Research on body image

Body image is a key issue affecting youth mental health. Over the last 10 years research in Ireland has consistently identified body image as a key source of concern for young people. This is concerning on many levels as body image is a key construct which affects how we feel about ourselves in general. Negative body image has been linked to a whole host of adverse outcomes for people of all ages, genders and backgrounds.

2019: My World Survey 2

This is the largest study ever carried out in relation to youth mental health in Ireland. This survey captures the views of more than 19,000 young people from across Ireland. The key findings are outlined below.

• Body-esteem was found to be one of nine key factors which related to youth mental health outcomes.

• There was a significant relationship between time spent online (more than 3 hours) and higher levels of depression and anxiety and lower levels of body esteem.

• The report found that body-esteem and body satisfaction decreased consistently over the course of adolescence, with first year students reporting the highest body-esteem in secondary school and sixth year students reporting the lowest. This trend was seen for both males and females.

• In adolescents, 26% reported being dissatisfied or very dissatisfied with their bodies.

• Levels of body-esteem and body satisfaction continued to decrease after adolescence, with 44% of young adults reporting that they were dissatisfied with their bodies.

• Lower body-esteem was related to higher levels of depression and anxiety, and greater use of “strategies for altering appearance”.

• Over two-thirds of young people reported attempting to alter their appearance using strategies such as exercising, reducing their food intake, and trying to ‘bulk up’.

• The report also found that young people who reported having attempted suicide had lower body-esteem than their peers who had not attempted suicide.

Crucially, the report found that having positive support from One Good Adult in their life was linked to higher levels of body-esteem.

Dooley, B. & Fitzgerald, A. (2019). My world survey 2. National Study of Youth Mental Health in Ireland. My World Survey 2 report - click here to read the report.

2018: #MoreThanASelfie Research

In 2018 Bodywhys conducted research (funded by the Irish Research Council) in collaboration with Maynooth University and the Centre for Mental Health and Community Research (CMHCR) at Maynooth to develop and evaluate a schools based intervention to promote positive body image and social media literacy in young adolescents. This research involved three separate but related stages undertaken to: (i) develop and co-design, in collaboration with young people and teachers, a school-based intervention to promote positive body image and social media literacy; (ii) pilot test the new intervention to assess its ability to enhance social media literacy, improve body image and, at the same time, examine the nature and experience of media and social media use in the young adolescent (age 11-14); and (iii) to increase awareness of the importance of body image as a key issue for youth mental health whilst also disseminating the study findings.

Stage One of this multi-stage project, involved the development of the #MTAS intervention, which incorporated engaged research approaches throughout.  Stage Two of the research involved: (1) a non-randomised pilot evaluation of the intervention involving 161 young people from three schools; and (2) the exploration of participants’ experiences and views of the intervention. Stage Three of the research involved the development of a comprehensive website dedicated to promoting positive body image and to include a focus on parents and education professionals as well as young people themselves.

Findings:

• Almost all participants reported using social media daily (92%) with only small proportions using/checking it every few days (5%), or less than once a week (3%). More than half the sample reported checking social media at night (55%).

• Almost one in five of the sample (17%) and proportionately more males (22%) than females (16%) had started using SM before the age of 10, while the largest proportion of the sample (59%) had started at age 10 or 11

• Results suggest that participation in the #MoreThanASelfie intervention had positive effects on participant’s attitudes to their body image, particularly among male students. A reduction in drive for muscularity was observed in boys who participated in the intervention and a reduction in overall time spent on social media was also demonstrated in male intervention participants at follow up compared to boys in the control group. Positive changes were also noted for female intervention participants with a reduction in perceived pressure from family related to appearance noted and an improvement in social media literacy compared to the control group.

• The feedback from participants on their experience of the #MoreThanASelfie programme (on anonymous evaluation forms at follow up) was overwhelmingly positive. The vast majority of participants (91%, 77/85) felt that the programme was good for their class, with only some small variations by school type (all boys school: 89%, mixed School: 91% and all-girls school: 94%). Likewise, most respondents (88%, 75/85) indicated that they would like a younger sibling or friend to receive the programme (88%, all boys school: 86%, co-educational school: 89% and all girls school; 88%).

2017: What’s wrecking your head?

This survey of 2,500 young people in Ireland conducted by ReachOut and The Irish Examiner indicated that 72% reported body image concerns (Chambers, 2017).

72% of young people surveyed identified body image as causing them stress or difficulty.

