Body Shape Questionnaire:
Studies of Validity and Reliability
James C. Rosen
Adele Jones
Elena Ramirez
Shari Waxman
(Accepted 28 July 1995)
Objective: The Body Shape Questionnaire (BSQ) is a useful measure of weight and shape
concern. The purpose of this study is to contribute new psychometric information on the
BSQ in order to assist clinicians and researchers who intend to use this measure. Method:
This paper reports average scores on American samples of clinical subjects referred for body
image problems, obese persons seeking weight reduction, and nonclinical samples of college
students and adults. Results and Discussion: The BSQ demonstratedgood test-retest reliability,
concurrent validity with other measures of body image, and criterion validity for clinical
status. 0 1996 by John Wiley & Sons, Inc.
The Body Shape Questionnaire (BSQ) was developed by Cooper, Taylor, Cooper, and
Fairbum (1987) to measure concern about body weight and shape experienced by persons
with eating disorders or related body image problems. To date, the body image questionnaires that have been used most often with weight-preoccupied subjects are the Body
Dissatisfaction scale of the Eating Disorder Inventory (EDI; Garner & Olmsted, 1984), the
Eating Attitudes Test (EAT; Gamer & Garfinkel, 1979), and ratings of ideal body figure
drawings (e.g., Williamson, Davis, Bennett, Gorenczny, & Gleaves, 1989). These questionnaires are appropriate for assessing dissatisfaction with weight or shape. However, an
advantage of the BSQ seems to be the inclusion of questions that tap into other important
body image symptoms, such as distressing preoccupation with weight and shape,
embarrassment in public and avoidance of activity or exposure of the body due to selfconsciousness, and excessive feelings of fatness after eating. The Eating Disorder Examination (EDE; Cooper & Fairbum, 1987) also taps into these symptoms, but in an interview
format. In sum, the BSQ seems to be relevant and practical measure of body image
symptoms for persons with excessive concerns about weight or shape.
James C. Rosen, Ph.D., is Professor of Psychology at the University of Vermont. Adele Jones and Elena Ramirez
areclinical psychology graduate students, and Shari Waxman was an undergraduatestudent. Addresscorrespondence
to Dr. Rosen, Department of Psychology, University of Vermont, Burlington, VT 05405.
international journal of Eating Disorders, Vol. 20, No. 3, 31 5-31 9 (1996)
0 1996 by John Wiley & Sons, Inc.
CCC 0276-3478/96/030315-05
Rosen et al.
31 6
The purpose of this study is to contribute new psychometric information on the BSQ
in order to assist clinicians and researchers who intend to use this measure. (1) We
calculated the test-retest reliability. This coefficient is required to compute the standard
error of measurement, (square root of 1 minus test-retest reliability) X standard deviation,
which in turn would be required to compute a confidence interval for clinically significant
change (Speer, 1992) on the BSQ. The test-retest statistic has not been available. (2) We
examined the concurrent validity of the BSQ with the Multidimensional Body-Self Relations Questionnaire (MBSRQ; Brown, Cash, & Mikulka, 1990) and the Body Dysmorphic
Disorder Examination (BDDE; Rosen, Reiter, & Orosan, 1995).To date, the BSQ has been
validated with measures of weight dissatisfaction (Cooper et al., 1987; Evans & Dolan,
1993),but not with overall appearance concerns as measured by the MBSRQ and BDDE.
(3) To date, the BSQ has been studied with young women and bulimia nervosa patients
(Cooper et al., 1987;Evans & Dolan, 1993).We examined the BSQ in normal older women
and clinic-referredwomen with body image problems who do not have an eating disorder.
(4)Because the BSQ is positively correlated with weight (Evans & Dolan, 1993),we thought
the measure would be appropriate for body image concerns in obesity. Therefore, we
examined the BSQ with various clinical and nonclinical obese subjects, including obese
men. (5) Previous studies used British subjects. This report is based on American samples.
METHOD
Subjects
Participants included 466 women and men from four study samples (see Table 1).
(1) Body image therapy patients were women who had requested treatment in an outpaTable 1. Body Shape Questionnaire and sample characteristics
~
Body Image
Therapy Patients
Number of subjects
Total
Obese
Nonobese
Age
Total
Obese
Nonobese
Body mass index
Total
Obese
Nonobese
Body Shape Questionnaire
Total
Obese
Nonobese
Number of subjects
Age
Body mass index
Body Shape Questionnaire
Obese Dieters
University
Undergraduates
University Staff
Women
155
72
83
59
-
163
-
-
89
25
64
41.4 (10.0)
41.1 (9.4)
41.6 (9.9)
35.6 (11.4)
40.4 (10.6)
31.5 (10.5)
41.7 (11.0)
-
18.5 (1.9)
27.9 (6.9)
33.8 (5.8)
22.9 (2.6)
33.5 (4.6)
21.7 (2.7)
-
24.1 (4.7)
34.2 (6.1)
22.5 (2.2)
129.9 (29.0)
135.6 (27.9)
125.1 (29.2)
123.1 (27.9)
-
96.3 (32.8)
75.8 (28.4)
97.8 (36.1)
72.9 (28.7)
-
-
-
-
Men
24
46.7 (8.4)
35.2 (4.4)
86.6 (20.7)
-
-
-
-
-
Note. Statistics for age, body mass index, and Body Shape Questionnaire are means with standard deviations
in parentheses.
