Body Image and Self-Esteem in Indian and Italian University Students: Cross-Cultural Insights for Psychiatric Well-Being

Abstract

Body image and self-esteem are central to psychological health and have been identified as contributing factors in the development and maintenance of psychiatric conditions such as eating disorders, depression, and anxiety. This study investigates the relationship between these variables among university students in India and Italy, contributing to the understanding of how cultural contexts shape these psychological constructs in adult populations. The sample consisted of 767 participants (391 from Lokmanya Tilak Municipal Medical College and 376 from University of Campania Luigi Vanvitelli), aged 18 and above. Participants completed standardized measures, namely the Rosenberg Self-Esteem Scale, Body Investment Scale, and Body Uneasiness Test, through paper-based questionnaires administered in controlled settings. Indian students reported higher self-esteem and more positive body image compared to their Italian counterparts, who exhibited lower self-esteem and higher body dissatisfaction. Across both groups, higher self-esteem was strongly associated with lower body uneasiness. Regression analyses revealed high self-esteem significantly predicted positive body attitudes, with stronger protective effects among Italian participants. Indian students demonstrated broader resilience, potentially linked to cultural values. The findings contribute to psychiatry by emphasizing self-esteem and body image as culturally sensitive psychological constructs that may influence vulnerability to psychiatric distress in young adults. Understanding these factors can support prevention and early intervention strategies in student populations, particularly regarding body dissatisfaction, emotional regulation, and self-concept.

1. Introduction

Body image includes individuals’ perceptions, attitudes, and evaluations regarding their physical appearance, including aspects such as shape, size, and overall attractiveness. It has a central role in emotional well-being and psychological functioning [1,2]. A clear perception of one’s body enables individuals to value their physical appearance, promoting emotional well-being and self-acceptance [3,4], and a negative perception of one’s body results in dissatisfaction, characterized by unease and unhappiness with physical characteristics, which can profoundly affect mental well-being and self-worth [5,6]. Negative body image is a major risk factor for mental health problems, including eating disorders, depression, and anxiety. These conditions are central concerns in psychiatry, and understanding their psychological precursors—such as body dissatisfaction and low self-esteem—is essential for early detection and intervention. People with negative body perceptions may develop unhealthy eating habits, such as extreme dieting or binge eating, which can cause serious health issues. Body dissatisfaction is also linked to low self-esteem and social isolation, which can worsen mental well-being. Addressing body image issues through treatments like cognitive–behavioral therapy has been found to improve self-image and lower the risk of developing these mental health conditions [7,8,9,10,11]. Body dissatisfaction stems from the perceived differences between an individual’s actual look and societal beauty standards, which vary considerably across different cultures [12,13]. Cultural norms and social expectations establish beauty standards that are often unreachable and leave individuals with feelings of inadequacy and psychological discomfort [14,15]. In cultures that emphasize physical perfection, individuals with poor body image often experience heightened self-criticism and emotional distress, which can be the starting point of a cycle of body dissatisfaction and reduced self-esteem [16,17]. People who feel dissatisfied with their bodies tend to engage in maladaptive behaviors, including avoidance and compulsive self-monitoring, in an effort to ease their discomfort regarding their appearance [16,18]. Although these behaviors may offer temporary relief, they contribute to the continuance of negative self-perceptions [19,20].

Culture is a complex system of shared values, beliefs, customs, and practices that shape how individuals perceive themselves, others, and the world. These cultural frameworks influence all aspects of life, including mental health [21,22]. Collectivistic cultures prioritize group harmony, social cohesion, and community needs, with conformity to societal norms being emphasized. An individual’s worth is closely tied to their role within the family and society [23,24,25]. Individualistic cultures emphasize personal achievement, autonomy, and self-expression, often linking worth to individual success [26,27].