The survey asked teenagers to select things that have ever caused them stress or difficulty from a list of 12 items, with the option to specify additional stressors. Overall, ‘Exams’ (selected by 81%) followed by ‘School’ (selected by 80%) were the most common stressors. Of note, the next most frequently selected issue was ‘Body image’ (72%) with 81% of females selecting ‘Body image’ as a source of stress, compared to 52% of males.

The study found that body image and difficulties around body image appeared to be strongly linked to social media use. Comments from the respondents supported this finding, with one individual asserting that, “Through social media teenagers see images of celebrities and models which causes some to have body image problems.” Another respondent, a 19 year-old female, suggested that “Teenagers are so focused on body image and their 30 likes on social media that bullying and self-shaming affects the way they think about themselves and others.”

Research by Cybersafe Ireland

Research by Cybersafe Ireland (2017) found that despite age restrictions of 13 and older on many social media sites, the vast majority of the 4,893 children they met, aged 8-13, already had a significant online presence. In addition, 16% of children in this age group were spending more than four hours online daily. Despite age restrictions, 52% of 11-12 year olds one in five 9-10 year olds, already had a social media profile. Given these figures, the body image pressures identified by teenagers in relation to social media use, such as increased exposure to media ideals, perception of ‘the perfect life’ perpetuated by social media and the impact of comments and ‘likes’ to body image and self-esteem, are likely to be affecting younger children in the same way. Increased time spent online may also preclude the development of other interests which could foster a strong sense of self and greater self-esteem and serve as preventative factors for mental health.

2016: Body image in adolescent boys

In a study involving 6,187 boys, aged 10-17, researchers found that one third of participants reported weight concerns - either that they wished to lose or gain weight. The study also found that those with weight concerns experienced lower levels of self-rated health, life satisfaction and happiness, and more frequent emotional and physical symptoms. Similar to previous research, this study found that the boys’ weight concerns increased consistently with age (Kelly et al., 2016).

2015: Bodywhys Focus Groups

In response to the growing concern around body image, in 2015, Bodywhys met with groups of young people to discuss body image, to learn about their experience of body image pressure and to discuss how body image concerns could be addressed. The young people involved in the focus groups were aged 16-22. In total, four focus groups were carried out with 10-12 participants in each. Without exception, all participants in the focus groups indicated that the primary source of pressure to body image was social media. They also named peers and the media as factors affecting body image.

“LOOKING GLASS SURVEY” NATIONAL WOMEN’S COUNCIL OF IRELAND (NWCI)

A survey of young women aged 16-24 found that:

• A worrying 41% of Irish women reported being unhappy or very unhappy with how they look.

• Negative feelings about how they look prevent 1 in 5 young women from applying for a job.

• 8% of young women are discouraged from going to the doctor because of their personal appearance.

• Social media has the most negative influence on a young woman’s body image (16-24) while advertising has the most negative influence overall on women’s body image.

2014: Health Behaviour in School-Aged Children in Ireland survey

Focusing on Irish adolescents aged 13 to 18, this study involved the following three strands: an investigation of peer influence on body image through the medium of focus groups; survey results from nearly 4,500 adolescents involved in the 2013/14 (HBSC) survey in Ireland, and workshops with 74 adolescents; and an analysis of the views of more than 7,000 adolescents on cyber-bullying and its role in perceptions of a young person’s body image.

Peer pressure, pressure to conform, and cyber-bullying are all factors influencing the incidence of negative body image in adolescents. One in four participants reported being cyber-bullied once or more in the past couple of months, with girls (31.0%) more likely than boys (17.4%) to report experiencing cyber-bullying.

The results suggest that cyber-bullying may play a role in body dissatisfaction among adolescents; while supportive peer relationships may serve as a buffer against body dissatisfaction. Results indicate that adolescents who report experiencing cyber-bullying are approximately twice as likely to perceive themselves as too fat, compared to those who report never experiencing cyber-bullying.

2013: Growing up in Ireland Survey

In 2013, The Growing Up in Ireland Survey indicated that 39% of 13 year olds had dieted to lose weight.

2013: My World Survey

This survey examined the mental health of 8,221 young people aged 17-25.

2012: Dáil na n’óg survey

In 2012, young people involved in Dáil na n’Óg selected body image as the main issue of importance to them and carried out a survey of over 2,000 young people aged 12-21. Despite the fact that the majority of those surveyed were less than 18, 15% of girls and 12% of boys indicated that they had taken diet supplements to change their body shape. In the same survey 50% of participants indicated that body image concerns had prevented them from taking part in activities they enjoyed.

2009: Teenage mental health: what helps and what hurts?

