Any form of physical activity can be beneficial to the physical and mental health of youth and adults when undertaken regularly and with sufficient duration and intensity [1,2]. These recommendations are highly relevant since there is simultaneously a worldwide prevalence of physical inactivity and obesity. Indeed, the current sedentary lifestyle is one of the main causes of overweight/obesity [3,4], and this results in a high prevalence of dissatisfaction with the perceived body image (BI) because of the ideal of body thinness prevalent in Western societies [5].

Sports make an important, though underused, contribution to the physical activity of persons of every age [1]. Athletes are engaged in structured and planned physical activity with prominent influences on their physical and mental health. Generally, a positive BI is associated with increased participation in physical activity and sports [6]. BI is considered a multidimensional construct focused on the appearance and function of the body [6]. Body dissatisfaction with an individual’s own physical appearance and body size, as well as discrepancies between actual and ideal dimensions, are cognitive, affective, and perceptual indicators of a negative BI [7]. In essence, a negative or positive BI is shown through the perceptual dimension (how I see myself), and cognitive and affective dimensions (how I think and feel about my physical appearance) [7].

In a sports context, a more favorable BI would depend on actual physical changes resulting from the sport practiced (e.g., body shape), perceived changes in the physique, and building self-efficacy and confidence. However, this relationship is by no means simple: while physical activity practice contributes to raising self-confidence through a number of discernible physical changes (e.g., an increase in fat-free-mass) resulting in improved BI satisfaction, BI may, in turn, induce motivation or dissuasion for physical activity and sports participation [6]. Thus, for example, exercise addiction arises from a misperception of BI [8] and can also result in decreased performance owing to overload and physical burnout [9].

An important aspect to consider is whether dissatisfaction is influenced by the type of exercise practiced. Some differences in body dissatisfaction recorded among practitioners of different sports [10] might depend on the importance of body weight and body thinness within that sport [11]. A particular relevance of physical appearance can be found in aesthetic sports, such as rhythmic gymnastics. In this case, the assessment of the athlete considers his/her morpho-kinetic abilities based on well-coded aesthetic requirements. Therefore, in addition to performance, the athlete’s physical appearance strongly contributes to the judgment, so much so that a prevalence of dissatisfaction among athletes involved in aesthetic sports has been reported in several studies [12,13]. With particular reference to the female gender, a higher risk of body concerns was observed in gymnastics than in swimming and long-distance running [14]. However, in these cases, it is important to distinguish the “sport” body image dissatisfaction (sport-BID = perceived discrepancy between current and ideal body size for sport) from the general body image dissatisfaction (BID) [15,16]. Indeed, the literature [15] shows that athletes, especially in aesthetic sports, would not be driven toward dieting and pathological weight control because of general BID, but because of the specific needs of the sport they play. Greenleaf [17] distinguished the BI of the athlete within an athletic context from a social BI that relates to the context of everyday life. Satisfaction/dissatisfaction with one’s body image will therefore depend not only on one’s physical appearance, but also on the social or sports environment of reference. Although athletes tend to be more satisfied than non-athletes in the social environment [18], in the sports environment, athletes often are under pressure from coaches and athletic trainers to achieve and retain a body that is favorable to their respective sport [19]. Regarding aesthetic sports, for example, it has been found that the ideal sports figure of the female gymnast does not coincide with the ideal figure in everyday life, being leaner [16].

According to previous literature reviews, athletes have a more positive BI than non-athletes both considering studies published between 1975 and 2000 [18] and between 2000 and 2012 [14]. Although both reviews made this comparison taking into account age and competitive level, no gender comparisons were made in either the first review (which reports a small percentage of males) or the second review (focused exclusively on females). The majority of studies in this field concern eating disorders, showing a higher incidence of disordered eating in athletes, particularly in aesthetic and weight-class-dependent sports [20]. De Bruin et al. [15] analyzed the role of BI in athletes’ disordered eating, showing that the athletic BI contributes greatly to this symptomatology. To date, research has focused primarily on the impact of negative BI on the athlete or pathological aspects without thoroughly considering the framework [21].

2. BID by Gender

3. BID by Type of Sports: Aesthetic Sports vs. Non-Aesthetic Sports

4. BID by the Level of Sport: Elite Level vs. Non-Elite Level in Aesthetic Sports

5. BID by Weight Status: Underweight Athletes vs. Normal-Weight Athletes

	Underweight			Normal-Weight
Subgroup	N	Mean	SD	N	Mean	SD	Weight	SMD [95% CI]
UW (international RG) vs. NW (controls) [28]	20	−0.5	0.8	80	−1.0	1.1	31.55	0.47 [−0.02, 0.97]
UW (national RG) vs NW (controls) [28]	61	−0.8	0.9	80	−1.0	1.1	68.45	0.29 [−0.04, 0.63]
Total (random effects)	81			160			100.00	0.35 [0.07, 0.63]

6. Sport-BID by Gender