These contrasting cultural orientations can influence how people perceive and evaluate their bodies. Such cultural influences may also affect psychiatric vulnerability, particularly in disorders where self-worth and body image are implicated, such as body dysmorphic disorder or eating-related psychopathologies. In collectivist cultures, body image is often associated with health, modesty, and social roles, such as fulfilling family responsibilities [23,28]. This cultural alignment may act as a buffer or, conversely, intensify dissatisfaction, depending on how societal expectations are internalized [22,29]. In contrast, individualist cultures often place greater emphasis on autonomy and physical appearance as expressions of personal identity and success, thereby linking self-esteem more strongly with physical attractiveness [26,30].

Self-esteem, defined as an individual’s global evaluation of their own worth, is closely linked to body image [19,31]. People with high self-esteem are able to appreciate their worth beyond physical characteristics, which cultivates resilience in the face of societal pressures and reduces exposure to body dissatisfaction [32,33]. On the other hand, low self-esteem heightens the effects of negative body image, resulting in feelings of inadequacy and increased sensitivity to external judgments [34,35]. There are mutual relationships that exist between self-esteem and body image; a positive body image serves to enhance self-esteem through the encouragement of acceptance regarding one’s physical characteristics. In turn, elevated self-esteem can mitigate the negative impacts of societal beauty norms [4,20]. Conversely, a negative perception of one’s body can lower self-esteem, leading to a repetitive cycle of self-critique and emotional turmoil that adversely affects psychological health [18,36].

While the connection between body image and self-esteem has been extensively examined, a significant portion of the current literature emphasizes adolescents [2,6,37,38]. There is relatively less focus on adults, especially within non-Western cultural settings, resulting in a lack of focus on culturally diverse populations [7,38,39,40]. This gap is particularly important to address, as adults may interpret and experience body image differently due to life experiences, shifting priorities, and cultural frameworks. For instance, Italian society, reflective of individualistic Western values, often places considerable emphasis on appearance and personal autonomy. In contrast, Indian society, rooted in collectivist traditions, may foster self-worth through relational and familial roles, potentially reducing the weight placed on physical appearance. Exploring these differences could offer a more culturally nuanced understanding of how body image and self-esteem interact across diverse societies [41,42]. By examining how cultural background moderates the link between self-esteem and body image, this study provides insights into culturally sensitive risk factors for psychiatric conditions, particularly those affecting young adults during a vulnerable stage of their life.

Based on the theoretical distinctions between individualistic and collectivist cultures, this study aims to investigate the following research question: How do self-esteem and body image interact in Indian and Italian university students, and does cultural background moderate this relationship? The specific hypotheses derived from this question are detailed in Section 2.3.

2. Materials and Methods

2.1. Study Design and Procedure

This study used a cross-sectional, comparative design to examine the relationship between self-esteem and body image among university students in India and Italy. Data were collected using paper-and-pencil questionnaires, which the participants completed by hand during organized data collection sessions on their respective campuses. These sessions were conducted in quiet, classroom-like environments to ensure participants could focus and respond thoughtfully. Researchers and trained assistants were present during these sessions to provide instructions, answer any questions, and ensure that the process ran smoothly. The anonymity of participants was carefully maintained, and the confidentiality of the data was emphasized, in line with ethical research standards. Upon completion, the questionnaires were immediately collected, stored securely, and anonymized for analysis. The study protocol was approved by the ethics committees at both institutions. Informed consent was obtained from all participants, and data were collected anonymously in accordance with ethical research standards.

2.2. Sample Characteristics

The study consisted of 799 participants, all of whom were university students. Out of 799 participants, 420 participants were students from Lokmanya Tilak Municipal Medical College in India, and the rest of the 379 participants were students from the University of Campania Luigi Vanvitelli in Italy. The participants were recruited through a combination of in-person outreach on campus and communication with faculty who assisted in inviting students to participate in the study. The inclusion criteria required participants to be at least 18 years of age and able to provide informed consent. Participation was voluntary, with no financial or academic incentives offered, and participants were free to withdraw from the study at any time.

