Protocol Id 020401
Description of Protocol
This protocol encompasses self-reported prior, current, or ideal body image of the respondents and their children. The majority of studies using pictograms have used
Stunkard’s scale, which contains nine silhouettes that are on an ordinal scale. An alternate using Collins has also been provided. Specific pictograms for African
Americans and children are also included.
Specific
Instructions
Participants are instructed to choose the picture from the pictogram that they think represents their actual size at a specific age or, as instructed and when appropriate, circle the size they would ideally like to be at another age or currently. The pictograms can also be used to provide input on body size/image of children and/or parents. See Protocol Text for more detail.
Protocol
Text
The following protocol is taken from a personal interview study in which study participants are asked to self-report about their own body image and then report about first-degree family members.
Please refer to the following adult and child pictures below to answer the following questions about yourself and your first-degree family members (e.g., mother, father, and/or children).
TO BEGIN:
Step 1: Look at the pictures below of males or females and try to choose the picture that most closely resembles how you looked at each age listed below.
Step 2: Look at the adult and child pictures. Choose the picture that most closely resembles your (or your child’s) body shape right now and at the ages of 5, 10, and
20. The child pictures should be used for ages 5 & 10 and the adult pictures for ages 20 or older.
Editor’s Note: The participant is shown pictures that display various body shapes associated with a scale. For adults, three scales are provided here. The Stunkard graphics show nine images for men and for women. Consequently, the responses should be recorded on a form that includes 1 through 9. Pulvers et al. provided graphics validated for African American men and women on a 1 to 9 scale. Collins presents a range of seven male and seven female figures. Consequently, the forms indicated can be used with those graphics. (The Working Group was not aware of other population-specific graphics.) For children, Collins provides graphics for
boys and for girls on a 1 to 7 scale. All graphics are provided below.

PARTICIPANT (Stunkard or Pulvers Scale)
PARTICIPANT (Collins Scale)
PARTICIPANT’S CHILDREN (Collins Scale)

PARTICIPANT’S CHILDREN (Collins Scale)
Collins Adult Female
Editor’s Note: To score this scale, please record a number 1 through 7
corresponding to the figure the respondent indicates for the Collins scale.
Adapted from Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10,199-
208.

Stunkard Adult Female
Editor’s Note: To score this scale, please record 1 through 9 corresponding to the
figure the respondent indicates for the Stunkard scale.
Adapted from Stunkard, A. J., Sorensen, T., & Schulsinger, F. (1983). Use of the
Danish Adoption Register for the study of obesity and thinness. Research
Publications - Association for Research in Nervous and Mental Disease, 60, 115-
120.
Collins Adult Male
Editor’s Note: To score this scale, please record a number 1 through 7
corresponding to the figure the respondent indicates for the Collins scale.
Adapted from Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10,199-
208.

Stunkard Adult Male
Editor’s Note: To score this scale, please record 1 through 9 corresponding to the
figure the respondent indicates for the Stunkard scale.
Adapted from Stunkard, A. J., Sorensen, T., & Schulsinger, F. (1983). Use of the
Danish Adoption Register for the study of obesity and thinness. Research
Publications - Association for Research in Nervous and Mental Disease, 60, 115-
120.
Pulvers Adult African American Female
Editor’s Note: To score this scale, please record a number 1 through 9
corresponding to the figure the respondent indicates for the Pulvers scale.
Adapted from Pulvers, K. M., Lee, R. E., Kaur, H., Mayo, M. S., Fitzgibbon, M. L.,
Jeffries, S. K., Butler, J., Hou, Q., & Ahluwalia, J. S. (2004). Development of a culturally relevant body image instrument among urban African Americans. Obesity
Research, 12, 1641-1651.

Pulvers Adult African American Male
Editor’s Note: To score this scale, please record a number 1 through 9
corresponding to the figure the respondent indicates for the Pulvers scale.
Adapted from Pulvers, K. M., Lee, R. E., Kaur, H., Mayo, M. S., Fitzgibbon, M. L.,
Jeffries, S. K., Butler, J., Hou, Q., & Ahluwalia, J. S. (2004). Development of a culturally relevant body image instrument among urban African Americans. Obesity
Research, 12, 1641-1651.
Collins Child Female
Editor’s Note: To score this scale, please record a number 1 through 7
corresponding to the figure the respondent indicates for the Collins scale.
Adapted from Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10,199-
208.