In 2009, the Department of Health ‘Teenage Mental Health – What Helps and What Hurts?’ Report indicated that young people had identified body image as the number one factor which ‘hurt’ their mental health or ‘made them feel bad about themselves.’

INTERNATIONAL RESEARCH ON BODY IMAGE

Young people and body image

The Health Behaviour in School-aged Children cross-national study (2020) reported that more than 1 in 4 adolescents perceived themselves as being ‘too fat’. This research highlights just how prevalent body image concerns are among young people today. A vast body of research outlines the potential negative outcomes of this in relation to psychological, physical and social functioning. Researchers in Canada, for example, reported that body dissatisfaction can cause lower levels of self-esteem, which can then lead to increased symptoms of psychological distress (Duchesne et al., 2017), while other research has shown that body dissatisfaction can predict later depressive symptoms in both male and female adolescents (Sharpe et al., 2018). In a study of Spanish adolescents, researchers found that those with lower body image satisfaction and those who perceived themselves as being overweight were more likely to report physical complaints and internalising symptoms including anxiety, depression and social withdrawal (Ramos et al., 2019).

Most of the research in this area has found the prevalence of body image concerns to be higher in females than in males, for example the Health Behaviour in School-aged Children (2020) reported that 31% of girls and 22% of boys are dissatisfied with their bodies. However, there is evidence to suggest that this gender gap is narrowing. Body image concern in adolescent males appears to be on the increase, with greater pressure than ever coming from the media, social media and peers to achieve a lean, muscular body (Good Childhood Report, 2019).

Credos (2016) surveyed 1,005 boys from primary and secondary schools around the UK to explore their attitudes towards advertising and body image, and conducted focus groups of boys aged 8 to 18. Of more than 1,000 boys surveyed, 55% would consider changing their diet to look better and 23% said they believed there was a perfect male body. Most of the boys saw eating disorders (56%) as an issue for both boys and girls and almost as many felt dieting (55%) and extreme exercising (48%) were gender neutral issues. 

Men and body image

Longitudinal research conducted on a group of men and women between 20 and 86 years of age over two years indicated that a relationship exists between self-esteem and levels of body dissatisfaction. Results indicated that the male participants placed the greatest importance on appearance and had higher levels of body dissatisfaction than the women in the study (Mellor et al., 2010).

Barlett et al. (2008) reported that pressure from the mass media to conform to the ‘muscular ideal’ has a negative impact on men’s body image and self-esteem. This research relates to Calzo and colleagues’ study (2012) which reported that, for both females and males, concerns about body image intensify throughout adolescence. However, the researchers also reported that for males, there was a steady increase in their desire to become more muscular each year during their teens. It is likely that this is, in part, due to the extent to which boys internalise the muscular ideal presented in the media and on social media. Research has consistently found a relationship between body dissatisfaction, drive for muscularity and internalisation of the muscular ideal (Edwards et al., 2014).

There has been a rise in the use of apps to track our food, exercise, sleep and more in recent times. Linardon and Messer (2019) researched the link between the use of the fitness tracking app, MyFitnessPal, and the prevalence of disordered eating symptoms in men. They found a higher prevalence of eating disorder symptoms in male users of MyFitnessPal, including greater concern regarding weight and shape and increased dietary restriction. Over a third of the men in the study who used MyFitnessPal said that they saw the app as something that contributed to their disordered eating.

Research indicates that the extent to which men conform to or agree with traditional male gender norms is related to rates of body dissatisfaction. De Jesus and colleagues (2015) found that men with higher levels of conformity to traditional gender norms such as winning, emotional control, violence, and risk-taking were at greater risk of experiencing concerns about body image.

Baker and Blanchard (2018) conducted a review of the effects of concerns about weight, body dissatisfaction and body image in males in relation to the psychological, cognitive and behavioural consequences.  The researchers state that there has been a rise in eating disorders and concerns about body image in men, which may be a result of greater visibility of men in the media and the promotion of the muscular ideal.

Women and body image

Research indicates that levels of body dissatisfaction in younger and older women do not differ significantly, which demonstrates that body image concerns can affect people of all ages. The study reported a higher drive for thinness and greater societal influence on body image in younger women than in older women (Pruis and Janowsky, 2010). Similarly, Webster & Tiggemann’s (2003) study found that many younger, middle-aged and older women experience dissatisfaction with their bodies. They also reported that body dissatisfaction was linked to women’s self-concept and self-esteem and that this relationship decreased with age and with greater cognitive control. Another research study found that older and middle-aged women still feel societal pressure to control their weight and that they will use weight management methods such as dieting, exercise, and dietary supplements to do so (Bedford and Johnson, 2006).