The emphasis on university students as the primary participants was intentional, as this group is known to face particular challenges related to body image and self-esteem, often heightened during their academic years. Participants were not asked about any diagnosed mental health conditions, and there were no exclusion criteria related to mental health status. This decision was made to ensure an inclusive and naturalistic sample representative of the general university student population.

2.3. Measures

The participants were administered the following questionnaires to assess their self-esteem and body image:

2.3.1. Rosenberg Self-Esteem Scale (RSES)

The Rosenberg Self-Esteem Scale (RSES) is a globally recognized tool designed to measure an individual’s overall sense of self-worth and self-acceptance. The RSES consists of 10 items that assess both positive and negative feelings about the self [43]. Responses are recorded on a 4-point Likert scale, where participants indicate their level of agreement with statements such as “On the whole, I am satisfied with myself” (positive item) and “I feel I do not have much to be proud of” (negative item, reverse scored). The total score ranges from 0 to 30, with higher scores indicating greater self-esteem. The Cronbach alpha for the RSES in the present study was 0.86, indicating good reliability.

2.3.2. Body Investment Scale (BIS)

The Body Investment Scale (BIS) is a 24-item instrument developed to measure the degree to which individuals care for, protect, and value their bodies [44]. It assesses four distinct dimensions of body investment: Body Image (BI), Body Touch (BT), Body Care (BC), and Body Protection (BP). Each item is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating greater body investment and more positive attitudes toward the body [44].

The BIS showed good overall reliability, with a Cronbach alpha of 0.80, indicating that the scale consistently measures body investment. Among its subscales, BI had excellent reliability (α = 0.90), and BT had acceptable reliability (α = 0.77). However, BC (α = 0.67) and BP (α = 0.66) had lower reliability, which suggests that these subscales may have some inconsistencies or that the items may not be measuring exactly the same aspect of body investment. Overall, while the BIS is reliable, some subscales may need further refinement in future research.

The BIS captures a holistic view of how individuals engage with their physical selves, from their comfort with body touch to the care they provide their bodies through grooming and health-related behaviors. The BI subscale measures individuals’ perceptions of their appearance, while the BT subscale examines how comfortable they feel with physical contact. The BC subscale focuses on behaviors aimed at maintaining health and appearance, and the BP subscale evaluates how much participants protect their bodies from harm or danger.

2.3.3. Body Uneasiness Test (BUT)

The Body Uneasiness Test (BUT) is a comprehensive instrument designed to measure various aspects of body image concern, body dissatisfaction, and the psychological unease that individuals experience related to their physical appearance. The BUT is composed of 34 items and is divided into five subscales: Global Severity Index (GSI), Weight Phobia (WP), Body Image Concerns (BIC), Avoidance (A), and Compulsive Self-Monitoring (CSM). Participants rate each item on a 6-point Likert scale, where 0 indicates no concern and 5 reflects severe concern. Higher scores indicate greater body uneasiness and dissatisfaction [45].

The BUT demonstrated excellent overall reliability, with a Cronbach alpha of 0.97 for the GSI. Among its subscales, BIC (α = 0.92) and WP (α = 0.89) showed strong internal consistency. A (α = 0.87) and D (α = 0.87) also displayed good reliability. CSM (α = 0.79) had acceptable reliability, though slightly lower than that of the other subscales. Overall, the BUT and its subscales demonstrate high reliability, making it a strong tool for assessing body uneasiness in this study.

The GSI provides a global measure of body image discomfort, while the WP subscale focuses specifically on concerns related to weight and body shape. The BIC subscale addresses broader concerns about specific body areas, such as the abdomen, thighs, or face, and the A subscale evaluates the extent to which participants avoid social situations due to concerns about their appearance. The CSM subscale measures the degree of compulsive behaviors, such as checking one’s appearance in mirrors or excessively monitoring weight changes. Finally, the D subscale is concerned with detachment and estrangement feelings toward one’s body.