Selection
Rationale
Collins Child Male
Editor’s Note: To score this scale, please record a number 1 through 7
corresponding to the figure the respondent indicates for the Collins scale.
Adapted from Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10,199-
208.
Pictograms have been associated with health outcomes including diabetes, hypertension, coronary disease, and mental health status. They may be used to identify current, younger, and/or ideal body image; and when used to assess image over time, a chronological approach for age-specific groups has been used. Use of an ethnic group-specific body image is advisable, as size and perception may vary by ethnicity.
Source Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10, 199-208.
Pulvers, K. M., Lee, R. E., Kaur, H., Mayo, M. S., Fitzgibbon, M. L., Jeffries, S. K.,
Butler, J., Hou, Q., & Ahluwalia, J. S. (2004). Development of a culturally relevant body image instrument among urban African Americans. Obesity Research,
12, 1641-1651.
Stunkard, A. J., Sorensen, T., & Schulsinger, F. (1983). Use of the Danish Adoption
Register for the study of obesity and thinness. Research Publications - Association
for Research in Nervous and Mental Disease, 60, 115-120.
Language English
Participant Participant, aged 6 years and older for self-report
Personnel and
None

Training
Required
Equipment
Needs
Flash cards depicting body image scales
Standards
Standard Name
Common Data Elements (CDE) Person Body Image
Rating Scale Value
Logical Observation Identifiers Names and Codes (LOINC)
Body image proto
ID
2794263
63522-7
Source
CDE Browser
LOINC
General
References
Cachelin, F. M., Monreal, T. K., & Juarez, L. C. (2006). Body image and size perceptions of Mexican American women. Body Image, 3(1), 67-75.
Costello, E. J., Sung, M., Worthman, C., & Angold, A. (2007). Pubertal maturation and the development of alcohol use and abuse. Drug and Alcohol
Dependence, 88(Suppl. 1), S50-59.
Doswell, W. M., Millor, G. K., Thompson, H., & Braxter, B. (1998). Self-image and self-esteem in African-American preteen girls: implications for mental health. Issues in Mental Health Nursing, 19(1), 71-94.
Graber, J. A., Seeley, J. R., Brooks-Gunn, J., & Lewinsohn, P. M. (2004). Is pubertal timing associated with psychopathology in young adulthood. Journal of
the American Academy of Child and Adolescent Psychiatry, 43(6), 718-726.
Maximova, K., McGrath, J. J., Barnett, T., O’Loughlin, J., Paradis, G., & Lambert,
M. (2008). Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents. International Journal of Obesity, 32(6),
1008-1115.
Must, A., Phillips, S. M., Stunkard, A. J., & Naumova, E. N. (2002). Expert opinion on body mass index percentiles for figure drawings at menarche.International
Journal of Obesity, 26(2), 876-879.
Olvera, N., Suminski, R., & Power, T. G. (2005). Intergenerational perceptions of body image in Hispanics: role of BMI, gender, and acculturation. Obesity
Research,, 13(11), 1970-1979.
Siegel, J. M., Yancey, A. K., Aneschensel, C. S., & Schuler, R. (1999). Body image, perceived pubertal timing, and adolescent mental health. Journal of Adolescent
Health, 25(2), 155-165.
Snooks, M. K., & Hall, S. K. (2002). Relationship of body size, body image, and selfesteem in African American, European American, and Mexican American middleclass women. Health Care for Women International, 23(5), 460-466.

Protocol
Type
Derived
Variables
Self- or proxy-reported value
None
Requiremen ts
Requirement Category
Average time of greater than 15 minutes in an unaffected individual
Average time of greater than 15 minutes in an unaffected individual
Required
No
Major equipment
This measure requires a specialized measurement device that may not be readily available in every setting where genome wide association studies are being conducted. Examples of specialized equipment are
DEXA, Echocardiography, and Spirometry
No
No Specialized requirements for biospecimen collection
This protocol requires that blood, urine, etc. be collected from the study participants.
Specialized training
This measure requires staff training in the protocol methodology and/or in the conduct of the data analysis.
No