Negative body image: causes, consequences and intervention ideas

Question 1

Glossary

Accepted Answer

Glossary footnote^{[footnote 1]}

Bisexual: Attraction towards more than one gender or sex

Body appreciation: Appreciating the ‘features, functionality and health’ of one’s body

Body image: Body image has been conceptualized as a complex and multi-faceted construct encompassing many aspects of how people experience their own embodiment, especially their physical appearance

Body incongruence: The disconnect or ‘incongruence’ between the physical body and the experienced self

Body neutrality: A Body Image Movement that doesn’t focus on appearance, but instead encourages individuals to place less importance on their physical body

Body positivity: A Body Image Movement rooted in the belief that everyone should have a positive body image and challenge the ways in which society presents and conceives of the physical body. The movement encourages acceptance of all bodies, no matter their size or shape

Body satisfaction: The extent to which an individual is content with their body size and shape. Incorporated into this theme are terms such as body confidence, body esteem, and body dissatisfaction

Body surveillance: The habitual monitoring of how one’s body is perceived by others

Cisgender: Refers to individuals whose gender identity matches with the sex assigned to them at birth

Fitspiration: A person or ‘thing’ that serves to motivate an individual to sustain or improve their health and fitness

Gay: A term used to describe someone who has an emotional, romantic or sexual orientation towards someone of the same sex or gender

Gender/body dysphoria: A medical diagnosis that someone is experiencing discomfort or distress because there is a mismatch between their sex and their gender identity. This is sometimes known as gender identity disorder or transsexualism. It is not a mental illness

Heteronormative: The assumption that all people are heterosexual and that heterosexuality is normal and natural

Lesbian: A woman who is attracted to other women. Some lesbians may prefer to identify as gay

LGBT: An abbreviation used to refer to lesbian, gay, bisexual and trans people

Non-binary: People who self-identify as non-binary, gender fluid, agender, non-gender, or genderqueer

Self-objectification: The phenomenon that occurs when people come to view themselves and their bodies as ‘objects to be looked at’

Question 2

Executive summary

Accepted Answer

Background and objectives

Body image, and more specifically body satisfaction, is one of the many factors that impact people’s decision making and confidence. As such, body dissatisfaction has been identified as an issue of growing concern to young people and their parents^{[footnote 2]} and was identified by the British Youth Council (2017)^{[footnote 3]} as an issue that warrants urgent attention and further research. The Government Equalities Office (GEO) has commissioned research into this area as there is evidence that body image may not only influence individual confidence and aspiration, but may also be one of the ‘invisible factors’ that contributes to the Gender Pay Gap. Specifically, this research aims to address the 2 following questions:

What impact has the increased use of social media and edited images had on negative body image?
How does negative body image impact different demographics (including men and boys, ethnic minority audiences, LGBT audiences)?

Methods and sample

This report presents the results of 2 parts of this project, a rapid evidence review and primary qualitative research. The evidence review synthesised findings from over 60 academic published sources. The primary research sample totalled 46 participants and included a mix of private ‘digital diary’ tasks and co-design workshops to test hypotheses and design potential policy interventions with the public.

This report blends the findings from the academic literature with the voices of a wide range of different groups represented in our primary research, including girls and boys, men and women (age range 15-35 years), LGBT and ethnic minority audiences.

Full details of method and sample can be found in Chapter 1.2.

Key findings and implications

Interventions aimed at tackling [negative/poor] body image are likely to be welcomed

Negative body image was recognised as a ‘problem’ that warrants attention by most of the participants in our primary research and many were aware and supportive of the trend towards body positivity and body neutrality.

Interventions need to take a holistic approach to tackling body image

Body image is about more than just the physical body and many factors, such as cultural and societal norms, mental health, peer-to-peer dynamics, families and mass media, play an important role in shaping it.^{[footnote 4]}^{[footnote 5]} As such, any interventions will need to take a holistic approach, tackling the issue from multiple angles.

Interventions should be mindful that experiences of body image vary amongst different groups, and change over time

Gender, ethnicity and sexual orientation all play a role in how people experience body image. The way people experience body image also varies over time as societal beauty standards change.

Interventions may need to be targeted at specific life milestones rather than just particular age groups

Both the evidence review and our primary research suggest body image impacts behaviour and decision making on a day-to-day basis and throughout people’s lives.^{[footnote 6]} While adolescence is a particularly challenging time for most people,^{[footnote 7]} our primary research suggests body image is not experienced as a ‘linear journey’. Life events and milestones (for example, having a child, going through a divorce) can play an important role in shaping body image.

Interventions should encourage a shift in focus from the aesthetics of the body to its functionality, particularly for women

Findings from the evidence review suggest that women^{[footnote 8]} are particularly affected by negative body image, as they tend to spend more time engaged in taking and circulating photographs; have lower body ‘appreciation’ than men; and experience more pressure to look youthful.^{[footnote 9]}^{[footnote 10]}^{[footnote 11]}^{[footnote 12]}

Men may need to be eased into the conversation about body image through interventions which encourage them to feel they have ‘permission’ to discuss the issue

Overall, the heterosexual men in our sample felt more distant from the issue, feeling it was more of a ‘woman’s issue’. However, boys and men in our sample also discussed feeling less empowered to speak out about body image than girls and women, suggesting they may in fact face similar struggles but feel less comfortable talking about them.

