From time immemorial, society has played a significant role in transmitting culturally accepted ideals of beauty. The sociocultural perspective emphasizes the importance of physical appearance in Western cultures, with the predominant beauty ideal for women being thinness (1–3). The societal pressure to conform to culturally imposed body ideals has been consistently linked to various negative outcomes, including body dissatisfaction (4, 5), eating disorders (6, 7), low self-esteem (8, 9), the desire to undergo cosmetic surgery (10, 11), and self-objectification (12, 13). Objectification Theory (14) describes how social norms and representations can lead women to internalize an observer’s perspective of their own bodies, resulting in self-objectification. This process is associated with increased body surveillance, feelings of shame and guilt, and negative perceptions of body image (15–18, 112). According to this framework, women are often perceived more as objects than as individuals, and their bodies become instruments for the pleasure and evaluation of others (19, 20). Experiences of sexual objectification have been associated with body surveillance and body shame, which, in turn, are linked to positive attitudes toward cosmetic surgery (15, 21).

Although objectification is a widespread phenomenon, cultural context plays an important role in how body-related pressures are expressed and internalized. In Romania, the post-socialist legacy has contributed to the persistence of traditional gender norms, especially after 1989, when women were redefined primarily as caregivers and esthetic figures, and the pursuit of gender equality was deprioritized (22–24). The liberalization of the market economy after communism reinforced consumerist ideals, positioning physical appearance—particularly for women—as a key indicator of value and success (25, 26). These historical and cultural processes have shaped a context in which women are often evaluated based on their physical appearance. At the same time, Romanian public discourse continues to reflect patriarchal expectations and sexualized portrayals of women. Scholars have highlighted how patriarchal ideologies are sustained through norms and imagery that reinforce traditional roles and the objectification of women (27, 28). For example, Kaser (29) notes the frequent use of overtly sexualized representations of women in Romanian media, while Frunza et al. (30) document the use of hypersexualized imagery in advertising. These dynamics contribute to a socio-cultural environment in which women’s appearance is emphasized and objectifying messages are normalized.

One psychological variable that has received attention in relation to body image is body image flexibility, a construct grounded in Acceptance and Commitment Therapy (31). It refers to an individual’s capacity to experience negative body-related thoughts and emotions without attempting to suppress or change them (32). Individuals with high body image flexibility can respond to these experiences with openness and self-compassion rather than avoidance or criticism (33, 34). This construct has been studied in connection with body image difficulties (35) and disordered eating (36). A systematic review by Rogers et al. (37) identified associations between body image flexibility and lower levels of eating disorder symptoms, appearance concerns, and psychological distress, as well as higher levels of intuitive eating and self-compassion. It has also been examined as a mediator between negative emotional experiences and behavioral outcomes such as binge eating and BMI (38), and in relation to body appreciation among women with low BMI (39). Webb (40) found that body image flexibility partially explained the relationship between body dissatisfaction and body appreciation. In the context of objectification, Huang et al. (41) showed that body image inflexibility mediated the relationship between self-objectification and the intention to undergo cosmetic surgery. Individuals with lower body image flexibility may respond to body-related distress through maladaptive coping strategies, including cosmetic surgery, as a way to reduce unfavorable comparisons and internal discomfort (42).

A second construct of interest in this study is intuitive eating, which refers to eating based on internal physiological cues rather than external or emotional ones (43). The model includes four components: unconditional permission to eat, eating for physical rather than emotional reasons, reliance on internal hunger and fullness cues, and making food choices in line with the body’s needs (44, 45). Intuitive eating has been associated with lower engagement in unhealthy dietary behaviors and eating disorder symptoms (46–48), reduced pressure to maintain a thin ideal (49, 50), and more positive body image (51–54). Other findings point to associations with higher well-being and lower BMI (55, 56). Although intuitive eating has been associated with constructs relevant to objectification theory, including lower body surveillance, reduced internalization of appearance ideals, and greater body appreciation (57, 58), its mediating role in the link between objectification and cosmetic surgery interest remains unexplored. Additionally, intuitive eating has been found to be negatively associated with objectification experiences (59, 60), suggesting its potential relevance in understanding appearance-related investment behaviors.

