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27 September 2026

20 Pages

Psychometric Evaluation of the Brief MBSRQ-AS15 Across Sexes: Structural Validity, Scalar Invariance, and the Male Overweight Preoccupation Caveat

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1
Department of Physical Education & Sport Science, Aristotle University of Thessaloniki, 62122 Serres, Greece
2
Department of Physical Education & Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
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Department of Physical Education & Sport Science, University of Thessaly, 42100 Trikala, Greece
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Author to whom correspondence should be addressed.
Obesities2026, 6(5), 70;https://doi.org/10.3390/obesities6050070
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Abstract

Assessing body image efficiently requires brief, psychometrically sound instruments. This study evaluated the 15-item short-form Appearance Scales of the Multidimensional Body-Self Relations Questionnaire (MBSRQ-AS15) to determine its structural validity, internal consistency, and cross-sex measurement invariance. A community sample of 1776 Greek adults (899 men, 877 women; mean age = 33.68 ± 9.89 years) completed the MBSRQ-AS15 alongside validation measures (Rosenberg Self-Esteem Scale [RSES], Eating Attitudes Test-26 [EAT-26]). Sex-specific Confirmatory Factor Analysis (CFA) and Multi-Group CFA evaluated factor structure and scalar invariance. The five-factor model showed excellent fit in women (CFI = 0.984, RMSEA = 0.070) but poorer fit in men (CFI = 0.946, RMSEA = 0.105). Multi-group analysis established full scalar invariance (ΔCFI = 0.000). Internal consistency was robust in women (ω = 0.681–0.843) and most male subscales, except Overweight Preoccupation (OWPREOC) (ω = 0.477). Convergent validity was supported, though OWPREOC correlated weaker with eating attitudes in men (r = 0.348) than women (r = 0.555; z = −5.52, p < 0.001). To facilitate preliminary empirical research, sample-based reference percentiles for community comparisons are provided. Overall, the MBSRQ-AS15 offers a practical brief option for body image research, though its psychometric performance remains distinctly stronger in women than in men. While scalar invariance enables mean comparisons, male weight preoccupation scores require cautious interpretation due to potential confounding with muscularity goals.

1. Introduction

Accurate evaluation of body image in large-scale epidemiological and clinical research requires instruments that balance theoretical comprehensiveness with low respondent burden [1,2]. Comprehensive questionnaires, such as the full 69-item Multidimensional Body-Self Relations Questionnaire (MBSRQ) [3] provide detailed multi-domain coverage but impose high participant burden, increasing completion time and dropouts [4,5]. Empirical usability research demonstrates that completion time decreases notably from ~10 min for 19-item instruments to ~5 min for 10-item instruments [2]. Consequently, brief scales, such as the Body Shape Questionnaire 8-item Direct version (BSQ-8D), Body Image Acceptance and Action Questionnaire 5-item version (BI-AAQ-5), and Body Image Life Disengagement Questionnaire (BILD-Q), are increasingly favored in population studies because they reduce participant burden while maintaining psychometric integrity [6,7,8]. However, most brief alternatives are strictly unidimensional, capturing only global satisfaction or disengagement while omitting distinct cognitive, affective, and behavioral dimensions.
The Appearance Scales of the MBSRQ (MBSRQ-AS) are widely recognized as a valid multi-subscale framework for appearance-related body image [9,10]. The original version evaluates five core factors: Appearance Evaluation (APPEVAL), Appearance Orientation (APPOR), Overweight Preoccupation (OWPREOC), Self-Classified Weight (WTCLASS), and the Body Areas Satisfaction Scale (BASS) [3,9]. The original five-factor structure has been confirmed across diverse populations, including Spanish, French, Brazilian, German, and Polish adaptations [9,10,11,12,13]. However, establishing measurement invariance across sexes remains a significant psychometric hurdle [14,15]. Cross-cultural studies show mixed invariance results: while some adaptations support baseline structures, others fail to achieve scalar invariance across sex (e.g., in Malay adults) or demonstrate gender-linked differential item functioning [14,15]. In particular, the BASS and OWPREOC subscales frequently exhibit gender non-invariance, complicating direct cross-gender mean comparisons [14,16].
A major underlying factor contributing to gender non-invariance in body image instruments is the conceptual difference between male and female body dissatisfaction [17,18]. While female dissatisfaction primarily targets thinness and body fat reduction, male body image involves a complex dual orientation toward both leanness and muscularity [17,19]. Crucially, thinness (aiming for a smaller, lighter frame) and low body fat or leanness (reducing adiposity specifically to highlight underlying muscle definition) represent non-equivalent constructs. While some men pursue traditional thinness, for many others, body fat reduction serves as a vehicle for muscular enhancement rather than the attainment of a thin physique [17,18,19]. Drive for muscularity represents a central construct in men, closely tied to masculine norm conformity, appearance comparisons, and behaviors such as weightlifting and performance-enhancing substance use [20,21,22,23]. Drive for thinness and drive for muscularity are not mutually exclusive; rather, they frequently coexist in men [17,19]. Standard weight preoccupation subscales, originally conceptualized around thinness-based anxiety, can create measurement ambiguity in men, as male weight gain is frequently associated with muscular hypertrophy rather than excess adiposity [17,18].
To resolve the tension between comprehensive assessment and participant burden, this study evaluates the 15-item short-form Appearance Scales of the Multidimensional Body-Self Relations Questionnaire (MBSRQ-AS15). Developed using item-level factor loadings and reliability data from the full 69-item Greek MBSRQ validation [24], the MBSRQ-AS15 condenses the five core appearance subscales into a concise instrument. The primary objective is to examine the structural validity, internal consistency, and multi-group measurement invariance (configural, metric, and scalar) of the MBSRQ-AS15 across Greek adult men and women, with special focus on subscale performance and the psychometric behavior of male weight preoccupation [24].

