Development and validation of the Japanese version of Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised (SATAQ-4R) among Japanese adolescents

PURPOSE: Internalization of appearance ideals and sociocultural pressures contribute to body dissatisfaction and eating disorders. Japanese adolescents report high levels of body dissatisfaction despite relatively low body mass index compared to peers in other countries, highlighting potential cultural influences. However, the Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised (SATAQ-4R) has not been validated in Japan. This study aimed to develop a Japanese version of the SATAQ-4R and examine its psychometric properties among Japanese adolescents. METHODS: A nationwide population-based study was conducted in 2023 among 1,368 adolescents aged 11-17 years (girls: n = 694; boys: n = 674). Participants completed self-reported questionnaires. The factor structure of the SATAQ-4R was evaluated using exploratory and confirmatory factor analyses (EFA and CFA), internal consistency was assessed using Cronbach's alpha, and convergent validity was examined using eating-related measures. RESULTS: EFA suggested a five-factor 23-item structure for girls and a seven-factor 23-item structure for boys. CFA showed suboptimal fit for the female model and comparatively better fit for the male model. Most subscales showed acceptable internal consistency, although one female pressure-related subscale showed inadequate reliability. Correlations with external measures provided partial evidence of convergent validity, with associations varying by sex and subscale. CONCLUSION: These findings provide preliminary evidence for psychometric properties of the Japanese SATAQ-4R. However, suboptimal female model fit, inadequate reliability of one female subscale, and mixed convergent validity evidence indicate that the resulting Japanese models should be used with caution. LEVEL OF EVIDENCE: Level III, cross-sectional observational study.