Considering the broader cultural context characterized by persistent patriarchal influences and the hypersexualization of women documented in Romania (29, 30), alongside the potential protective roles of body image flexibility and intuitive eating, the present study examines whether these constructs mediate the relationship between objectification and the desire to undergo cosmetic surgery. Building on the findings of Huang et al. (41), this study includes both body image flexibility and intuitive eating as parallel mediators. In addition, we examine three specific outcomes: intrapersonal reasons for cosmetic surgery, social reasons, and future consideration. To our knowledge, no prior study has investigated these mediators simultaneously within a Romanian sample. The proposed mediation models and hypotheses are presented in Figure 1.

The objective of this study was to examine whether body image flexibility and intuitive eating mediate the association between body objectification and the desire to undergo cosmetic surgery for intrapersonal and social reasons, as well as the likelihood of pursuing such interventions in the future, within an exclusively female population in Romania.

Across all tested models, body objectification was negatively associated with intuitive eating. Intuitive eating showed negative, yet non-significant, associations with the desire to undergo cosmetic surgery for social reasons and future intentions, and a positive, non-significant association with the intrapersonal motive. Consequently, intuitive eating did not emerge as a significant mediator in any of the proposed models.

This outcome may be understood in light of previous findings, which primarily link intuitive eating to eating behaviors and disorders (46–48). Individuals who engage in intuitive eating rely on physiological hunger and satiety cues to guide their food-related decisions (75). Moreover, intuitive eating is a relatively new concept, positioned as a psychologically adaptive strategy when compared to emotional or restrictive eating patterns (76), which are reportedly more prevalent among the Romanian population (77, 78).

Given the inconsistent levels of nutritional education in Romania (63, 79), it is plausible that participants were unfamiliar with this approach or less inclined to associate it with body-related investment strategies such as cosmetic surgery. It is also possible that intuitive eating, when employed, is more often linked to non-invasive appearance regulation behaviors such as healthy eating (80), gym participation (81), or maintaining a toned physique (82). Although intuitive eating was not found to be a significant mediator in the current study, this finding does not necessarily imply that the construct is irrelevant to appearance-related investment behaviors. While the mean score on the intuitive eating scale was above the minimum, suggesting some familiarity or openness to the construct, this does not guarantee consistent behavioral application or deep internalization of intuitive eating principles. As Avalos and Tylka (57) noted, intuitive eating is a multifaceted construct that requires both body trust and attitudinal alignment—not merely occasional reliance on hunger cues. In the Romanian cultural context, where appearance-focused norms and diet culture remain prevalent (63, 79), it is plausible that intuitive eating is not as deeply rooted or practiced as in populations where it has been more widely promoted or studied. Consequently, even moderate levels of intuitive eating may not be sufficient to act as a protective factor against objectification-related cosmetic surgery motivations in this sample (57). Future research using qualitative methods or subscale-level analysis could help clarify how intuitive eating is expressed and internalized in such cultural contexts.

Regarding body image flexibility, this construct was consistently and negatively associated with body objectification in all three models. Significant negative associations were also found between body image flexibility and the desire to undergo cosmetic surgery for social reasons and future intentions. The association with intrapersonal desire was negative but not statistically significant. As such, body image flexibility significantly mediated two of the three relationships tested.

These findings are consistent with prior research highlighting body image flexibility as a protective psychological resource. One possible explanation for these results lies in the social interaction model of objectification, which posits that individuals weigh the costs and benefits of objectifying interactions within patriarchal structures that grant men greater power and reduce women to bodily attributes (83). While men are known to objectify women through suggestive comments and gazes (84), women also engage in self-objectification through strategies such as provocative dress (85) or curated online appearances (86).

In this context, Romania remains shaped by persistent patriarchal norms and post-communist gender expectations (87). Following Romania’s accession to the European Union and neoliberal transitions, women have increasingly been positioned as hyper-feminine, sexualized subjects, especially in the media (28, 88, 89). The present findings align with these cultural patterns, suggesting that cosmetic surgery motivations may be rooted in sociocultural dynamics that reinforce appearance-based worth.

Theoretical frameworks such as self-verification (90), symbolic self-completion (91), and self-affirmation theory (92) further explain how individuals pursue identity-consistent behaviors. When objectification is normalized and perceived as socially rewarding, women may engage in body-altering practices as a means of reinforcing their self-image and gaining social validation (93).