Different support/interventions may need to be considered for LGBT individuals, as the evidence indicates that their experiences tend to be very different to those of cisgender heterosexual individuals. Likewise, interventions should be mindful of the variation in experience within the LGBT community

The picture is slightly different for LGBT groups. Findings from the evidence review suggest that:

overall, gay men tend to have lower body satisfaction than heterosexual men^{[footnote 13]}
lesbian and bisexual women tend to face different body image pressures and challenges – however, on the whole, the evidence suggests that they experience greater body satisfaction than heterosexual women^{[footnote 14]}
trans men and trans women tend to experience lower body satisfaction than their cisgender counterparts – largely due to the incongruence these individuals experience between their physical body and their experienced gender identity^{[footnote 15]}
both trans men and trans women report higher degrees of body dissatisfaction, accompanied by disturbed eating patterns, a greater drive for thinness and increased body surveillance^{[footnote 16]}
non-binary individuals tend to have higher body satisfaction than binary trans individuals, but they still experience greater dissatisfaction than cisgender individuals – the evidence suggests that this is likely associated with the ‘social isolation’ that can accompany being excluded from binary gender and language systems^{[footnote 17]}

Overall, individuals who may experience social disadvantage on ‘multiple levels’ (for example, a gay black woman) are more likely to experience body dissatisfaction. This is linked to their stigmatised status in society, which puts them under more stress, which increases their risk of depression and body dissatisfaction.^{[footnote 18]}

It is important for brands and advertising aiming to promote body positivity to be truly inclusive

Our primary research, particularly amongst LGBT and non-binary audiences, indicates that brands are not doing enough to be inclusive of these audiences. Our non-binary and trans participants in particular felt that brands could do more to show the huge variability of bodily expression that exists within the umbrella ‘LGBT’.

It is crucial for any initiative promoting positive body image through health and exercise to be accessible (and affordable) for everyone

Many of our participants made links between body image, standards of beauty and social class. They felt that body size and body shape are often used as shortcuts to determine someone’s social class and that the standards set by brands and the media are unattainable for most of the population.

The effect on body image of new media such as highly visual dating apps also needs to be considered, but requires further research

The limited evidence available suggests that highly visual dating apps like Tinder can have a negative impact on self-esteem and body dissatisfaction and provide another avenue for users to make social comparisons.^{[footnote 19]}

For example, the potential social media creates for upward comparisons to peers, celebrities, and ‘past selves’ may be particularly problematic. Specific behaviours associated with social media have also been identified as leading to body dissatisfaction, including time spent on social media, number of Facebook friends, or time spent engaging in photo-based activities. ^{[footnote 20]}^{[footnote 21]}^{[footnote 22]}

Not everyone is affected by social media in the same way or to the same extent. These individual differences must be taken into account when targeting and prioritising audiences.

The way ‘thinspiration’ and ‘fitspiration’ content is uploaded and shared may need to be considered, to avoid spreading inaccurate information

The evidence review findings suggest that ‘thinspiration’ and ‘fitspiration’ content may be harmful to users due to the proliferation of thin-ideal imagery, unhealthy and unrealistic practices, as well as inaccurate information.^{[footnote 23]}^{[footnote 24]}^{[footnote 25]}

The increased attention to face, hair and skin suggests that interventions may need to take into consideration more than just body shape and size.

The evidence review suggests that social media has led to a shift in focus from body image to face, hair and skin comparisons due to portrait-style photography it encourages.^{[footnote 26]}

The issues explored in this report are complex and multi-faceted. The findings presented are intended to provide a useful knowledge foundation, which we hope will create dialogue and both inspire and create a framework for further research.

Question 3

1.  Introduction

Accepted Answer

1.1 Background to the research

The Government Equalities Office (GEO) leads work on policy relating to women, sexual orientation, and trans gender equality, and is responsible for a range of equalities legislation. It is estimated that 35% of the gender pay gap is attributed to unobserved factors - things not readily captured in data - but which are likely to include gender stereotypes and discrimination against women^{[footnote 27]}. GEO is commissioning research to explore what more government, schools, parents and individuals can do to help reduce harmful stereotypes, attitudes and behaviours.

Body image, and more specifically, body dissatisfaction is one of the many factors that impacts people’s decision making and confidence. Body dissatisfaction has been identified as an issue of growing concern to young people and their parents,^{[footnote 28]} and was identified by the British Youth Council (2017) as an issue that warrants urgent attention and further research to fill the knowledge gaps. GEO committed to addressing these gaps in their recent response to the Youth Select Committee report on Body Confidence.^{[footnote 29]}

GEO commissioned a Rapid Evidence Assessment (REA) synthesising the evidence on the causes and consequences of negative body image in 2013.^{[footnote 30]} The review identified potential causes of negative body image, such as being overweight or obese; viewing media images of ideal body shapes; the influence of family and peers as well as individual psychological factors such as the tendency to compare against others. It also identified potential consequences, such as low self-esteem, depression, and the use of unhealthy weight control behaviours. The review concluded that women tend to be most impacted by negative body image compared to men, regardless of age or ethnicity.^{[footnote 31]}

While this review identified some of the key causes and consequences of negative body image, the landscape has changed significantly since 2013, and the evidence required updating.

Specifically, 2 new areas of interest needed to be investigated:

What impact has the increased use of social media and edited images had on negative body image?
How does negative body image impact different demographics (for example, men and boys, ethnic minority audiences, LGBT audiences)?

GEO commissioned research agency 2CV to answer these 2 questions using a multi-method approach, combining both primary and secondary research methods. This report blends findings from all 3 phases of research, as detailed below.

1.2 Methodology

2CV (henceforth referred to as ‘we’) took a 3-phased approach, with findings from each phase feeding into subsequent phases.

Rapid Evidence Assessment (REA)

We conducted a review of the academic evidence and synthesised findings from over 60 academic published sources investigating the relationship between social media and body image and the impact of body image on different demographics. The REA built on a review previously commissioned by GEO^{[footnote 32]} that explored the causes and consequences of negative body image. We replicated the search terms used in the previous review: “body image” or “body confidence” or “body satisfaction” or “body dissatisfaction” or “body esteem” with the additional search criteria of “social media” and/or “LGBT/ethnic minority audiences”. Databases included Google Scholar, JSTOR and Science Direct. Studies were included if they were published in or after 2013; investigated the relationship between social media, body image, body confidence, mental health and psychosocial outcomes; or if they investigated the impact of negative body image on different demographics. The findings from this review form their own output but have been included in this report as additional evidence to support our primary research findings with the public, or as sole evidence where our primary research was unable to gather enough audience-specific insights as a result of sample size limitations.

