individuals , regardless of their bmi . in a study conducted by cramer and steinwert , children aged between 3 and 5 years viewed thin or average pictures of children as being while cramer and steinwert 's research did not highlight any gender differences in this regard , holub observed more negative attitudes toward obese people in preschool girls than boys . this study found a relationship between bmi and girls perception of children with more friends . this finding emphasizes the body image disturbances issues experienced by girls . according to the relationship between bmi and bd , social and familial messages about thinness have a greater impact on girls than boys ; this may explain by boys desire to be larger . it appears that body image concerns and its consequences , such as eating disorders , are increasing in asian cultures , including in iran . one iranian study has shown that the number of girls who are overweight or obese is greater among those with highly educated mothers . therefore , it is necessary to study the predictive factors of obesity and body image disturbances and associated behaviors ( such as body management strategies ) among iranian children and families . healthcare planners , researchers , educators , and parents are concerned about body image issues and its consequences in childhood . it is recommended that asian countries work to identify the related risk factors particularly , during childhood . identifying the risk factors of body image and related issues will be helpful in terms of developing preventive and therapeutic protocols . given the limitations of this study , it is recommended that future studies further explore body image concerns and its associated behaviors or consequences among iranian children .
background : there is increasing evidence that children are showing body image issues in recent years . 
 body image disturbances in childhood must be taken seriously . 
 the thin ideal is becoming more prominent in asian countries ; however , there is little research examining how this issue affects iranian children . 
 this study explores body weight concerns and associated factors among children in iranian elementary schools.methods:this study was conducted in 500 elementary schools . 
 an assessment of body image and antifat attitudes was undertaken using the figure rating scale . 
 in addition , body mass index ( bmi ) and demographic variables were assessed.results:nearly , 27.4% of children were underweight , and 13.3% were obese . 
 there was a significant difference between the mean score of body dissatisfaction ( bd ) between boys and girls ( p < 0.05 ) . 
 there were no differences between bd and education of parents , age , and academic grades . in girls , antifat attitudes 
 were significantly related to bmi.conclusions:the results of this study demonstrate the paramount importance of undertaking further research in order to identify the predictive factors of body concerns and its consequences among iranian children . 
 in addition , researchers must plan prevention and educational program for these children .