These dynamics may help explain why lower levels of body image flexibility were associated with cosmetic surgery motivations, particularly for social reasons and future intentions. Recent studies have emphasized how social media environments amplify these pressures by promoting narrow beauty ideals and appearance-based comparison. Zaharia and Gonța (94) demonstrate that exposure to idealized body representations on social platforms contributes to internalization of unrealistic esthetic standards, body dissatisfaction, and compensatory behaviors aimed at reducing the gap between actual and ideal appearance. Similarly, Arab et al. (95) found that viewing cosmetic surgery-related content online and comparing oneself to influencers significantly increases the likelihood of considering cosmetic procedures, often driven by perceived social expectations rather than intrinsic desire. Franchina and Lo Coco (96) further argue that even positive social media feedback may reinforce body monitoring and concern, as individuals internalize the idea that their appearance is continuously evaluated. Taken together, these findings suggest that the pursuit of cosmetic enhancement is not merely esthetic, but reflects a deeper social logic of validation, symbolic affirmation, and identity maintenance. In contrast, the intrapersonal pathway was not statistically significant, potentially because such motivations relate more to self-worth and internal validation, which may not be fully captured by body image flexibility alone (97).

The desire to enhance physical appearance may also be fueled by broader interpersonal concerns, such as partner retention strategies (98–100) or intrasexual competition (101, 102). Previous research indicates that women may be more likely to invest in appearance-enhancing behaviors when competing for male attention (103).

Finally, our results complement those of Huang et al. (41), who found that body image inflexibility mediates the relationship between self-objectification and cosmetic surgery interest. Individuals with low flexibility may rely on maladaptive coping strategies to manage body-related distress and unfavorable comparisons (42), including cosmetic procedures aimed at restoring perceived body control and social value.

The primary limitation of this study lies in its cross-sectional design, which does not allow for causal inferences. Longitudinal or experimental intervention studies are needed to examine how these variables change over time and to explore the potential of intuitive eating and body image flexibility as protective and adaptive factors in the relationship between objectification and the desire to undergo cosmetic surgery.

Another limitation concerns the composition of the sample. Most participants were recruited from the Timișoara region, which may reduce the geographical and cultural variability within the sample. Additionally, information regarding the participants’ residential environment (urban vs. rural) was not collected, although the recruitment methods likely reached predominantly urban individuals. These factors limit the generalizability of the findings to women from other regions of Romania or from rural settings, where sociocultural attitudes toward body image and cosmetic surgery may differ.

An additional limitation concerns the recruitment strategy. Participants were recruited online, primarily through Facebook groups oriented toward themes such as body image, self-acceptance, psychological wellbeing, or general women’s interests. Although the study invitation was framed broadly and did not explicitly mention cosmetic surgery or related constructs, it is possible that individuals already invested in appearance-related issues were more likely to participate. This self-selection may limit the generalizability of the findings to the broader female population, particularly to women who are less engaged with appearance or body image topics. Future research should consider broader and more diverse recruitment strategies to minimize potential sampling biases.

Furthermore, although the study included a wide age range of participants (18–79 years), the majority were younger women, with a mean age of 29.61 years. Age was statistically controlled for in all analyses to minimize potential confounding; however, objectification experiences and attitudes toward cosmetic surgery may vary across developmental stages. Therefore, future research could benefit from stratified analyses or targeted recruitment to explore age-specific patterns. Such investigations may help clarify whether the psychological mechanisms identified in this study operate differently across early, middle, and later adulthood.

Additionally, a limitation of the current study is the lack of detailed information regarding the specific composition of the ethnic minority group(s). Although ethnicity was controlled for in the analyses, the use of general ethnic categories (“majority” vs. “minority”) limits the possibility of exploring within-group differences among minority participants. Future research may benefit from including more granular ethnic identification, provided confidentiality can be ensured.

Moreover, the present study did not examine the specific motivations underlying participants’ interest in cosmetic surgery beyond the three general dimensions assessed (intrapersonal, social, and future intention). It is possible that intuitive eating may be more or less relevant depending on the reason for pursuing surgery—for example, motivations driven by body dissatisfaction may relate differently to eating behaviors than those rooted in social approval or appearance enhancement. Additionally, the study did not assess which specific body areas participants were interested in modifying through cosmetic surgery (e.g., face, breasts, and body fat). This distinction may be important, as dissatisfaction with weight-related areas could be more closely linked to eating behaviors and intuitive eating than dissatisfaction with features less influenced by weight. Future research should incorporate assessments of the targeted body areas to better understand how different types of appearance concerns may interact with psychological factors such as intuitive eating.