Digital diaries with participants

We conducted a one-week digital community with 30 participants to deliver an in-depth understanding of people’s attitudes, experiences and behaviours regarding body image. Participants were given a range of private creative tasks to understand their relationships with their bodies, how this has changed over time and what influences this (see Appendix 2.1 for a full break-down of the tasks). Participants were recruited from across the UK; were aged 15-45; and included a range of demographics including LGBT and ethnic minority representation (see Appendix 1.1 for a full sample break- down). It is worth noting that while our sample included LGBT and ethnic minority representation, sample sizes for these audiences were small and we thus refrain from drawing any audience-specific insights, unless our findings were backed up by the academic literature synthesised in the REA.

Importantly, we recruited people to have a ‘mix’ of attitudes and feelings towards their bodies using elements of the Body Esteem Scale^{[footnote 33]} and the Body Shape Satisfaction Scale.^{[footnote 34]} We excluded anyone who felt overly positive about their bodies, focusing on those who were more vulnerable to feeling negatively about themselves, to better understand the factors that drive this feeling.

Stop and Think

We held a workshop with GEO to share findings from the first 2 phases and used these to generate ideas and hypotheses to test in the subsequent phase: the creative co-design workshops. The REA allowed us to gather evidence from the academic literature and gain a theoretical understanding of the issues, while the digital phase allowed us to understand people’s lived experiences.

Creative co-design workshops with participants

We conducted 2 half-day workshops with men and women aged 20-40 in London (all were cisgender, heterosexual men and women) who were recruited to have a mix of attitudes towards their own body image (ranging from more positive to more negative, screening out anyone who had ‘extreme views’ in either direction (they felt extremely positive or extremely negative) to ensure views expressed reflected those of the ‘general population’). These intervention-focused workshops put the hypotheses and ideas generated in the REA and digital diaries in front of participants to validate, critique, finesse and build upon. While LGBT audiences were included in the digital phase, we did not feel it was appropriate to include a mix of audiences in the face-to-face workshops, as the body image experiences of LGBT audiences tend to be so different to those of cisgender heterosexual people, potentially making a workshop dynamic uncomfortable and unproductive. We thus decided to run 2 workshops with a more homogenous sample of men and women who identified as heterosexual. Though our workshops did include a mix of ethnicities, we did not focus in depth on the different experiences of these ethnicities specifically in the workshops.

1.3 Challenges and recommendations for future research

While this research explored ‘body image’ from multiple angles with a diverse sample, budgetary constraints meant we had to make some pragmatic choices about the sample that the reader should bear in mind when reading this report. This research also identified some key gaps in the academic literature that we recommend should be addressed in future research. We summarise the limitations of this research and our recommendations below. Full details of challenges and recommendations can be found in Appendix 3.

Building on this research, future research should continue to focus on investigating the relationship between social media and body image among a wider range of audiences, including ethnic minority groups, LGBT groups and people with disabilities. This is especially important given the lack of academic research in this space.

There is also little evidence on how body image is experienced by different demographics and minority audiences in the academic literature.

We recommend that future research focus on investigating how different factors such as race, gender and sexual orientation intersect when exploring body image.

We recommend experimental research (for example, a Randomised Controlled Trial (RCT)) that manipulates exposure to social media to understand causal impact. We also recommend longitudinal research that tracks social networking usage and the effect on body image over a longer time period.

Question 4

2.  Current perceptions of and attitudes towards ‘body image’

Accepted Answer

In this chapter, we explore how participants in the primary research (the digital diaries and co-creative workshops) perceived the issue of ‘body image’ on a macro level, exploring how they view the current societal and cultural ‘trends’ around body image and the scale of the issue. The insights outlined below span across our different audiences, but where any audience differences occurred, we call these out.

The findings detailed in this chapter are drawn from our primary research. Where relevant, we support our findings with academic research from the REA.

Chapter summary: Implications/hypotheses for interventions

Among our sample, body image was perceived as an issue that is important to address.

Across our different audiences and age groups in the primary research, it was clear that ‘body image’ as a topic feels highly topical and important to address. Given this audience were recruited to have body image issues, it stands to reason that they would hold these views. Our participants were open to ideas and interventions and would like to see proactive action to increase awareness of the issue, especially among men.

Men may need to be ‘eased into’ the conversation about body image.

There is a perception that men are less empowered to talk about body image issues. Our findings suggest that body image issues are more taboo for boys and men and that ‘the culture’ of talking openly about body image issues is less evolved for this demographic. Interventions may need to be tailored to this group specifically, to make it feel like this is an issue they have ‘permission’ to talk about.

While facilitating access to diet and exercise is important, a holistic approach to body image may be needed.

While participants in our primary research understood that a person’s body image is not necessarily determined by the aesthetics of their body, many still felt that fixing the issue from the ‘outside’ (for example, through diet, exercise, making more money, etc.) would be attractive. While these are certainly important factors that may contribute to improving body image, our research and the evidence from the REA suggests that a holistic approach (that tackles the broad range of influences on body image, such as self-esteem) may be needed.

As participants quickly made the link between social media usage and negative body image, interventions that address some of the ‘issues’ with social media are likely to be welcomed by the public. However, it should be noted that many participants rejected the idea that social media may have an impact on them while embracing that it may have an impact on others. This will need to be considered when creating ideas to tackle the issue.

Any interventions that attempt to make healthy diet and exercise more attractive should be inclusive and accessible to all.