31 7
Body Shape Questionnaire
tient program offering cognitive behavioral body image therapy. They were referred
by physicians (psychiatrists, general physicians, cosmetic surgeons) and mental health
therapists, or they were self-referred in response to newspaper advertisements. The types
of body image problems included body dysmorphic disorder symptoms and weight
preoccupation in normal and obese persons. Patients with anorexia or bulimia nervosa
were excluded from the study sample. The BSQ had been studied with eating disorder
patients previously (Cooper et al., 1987). (2) Obese dieters were men and women who
enrolled in a weight reduction program offered by an outpatient health maintenance
organization. All subjects were obese, defined as equal to or greater than a body mass
index (BMI)of 27.3. (3) University undergraduates were mainly freshwomen introductory
psychology students who volunteered for a study on ”gender and self-image” in exchange
for extra credit. (4) University staff were female employees who were randomly solicited
from the staff telephone directory to participate in a study of self-image.The participation
rate was 66% of those contacted.
Subjects completed a demographic questionnaire, the BSQ (Cooper et al., 1987),MBSRQ
(Brown et al., 1990), and BDDE (Rosen et al., 1995), and were measured for height and
weight by a research assistant. Measures were taken prior to treatment in the case of
clinical subjects. Because the BSQ seems to tap into stereotypic female weight concerns
rather than typical male concerns, it was not administered to male body image therapy
and nonclinical subjects. Male obese dieters, who presumably were more concerned with
weight, did complete the BSQ. There were sufficient obese subjects among the female
body image therapy patients and university staff to divide them into subsamples of obese
and nonobese. Because only 5% of the undergraduate women were obese, that sample
was not subdivided. Thirty-three undergraduate women were randomly selected for a
test-retest reliability sample. The second administration of the BSQ was 3 weeks after
the first.
Obese dieters and university staff were significantly older than body image therapy
patients, who were significantly older than undergraduates, F = 184.8, p < .0001. The
age ranges for the three samples of adult subjects (not including undergraduates) were
about the same, 20 to 68 years. Nonobese body image therapy patients were younger
than nonobese university staff, t (145) = 5.98, p < .001. All four groups differed significantly
from each other on BMI, F = 91.9, p < .0001. Obese subjects, including the men, were in
the moderately severe obesity range, on average.
RESULTS AND DISCUSSION
Descriptive Statistics
The female groups differed significantly on the BSQ, F = 68.7, p < .0001. In paired
comparisons, the body image therapy patients and obese dieters reported more negative
body image on the BSQ than the undergraduates who were more negative than the staff.
The subsamples of women differed according to main effects of group (body image
patients vs. staff) and weight (obese vs. nonobese), F = 139.79,14.63, p < .001, respectively.
Post hoc comparisons indicated that all four subsamples differed from each other at p <
.05. The male obese dieters reported less negative body image symptoms on the BSQ than
the female dieters, t = 6.56, p < .001. These results support the criterion validity of the
BSQ in that it differentiatesclinical from nonclinical subjects and persons with predictably
more or less weight concern (obese vs. nonobese persons).
Rosen et al.
318
In previous studies (Cooper et al., 1987; Evans & Dolan, 1993), young British women
from community and student groups averaged 81 and 85 on the BSQ. According to the
present findings, American undergraduate women score higher and older community
women score lower. The mean score for body image therapy patients is similar to Cooper
et ale'sreport of bulimia nervosa patients, indicating that the BSQ should be elevated for
women with different types of body image and weight complaints. Obese women report
much more distress about weight and shape on the BSQ than nonobese women. However,
clinical status is an important consideration with BSQ scores, because the obese body
image patients and dieters were significantly more distressed than the obese university
employees. Moreover, distress on the BSQ is positively correlated with degree of overweight (see the correlations in Table 2).
Test-Retest Reliability
The reliability coefficient was .88, p < .001. Reliability coefficients were significant at
p < .01 for all 34 items.
Concurrent Validity
Table 2 reports correlations between the BSQ and other body image measures. The BSQ
was strongly related to the BDDE which measures feelings of shame and embarrassment
about appearance, excessive importance given to appearance in self-evaluation,and body
checking and avoidance behavior. The BSQ also was related to Appearance Evaluation
(negative correlations mean that more distress on the BSQ is associated with less positive
feelings of attractiveness, i.e., lower scores on the MBSRQ); Appearance Orientation
(tendencies to groom and pay attention to one's appearance a great deal); and Body
Areas Satisfaction (satisfaction with nine body areas) subscales of the MBSRQ. The BSQ
demonstrated good concurrent validity for all clinical and nonclinical samples. These
correlations indicate that negative body image attitudes expressed on the BSQ are related
to other types of negative body image symptoms, including concerns about nonweightrelated appearance features.
In conclusion, these studies show that the BSQ is a reliable and valid measure of body
image. Although we found that the BSQ has acceptable concurrent validity for obese men,
more information is needed about its appropriateness for men. The descriptive sample
Table 2. Correlations of the Body Shape Questionnaire with body mass index and other
measures of body image
Measure
Body Dysmorphic
Disorder Examination
Multidimensional Body-Self Relations
Questionnaire
Appearance Evaluation
Appearance Orientation
Body Areas Satisfaction
Body mass index
Body Image
Therapy
Patients
.58*
- .47*
.29*
- .53*
.19*
Obese
Dietersa
.81*
- .66'
.58*
- .71*
.oo
University
Undergraduates
University
Staff
,778
.78*
- .67*
- .59*
.28
- .68'
.39*
.29'
- .66'
.30*
"Male and female subjects were combined because their correlations were equivalent.
' p < .05 (after Bonferroni correction for correlations between the Body Shape Questionnaire (BSQ) and body
image measures; unadjusted significance levels for correlations between BSQ and body mass index).
Body Shape Questionnaire
319
statistics provided here might be useful for researchers and clinicians who wish to have
some standard with which to compare their subjects.
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