2.4. Hypothesis Definition

Based on the research questions outlined in the previous section, we define our research hypotheses as follows:

Primary Hypothesis: We hypothesize that self-esteem and body image will be positively correlate, such that individuals with higher self-esteem will report a more positive body image.

Secondary Hypothesis: We hypothesize that nationality (Indian vs. Italian) will moderate the relationship between self-esteem and body image such that the strength of this relationship will differ between the two cultural groups.

2.5. Statistical Methods

To examine the study hypotheses, we employed the following statistical analyses:

• Pearson’s correlation analysis was conducted to assess the relationship between self-esteem and body image across the entire sample.
• Independent-samples t-tests and one-way ANOVA were used to compare self-esteem and body image scores between Indian and Italian students.
• Moderation analysis using multiple regression was performed to test whether nationality moderated the relationship between self-esteem and body image. In this model, self-esteem was the predictor variable, body image was the outcome variable, and nationality (Indian vs. Italian) was included as the moderator.

3. Results

3.1. Descriptive Statistics

Prior to the main analysis, the data were cleaned to remove any missing information. After removing the missing values, data of a total of 767 participants remained. To understand the general characteristics of self-esteem and body image measures across the Indian and Italian samples, we computed descriptive statistics (mean ($\mu$) and standard deviation ($\sigma$)) of various subscales of the considered measures (

Table 1. Descriptive statistics for key subscales for Indian and Italian populations.

Measurement Scale	Indian (n = 391)		Italian (n = 376)
	$\mathit{\mu }$	$\mathit{\sigma }$	$\mathit{\mu }$	$\mathit{\sigma }$
Self-esteem a	18.67	5.04	16.71	5.98
Body investment b	3.68	0.39	3.61	0.50
Body image b	3.76	0.85	3.31	0.98
Body touch b	3.06	0.70	3.32	0.81
Body protection b	3.78	0.69	3.90	0.66
Body care b	4.13	0.53	3.90	0.55
BUT global severity c	1.40	0.89	1.67	1.06
Weight phobia c	1.68	1.00	2.23	1.29
Body image concerns c	1.49	1.04	1.93	1.24
Avoidance c	1.10	1.00	0.99	1.01
Compulsive self-monitoring c	1.48	0.93	1.70	1.13
Depersonalization c	1.10	0.94	1.19	1.10

^a RSES; ^b BIS and subscales; ^c BUT scale and subscales.

). The mean ($\mu$) represents the average score, while the standard deviation ($\sigma$) reflects the degree of variation in responses.

3.2. Correlation Between Self-Esteem and Body Image

To investigate the relationship between self-esteem and body image, we calculate the Pearson Correlation Coefficient (PCC) between the overall RSES score and the subscales of the BIS and BUT questionnaires (

Table 2. Pearson correlation coefficient between self-esteem and subscales of the BIS and BUT.

	Self-Esteem
Body investment b	0.61 **
Body image b	0.72 **
Body touch b	0.11 *
Body protection b	0.27 **
Body care b	0.27 **
BUT global severity c	−0.58 **
Weight phobia c	−0.54 **
Body image concerns c	−0.6 **
Avoidance c	−0.48 **
Compulsive self-monitoring c	−0.39 **
Depersonalization c	−0.50 **

^b BIS and subscales; ^c BUT scale and subscales. Statistical significance: ** ($p < 0.001$) and * ($p < 0.05$).

).

Positive correlations were observed between self-esteem and components of the body investment scale. The strongest positive relationship was found with body image ($r=0.72$), indicating that higher self-esteem is closely associated with more positive feelings about one’s body. Moderate positive correlations were also noted for overall body investment ($r=0.61$), as well as for body protection and body care (both $r=0.27$). Interestingly, body touch showed only a weak correlation $(r=0.11)$, suggesting that comfort with physical touch is less influenced by self-esteem.