In general, women have been shown to have poorer body image than men across the lifespan, scoring lower on measures of body appreciation, body pride and body image flexibility (Richard et al., 2016; Swami et al., 2017). Longitudinal research conducted on a group of men and women between 20 and 86 years of age over two years indicated that a relationship exists between self-esteem and levels of body dissatisfaction. This relationship was strongest in younger women and was such that those with lower self-esteem were likely to have greater body dissatisfaction (Mellor et al., 2010).

In terms of the effects of body image concerns, research indicates that approximately one third of young women avoid getting smear tests as a result of concerns about their body shape and appearance.

Pregnancy, post-partum and body image

There is evidence both for increases and decreases in body dissatisfaction during pregnancy. Some studies report that women experience greater dissatisfaction with their bodies in the early stages of pregnancy (Goodwin et al. 2000). Others suggest that some women adapt well to bodily changes which occur during pregnancy and in some instances there can be improvements in body image during this period (Clark et al. 2009; Loth et al. 2011).

Evidence suggests that during the postpartum period, women can experience greater body dissatisfaction (Rallis et al. 2007; Clark et al., 2009; Gjerdingen et al., 2009). Researchers recommend that women be better educated about how their bodies will change after giving birth and that action is taken to improve new mothers’ body image in the postpartum period (Gjerdingen et al., 2009).

The effects of weight stigma

Weight stigma or weight bias is defined as ‘negative attitudes towards, and beliefs about, others because of their weight.’ These beliefs can lead individuals to engage in stereotyping and prejudice against people with overweight and obesity. Studies have shown that weight stigma is associated with ‘significant physiological and psychological consequences, including increased depression and anxiety, disordered eating, and decreased self-esteem’ (World Health Organisation, 2017). A recent meta-analysis found a strong relationship between weight stigma and a range of adverse mental health outcomes including but not limited to: self‐esteem, quality of life and life satisfaction, depression, anxiety, body image dissatisfaction and eating disorders. In general, participants in the study who perceived higher weight stigma had poorer mental health (Emmer et al., 2019).

In terms of physical consequences, research indicates that weight stigma can negatively affect quality of medical care received, thus leading to poorer health outcomes. In addition, weight stigma is associated with maladaptive eating patterns, avoidance of physical activity, stress-induced physiopathology and avoidance of medical care (Kahan & Puhl, 2017). The evidence suggests that an approach which focuses on making health gains through behaviours such as physical activity and stress management produce better overall health outcomes than an approach which focuses solely on weight loss (Bacon & Aphramor, 2011).

Social media and body image

The Royal Society for Public Health #StatusofMind report (2017) asked nearly 1,500 adolescents about their views on the effects of using different social media platforms, including YouTube, Facebook, Instagram, Twitter and Snapchat. Participants reported that every single one of these five platforms has a negative impact on body image, with Instagram being voted as the most harmful.

A review of cross-cultural evidence links social media use to body image concerns, dieting, body surveillance, a drive for thinness and self-objectification in adolescents (Holland & Tiggemann, 2016). A growing number of studies also suggest a link between social media use and adolescent mental health, including lower self-esteem and higher levels of anxiety and depression (Woods & Scott, 2016). Social networking sites like Facebook, Instagram and Snapchat enable teens to share photos online. Research indicates that the highest frequency users are more likely to link their self-worth to their looks (Stefanone et al., 2011). Evidence suggests that taking and posting selfies online can result in low mood, anxiety, reduced self-confidence, and poorer body image (Mills et al., 2018), and that photo manipulation (i.e. photoshopping, editing and using filters on selfies) is linked to greater levels of body dissatisfaction in men and women (Lonergan et al., 2019).

Interestingly, while girls report more body image disturbance and disordered eating than boys, some research indicates that social media use can play an adverse role in the body image of both adolescent boys and girls (de Vries et al., 2016). And it’s not just adolescents who experience negative outcomes from spending too much time online. Research in adult samples has revealed that adults, both men and women, can be prone to comparing themselves to peer and celebrity images they see on social media, and that this can lead to increases in body dissatisfaction and negative mood (Modica, 2020; Brown & Tiggemann, 2016).

Research indicates that viewing ‘fitspiration’ images have a positive effect for some people on motivation to pursue healthy goals. However, ‘fitspiration’ images were found to have a negative effect on body image as a result of appearance-based social comparison (Tiggemann & Zaccardo, 2015). Viewing ‘fitspiration’ images has also been shown to be related to increased disordered eating behaviours and compulsive exercise (Holland & Tiggemann, 2017).

