Aimed: This study protocol seeks to understand the self-image perceptions of Brazilian university students before and during the COVID-19 pandemic.

Methods: CAAE: 47770421.3.0000.5662, the study will employ an electronic form distributed on social media platforms, designed with a semi-structured questionnaire, aiming to delve into the pandemic’s impacts on university students, exploring mental, social, emotional, and physical aspects as well as their overall quality of life. Conducted via the Google Forms Platform, the questionnaire will be accessible online. Participants will first encounter a Term of Free and Informed Consent. Completed forms and responses will be stored on a secure database, protected by a unique URL and password.

Protocol: Tables will portray the characteristics of the investigated population, subjective perceptions of body image, perception of health status, physical fitness and physical and leisure activities, comparing the pre-pandemic period and during COVID-19. Correlations will also be tested between BMI and variables such as subjective perception, anxiety, diet and sedentary lifestyle.

Conclusion: This research aspires to yield outcomes that can contribute to precise decision-making in the realm of health promotion, and to aid in the formulation of new strategies to support the mental, emotional, physical well-being, and overall quality of life for university students.

• COVID-19

• Self-concept

• Body mass index

• University students

do Vale ABN, Domingos LLP (2024) Analysis of Self-Image and Body Mass Gain in College Students during COVID-19: A Cross-Sectional and Exploratory Study Protocol. Ann Clin Exp Metabol 4(1): 1031.

In December 2019, in China, the COVID-19 epidemic began, growing to be a major public health problem. In January 2020, the World Health Organization (WHO) declared this outbreak a pandemic state. The definition of the term “pandemic” is a classification for a disease spread across several countries and even continents. Due to the crisis, the WHO encouraged several measures to try to stop the infection of COVID-19 [1].

The pandemic environment favored a sedentary lifestyle due to social contact restrictions, daily life maintenance outdoor activities such as going to the University or gym, added to the excessive intake of low nutritional value and industrialized foods, which may have led to weight gain per fat mass [2,3].

The link between overweight and risk factors for the development of other diseases has been widely registered, especially after the COVID-19 pandemic. In addition to the greater risk for the development of chronic non-communicable diseases, it was found, with the coronavirus pandemic, the risk of obesity for the development and worsening of infection by this virus [4].

In the population of Brazilian university students, consisting mainly of young adults, Costa et al. found that, in general, men would like a more defined body, and women, with less fat. Body image perception disorders (attitudes that individuals have regarding the size and contour of their own body) can be caused by overweight and weight gain by fat mass in general, and the pandemic was a dominant factor in inhibiting the practice of physical activity. When the dissatisfaction with body image is severe and self-image is distorted, individuals tend to develop other illnesses, such as eating disorders, and other mental health problems, such as depression and anxiety. Considering that overweight is a risk factor for body image dissatisfaction, it is necessary to analyze the perception of body self-image and body mass gain in university students before and during the COVID-19 pandemic [5,6].

The confinement, ‘lockdown’, imposed due to the severity of the COVID-19 pandemic, had as its main purpose to reduce the number of hospitalizations in an attempt not to overload the health system, both public and private, which was already in a critical state. Thus, educational institutions adopted the style of activities in the online mode, causing students to only go outdoors for activities considered essential. The consequence of this is that interpersonal relationships could only exist between people from the same ‘’bubble’’ and in restricted spaces, leading to the aggravation of several possibly pre-existing conditions such as sleep disorders, and reduced physical activity, which is the gold standard for treatment of mental health issues and prevention of overweight and chronic non-communicable diseases such as obesity and diabetes.

During the COVID-19, observational studies was expressly addressed through digital tools gained visibility, credibility and helped us to understand the behavior of the world population, from the perspective of different aspects: eating habits [7], maintenance/regularity of physical activity [8], sleep patterns [9], emotional aspects [10], among others. In this study, we followed the recommendations proposed by health regulatory agencies, using the electronic form as an instrument for observation and data collection.

Thus, this study protocol aims to understand the self- image perceptions of Brazilian university students before and during the COVID-19 pandemic. As a hypothesis, we point out the consequences of social isolation, changes in school routine, sedentary lifestyle, loss of contact with other university students and inadequate eating habits, as the main causes of changes in body image, and consequently, in their self-perception.

