Associations between muscle dysmorphia-related body image concerns, physical activity, and body composition: a cross-sectional study among young Asian adults in Malaysia

Abstract Background Muscle dysmorphia (MD) is a body image disturbance characterized by an obsessive drive for muscularity, increasingly observed in non-Western populations. However, limited data exist on its associations with physical activity (PA) and body composition in Asian contexts. This study examined the relationships between MD-related body image concerns, PA levels, and anthropometric/body composition characteristics among young Asian adults in Malaysia. Methods A cross-sectional study involving 513 university students in Malaysia (207 males, 306 females; median age 21 ± 2 years) was conducted. Participants completed validated questionnaires assessing MD-related concerns—Drive for Leanness Scale (DLS), Drive for Muscularity Scale (DMS), MD Disorder Inventory (MDDI), Muscularity-Oriented Eating Test (MOET)—and weight control behaviors. PA was assessed using the IPAQ-SF, and body composition was measured via bioimpedance. Sex differences, correlations, and multiple regression analyses were performed. Results Males reported significantly higher DMS and MDDI scores, greater skeletal muscle, and higher PA levels ( p < 0.001), while females had higher adiposity measures. PA showed positive associations with all MD-related body image concerns, including DMS (β = 0.149), MDDI (β = 0.188), and MOET (β = 0.107). Regression models also identified BMI, waist-to-height ratio, subcutaneous fat, financial adequacy, and life satisfaction as significant associated factors. Participants in higher PA categories reported more severe MD-related concerns. Conclusion Overall, the findings indicate that while PA and body composition are statistically associated with MD-related concerns, these relationships are relatively weak, suggesting that objective physical characteristics play a limited role. This underscores the importance of considering psychological and sociocultural factors when examining MD among young Asian adults.