The findings of the My World Survey 2 (Dooley et al., 2019) suggest that many adolescents and young adults may be using social media to build on and extend their social connections in real life, and there may be some benefits to spending time online. However, a significant relationship was found between time spent online (more than three hours) and higher levels of depression and anxiety and lower levels of body-esteem in adolescents. Other research reports that what is important is whether we use social media in an active or passive way. If social media is being used actively, i.e. to connect with others, it can have a positive impact on overall mental health. However, if social media is being used passively, i.e. scrolling through without a particular purpose, it is more likely to lead to social comparison and, as a result, decreases in well-being (Verduyn et al., 2017).

If you would like to read in more detail about the internet, body image and eating disorders, the following resource provides some useful information about navigating social media and smartphone apps and changing the way that we engage with them - click here.

Self-compassion and body image

A literature review of 28 studies found a relationship between greater self-compassion and lower rates of disordered eating. The study also found that self-compassion may act as a protective factor against negative body image and disordered eating. (Braun et al., 2016). Another study observed an association between self-compassion and body image; higher levels of self-compassion predicted lower levels of body preoccupation, decreased concerns about weight and shape, and more appreciation of one’s body. The researchers also found that being very judgemental and critical of ourselves can lead to an increase in body preoccupation (Wasylkiw et al., 2012).

One research study in the UK found that even just viewing quotes about self-compassion can positively influence our levels of body dissatisfaction, body appreciation, self-compassion and overall mood. Meanwhile, it was found that women who viewed ‘fitspiration’ (i.e. fitness inspiration) images had lower levels of self-compassion in the study (Slater et al., 2017). An important finding is that self-compassion can protect against the negative effects of low self-esteem on adolescent mental health. Researchers in Australia found that high levels of self-compassion predicted positive outcomes for mental well-being in adolescents, even in the incidence of low self-esteem (Marshall et al., 2015).

Promoting positive body image

Positive body image incorporates constructs such as body appreciation, body acceptance, body pride, body image flexibility and positive rational acceptance, amongst others (Webb et al., 2015). In its simplest form, positive body image means accepting how your body looks most of the time and ensuring that thoughts about your body image are not holding you back from engaging fully with other aspects of your life. Evidence suggests that body appreciation, a key facet of positive body image, is significantly and positively associated with greater life satisfaction and flourishing in men and women (Davis et al., 2020).

Menzel and Levine's (2011) embodiment theory of positive body image suggests that activities which help us to foster a mind-body connection - i.e. ‘get into our bodies’ more and become more in touch with our bodies’ experiences and needs - can be beneficial for reducing body image concerns. There is some evidence for this theory in the areas of yoga, certain forms of dance, and some sports.

In relation to yoga, a longitudinal study (15 years) showed a positive impact of yoga on body image in young adults, both male and female (Neumark-Stainzer et. al., 2018). Another study which examined a group of female university students found that those who practiced yoga had greater positive body image and embodiment, and reduced self-objectification and desire for thinness than the control group (Mahlo & Tiggemann, 2016). In men, research has found greater body satisfaction in both beginner and experienced yoga practitioners than in those who engage only in weight training and aerobic exercise (Flaherty, 2014).

In relation to dance, a 36-week dance therapy intervention was found to result in increased body consciousness and improved body image in patients with obesity (Muller-Pinget et al., 2012). Another study tested whether belly dancing could improve body image by fostering this mind-body connection. The researchers found that belly dancers had more positive body image, reduced body dissatisfaction and lower self-objectification scores than those who were not belly dancers. They also found that this effect on positive body image in the belly dance group occurred through reduced levels of self-objectification (Tiggemann et al., 2014).

In relation to exercise and body image, research indicates that the reasons that motivate us to exercise are important. The relationship between exercise and body image depends on a person’s reasons for exercising rather than the amount or frequency of physical activity. When someone is motivated mainly by appearance-related factors e.g. weight management or attractiveness, there tends to be greater body dissatisfaction and an increase in dietary restraint. However, when motivation is internal e.g. exercising for functional reasons such as physical and mental health benefits or challenging oneself, the opposite is true - body dissatisfaction and dietary restraint are reduced (Tylka & Homan, 2015).

There is evidence to suggest that focusing on our body’s functionality rather than its appearance can promote positive body image. An intervention which trained women to increase their focus on the functional abilities of their bodies found that this lead to improvements in participants’ body image and reduced levels of self-objectification (Alleva et al., 2015).

Spending time in nature, and maybe even just viewing images of nature, has been found to boost one’s body-esteem and appreciation of one’s body (Swami et al., 2018).

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