Negative correlations were found between self-esteem and indicators of the body uneasiness test. The global severity of body uneasiness exhibited a moderate-to-strong negative relationship with self-esteem, reflecting the fact that higher self-esteem is associated with lower overall body distress. Among the BUT subscales, the strongest negative correlation was with body image concerns ($r=-0.60$), followed by weight phobia ($r=-0.54$) and depersonalization ($r=-0.50$). These results suggest that individuals with higher self-esteem experience less dissatisfaction with their appearance, reduced fear of weight gain, and lower levels of detachment from their physical selves. Moderate negative correlations were also observed with avoidance behaviors ($r=-0.48$) and compulsive self-monitoring ($r=-0.39$), indicating that higher self-esteem is linked to fewer avoidance tendencies and less obsessive checking of one’s appearance.

3.3. Regression Analysis

To further explore the relationship between self-esteem and body image, we performed regression analysis using RSES as the predictor variable to understand its influence on various subscales of the BIS and BUT.

Table 3. Regression analysis using RSES as the independent variable.

Measure	$\mathit{\beta }$	Constant	${\mathit{R}}^2$
Body investment b	0.05	2.78	0.37 *
Body image b	0.12	1.40	0.51 *
Body touch b	0.02	2.91	0.01
Body protection b	0.03	3.25	0.07 *
Body care b	0.03	3.54	0.07 *
BUT global severity c	−0.10	3.33	0.34 *
Weight phobia c	−0.11	3.97	0.29 *
Body image concerns c	−0.12	3.90	0.36 *
Avoidance c	−0.09	2.59	0.23 *
Compulsive self-monitoring c	−0.07	2.88	0.15 *
Depersonalization c	−0.09	2.78	0.25 *

^b BIS and subscales; ^c BUT scale and subscales. * Statistical significance ($p<0.001$).

shows the results of the regression analysis.

Self-esteem was positively associated with overall body investment behaviors, as indicated by a $\beta$ coefficient of 0.05 with an $R^2$ of 0.37, suggesting self-esteem accounts for 37% of the variance in the overall BIS. The relationship is particularly strong for the body image (BI) subscale, where a $\beta$ coefficient of 0.12 and an $R^2$ value of 0.51 indicate that self-esteem explains 51% of the variance in positive body image. For body touch (BT), body protection (BP), and body care (BC), the influence of self-esteem is weaker (as seen by the low $R^2$ value) but still statistically significant, with $\beta$ coefficients ranging from 0.02 to 0.03.

When examining the BUT, self-esteem exhibits a strong negative association with overall body uneasiness, as reflected by BUT global severity. The $\beta$ coefficient of −0.10 and $R^2$ value of 0.34 suggest that individuals with higher self-esteem experience significantly lower levels of body uneasiness, with self-esteem explaining 34% of the variance in these scores. Among the BUT subscales, the strongest relationship is observed with body image concerns (BIC), where a $\beta$ coefficient of −0.12 and an $R^2$ value of 0.36 demonstrate that self-esteem is a substantial predictor of body dissatisfaction. Similarly, the weight phobia (WP) subscale shows a strong negative association, with a $\beta$ coefficient of −0.11. The avoidance (A) and depersonalization (D) subscales exhibit moderate negative relationships with self-esteem, with $\beta$ coefficients of −0.09 for both. The compulsive self-monitoring subscale has the weakest relationship, with a $\beta$ value of $-0.07$ and $R^2$ value of 0.15.

3.4. Interaction with Participants’ Nationality

To compare Indian and Italian participants across the different dimensions of self-esteem, body investment, and body uneasiness, we conducted a series of one-way analyses of variance (ANOVAs) on the subscales of the RSES, BIS, and BUT. This allowed us to examine whether there were statistically meaningful differences in scores between the two national groups. In addition to the ANOVA results, we also report the effect size calculated using Cohen’s d formula to show the practical significance (

Table 4. One-way ANOVA results and effect size to show impact of nationality.