As participants made a clear link between body image, standards of beauty and social class, it is important for brands and advertising aiming to promote more ‘body positivity’ to be inclusive of everyone. Likewise, it is important that any initiative promoting exercise or diet feel accessible (and affordable) for everyone.

2.1 Negative body image was recognised as a problem by most participants, and the trend towards body positivity and body neutrality reflects this.

There was general agreement among our participants that ‘body image’ is an issue that warrants discussion and attention. The participants recognised that there is a growing trend at both a grassroots level (through influencers on social media) and from the media (for example, the Dove Real Beauty campaign) to embrace one’s body through concepts like ‘body positivity’ or ‘body neutrality’ – movements that encourage a rejection of the narrow beauty ideals prescribed by society and the mass media. In line with this, many of our participants reported being critical of media imagery that has been photoshopped and many reported rejecting the idea that there is such a thing as a ‘perfect body’ to strive for:

“I think we are seeing more body positivity in the media now…people being encouraged to embrace their bodies and accept that their flaws are what makes them unique.” – Heterosexual female, 28

“There’s no such thing as a perfect body, a perfect body is one that has been accepted by its owner” – Heterosexual female, 40

That said, a number of men in our sample reported feeling that ‘body positivity’ movements exclude men, as the move towards more diversity in the media is largely focused on showing more diverse female shapes and sizes:

“I think there is more pressure for men. There have been some great campaigns for women on accepting different body types, but I feel this is not the same for men. There is a large imbalance. In a similar way to mental health, I think men are less likely to discuss their struggles.” – Gay male, 36

However, as we’ll see in Chapter 3, this positivity has not filtered down into how people experience their own bodies – with many still espousing negative views about themselves and struggling to ‘accept’ their bodies for what they are. It was also clear from our primary research that, despite body positivity and body neutrality movements, there is still a stigma around seeking support for body image issues, with many participants reporting they wouldn’t talk about their issues or seek help unless the issue was very ‘severe’ (such as an eating disorder).

2.2 Our participants recognised that body image hinges on more than just diet and exercise

Many of our participants felt that body image is about more than aesthetics. Many expressed a belief that even those who meet normative beauty standards may struggle with negative body image. In other words, they felt that while diet and exercise can help with negative body image, it is not the ‘intervention’ to the issue as the root causes tend to be more deep-seated.

A few participants in our sample likened the increased openness around body image to the increasingly open public discourse around previously taboo issues, such as mental health. This link was especially clear to the women in our sample (across age groups), many of whom drew bi- directional links between positive body image and desirable traits, such as confidence and assertiveness:

“If I felt better about my body I think I’d be a lot more assertive in my life” – Heterosexual female, 27

“If I looked like her (referring to a photo of a woman on the cover of a magazine), I’d feel like a total boss woman all the time”- Heterosexual female, 20

It should be noted that while diet and exercise were not seen as ‘interventions’ to deep-rooted body image issues, they were still perceived to be important contributors to positive body image (with the added benefit of contributing to improved mental health).

2.3 Despite making links between body image and mental health, many men in our sample (especially heterosexual men) still reported feeling body image was more of a ‘woman’s issue’

Interestingly, when discussing body image as a ‘societal issue’, some men in our sample (particularly those defining as heterosexual) were quick to distance themselves from the issue and instead depersonalise it by conceptualising it as an issue that mainly affects women. However, when discussing the experience of body image, these same men were able to articulate the issues they faced quite clearly. This suggests a mismatch between how body image is experienced and the amount of permission men feel they have to ‘claim’ it as something they may also struggle with:

“Body image is more of a problem for women and that’s reflected in the way brands target them. For example, you go into H&M and there are 3 storeys of women’s clothing and one for men” – Heterosexual male, 20

2.4 There is a perception that boys and men are less empowered to speak out about body image issues than girls and women, but that they face similar struggles

There was agreement among our primary research sample (particularly in the digital phase where people were able to give private responses) that boys and men face significant body image issues but are less empowered to share them openly. While the ‘ideals’ both genders strive for may be different (for example, boys and men feel more pressure to be muscular; girls and women feel more pressure to be thin), our participants agreed that both genders experience societal pressure to fit a certain mould. Our participants agreed that pressure on boys and men to look a certain way may be increasing because of exposure to social media and more male-focused media in recent years (for example, men’s health magazines):

“I think women are both under more pressure and more susceptible to pressure to look a certain way. I think the pressure on men is increasing due to things like men’s health magazines.” – Gay female, 41

“I think the pressure is the same now but it hasn’t always been. I think there used to be more pressure on women and girls, but now boys and men are under pressure to have lots of muscles and definition, to the point where lots of males use steroids. I think we are all under pressure to have the perfect body even though most of us know that it is an unrealistic ideal” – Heterosexual female, 18

However, our participants agreed that ‘masculine norms’ may be holding men back from sharing their insecurities or struggles more openly. Some of our participants compared this trend to mental health social norms that allow women to talk more openly than men:

“However, men do have the pressure of their ‘masculinity’ being tainted by the way that they act or dress, where this doesn’t seem to be as much of a problem for women. They both have similar and yet unique struggles that they have to go through with body image” – Heterosexual female, 40

“Though I do believe each gender puts pressure for the ideal body, I do believe as well that women vocalise this pressure more. Men keep it in more to themselves, but women outwardly put pressure on themselves. And I do believe that this is due to gender stereotypes.” – Heterosexual female, 31

In our primary research, our participants very quickly linked body image issues to social media usage. When we asked our participants to list words associated with the term ‘body image’, social media consistently emerged as a top association. While participants recognised that there are multiple factors that influence body image (for example, the media, peers), there was a sense that this influence has increased since the advent of social media. Participants blamed the proliferation of edited images on social media and unwanted exposure to certain types of content for society’s obsession with ‘perfection’ and unattainable standards of beauty.

