Are Body Size Misperception or Body Image Dissatisfaction Potential Influences in Addressing Obesity? A Mediation Study in an Adult Mexican Population

Obesity is among the most prevalent health conditions worldwide. Incorporating variables beyond metabolic factors, such as body image (BI), may improve understanding of its underlying mechanisms. Body image dissatisfaction (BID) and body size misperception (BSM) have been associated with psychological outcomes; however, further research is needed. This study aimed to characterize BI in Mexican adults with obesity and examine its relationships with BSM and BID. A cross-sectional study was conducted at the Unidad de Investigación en Epidemiología Clínica in 2025. The Stunkard Figure Rating Scale, BSQ-34, BAS-2, and Rosenberg Self-Esteem Scale assessed BSM, body concern (BC), body appreciation (BA), and self-esteem (SE), respectively. Pearson correlations and two PROCESS serial mediation models (6) were applied, with BMI as the dependent variable and age and sex as covariates. Model 1 specified BSM as the independent variable and BC, BA, BID and SE as sequential mediators; Model 2 specified BID as the independent variable and included BSM as the final mediator. BSM and BID were associated with BMI (B = 1.46, p < 0.01 and B = 1.43, p < 0.01). No significant indirect effect was observed. These findings suggest distinct associations of psychological components of body image with obesity.