Measure	F Statistic	Cohen’s D
Self-esteem a	24.16 *	0.36
Body investment b	4.77	0.16
Body image b	45.65 *	0.49
Body touch b	23.16 *	−0.35
Body protection b	6.63	−0.19
Body care b	34.22 *	0.42
BUT global severity c	14.75 *	−0.28
Weight phobia c	43.96 *	−0.48
Body image concerns c	27.88 *	−0.38
Avoidance c	2.37	0.11
Compulsive self-monitoring c	8.15	−0.21
Depersonalization c	1.57	−0.09

^a RSES; ^b BIS and subscales; ^c BUT scale and subscales. * Statistical significance ($p<0.001$).

).

The analysis revealed significant differences between the Indian and Italian participants on several subscales. For the self-esteem scale, there was a significant score difference ($F=24.16, p<0.001$) with a small effect size ($d=0.36$). For overall body investment, the population reported similar scores with no significant differences, whereas, on the subscale level of the body investment scale (BIS), there were significant differences on all the subscales, except the body protection (BP) subscale.

For the global severity index (GSI) of the body uneasiness test (BUT), nationality was a significant factor $(F=14.75, p< 0.001)$, with a smaller but notable effect size $(d=0.28)$, suggesting higher overall body uneasiness in one group. Similarly, for the body image concerns (BIC) subscale, a significant effect of nationality was observed $(F=27.88, p<0.001)$, with a small to moderate effect size $(d=0.38)$, indicating meaningful differences in the levels of body image concerns. The weight phobia (WP) subscale demonstrated the most substantial difference $(F=43.96, p<0.001),$ with a moderate effect size $(d=0.48),$ reflecting notable variation in weight-related anxieties across the two groups. However, for the avoidance (A), depersonalization (D), and compulsive self-monitoring (CSM) subscale, the differences between the groups were not statistically significant, with small effect sizes suggesting minimal variation.

Second, we use moderated regression analysis to investigate the interaction of nationality with the relationship between self-esteem and body image, i.e., to understand if nationality influences the strength of this relationship.

Table 5. Regression analysis results using nationality as a moderating factor.

Measure	$\mathit{\beta }$	${\mathit{R}}^2$
Body investment b	0.012	0.38
Body image b	0.016	0.53
Body touch b	0.032	0.06 *
Body protection b	−0.013	0.10
Body care b	0.013	0.10
BUT global severity c	−0.043	0.35 *
Weight phobia c	−0.052	0.33 *
Body image concerns c	−0.045	0.38 *
Avoidance c	−0.026	0.26
Compulsive self-monitoring c	−0.046	0.17 *
Depersonalization c	−0.042	0.27 *

^b BIS and subscales; ^c BUT scale and subscales. * Statistical significance ($p<0.001$).

shows how nationality moderates the relationship between self-esteem (RSES) and various subscales of body investment (BIS) and body uneasiness (BUT). The interaction term $\left(\beta \right)$ represents the degree to which the effect of the RSES on these subscales differs between Italians and Indians. For the Body Investment Scale (BIS) and its subscales, the interaction effects are small and generally not statistically significant, indicating that nationality does not significantly moderate the relationship between the RSES and most BIS subscales. The only exception is the body touch (BT) subscale, which has a significant positive interaction effect $(\beta =0.032, p<0.001)$. This suggests that the influence of the RSES on body touch is stronger for Italians compared to Indians. Other BIS subscales, such as body image (BI), body protection (BP), and body care (BC), have non-significant interaction effects. This indicates that the relationship between the RSES and these subscales does not vary meaningfully across nationalities.

The Body Uneasiness Test (BUT) and its subscales show a different pattern, with most interaction effects being negative and statistically significant. This suggests that the protective effect of the RSES (on reducing body uneasiness) is stronger for Italians compared to Indians. For the Global Severity Index (GSI), the interaction effect is $(\beta =-0.043, p<0.001)$, indicating a significant moderation by nationality. In comparison to the Indian participants, the Italian participants experienced a stronger reduction in overall body uneasiness as RSES scores increased. Other significant subscales with negative interaction effects include weight phobia (WP, $\beta =-0.052, p<0.001)$, body image concerns (BIC, $\beta =-0.045, p<0.001)$, compulsive self-monitoring (CSM, $\beta =-0.046, p<0.001$), and depersonalization (D, $\beta =-0.042, p<0.001)$. These findings consistently demonstrate that Italians benefit more from higher self-esteem in terms of reduced body uneasiness.