Interestingly, we found a clear chasm between how social media is perceived to influence ‘the self’ vs how it affects ‘other people’. Most of our participants felt that social media was harmful and likely to have a negative impact on people’s body image, but they struggled to articulate how they themselves were affected, or even refused to acknowledge they were affected at all. In other words, most participants felt social media was something they were able to engage in for fun, without too many negative consequences, whereas the impact on others could potentially be severe:

“I wouldn’t say it affects me but I’ve read news articles of how it can affect people. I do believe that the rise in suicide rates is linked to social media – it can break up relationships as much as maintain them – Heterosexual female, 32

A considerable number of participants made spontaneous associations between body image and social class. They felt that body size and shape is often used as a shortcut to determine someone’s social class, with larger body sizes being indicative of lower socioeconomic status. Our participants also asserted that having more money allows people to take better care of their bodies, through gym memberships, access to healthier foods, information, and in some cases, cosmetic surgery. On top of this, there was a sense that ‘mass media’ and advertising is, in itself, classist, with the ‘elite’ members of society setting standards of beauty and making those who can’t live up to those standards invisible:

“People are going into debt to improve their bodies – my sister in law spent £5000 on getting fat injected into her bum” – Heterosexual female, 26

“Paris Hilton used to be the ideal body shape, now it’s Beyoncé. They’re both unachievable unless you’re rich” - Heterosexual male, 28

“The advertising industry is dominated by rich white dudes who set standards of beauty for the rest of us. There’s no escaping it” – Heterosexual female, 21

Question 5

3.  Setting the scene: experiences of body image

Accepted Answer

In this chapter, we explore how body image is experienced by different audiences (including LGBT and ethnic minority audiences) and the factors that contribute to audience differences in experience.

Most of the evidence outlined in this section draws from the REA. As our sample of LGBT and ethnic minority audiences was fairly limited in our primary research (see appendix), we stray away from drawing out audience-specific insights based on our primary research. We do, however, use our research to provide additional support for the evidence found in the REA and help bring these points to life, where relevant, using quotes.

The findings in the section to follow are not intended to be exhaustive or representative of all the different audiences included in this research. Within umbrella terms such as ‘LGBT’ and ‘ethnic minority’ there exists huge variability of experience and there are a wide array of intersecting issues and subcultures that are not covered in this report.

The findings outlined below should thus be viewed as a starting point for further conversations and serve as a springboard for future research.

We begin by outlining some overarching audience insights about how body image is experienced, before delving into audience-specific findings from the REA.

Chapter summary: Implications/hypotheses for interventions

As the evidence suggests that certain groups of people are more likely to suffer negative body image as a result of oppression or discrimination on multiple levels, specialist support should be considered for these groups.

Different support/interventions may need to be considered for trans and non-binary individuals, as their experiences are very different from cisgender individuals.

Evidence from both the REA and our primary research suggests that the body image experiences of trans and non-binary individuals are very distinct from those of cisgender individuals. Issues like body incongruence, body dysmorphia and a feeling of societal isolation will need to be considered for any interventions targeted at these groups. It is also important to recognise the different experiences of non-binary versus binary trans people, as the REA found that the root causes of their body dissatisfaction and displays and manifestations thereof may not be the same.

Interventions may need to be targeted at specific life milestones, rather than just at particular age groups.

While adolescence is a challenging time for most young people, our primary research suggests that men may not start to suffer body image issues until they are a bit older (for example, when they may be more susceptible to weight gain or hair loss – in middle age). Likewise, some groups of people may need heightened support during specific life stages (for example, trans individuals are likely to require specialist support when they go through puberty as a result of heightened gender incongruence, and some women may require additional support during pregnancy, for example).

Interventions may need to encourage a focus on the functionality of the body rather than aesthetics through, for example, health and mental wellbeing approaches.

Evidence from both the REA and our primary research suggests that men have greater appreciation for the functionality of their bodies (how the body works and what it can achieve) compared to women. Findings from the REA also suggest that simple things like exercise and mindfulness can encourage people to focus more on the functionality of their bodies, and that this may be an effective way to encourage a mindset switch in the way people (especially women) conceptualise their bodies.

As adolescence tends to be a particularly challenging time, schools may increasingly need to play a role in preventing and managing negative body image.

Our research and findings from the REA indicate that adolescence is a particularly vulnerable time for body image issues, especially for young women and trans individuals. Schools may need to consider programmes/lessons that address body image issues.

3.1 Overarching audience insights

3.1.1 People do not experience body image as a linear journey – it is marked by ups and downs that are often linked to life events

Our participants’ negative perceptions of their bodies were not always linked to a life-stage or specific age. While adolescence was generally recognised as a challenging stage (especially for young women) by our participants and the evidence in the REA,^{[footnote 35]} our participants told us that there are many other periods or life events that can be as challenging, if not more challenging for people’s body image. Commonly cited examples include: starting secondary school or university; beginnings and ends of relationships; becoming pregnant/post-pregnancy; and starting a new job. It is perhaps unsurprising that many of these life events are accompanied by considerable stress, uncertainty and change.

Overall, there was less consensus among the men in our sample about specific life-periods when body image may be experienced. Instead, body image issues appeared to be linked to considerable physical changes such as hair loss or weight gain, that could occur at any time.