2. Materials and Methods

2.1. Participants and Procedure

A community-based, cross-sectional sample of 1776 Greek adults was recruited for this study. The sample comprised 899 men (50.6%) and 877 women (49.4%). The mean age of the participants was 33.68 years (SD = 9.89, range: 18–59 years). Anthropometric characteristics for the total sample included a mean height of 1.74 m (SD = 0.08), mean weight of 70.95 kg (SD = 13.31), and a mean Body Mass Index (BMI) of 23.28 kg/m2 (SD = 3.37). Specifically, sex-stratified values were as follows: men reported a mean height of 1.80 m (SD = 0.06), weight of 80.43 kg (SD = 9.56), and BMI of 24.86 kg/m2 (SD = 2.71); women reported a mean height of 1.68 m (SD = 0.05), weight of 61.23 kg (SD = 9.23), and BMI of 21.67 kg/m2 (SD = 3.19). This specific age cohort was targeted to capture emerging, young, and middle-aged adults, focusing the investigation on active, working-age community segments. Participants were recruited through a combination of online platforms and physical distribution across community hubs, higher education institutions, athletic associations, sports clubs, and fitness centers across Greece to maximize demographic diversity. Eligibility criteria required participants to be at least 18 years of age and fluent in the Greek language.
The research protocol was reviewed and approved by the Internal Ethics Committee of the Department of Physical Education and Sport Science, University of Thessaly, Greece (Protocol number: 2252, 3-2/11 October 2023). All participants were informed about the objectives of the study, the voluntary nature of their participation, and the guaranteed anonymity and confidentiality of their data. Digital or written informed consent was mandatory prior to accessing the psychometric battery. Data collection followed a strict cleaning protocol. Due to the mandatory-field configuration of the online questionnaire platform, missing data at the item level were entirely eliminated. A total of 12 incomplete or abandoned submissions were automatically filtered out at the server level and excluded from compiling the final database, resulting in a final analyzed dataset of 1776 fully completed responses requiring no statistical missing data imputation. No financial compensation or external incentives were provided for participation.

2.2. Measures

Body image appearance scale was operationalized and assessed utilizing a 15-item, brief form of the appearance-related components of the Multidimensional Body-Self Relations Questionnaire (MBSRQ-AS15). This abbreviated version was specifically structured to capture the core cognitive, behavioral, and affective dimensions of appearance-related body image while minimizing respondent burden. The instrument comprises five distinct subscales based on a specific subset of indicators:
I. Appearance Evaluation (APPEVAL) (4 items: 5, 11, 30, 39; e.g., “My body is sexually appealing.”) measures feelings of physical attractiveness and satisfaction with one’s overall appearance.
II. Appearance Orientation (APPOR) (3 items: 1, 2, 22; e.g., “Before going out in public, I always notice how I look”) assesses the extent of cognitive investment in one’s appearance and grooming behaviors.
III. Overweight Preoccupation (OWPREOC) (2 items: 10, 57; e.g., “I constantly worry about being or becoming fat”) evaluates fat anxiety, weight vigilance, and dieting behaviors.
IV. Self-Classified Weight (WTCLASS) (2 items: 59, 60; e.g., “From looking at me, most other people would think I am…”) measures how individuals perceive and label their own weight.
V. Body Areas Satisfaction Scale (BASS) (4 items: 61, 64, 66, 69) assesses satisfaction with discrete body domains (e.g., face, muscle tone).
All items, except those on the BASS and WTCLASS, are rated on a 5-point Likert scale ranging from 1 (definitely disagree) to 5 (definitely agree). The BASS items utilize a 5-point satisfaction scale ranging from 1 (very dissatisfied) to 5 (very satisfied), while the WTCLASS items are scored on a specific categorical weight classification scale. Subscale scores are calculated as the mean of their constituent items. The full item wording, subscale mapping, and response options for both the English and Greek versions of the instrument are provided in Table S3 (Supplementary File S3).
The selection of these 15 specific indicators was empirically driven rather than arbitrary. Item retention was directly based on psychometric data derived from the parent validation of the full 69-item MBSRQ in the Greek population [24], which performed separate male and female Confirmatory Factor Analyses (CFAs) as well as multi-group invariance testing, confirming full scalar invariance across sexes. Indicators were selected based on consistently high standardized factor loadings across both combined and sex-stratified models. Regarding the BASS subscale specifically, the retention of four indicators (Face, Mid torso, Muscle tone, and Overall appearance) was purposefully designed to preserve content validity across key anatomical and esthetic domains while systematically eliminating anatomical indicators (e.g., lower torso, height) that exhibited weaker factor loadings in the parent scale relative to general muscle tone and overall appearance indicators. This approach yielded a compact 15-item instrument designed to retain core subscale coverage while reducing respondent burden.
Rosenberg Self-Esteem Scale (RSES): To measure global trait self-esteem, the 10-item RSES [25] was employed, assessing participants’ overall sense of self-worth. Responses are gathered on a 4-point Likert agreement scale and consist of five positively worded items (e.g., “In general I am satisfied with myself”) alongside five negatively worded items (e.g., “I feel worthless sometimes”). Higher cumulative scores represent higher self-esteem levels. In the present sample, internal consistency was robust (omega = 0.88, alpha = 0.87). The Greek adaptation of the instrument has exhibited statistically sound validity and reliability across empirical studies [26].
Eating Attitudes Test-26 (EAT-26): Eating disorder risk and symptoms were assessed via the 26-item EAT-26 self-report inventory [27] (e.g., “I think very often that I want to become thinner”). Participants respond using a 6-point forced-choice Likert format ranging from 1 (“never”) to 6 (“always”). For items 1–25, responses are recoded onto a 4-point scoring scheme (3 = “always”, 2 = “usually”, 1 = “often”, and 0 = “sometimes”, “rarely”, or “never”). Item 26 is reverse-scored, and item values are summed to yield a total score. Internal consistency in our sample was high (omega = 0.89, alpha = 0.89). Extensive research across international contexts and Greek populations has consistently substantiated the scale’s construct validity [28,29].