4. Discussion

This study explored the relationship between self-esteem and body image among Indian and Italian university students, with a specific focus on whether nationality moderates this association. We hypothesized that self-esteem and body image would be positively correlated across both groups, that nationality would moderate this relationship, and that there would be differences in self-esteem and body image scores between Indian and Italian students.

The findings of this study show significant differences in body image and self-esteem in Italian and Indian individuals. We observed the influence of cultural frameworks on personal perception, as Indian participants reported higher self-esteem compared to Italians, which may be the result of the collective nature of Indian society, where familial and communal ties are emphasized, often providing emotional support and resilience against societal pressures [25,28,46]. In collectivist cultures, self-worth is often derived from devotion to the community and belonging to it and its interpersonal harmony, reducing the importance of appearance as a determinant of self-esteem [30,47]. This may explain the lower variability in body image concerns among Indian participants.

In contrast, the lower self-esteem and higher levels of body uneasiness reported by Italian participants reflect the individualistic emphasis on personal achievement and appearance, a characteristic of Western cultures [48,49]. Individualistic societies prioritize self-expression and autonomy, often leading individuals to focus heavily on their physical attributes as a measure of personal value [27,50,51]. This cultural backdrop may contribute to the higher weight phobia and body image concerns observed among Italians in this study, as supported by some cross-cultural research [52,53]. Our results align with previous research indicating that individuals from collectivistic cultures may experience higher body dissatisfaction, underscoring the importance of cultural context in body image studies [53,54]. However, the literature also reports opposite effects in collectivist societies where participants feel more pressure from family and friends to conform to standard beauty norms compared to individualistic societies [55,56].

Another possible explanation for our findings could be stronger familial and community support, where interpersonal relationships in collectivist cultures can buffer negative self-perceptions and mental health problems [23]. In India, traditional practices (e.g., yoga and meditation) might promote holistic well-being and acceptance of the body [38]. While social media can heighten pressure on body image globally, patterns of use (e.g., types of content consumed) and cultural interpretations might differ significantly between Indian and Italian youth [5]. Furthermore, the specific university environment, educational background, socioeconomic conditions, and urban–rural distinctions between the Indian and Italian samples might have influenced body satisfaction independently of broader cultural dimensions.

Our finding of a strong correlation between self-esteem and body image in both groups highlights the universal significance of self-esteem in shaping body perception. This relationship is consistent with established theories of self-concept, which suggest that higher self-esteem enhances resilience against societal pressures and promotes positive evaluations of one’s physical self [19,57,58]. Interestingly, this relationship was particularly pronounced in the Indian population, suggesting that collectivist values may amplify the protective effects of self-esteem by emphasizing non-appearance-based sources of self-worth, such as academic, moral, or familial achievements [59,60,61]. Cultural differences in body engagement were also evident in the scores for body touch and body care. Italian participants demonstrated higher comfort with body touch, a reflection of Mediterranean cultural norms that value tactile expressions of affection and social connection [62,63]. In contrast, Indian participants scored higher in body care, likely reflecting traditional practices such as yoga, Ayurveda, and other wellness rituals that emphasize the maintenance of physical and spiritual well-being [64,65].