3.1.2 Across our audiences, body image can impact behaviour and decision-making on a day-to-day basis

Across our sample, participants agreed that the activities they chose to engage in or the decisions they made about what to wear had been impacted by how they felt about their bodies. Our participants told us they had avoided social events, turned down holidays, avoided the gym, or worked from home as a result of feeling badly about their bodies. In extreme cases, a few participants also told us they had been unable to focus on their studies because of a preoccupation with the way they looked:

“I was having exams and I couldn’t focus on the uni work because I would literally be spending hours thinking about my skin, I would cry every day, go on the internet googling everything” – Heterosexual female, 22

“In school one of the other kids called me fat during swimming class – I remember this concerned me for some time, so I stopped taking part in the classes” – Gay male, 41

The daily impact of body image on decision making is further reflected in research conducted by the Girl Guide Association which found that being unhappy with looks can have huge consequences for girls’ wellbeing, relationships, and ability to enjoy themselves, whether that manifests itself in disliking sports or feeling anxious in a job interview.^{[footnote 36]}

3.2 Audience specific insights

3.2.1 The evidence suggests that women (especially young women) are particularly affected by negative body image

While both men and women experience poor body image, women generally have lower body satisfaction than men.^{[footnote 37]} While the reasons for this are multiple and complex, we summarise 3 key reasons below:

The REA found that social media may be impacting young women more than young men, because they spend more hours on social media and engage in more varied activities.^{[footnote 38]} It also found that women use social media more to view other’s photos, compare themselves with others, and spend more time engaged in sharing and commenting on photos than men.^{[footnote 39]}

This is significant because research has found that engaging in photo-based activities on social media has a direct negative impact on mood and body image.^{[footnote 40]}

Women tend to have lower body appreciation than men

The REA found that men may have higher levels of body appreciation (which refers to appreciating the features, functionality, and health of one’s body) compared to women. Researchers argue this may be because appearance ideals tend to be more flexible for men and because they may have greater access to societal and individual resources that promote positive body image (for example, they often have greater financial resources to proactively support self-care and engage in physical activities).^{[footnote 41]}

This was supported by our primary research, which found that men were much more likely to talk about what their body can do (for example, go on long walks, run up a flight of stairs) than how it looks. The women in our sample, on the other hand, tended to focus on the parts of their body they felt were less aesthetically pleasing (for example, wide hips; excess belly fat) instead of focusing on the functionality of those body parts.

“As long as I’m healthy and can do my sport and exercise that’s fine. I don’t care that much about what I look like” – Heterosexual male, 36

Related to the above, many men in our sample described their bodies as a ‘work in progress’; something they might not be entirely satisfied with right now, but that they could always improve upon (for example, building more muscle). Women, on the other hand, tended to present a more ‘defeatist’ attitude about their bodies and body shapes, highlighting the features they disliked that were less in their control to change (for example, wide hips).

Interestingly, one exception to this was a young woman who, at the time of this research, had recently given birth. She spoke very proudly of her shift in focus from how her body looked to appreciating what her body could achieve (growing a baby and giving birth). She expressed regret that she had previously spent so much time worrying about her looks, when she should have been grateful for her body’s functionality.

“I see my body completely differently now. I think ’wow, I can’t believe I grew this amazing human being inside me!’ I wear my stretchmarks and scars proudly now. I wasn’t able to do that a few years ago” – Heterosexual female, 31

She told us that attending antenatal classes had helped her come to terms with the changes in her body and had helped her embrace these changes as positive rather than something to be feared. She felt that the yoga and mindfulness exercises these classes promoted had helped her become more in tune with her body.

The cultural idealisation of youth is more pronounced for women and young girls than for men

Findings from the REA suggest that there is a cultural double standard of aging, whereby the aging female body is viewed more negatively than the aging male body, with the aging male body often viewed positively (the “Sean Connery” effect).^{[footnote 42]}

Research has found that women, unlike men, tend to grow unhappier with their bodies between the ages of 7-10 and 21 with 51% of girls in the younger cohort saying they are happy with the way they look, compared to only 16% among the older age groups.^{[footnote 43]}^{[footnote 44]}

A 2014 study found that the prevalence of body dissatisfaction remains consistently high in women from young adulthood through mid-and-late life.^{[footnote 45]} The researchers found that 47% of a sample of 405 Caucasian and African American middle-aged women reported being dissatisfied with their appearance and 73% of the sample reported being ‘at least somewhat’ dissatisfied with their weight. This is further supported by research with a sample of nearly 500 women aged 60-70 years which found that over 60% were dissatisfied with their bodies and 56% restricted food intake to prevent weight gain, regardless of BMI.^{[footnote 46]}

While studies suggest that body dissatisfaction remains relatively high across the lifespan of women, some studies suggest that body appreciation may increase as women get older. A 2013 study of women aged 18-75 found that body appreciation was greater for those over 50. The researchers suggest that this may indicate that women become more appreciative of their health and their body’s ‘functionality’ with increasing age, even though they may remain dissatisfied with certain aspects of their bodies.^{[footnote 47]}

3.2.2 The REA suggests that black women may have historically been less affected by negative body image, though there are signs this may be changing

The REA found that black women tend to have more flexible and multifaceted definitions of attractiveness, as well as a greater cultural acceptance of larger body sizes. Studies included in the REA suggested that, because of this greater flexibility, weight-based stigma is less pronounced for black women versus white women and that black women are less likely to experience body shame and eating pathology than white women.^{[footnote 48]}

However, more recent research (2013; 2014) shows that body image and cultural norms of beauty might be shifting, with black women becoming more subject to feelings of body dissatisfaction and increasingly subject to pressure from image-related cultural factors.^{[footnote 49]} The REA suggests this may be the result of the heightened presence of ‘fit and skinny’ black female bodies in the media (for example, an increase in black female celebrities and the magnified presence of black women in rap music).^{[footnote 50]}

This sense of heightened media attention on the black female body is supported by the findings from our primary research. Participants reported noticing that the black female aesthetic is more ‘on trend now’, with more women desiring curvy but toned bodies (for example, big bums and toned stomachs). Some of our participants of colour also raised concerns that black body shapes are being co-opted by non-black celebrities (for example, the Kardashians) and are increasingly sought out by both black and white women as a new beauty ideal.