2.3. Statistical Analysis

Statistical analyses were performed using IBM SPSS Statistics, version 31 (IBM Corp., Armonk, NY, USA) and JASP, version 0.97.0 [30]. Prior to model estimation, initial data inspection was conducted in SPSS to evaluate item-level distributional characteristics. Descriptive statistics, including means, standard deviations, univariate skewness, and kurtosis, were computed to outline the sample’s properties. Given the ordinal nature of the 5-point Likert scale indicators and the presence of multivariate non-normality, standard Maximum Likelihood (ML) estimation was deemed inappropriate, as it can bias standard errors and distort goodness-of-fit indices.
Consequently, Confirmatory Factor Analysis (CFA) was conducted in JASP utilizing the Diagonally Weighted Least Squares (DWLS) estimator with robust standard errors and mean- and variance-adjusted test statistics. In the JASP/lavaan environment, this estimation configuration directly corresponds to the robust Weighted Least Squares Means and Variance adjusted (WLSMV) framework, which is widely recognized as optimal for non-continuous, ordinal 5-point Likert indicators in large sample sizes.
Model fit was assessed using multiple standard criteria: the Comparative Fit Index (CFI), the Tucker–Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA) alongside its 90% confidence interval (CI), and the Standardized Root Mean Square Residual (SRMR). Thresholds for acceptable model fit were defined as CFI ≥ 0.90, TLI ≥ 0.90, RMSEA ≤ 0.08, and SRMR ≤ 0.08, with values of CFI/TLI ≥ 0.95 and RMSEA/SRMR ≤ 0.06 indicating excellent fit [31,32,33]. Post hoc modification indices were intentionally not implemented to preserve the original theoretical framework of the MBSRQ-AS and avoid data-driven artificial inflation of fit parameters.
Following the establishment of baseline structural models separately for men and women, Multi-Group CFA (MGCFA) was conducted to evaluate measurement invariance across sexes using a hierarchical, sequential testing paradigm. Invariance was assessed progressively across three nested models: configural invariance (unconstrained model testing structural equivalence), metric invariance (constraining factor loadings across groups), and scalar invariance (constraining both factor loadings and item intercepts/thresholds across groups). Measurement invariance was considered supported if the decrease in CFI (Delta CFI) between nested models was less than or equal to 0.010. Establishing scalar invariance was deemed essential to ensure that latent and manifest subscale mean scores could be validly and meaningfully compared across sexes without measurement bias.
Upon establishing scalar invariance, gender differences in the MBSRQ-AS subscale mean scores were examined using independent-samples t-tests, with effect sizes quantified via Cohen’s d. Internal consistency reliability for the subscales was evaluated using both Cronbach’s alpha (α) and McDonald’s omega (ω) coefficients, computed separately for the male and female subsamples to account for congeneric measurement assumptions. Finally, to establish convergent and criterion-related validity, Pearson correlation coefficients (r) were computed between the MBSRQ-AS15 subscales, global self-esteem (RSES), eating attitudes (EAT-26), and BMI. Differences in the magnitude of these correlations between men and women were statistically compared using Fisher’s z-test. The full correlation matrix is provided in Supplementary File S2.
To facilitate preliminary research evaluation of individual scores, community-based reference percentiles (10th, 25th, 50th, 75th, and 90th percentiles), gender-specific means, standard deviations, and item-level response frequencies were computed for all five MBSRQ-AS15 subscales. Complete sample-based reference tables and frequency distributions are provided in Supplementary File S1.

3. Results

The demographic and anthropometric characteristics of the study sample, stratified by gender, are presented in Table 1. Independent samples t-tests were conducted to examine baseline differences between male and female participants across age, height, weight, and BMI.
Table 1. Demographic and Anthropometric Profiles of Study Participants Stratified by Gender.
As detailed in Table 1, independent-samples t-tests revealed statistically significant baseline differences between men and women across all demographic and anthropometric variables (p < 0.001). Men were significantly older (M = 36.44, SD = 9.90 vs. M = 30.86, SD = 9.05; t(1774) = 12.40, p < 0.001, d = 0.59) and exhibited higher BMI (M = 24.86, SD = 2.71 vs. M = 21.67, SD = 3.19; t(1774) = 22.77, p < 0.001, d = 1.08) compared to women. Large effect sizes were also observed for height (d = 2.10) and weight (d = 2.04), reflecting expected sexual dimorphism.

3.1. Confirmatory Factor Analysis and Model Fit Across Sexes

To evaluate the structural validity of the short-form MBSRQ-AS across sexes, separate CFA were initially conducted for female and male samples using DWLS estimation with robust standard errors to account for the ordinal nature of the item responses. Fit indices and model evaluations for both sexes are summarized in Table 2.
Table 2. Model Fit Indices Comparison for the MBSRQ-AS Across Female and Male Samples.
The five-factor baseline model showed excellent fit within the female sample, χ2(80) = 426.395, p < 0.001, CFI = 0.984, TLI = 0.979, NFI = 0.981, RMSEA = 0.070 (90% CI [0.064, 0.077]), SRMR = 0.061. All fit indices for women exceeded standard psychometric benchmarks for adequate model fit.
Conversely, when the identical five-factor structure was specified for the male sample, model fit showed notable degradation in absolute fit metrics, χ2(80) = 866.968, p < 0.001, CFI = 0.946, TLI = 0.929, NFI = 0.945, RMSEA = 0.105 (90% CI [0.098, 0.111]), SRMR = 0.086. The RMSEA point estimate for men exceeded the recommended threshold of 0.08 (RMSEA = 0.105), indicating poor fit and localized structural misfit of the standard model when applied to male participants.
These pronounced anthropometric differences reflect well-established biological sexual dimorphism and sex-specific variations in lean muscle mass versus adiposity, rather than equivalent levels of body fat dissatisfaction.