Study Design

This is a cross-sectional, descriptive and exploratory study, which will be carried out with students from the Federal University of Bahia (UFBA), Salvador, Bahia, Brazil. This study is part of the project entitled ‘’Analysis of the repercussions of the pandemic caused by COVID-19 on the health conditions of the Brazilian population and Health professionals working on the front lines’’ approved by the Research Ethics Committee and registered at Plataforma Brazil under number CAAE: 47770421.3.0000.5662 on August 2021. The STROBE checklist will be used to conduct the study and to ensure a more accurate and complete description of the data [11,12] (Figure 2).

Students with active enrollment in the courses offered at UFBA, aged 18 years or older who voluntarily accept to participate in the research will be included. All participants who agree to participate in the study must sign an informed consent form prior to inclusion in the study.

The application of a questionnaire in the exploratory research format will be conducted in accordance with the norms of resolution 510/16, using the Google Forms platform and its dissemination, access and completion will be through the internet network. It will be instrumentalized by an electronic form to be released on social media (WhatsApp, Instagram, Facebook, email list).

The electronic form will be made available via an access link, initially containing a Term of Free and Informed Consent, which must be read carefully and marked with an alternative (“I agree” or “I do not agree”) by the participant, confirming to be aware of all research-related information. If you agree, this will guarantee you anonymous participation, awareness of the risks and benefits and authorization to use your responses for scientific purposes.

All forms filled in with the respective responses will be hosted on a unique URL (Uniform Resource Locator) and password protected to ensure the security of the database. It is hoped that the results of this research will be consistent to contribute to assertive decision-making in the field of health promotion and to the construction of new strategies to welcome and help the mental, emotional, physical health and quality of life of university students, who are experiencing this pandemic period with so many challenges.

Participants, Interventions and Outcomes

Inclusion Criteria-Students with active enrollment number in the courses offered, aged 18 years or older who voluntarily accept to participate in the research will be included.

Exclusion Criteria-Students who, at any time, refuses to answer any item in the questionnaire, as well as requesting exclusion from the research.

Investigation

The semi-structured questionnaire included 43 questions, divided into 8 different sections. The college students will ask to answer the questions regarding the period during and before the pandemic using the “retrospective post-then-pre” design [13]. In this model, information regarding before and after are collected simultaneously, after the event or intervention has occurred [14].

The first 2 sections of the questionnaire are the presentation of the Free and informed consent form and the Participants’ Profile in which are confirmed their will to participate and it´s veracity of information.

The third and fourth sections use questions from the Brazilian National Institute of Geography and Statistics (IBGE) as a reference, related to Sociodemographic characteristics on section 3 such as: Sex, gender, age group, marital status, ethnicity, income and to Employability conditions, professional performance and academic training in section 4 [15].

The fifth section wants to know the Characteristics of the link with the University such as main field of study, time of exposure to the university, study shift and teaching, research and extension opportunities.

The sixth and seventh sections are about General health conditions such as Analysis of health habits before and during the pandemic on section 6 and Anthropometric Characteristics- height, mass and BMI on section 7.

The last section It will be combined with the Silhouette Test - Version adapted and validated in Brazil [16-18] (Figure 1),

Figure 1: The scale silhouettes figures of body image.

that in this study is responsible for the Classification of Self-Perception of Body Image - Before and During the COVID-19 Pandemic. This instrument allows the individual to carry out self-assessment both regarding the current body and the desired body, and from this difference, body dissatisfaction is obtained. Body dissatisfaction is associated with changes in behavioral patterns both in relation to food and physical activity, as both are correlated [17].

Statistical Analysis

In this study, we will adopt a non-probabilistic convenience sample, considering the pandemic context. A descriptive analysis will be performed. Frequencies will be presented in absolute and percentage values. Shapiro-Wilk test will be used to verify the normality of the data. According to the characteristics of the collected data, specific statistical tests will be performed. The comparison of the scores before and during the pandemic will be performed by paired Student’s t-test. To measure the correlation of the variables on the primary outcome, the Spearman or Pearson correlation coefficient will be determined, considering: 0

Considering strategies to avoid information bias in this study, from the choice and design of the instrument for data collection (electronic form) to the execution of data analysis with blinding, the researcher who will make the contact with the participants and will send the link will be different from the researcher who will do the statistical analysis. Additionally, despite obtaining self-reported data in this study, a robust inferential analysis will be performed to generalize the findings of the population studied.

The results of this study will reveal patterns related to body self-image and weight gain in college students before and during the COVID-19 pandemic. A flowchart (Figure 2), will be presented informing the number of individuals recruited participants in this study and the responses analyzed, considering the stratification by female and male gender.