However, it is worth noting a few caveats to these findings. Firstly, black women’s body image has been less researched overall, and the experiences of black women in different cultural environments is likely to be different (for example, most research studies on black women’s body image have been conducted in the USA with an African American sample). Secondly, we did not come across any research in the REA that explored the impact of the predominantly white cultural aesthetic (for example, in terms of skin colour and hair texture) on black women’s body image.

3.2.3 The REA found that lesbian and bisexual women face different body image pressures when compared to heterosexual women

The REA found that whilst body dissatisfaction is prevalent among women, it may be less common among lesbian women and that lesbian women prefer a larger ‘ideal’ body size and place more value on physical fitness and muscular physiques than heterosexual women.^{[footnote 51]} This reinforces findings from previous studies which showed that different standards of beauty and appearance norms are prevalent within LGBT communities.^{[footnote 52]}

However, recent research suggests that (similar to black women) this picture might be changing, now that lesbian and bisexual women are more widely represented in the mass media. One study included in the REA found that lesbian and bisexual women experience similar mainstream pressures to conform to a thin body ideal. In addition, the study found that these women experience additional pressure to conform to ‘heteronormative’ beauty standards, since the normalisation of homosexuality and the increase in Lesbian, Gay, Bisexual and Trans gender representation in mainstream media.^{[footnote 53]}

The REA found that discrepancies in body satisfaction might also be explained by different sub- cultures among lesbian and bisexual women, such as ‘butch’ and ‘femme’ cultures, which emphasise different appearance norms and levels of femininity. Femininity may influence levels of body satisfaction and internalisation of heteronormative ideals, with more ‘feminine’ lesbian and more ‘feminine’ bisexual women experiencing greater body dissatisfaction and eating pathology than less ‘feminine’, ‘butch’, lesbians or bisexual women.^{[footnote 54]} Studies included in the REA also suggest that lesbian and bisexual women can often feel constrained by a different set of appearance rules that act as a shortcut for ‘identification’. For example, ‘femme’ lesbians often reported feeling frustrated at not being perceived as ‘authentic’ lesbians and feeling unidentifiable to other lesbians. This may lead ‘femme’ and bisexual women to feel less connected to the lesbian and gay community, which may affect their overall wellbeing and body satisfaction.^{[footnote 55]}

The REA suggests that bisexual women may face additional challenges, as a result of being attracted to both men and women. For example, bisexual women may prioritise their physical appearance and try to conform to heteronormative standards of beauty to be desirable to men. This desire to conform to a certain standard may, in turn, lead to lower body satisfaction. This is supported by a 2012 study which found that bisexual women experienced more body dissatisfaction when in relationships with men than with women.^{[footnote 56]}

3.2.4 The REA suggests that overall, gay men tend to have a more negative body image than heterosexual men

A meta-analytic review (2004) included in the REA found that gay men tend to experience more negative body image and have increased body shape and weight dissatisfaction when compared to heterosexual men. The same review also found that gay men consider physical appearance to be critical to their sense of self because they live in a particularly ’appearance-potent subculture’, with greater focus on physical appearance and sexual objectification of male bodies. For example, gay male media more often features men who are nude and sexualised, compared to straight male media.^{[footnote 57]}

This is supported by evidence from our primary research in which the gay men in our sample generally expressed greater concerns about their body image than heterosexual men and gave more detailed accounts of their struggles to accept their bodies.

“In the gay community there is a lot of emphasis on your body and how you look. I don’t think straight men face the same pressures” – Gay male, 34

“There is more emphasis on appearance in the gay community. Clothes, hair, body…there is a lot of pressure to look a certain way” – Gay male, 36

One of the gay participants in our sample told us that he remembers becoming more concerned about his body image after coming out as gay. This period in his life marked the first time he was exposed to (and actively exploring) gay media and sexualised images of men, which made him feel more dissatisfied with his body.

“When I came out I started to actively explore gay media. It made me feel worse about my body and like I had to live up to an unrealistic ideal” – Gay male, 29

It should be noted that the REA found little research on how different male gay subcultures or bisexual men may experience body image, and as such, we don’t mention it here.

3.2.5 The REA suggests that trans individuals experience greater body dissatisfaction than their cisgender counterparts

Findings from the REA consistently indicated that trans men and trans women struggle with body dissatisfaction more than cisgender men and women and that trans individuals report higher degrees of body surveillance, disordered eating and idealisation of the ‘thin ideal’.^{[footnote 58]} This was supported by our primary research, which indicated that our transgender participants had complex and layered body image concerns and issues.

Body image is critically important during adolescence and young adulthood^{[footnote 59]} and the difficulties experienced at this time tend to be exacerbated for transgender youth. For them, changes associated with puberty may be an uncomfortable reminder of the gender incongruence they feel, as mature body characteristics such as broad shoulders and facial hair or hips and breasts may serve as a reminder of the mismatch between the body and their experienced gender identity.^{[footnote 60]} In fact, the trans men and trans women in our qualitative sample told us that going through puberty was one of the most painful periods in their life. One young trans man told us that as a little girl, he would repeatedly draw an adult version of himself as a male, with a beard and broad shoulders.

When puberty hit, and female characteristics became more pronounced, he sunk into a deep depression that wasn’t lifted until he discovered breast binding,^{[footnote 61]} making it easier for him to present to the world as male.

In addition to experiencing body incongruence, the REA found that transgender individuals may also experience gender dissociation. As a result, trans gender individuals may try to distance themselves from awareness of these characteristics (for example, trying to hide hands or refusing to look at body shape) as a way of coping. They may also experience intense hatred or dissociation from these parts of their bodies, and the REA found that trans individuals may try to lose weight in order to suppress the development of secondary sexual characteristics (for example, the growth of breasts; the broadening of shoulders).^{[footnote 62]}This is supported by findings from our primary research, in which our trans participants reported feeling that extreme ‘thinness’ is valued in the trans community. This was especially the case for the trans men in our sample, who reported associating any excess body fat with more feminine characteristics (for example, rounder waist, rounder cheeks, etc).