3.2. Measurement Invariance Across Sexes

To formally test whether the MBSRQ-AS measures the same underlying constructs in the same way across sexes, a Multi-Group Confirmatory Factor Analysis (MGCFA) was conducted.
First, a configural invariance model (baseline) was tested, allowing parameter estimates to vary freely across male and female groups. The configural model yielded acceptable fit to the data: χ2(160) = 1293.364, p < 0.001, CFI = 0.969, TLI = 0.959, RMSEA = 0.089, SRMR = 0.074. This indicates that the basic five-factor structure is conceptually valid across both sexes. Although the absolute fit index (RMSEA) for the multi-group models was marginally elevated (RMSEA ≈ 0.09), the negligible ΔCFI values strongly support the tenability of the invariance constraints across groups.
Next, a metric invariance model was evaluated by constraining the factor loadings to be equal across both groups. The metric model yielded the following fit indices: χ2(170) = 1415.946, p < 0.001, CFI = 0.966, TLI = 0.958, RMSEA = 0.091, SRMR = 0.077. To evaluate the tenability of the metric constraints, the change in CFI (ΔCFI) was examined. The difference in CFI between the configural and metric models was minimal (ΔCFI = 0.003). Because this value falls well below the recommended threshold for non-invariance (ΔCFI > 0.010), metric invariance is fully supported. This confirms that males and females interpret the scale items similarly, and the specific factor loadings are fundamentally equivalent across groups.
Finally, a scalar invariance model was evaluated by additionally constraining item intercepts and thresholds to be equal across male and female samples. The scalar model exhibited acceptable model fit to the data: χ2(180) = 1448.215, p < 0.001, CFI = 0.966, TLI = 0.956, RMSEA = 0.092 (90% CI [0.088, 0.097]), SRMR = 0.077. The change in CFI between the metric and scalar models was zero (ΔCFI = 0.000), which is well below the 0.010 threshold required to demonstrate invariance. Consequently, full scalar invariance was established across sexes. This outcome indicates that item intercepts and thresholds operate similarly across sexes, providing empirical support for cross-sex mean comparisons, provided that subscale-specific reliability in men is considered.
It should be noted that while the female baseline model displayed good overall fit, the male baseline model exhibited elevated RMSEA (0.105) and SRMR (0.086) values, despite acceptable comparative fit indices (CFI = 0.946, TLI = 0.929). Such inflation of RMSEA is common when using ordinal categorical estimators (WLSMV) in models with relatively small degrees of freedom [31]. Following established guidelines for multi-group invariance [32,33], invariance decision-making was based on the change in comparative fit indices (ΔCFI ≤ 0.010 and ΔRMSEA ≤ 0.015), which supported configural, metric, and scalar invariance across sexes.

3.3. Internal Consistency and Subscale Reliability Evaluation

Evaluation of internal consistency revealed sex discrepancies across subscales, particularly regarding weight preoccupation. Standardized factor estimates and subscale reliability coefficients (McDonald’s ω and Cronbach’s α) are presented in Table 3.
Table 3. Standardized Factor Loadings and Subscale Reliability Coefficients for Females and Males.
For female participants, internal reliability across all subscales was acceptable to strong, with McDonald’s ω coefficients ranging from 0.681 for OWPREOC to 0.843 for APPEVAL. Factor loadings for females were consistently robust across indicators.
In contrast, internal consistency among male participants exhibited noticeable degradation in specific subscales. Most prominently, the OWPREOC subscale showed inadequate reliability in men (ω = 0.477, α = 0.466), failing to meet acceptable psychometric criteria (typically > 0.70). Reliability remained acceptable for APPEVAL (ω = 0.743), APPOR (ω = 0.759), and BASS (ω = 0.685) in men, while the WTCLASS subscale maintained high reliability across both sexes (women ω = 0.835; men ω = 0.848).
Regarding individual item parameters, items MBSRQ 61 (lambda = 0.443 in females, 0.434 in males) and MBSRQ 66 (lambda = 0.390 in females, 0.471 in males) on the BASS subscale displayed factor loadings below the standard 0.50 threshold. However, given that the BASS operates as a domain-sampling measure capturing diverse, non-redundant anatomical domains (e.g., face, mid torso, muscle tone), lower item inter-correlations are typical. Consequently, these items were retained to maintain theoretical content coverage across key anatomical domains, as originally conceptualized in the full-length measure.

3.4. Latent Factor Correlations and Structural Inconsistencies

An examination of standardized latent factor correlations highlighted differences in how body image constructs interrelate across sexes, as shown in Table 4.
Table 4. Standardized Latent Factor Correlations Across Sex Models.
In both female and male models, almost all latent factor pairs exhibited statistically significant correlations (p < 0.001). APPEVAL correlated negatively with OWPREOC in both samples (females r = −0.413, p < 0.001; males r = −0.528, p < 0.001). APPEVAL was positively correlated with BASS across both models (females r = 0.271, p < 0.001; males r = 0.639, p < 0.001).
A non-significant bivariate latent association emerged in both sex samples where APPOR displayed no statistically significant correlation with WTCLASS (females r = 0.003, p = 0.912; males r = 0.034, p = 0.384). Overall, the lower reliability and altered correlation magnitudes surrounding OWPREOC in men support the theoretical proposition that scales focused purely on thinness and weight preoccupation function differently when evaluated in male populations.