Another methodological consideration concerns the inclusion of body mass index (BMI) as a covariate in all mediation models. Although BMI was not a primary variable of interest, it has been associated in prior research with both objectification experiences and body image-related outcomes, including appearance investment and cosmetic surgery intentions. Therefore, we included it to statistically adjust for its potential confounding influence on the relationships under investigation. Similar analytic choices have been reported in previous studies examining body image and esthetic attitudes (104–106). However, we acknowledge the ongoing debate in the literature regarding the role of BMI as a potential mediator or collider variable in appearance-related research. Future studies might consider modeling BMI differently or comparing models with and without BMI as a covariate to better understand its function within these psychological processes. Sensitivity analyses were also conducted excluding BMI as a covariate. These analyses indicated that the exclusion of BMI did not substantively alter the direction, significance, or interpretation of the direct and indirect effects observed in the study.

Finally, all research instruments were self-report scales, which may introduce response bias due to the inability to control factors specific to the respondents (e.g., their level of motivation to respond, providing answers inconsistent with reality to appear socially desirable).

In future research, it would also be valuable to explore other psychological factors that may mediate or moderate the relationship between self-objectification and the desire to undergo cosmetic surgery. Variables such as self-esteem (107), body dysmorphic disorder symptoms (108), and perfectionism (109) have been associated with body image disturbances and esthetic investment. For instance, Mancin et al. (108) found that individuals with higher levels of body dysmorphic disorder symptoms were more likely to engage in photo-related behaviors, such as frequent photo editing or sharing, which reflect heightened appearance concerns and may be linked to motivations for cosmetic procedures. Incorporating such constructs into future models could provide a more comprehensive understanding of the psychological mechanisms underlying body-related distress and the interest in cosmetic surgery.

Moreover, although this study tested three separate mediation models using different dependent variables, we did not apply formal correction procedures for Type I error (e.g., Bonferroni). Each model was theory-driven and addressed a distinct dimension of cosmetic surgery motivations. As Hayes (73) notes, applying overly strict correction methods in theoretically grounded models can unnecessarily inflate the risk of Type II errors. Additionally, the use of 10,000 bootstrap resamples offers a robust method for estimating indirect effects, reducing the likelihood of spurious findings. Future research may benefit from replication using preregistered designs or confirmatory models in independent samples.

This study underscores the importance of integrating cultural context when examining the psychological mechanisms linking body objectification to cosmetic surgery motivations. Rather than attempting to validate an existing theoretical model, our aim was to explore the applicability of concepts such as body image flexibility and intuitive eating within a Romanian sample—a population underrepresented in this area of research. Given Romania’s distinct sociocultural backdrop, shaped by both patriarchal values and post-communist gender dynamics, we argue that theoretical frameworks developed in Western contexts may not generalize seamlessly across cultures. As such, testing whether these mechanisms operate similarly in non-Western or transitional societies is a necessary step toward building culturally sensitive models of appearance-related investment. Given Romania’s specific sociocultural context, including its evolving post-communist identity and the influence of traditional gender expectations, the use of culturally adapted and semantically coherent measures is essential (110). This ensures that psychological constructs retain their theoretical integrity across languages and contexts. Our findings offer preliminary insights into how these psychological constructs manifest in a Romanian context and highlight the need for further cross-cultural investigations.

At the same time, psychotherapists, counselors, and school psychologists can develop prevention, psychoeducation, and intervention programs to emphasize the negative aspects of objectification in societies where such behavior is normalized. In this context, effective communication strategies are essential to ensure that messages related to body functionality, self-acceptance, and intuitive eating are accessible and impactful (111). Children and adolescents can thus learn from an early age to appreciate their bodies for their functionality rather than what they can offer to others. Educating individuals about intuitive eating can serve as a valuable starting point for fostering a positive relationship with their bodies. However, it is important to note that, in the present study, intuitive eating did not emerge as a significant mediator, and thus these recommendations should be considered preliminary and subject to further empirical validation in future research.

In a society that normalizes objectification and places significant emphasis on physical appearance, it is crucial to investigate factors that can counteract the harmful effects of these behaviors. Promoting a positive relationship with one’s body by appreciating it for its functionality and fostering trust in the signals it provides regarding its needs can serve as precursors to enhanced psychological and physical well-being.