Figure 2: Strobe flow diagram of the study protocol.

A table will be prepared with the description of the demographic data of the students participating in the study, with information such as: sex/gender, age, height in meters, body mass in kilo/gram, employability conditions, perception of value in the work environment, favorable study conditions, risk factors for worsening COVID-19 symptoms, race, color, and income.

Another table will be prepared with the general health conditions compared between the pre-pandemic period and the period during COVID-19, considering dietary pattern, feeling healthy, main manifested symptoms associated with Covid-19, lifestyle habits and clinical and/or therapeutic assistance obtained.

The will provide data on subjective perceptions of body image and associated factors, in a comparative analysis between the pre-pandemic period and the period during COVID-19. Data on satisfaction with body self-image, perception of health status, physical fitness and physical and leisure activities will be presented.

The last two will show the panorama of the perception of body image of women and men students before and during the Covid-19 Pandemic, according to the Body Image Self-Perception Classification presented by the Silhouette Test.

Finally, the description of the results of this study will permit to analyse a correlation between the BMI of the participants and the main variables studied: diet, anxiety, feeling healthy and the perception of Silhouette.

A study in June 2020, with residents of the city of Belo Horizonte aged over 18 years, to evaluate weight gain, observed that 54% of the participants gained weight, and correlated with feelings of anxiety, worry, anguish, and fear. The 44% of respondents who remained in social isolation stated that their diet had changed significantly, due to excessive weight gain of 72.3% of this public. The research found an increase in the intake of sweets and pasta, which may have contributed to this scenario [19].

Another cross-sectional, exploratory, and quantitative study, carried out between January and February 2017, with 324 university students in the areas of Health, Exact and Humanities Sciences, evaluated the self-perception of body image, through the silhouette scale, and nutritional status, by body mass index. The prevalence of overweight/obesity was 43.2% (n=141) and body image dissatisfaction was 76.5% (n=248). The population with the highest chances of being overweight and obese (95% CI: 1.0-2.7; p 0.03) were university students. Married students (95% CI: 1.8-5.9; p 0.01), who work (95% CI: 1.4-3.7; p 0.01), with income equal to or greater than one minimum wage (95% CI: 1.4- 4.8; p 0.01), were more likely to be overweight. Regular health status was related to greater dissatisfaction with body image (95% CI: 1.4-5.7; p 0.01). As expected, individuals with better physical occurrence were associated with a lower chance of body dissatisfaction (95% CI: 0.06-0.47; p 0.01). Thus, there is an association between overweight and age group, gender, marital status, work, income, and eating habits, as well as between self- perception of body image and self-perception of health status, requiring physical and study habits, in addition to the high prevalence of overweight/obesity and body image dissatisfaction among university students [20].

An integrative literature review (querying the databases PubMed, Lilacs, Bireme, and SciELO), with the exclusively university population, presented data regarding the prevalence of body dissatisfaction and/or the characterization of related factors. 40 national studies and 36 international studies were selected, totalling 76. Body image dissatisfaction in both sexes ranged from 8.3% to 87% in national studies, and from 5.2% to 85.5% in international studies. The assessment instruments were silhouette scales and questionnaires such as the Body Shape Questionnaire, the Eating Disorder Inventory, and the Body-Self Relationships Appearance Scales). Factors such as exposure to social networks, menstrual period, and low self-esteem were predominant. Body dissatisfaction is an increasingly present characteristic among university students. Standardization in construct evaluation is necessary for better specification and discussion of the problem [6].

It is expected to show, after identifying factors related to self- image, aspects that denote the consequences of COVID-19 but that can be properly managed with an appropriate therapeutic intervention. The relevance of this current investigation is to identify by an on-line survey (using an electronic tool Google forms), early stage the complications caused by isolation, lockdown, acquisition of sedentary habits, and excessive exposure to computer screens and other electronic devices experienced by university students during COVID-19.

As health professionals, we understand that all these aspects tend to compromise the health status of this population and other groups. We understand that prevention and health promotion involve, in this context, humanized care, adequately investigating the possible causes of weight gain, body image distortion and, more worryingly, self-image modification.

• Physiological changes during COVID-19 interfere with the body self-image of university students.
• Social isolation may have contributed to the body weight gain of university students.
• Body self-image plays a crucial role in mental and emotional health.

The Authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

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