3.5. Latent Mean Differences and Manifest Subscale Sex Comparisons

Following the verification of full scalar invariance, sex differences were primarily evaluated by directly comparing the latent factor means (intercepts) within the Multi-Group CFA framework. This approach offers methodological advantages over testing observed scores by accounting for item-level measurement error. With the female group designated as the reference group (latent means fixed to zero), the estimated latent means for the male group revealed significant structural differences across factors that aligned with theoretical expectations.
To complement these structural findings, facilitate cross-study comparisons with previous epidemiological research, and provide interpretable descriptive metrics, standard independent-samples t-tests were also conducted to compare manifest subscale mean scores between men and women. As detailed in Table 5, women scored significantly higher on OWPREOC (t(1774) = 15.31, p < 0.001, d = 0.73) and APPOR (t(1774) = 10.08, p < 0.001, d = 0.48). Conversely, men reported higher APPEVAL (t(1774) = −3.92, p < 0.001, d = −0.19) and BASS (t(1774) = −3.86, p < 0.001, d = −0.18). No significant sex difference emerged for WTCLASS (t(1774) = 1.33, p = 0.182, d = 0.06). These manifest differences were consistent with the latent mean evaluations extracted from the scalar invariance model.
Table 5. Manifest Subscale Mean Scores and Sex Comparisons.

3.6. Convergent and Criterion Validity

To establish convergent and criterion-related validity, Pearson correlation coefficients were computed between the MBSRQ-AS15 subscales, global self-esteem (RSES), eating attitudes (EAT-26), and BMI across the total sample and by sex (see Supplementary File S2 for the full correlation matrix).
APPEVAL displayed strong positive correlations with self-esteem (r = 0.475, p < 0.001; men: r = 0.366, women: r = 0.557) and strong negative correlations with eating attitudes (r = −0.458, p < 0.001; men: r = −0.361, women: r = −0.517), supporting convergent validity. BASS similarly showed positive associations with RSES (r = 0.410, p < 0.001) and inverse associations with EAT-26 (r = −0.193, p < 0.001). WTCLASS exhibited a strong positive correlation with objective BMI (r = 0.589, p < 0.001; men: r = 0.629, women: r = 0.712), supporting convergent validity between perceived weight status and objective anthropometrics. Furthermore, BMI showed moderate inverse correlations with APPEVAL (r = −0.311, p < 0.001) and BASS (r = −0.205, p < 0.001), with both negative associations being stronger in women (r = −0.456 and r = −0.347, respectively) than in men (r = −0.268 and r = −0.107, respectively). APPOR showed no significant association with self-esteem (r = −0.042, p = 0.077), indicating that cognitive investment in appearance represents a distinct construct from APPEVAL.
OWPREOC supported criterion validity as a key correlate of eating attitudes in the total sample (r = 0.474, p < 0.001). However, a Fisher’s z-test revealed that this correlation was significantly attenuated in men (r = 0.348, p < 0.001) compared to women (r = 0.555, p < 0.001), z = −5.52, p < 0.001. This divergence indicates that weight preoccupation accounts for less variance in eating attitudes among men (12.1%) than women (30.8%).

3.7. Reference Percentiles and Score Distributions

Sex-stratified reference percentiles and detailed score distributions for the MBSRQ-AS15 subscales were computed (n = 1776; 899 men, 877 women). Full descriptive statistics, exact percentile ranks, and response frequencies are tabulated in Supplementary File S1. Given the volunteer community-based nature of the sample, these values should be interpreted as preliminary reference distributions for community research comparisons rather than population-representative normative standards.

4. Discussion

The primary objective of the present study was to evaluate the structural validity, internal consistency, and multi-group measurement invariance across sex of the 15-item short-form Appearance Scales of the Multidimensional Body-Self Relations Questionnaire (MBSRQ-AS15) in a sample of Greek adults. Overall, the empirical findings support the baseline five-factor framework while revealing distinct sex-related psychometric nuances. Confirmatory factor analysis indicated excellent model fit in women, whereas the male sample exhibited degraded fit metrics and localized structural misfit. Nevertheless, multi-group testing established configural, metric, and full scalar invariance across sexes, supporting the tenability of cross-sex mean comparisons, provided that subscale-specific reliability constraints in males are taken into account.
However, subscale reliability analyses revealed a notable sex discrepancy: while internal consistency was acceptable to strong across all subscales for females, the OWPREOC subscale displayed inadequate reliability in males (ω = 0.477). Combined with altered latent associations surrounding weight preoccupation in men, these findings indicate that standard thinness-oriented weight preoccupation subscales capture male body image concerns with diminished psychometric precision. Notably, the poor absolute fit observed in the male baseline model, driven primarily by an elevated RMSEA (0.105), represents a clear psychometric weakness and structural misfit of the instrument when applied to men. This localized misfit aligns with theoretical expectations: the scale struggles to model male body image because standard, thinness-focused constructs like OWPREOC do not fully reflect the male muscularity-driven ideal. To pre-empt potential model respecification biases, post hoc modification indices were deliberately avoided, ensuring that fit indices reflect underlying construct representation rather than data-driven adjustments.
Beyond psychometric performance, the intersection of affective experience and rational health cognition is central to understanding behavioral drives, particularly physical activity engagement. Multidimensional body image assessments can inform targeted health promotion strategies by evaluating these dual-motivational interactive pathways. Specifically, efficient instruments like the MBSRQ-AS15 help clinicians simultaneously capture the cognitive appraisal of one’s appearance and localized affective body satisfaction. Evaluating both variables is necessary for designing interventions that concurrently promote health literacy, positive body image, and sustained physical activity engagement [34].

4.1. Measurement Invariance of the MBSRQ/MBSRQ-AS

Evaluating measurement invariance across sexes is a necessary prerequisite for conducting valid comparisons between men and women. International literature regarding the Appearance Scales of the MBSRQ-AS presents a mixed picture, indicating that structural invariance should not be assumed automatically but must be systematically tested in each specific translation and population [35,36]. Some adaptations, such as the full 69-item Greek version of the MBSRQ, achieved full scalar invariance between sexes [24], while psychometric studies in Spain, Germany, Brazil, Pakistan, and Greece confirmed the five-factor structure in mixed samples [9,12,13,37,38].
However, significant discrepancies and failures to establish measurement invariance have been documented in several studies. In the Malaysian translation of the MBSRQ-AS, scalar invariance across sex could not be established [15]. Similar findings were reported in a study among Chilean youth, where significant sex effects were identified across subscales, rendering direct mean comparisons problematic [14]. Furthermore, in clinical and specialized samples, such as women with breast cancer, certain subscales displayed systematic measurement bias [16].
Analyzing the performance of individual MBSRQ-AS subscales reveals a consistent pattern of sensitivity. The BASS, APPOR, WTCLASS, and OWPREOC subscales exhibit the most frequent invariance violations between men and women [14,15,16]. Conversely, the APPEVAL subscale consistently emerges as the most robust and invariant subscale, allowing for reliable comparisons between sexes [14,16]. Regarding the OWPREOC subscale specifically, while the large U.S. Body Project I study supported its scalar invariance across sex [39], other studies advise caution when comparing mean scores between men and women [14,16].