The regression analysis confirmed that self-esteem significantly predicts body investment behaviors and body uneasiness. The strong positive association between self-esteem and body image highlights the importance of self-worth in promoting a positive relationship with one’s body, a finding echoed in multiple studies on self-esteem and mental health [53,57,58]. Similarly, the negative relationship between self-esteem and body uneasiness underscores the protective role of self-esteem in reducing body dissatisfaction and related issues [1,10,49]. These results emphasize the need for interventions that boost self-esteem as a means of addressing body image concerns. Italians experience stronger protective effects of self-esteem against body uneasiness compared to Indians, which may be explained by cultural variations in self-evaluation processes. In individualistic cultures, where personal achievements and attributes are the primary markers of success, self-esteem likely plays a more central role in mitigating appearance-related concerns [27,30,48]. Meanwhile, the collectivist emphasis on social and relational harmony in Indian culture may diffuse the influence of self-esteem on appearance-specific outcomes, leading to less noticeable effects [47,53].

This study highlights the connection between body image and self-esteem in two different countries on different continents, emphasizing the importance of considering cultural context in psychological research and therapies. These findings suggest that strategies aimed at improving body image and reducing body uneasiness should be culturally aware. For instance, interventions in individualistic societies could focus on promoting intrinsic self-worth, while collectivist societies may benefit from approaches that integrate communal values and relational support systems.

While traditional cultural frameworks distinguish collectivist societies like India form more individualistic societies like Italy, these lines are increasingly blurred. The widespread use of social media platforms such as Instagram and TikTok has exposed young people across cultures to similar beauty ideals, often promoting narrow and unrealistic standards of attractiveness [66,67]. These global messages can reinforce or even override local cultural values, contributing to body dissatisfaction and shaping self-esteem in complex ways. Although our study did not directly assess media exposure, these influences should be considered in future research examining body image across cultural contexts.

A key limitation of this study is its cross-sectional design, which prevents conclusions about causality. Future research using longitudinal methods could help to clarify the directionality of the relationship between self-esteem and body image. Another limitation of this study is that participants were not screened for diagnosed mental health conditions. Given the established links between mental health, self-esteem, and body image, the presence of undiagnosed or diagnosed conditions among participants could have influenced the findings. Furthermore, as with all self-report studies, responses may have been affected by social desirability bias. Finally, one limitation of our study is that we focused only on university students. At this stage in life, young adults may emphasize physical appearance more due to limited experiences in other areas of accomplishment and increased interest in romantic relationships. In future studies, including participants of different ages and examining their relationship status could provide deeper insights into how these factors affect self-esteem and body image.

Potential future research could include longitudinal designs to track how self-esteem and body image evolve over time and whether cultural influences remain stable across different life stages. We also recognize the value of incorporating qualitative methods (e.g., interviews or focus groups) to gain deeper insights into participants’ experiences. Expanding the scope to include additional cultural contexts beyond India and Italy would also enhance the generalizability of these findings. Future research could also benefit from incorporating mental health assessments to better control for this potential confounding factor and provide a more nuanced understanding of the relationship between self-esteem and body image across different cultural contexts.

Although the main analyses revealed consistent patterns across the full sample, we did not conduct additional robustness checks within subgroups such as gender or age groups. Future studies could explore whether these findings remain stable when stratified by demographic characteristics (e.g., age, gender, and socio-economic status), which would enhance the reliability and generalizability of the results.

5. Conclusions

This research highlights the importance of cultural differences in the relationship between self-esteem and body image among Indian and Italian university students. Indian participants generally reported higher self-esteem and more positive body perceptions, reflecting the effect of collectivist cultural values. In contrast, Italian participants showed greater body uneasiness and weight-related concerns, likely influenced by individualistic cultural norms. The strong connection between self-esteem and body image in both groups show the global nature of self-esteem in shaping body perceptions. However, its protective effects against body uneasiness were more noticeable among Italians. These findings highlight the importance of considering cultural differences when developing programs to support students’ self-esteem and body image. Universities and mental health professionals can promote a culturally aware mindset by offering counseling, workshops, and awareness campaigns that respect different cultural views on self-worth and body image. For example, in individualistic cultures like Italy, interventions may focus on self-compassion and reducing external pressures related to appearance, while in collectivist cultures like India, support systems could emphasize social and familial reinforcement of self-worth. By adapting these approaches to different cultural contexts, institutions can better support students’ mental health and overall well-being.