4.2. Reducing Respondent Burden and Brief Body Image Instruments

Respondent burden is defined as the psychological, cognitive, and time effort required to complete questionnaires, and it is directly influenced by the number of items, linguistic complexity, completion time, and overall scale acceptability [1,2,40,41]. In practice, questionnaires with fewer than 20 items are strongly preferred by participants, as they minimize missing data and maximize completion rates [42].
In the field of body image, a range of brief instruments has been developed and validated to minimize participant burden while maintaining high levels of reliability and validity. The 6-item Brief Satisfaction with Appearance Scale (Brief-SWAP) demonstrates excellent internal consistency and structural validity [43]. The 9-item Body Image Life Disengagement Questionnaire (BILD-Q) effectively assesses functional disengagement resulting from body image concerns in adolescents [6]. Additionally, the 4-item Body Image Dimensional Assessment (BIDA) [44], the 6-item short form of the FKB-20 (FKB-6) [45], the revised 9-item BIQ-C [46,47], and the 10-item Body Image Scale (BIS) [48] offer highly practical and psychometrically sound solutions.
Regarding ultra-brief measures backed by confirmatory factor analysis (CFA), the 3-item State Body Appreciation Scale-2 Short Form (SBAS-2SF) represents the shortest validated option for ecological momentary assessment (EMA) research [49]. The 5-item Body Image Acceptance and Action Questionnaire (BI-AAQ) confirms a unidimensional structure and cross-sex invariance [50], while the 7-item Functionality Appreciation Scale (FAS) exhibits high factorial validity and sex invariance [51]. In contrast, single-item measures for appearance satisfaction or body size perception offer high practical utility but lack an underlying factor structure in the strict psychometric sense [52,53]. Despite the strong psychometric properties of the 34-item MBSRQ-AS [9,10], its administration entails a significantly higher respondent burden compared to these shortened alternatives.

4.3. Male Body Image: Drive for Muscularity, Drive for Thinness, and OWPREOC

Male body image is characterized by a dual ideal, wherein the drive for muscularity and the drive for thinness/leanness do not represent opposite poles of a continuum, but rather distinct and frequently co-occurring dimensions [17,19]. It is crucial to conceptually distinguish thinness from leanness in male body image research. Thinness refers to a small physical frame and low overall body weight, whereas leanness reflects an athletic physique characterized by low adiposity combined with visible muscle definition. Conflating these constructs risks misclassifying distinct bodily ideals and motives [19]. Nearly two-thirds of late adolescent males simultaneously report a desire to increase muscle mass and decrease body fat [17].
The drive for muscularity is strongly tied to conformity to traditional masculine norms, weightlifting frequency, performance-enhancing substance use, body dissatisfaction, and social physique anxiety [20,21,22,23,54,55]. Its evaluation is primarily conducted using the Drive for Muscularity Scale (DMS), which differentiates muscularity-oriented attitudes from behaviors [56,57]. Conversely, drive for thinness in men is more closely related to sexual functioning and eating disorder pathology [58,59].
The OWPREOC subscale reflects anxiety regarding body fat, constant weight vigilance, and dietary restraint [60,61,62]. In men, OWPREOC represents a distinct pathway of body dissatisfaction. In a sample of male collegiate athletes, elevated OWPREOC was significantly associated with cognitive restraint, binge eating episodes, purging behaviors, and excessive exercise [62]. Although men generally score lower on OWPREOC compared to women [24,39,63,64], the subscale demonstrates satisfactory reliability and high predictive validity for eating attitudes among males [39,52].
To comprehensively capture male body image, dual-ideal assessment tools are required, such as the Body Image Matrix of Thinness and Muscularity, Male Bodies (BIMTM-MB) [65], the revised Male Body Attitudes Scale (MBAS-R) [66,67], the Muscularity-Oriented Eating Test (MOET) [68], and the Muscularity Bias Internalization Scale (MBIS) [69]. Furthermore, the systematic elimination of specific anatomical indicators during short-form development, such as the lower torso (‘abs’) and height, may also contribute to the localized structural strain observed in men. Given that regions like the lower torso are central to male muscularity and lean physique ideals, their omission from the BASS subscale may limit the instrument’s capacity to fully capture male-specific body satisfaction dynamics.
This theoretical duality is consistent with our empirical findings. The degraded internal consistency (ω = 0.477) and the altered correlation patterns surrounding OWPREOC observed in our male sample demonstrate that when men respond to traditional thinness-oriented items, the captured construct exhibits increased measurement error and diminished construct clarity. Specifically, the degraded internal consistency of the OWPREOC subscale in men suggests a potential conceptual caveat. We hypothesize that because male body dissatisfaction frequently involves a drive for muscular hypertrophy rather than solely fat reduction, traditional thinness-oriented items may operate with lower precision for male respondents. However, as direct measures of muscularity were not included in the current protocol, this interpretation remains a hypothesis that requires formal empirical testing in future research co-administering muscle-oriented scales.
The assessment of convergent and criterion validity further reinforces the psychometric utility of the MBSRQ-AS15 while corroborating the male validity caveat. As hypothesized, APPEVAL strongly aligned with higher self-esteem and lower eating attitudes, confirming its role as a key protective indicator of psychological well-being. Conversely, OWPREOC emerged as the primary correlate of eating attitudes. Crucially, however, the statistical comparison of sex correlations via Fisher’s z-test (z = −5.52, p < 0.001) indicated that OWPREOC is significantly less strongly associated with eating attitudes in men (r = 0.348) than in women (r = 0.555). This divergence likely stems from the fact that the EAT-26 is inherently a female-centric measure focused primarily on thinness-driven eating pathology. Because male eating pathology frequently revolves around muscularity-oriented behaviors rather than pure weight minimization, the EAT-26 captures less variance in men. Coupled with the marked internal consistency degradation observed in men (ω = 0.477), these findings reinforce the notion that traditional thinness-based items may not fully capture the spectrum of male body image concerns, underscoring the necessity of utilizing male-tailored instruments (such as the Muscularity-Oriented Eating Test [MOET]) when evaluating criterion validity in male samples. This aligns with the broader consensus in the literature emphasizing that assessing men with female-centric, thinness-focused instruments systematically underestimates male body image disturbances, masking the high prevalence of muscularity-oriented psychopathology [70].
Furthermore, the inclusion of BMI further substantiates the convergent validity of the MBSRQ-AS15. The robust correlation between WTCLASS and objective BMI (r = 0.589; r = 0.712 in women) indicates that the 2-item weight classification scale accurately reflects actual body mass. Interestingly, the negative impact of higher BMI on APPEVAL and BASS was markedly more pronounced in women than in men. This sex disparity aligns with social comparison theory and sociocultural pressures, where higher body mass in women heavily violates thinness-oriented beauty ideals, leading to steeper declines in body satisfaction. In contrast, for men, higher BMI may partly reflect increased muscle mass rather than elevated adiposity alone, thereby dampening the negative psychological impact of higher body weight on APPEVAL and overall body image, further underscoring the distinct nature of male body composition concerns.
To better capture male body concerns, as well as evolving female body image ideals, future psychometric adaptations could transition from a rigid weight/fat preoccupation construct toward a broader ‘body composition preoccupation’ framework. Such an adapted scale would shift focus toward the balance between muscle mass and body fat percentage, dietary restraint aimed at muscle definition rather than pure weight loss, and physique modulation. Importantly, this conceptual shift is increasingly relevant to women as well, among whom athletic, muscular, and ‘healthy weight’ ideals have gained prominence alongside traditional thinness pressures.

4.4. Practical and Clinical Applications in Athletic Settings, Gyms, and Clinical Populations

In athletic environments, fitness centers, and large-scale epidemiological studies, instrument selection is guided by the need for brief, valid, and low-burden tools. For rapid screening in gym settings, instruments such as the BILD-Q [6], single-item appearance satisfaction measures [52], the Situational Inventory of Body Image Dysphoria-Short Form (SIBID-S) [71], the Body Appreciation Scale-2 (BAS-2) [72,73], the BI-AAQ-5 [50], and the FAS [51] provide an optimal balance between efficiency and psychometric validity. In general, epidemiological research using established scales like the MBSRQ-AS, BSQ, and Silhouette Rating Scales facilitates broader cross-study data comparison [74,75,76]. However, while ultra-brief or unidimensional tools effectively assess overall body or functional appreciation, they often lack domain-specific granularity. In contrast, the MBSRQ-AS15 offers distinct practical utility in gym and athletic settings by enabling trainers, sports psychologists, and researchers to rapidly capture a comprehensive 5-domain diagnostic profile within a single 5-minute administration. This multidimensional capability allows professionals to differentiate whether an individual’s body image distress stems from overall appearance evaluation (APPEVAL), dissatisfaction with discrete anatomical areas (BASS), or excessive cognitive appearance investment (APPOR), thereby guiding more tailored fitness or psychological interventions.
Specifically for male populations in athletic contexts, evaluation should focus on muscularity and leanness through targeted tools, such as the Drive for Muscularity Scale (DMS) [56,57], the Drive for Leanness Scale (DLS) [77,78], the Drive for Muscularity Attitudes Questionnaire (DMAQ) [79,80], and the BIMTM-MB [65].
From a clinical standpoint, elevated drive for muscularity in men is directly linked to muscle dysmorphia, anabolic steroid abuse, low self-esteem, and severe psychosocial impairment [81,82,83,84]. Men may present with diverse body image pathologies across a broad spectrum: while some experience traditional thinness-oriented eating disorders aimed at weight minimization, others suffer from muscularity-oriented conditions such as muscle dysmorphia. Acknowledging this clinical heterogeneity is essential for accurate screening and targeted interventions [81]. Consequently, clinical assessment must not be restricted to traditional scales focusing solely on thinness, but should concurrently incorporate measures of both muscularity and body fat to ensure early detection of all forms of body image disturbance [19,85,86].
Furthermore, the accurate assessment of body image in specialized clinical populations, such as women with polyendocrine metabolic ovarian syndrome (PMOS), represents a critical methodological challenge. Because systemic physiological and morphological changes in endocrine disorders manifest across diverse bodily domains, relying on unidimensional tools often fails to capture the specific nature of a patient’s psychological distress. Compared to other assessment measures like the Body Image Concern Inventory (BICI), the MBSRQ-AS15 offers a distinct clinical advantage in these contexts [87]. By isolating specific constructs, such as overall cognitive appearance investment versus discrete anatomical satisfaction, the scale provides actionable diagnostic granularity while maintaining a low respondent burden, making it highly suitable for female patients navigating complex metabolic evaluations.

4.5. Limitations and Future Directions

Several limitations must be considered when interpreting the findings of this study. First, the cross-sectional design precludes causal inferences and prevents the evaluation of test–retest reliability, which is essential for establishing the temporal stability of the MBSRQ-AS15. Future research should incorporate longitudinal designs to address this gap. Second, although the sample was large, appropriately powered (n = 1776), balanced across sexes, and geographically diverse, it relied on a convenience community-based volunteer sampling strategy (e.g., sports clubs, universities, online channels). Consequently, the provided sex-specific percentile ranks should be interpreted as sample-based reference benchmarks for non-clinical community groups rather than population-representative normative data, and findings may not fully generalize to clinical populations (e.g., individuals with diagnosed eating disorders or muscle dysmorphia) or cross-cultural contexts without further validation. Third, the reliance on self-report measures introduces inherent reporting biases, such as social desirability. Fourth, retaining only two indicators for the OWPREOC and WTCLASS subscales introduces psychometric identification and stability constraints. In structural equation modeling, two-item latent factors are mathematically just-identified in isolation and rely heavily on cross-factor covariances for model stability. Consequently, two-item subscales are highly susceptible to item-specific measurement error, as reflected by the marked reliability degradation observed for male OWPREOC (omega = 0.477). Future psychometric revisions of the MBSRQ-AS short form should evaluate expanding these subscales to a minimum of three indicators to enhance construct stability and measurement precision across diverse demographic groups. Fifth, the degraded internal consistency of the OWPREOC subscale in men highlights a critical conceptual caveat… Future research should focus on structurally updating both the full and brief MBSRQ-AS instruments by integrating male-relevant indicators (e.g., satisfaction with muscle mass and body composition ratio) directly into the core scale, creating a modernized, sex-responsive tool rather than relying solely on secondary complementary questionnaires. Consequently, while the APPEVAL, APPOR, WTCLASS, and BASS subscales demonstrate robust psychometric performance and should be retained across sexes, the OWPREOC subscale requires redevelopment or sex-specific alternative forms for men to incorporate muscle-oriented weight concerns. Future research should explore adapting this construct to assess ‘body composition preoccupation’, focusing on relative body fat versus muscle mass and physique modulation, rather than sole anxiety over weight or fat. Co-administering muscle-oriented measures alongside such adapted scales will further clarify the full spectrum of male and female body image pathology. Sixth, significant baseline differences in age and BMI were observed between men and women in our community sample. Although these differences reflect typical demographic and physical variations, future research examining sex differences in body image should routinely include anthropometric metrics (e.g., BMI and body composition) as covariates to isolate pure psychological sex effects from underlying biological dimorphism.
A methodological limitation concerns the baseline CFA model fit in the male subsample, which presented marginal absolute fit indices (RMSEA = 0.105). Although multi-group analyses supported scalar measurement invariance based on ΔCFI criteria, this localized strain suggests that body image construct dimensionality may operate with subtle nuances in men compared to women (e.g., driven by muscularity considerations not fully captured by general appearance scales). Consequently, direct cross-sex score comparisons should be interpreted with appropriate caution.
Seventh, the elimination of certain BASS items during scale abbreviation, such as the lower torso (‘abs’), represents a conceptual limitation. Because the lower torso is strongly tied to male muscularity ideals, omitting this region may have contributed to the poorer structural fit observed in male baseline models. Future iterations of brief male body image measures should evaluate whether reinstating key muscularity-relevant anatomical regions improves structural fit in men.

5. Conclusions

The present study provides support for the psychometric utility of the MBSRQ-AS15 as a brief, low-burden instrument for assessing multidimensional body image in adults. Although multi-group analysis indicated full scalar measurement invariance across sexes, model fit and internal consistency exhibited notable limitations in men, particularly within the OWPREOC subscale. While scalar invariance permits latent mean comparisons, the attenuated association between weight preoccupation and eating attitudes in men highlights the need for sex-sensitive interpretations. Consequently, rather than relying exclusively on secondary complementary measures, future research should prioritize updating the core items of both the full and brief MBSRQ-AS to better capture male-specific body image nuances, such as muscle mass and body composition. In summary, the MBSRQ-AS15 offers a time-efficient alternative to the full-length MBSRQ-AS, reducing participant burden while maintaining acceptable psychometric performance in general research contexts, provided sex-specific nuances are taken into account.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/obesities6050070/s1, File S1: Community-Based Reference Percentiles and Score Distributions for the MBSRQ-AS15 (Table S1a: Descriptive Statistics for the MBSRQ-AS15 Subscale Scores (N = 1776); Table S1b: Percentile Table (Percentile Reference Values by Gender)); File S2: Pearson Correlation Matrices (Table S2a: Pearson Correlation Matrix for the Total Sample (N = 1776); Table S2b: Pearson Correlation Matrix Stratified by Gender: Men (N = 899) and Women (N = 877)); File S3: The Bilingual 15-Item MBSRQ-AS15 Scale (Table S3: Item Wording and Subscale Structure of the Greek and English MBSRQ-AS15).

Author Contributions

Conceptualization, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis) and A.Z.; methodology, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; software, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; validation, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; formal analysis, I.T. (Ioannis Tsartsapakis); investigation, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; resources, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; data curation, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; writing—original draft preparation, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis) and A.Z.; writing—review and editing, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; visualization, I.T. (Ioannis Tsartsapakis), I.T. (Ioannis Trigonis), A.Z., E.K. and M.G.; supervision, I.T. (Ioannis Tsartsapakis); project administration, I.T. (Ioannis Tsartsapakis). All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Internal Ethics Committee of the Department of Physical Education and Sport Science, University of Thessaly, Greece (2252, 3-2/11 October 2023).

Data Availability Statement

Data available on request due to restrictions (e.g., privacy, legal or ethical reasons). The data presented in this study are available on request from the corresponding author due to privacy and ethical restrictions.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
MBSRQ-AS15Multidimensional Body-Self Relations Questionnaire—Appearance Scales 15-item
APPEVALAppearance Evaluation
APPORAppearance Orientation
OWPREOCOverweight Preoccupation
WTCLASSSelf-Classified Weight
BASSBody Areas Satisfaction Scale
CFAConfirmatory Factor Analysis
MGCFAMulti-Group Confirmatory Factor Analysis
DWLS/WLSMVDiagonally Weighted Least Squares/Weighted Least Squares Means and Variance adjusted

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