“When puberty started my body image declined terribly, I started going through female puberty and it was hell on earth. My lowest point was when I was 12.” - Transgender male, 25

“I think in the trans community there is an intense focus on being really thin for both trans men and trans women. I don’t know where it comes from, but I definitely feel that pressure” - Trans gender male, 29

Studies reviewed in the REA indicated that post-operative transgender individuals tend to have lower body concerns, higher self-confidence and body satisfaction compared to pre-operative transgender individuals or cisgender male/female controls. Researchers argue this is likely a result of the incongruence between perceived body image and internal sense of gender being reduced post-operation^{[footnote 63]}. While none of the transgender individuals in our sample were post- operation, this is something they were striving for, with many reporting looking forward to the day when their bodies would reflect to the world what they felt inside.

3.2.6 The REA suggests that non-binary people and binary transgender people have different experiences of body image

The findings of the REA found that there are differences in gender congruence and body satisfaction between non-binary and binary transgender people, with the former experiencing greater congruence and satisfaction. On sex-specific parts of the body (chest, genitalia, and secondary sex characteristics), non-binary people reported significantly higher levels of gender and body satisfaction compared to binary transgender people. However, the REA found that non- binary people still experience considerably lower levels of body satisfaction and gender congruence than cisgender controls, and that the way this incongruence and dissatisfaction are experienced is different to binary transgender people.

For example, the REA found that non-binary people often report feeling ‘socially invisible’ and as though they are not accepted or recognised by society,^{[footnote 64]} because of socially ingrained systems like the binary gender and language systems. This feeling of invisibility and victimisation of non- binary individuals has been found to be associated with poor mental well-being,^{[footnote 65]} which in turn is likely to further contribute to low levels of body congruence and satisfaction with a societally ascribed ‘social gender role’.

This is supported by our primary research, which found that non-binary people can struggle to cope with how they are perceived by society and may feel they have to try to fit into a binary identity they may not feel comfortable with. As one non-binary individual told us:

“I feel like a lot of my emotions about my body are entirely based on how I think others perceive it, not how I perceive it. I can look in the mirror sometimes and I think I look okay, but when I start looking about whether or not I’m attractive to others or how I feel they perceive my gender presentation I start to question everything. There are things I’d wear and ways I’d present myself if I wasn’t concerned about these things, but I don’t because I am – for example, there are things I don’t necessarily view as objectively ‘feminine’ and would be happy to wear if it wasn’t for the fact that other people see them as signifiers of femininity. I think there was a period earlier this year where I was both okay with my weight and okay with being perceived as feminine despite being non-binary. I got into my own perceptions of attractiveness and of my ideal gender presentation. It mattered less to me what other people might view as pertaining to x gender. I think the reason I’ve become more concerned about the perceptions of others is because I’ve started dating cisgender men again, rather than just girls and trans people. I worry a lot about being normatively attractive, but also that the things I do to make myself normatively attractive erase my gender” – Non-binary Participant, 31

Findings from the REA suggest that individuals who experience oppression or social disadvantage on multiple levels are likely to experience increased stress, which in turn increases individuals’ risks for developing mental health problems and body dissatisfaction. For example, being both a woman of colour and identifying as lesbian puts a person at a societal disadvantage on multiple levels (being non-white; a woman; and identifying as lesbian).

For example, a 2019 study in the USA explored body image amongst men of colour who have sex with men (MCSM). This group reported similar levels of body dissatisfaction as White MSM. However, the study found that MCSM reported more engagement in behaviours aimed at changing their bodies than White MSM. Additionally, experiencing sexual racism was related to higher body dissatisfaction and body image in MCSM.^{[footnote 66]}

Related to the above, the minority stress model argues that simply being a member of a stigmatised minority group (for example, a gay man) leads to stress and anxiety which, in turn, creates an environment that increases individuals’ risk for developing mental health problems and a worsened body image.^{[footnote 67]}

Question 6

4.  The influences on body image

Accepted Answer

While the focus of this research was to understand the impact of social media on body image specifically, it is important to outline the other factors that are known to influence body image, as the impact of social media does not operate in isolation. In this section, we blend the findings from our primary research and the REA to paint a picture of what factors (outside of social media) have an impact on body image.

Chapter summary: Implications/hypotheses for interventions

Peer-to-peer dynamics should be considered when creating potential interventions.

The REA and findings from our primary research indicate that people tend to compare themselves to those they perceive to be similar to them and that these comparisons have an impact on body image. This indicates that interventions will need to be mindful of this dynamic.

The influence of parents (and mothers in particular) may need to be considered when designing interventions.

Our primary research indicates that parents (particularly mothers) appear to play a pivotal role in influencing how their children (particularly their daughters) feel about their bodies. Our female participants who had mothers who were overly critical or negative of their own bodies reported internalising these feelings. This indicates that intervention ideas may need to consider when and how to involve parents.

The influence of new media such as highly visual dating apps should be researched further and considered when designing interventions.

Highly visual dating apps like Tinder, Bumble and Grindr allow its users to make ‘snap judgments’ based on photos. Our findings from both the primary research and the REA suggests that using dating apps can have a negative impact on self-esteem and body satisfaction. They are also another avenue for users to make social comparisons to their peers. In addition to social media, the influence of this type of media may need to be considered when designing interventions.

Mass media can do more to feel truly inclusive.

While our participants felt that the media is moving in the right direction in terms of including more diverse bodies, shapes and sizes (for example, the Dove Real Beauty campaign), they still felt more could be done for the media to feel truly inclusive, not merely tokenistic (for example, showing interracial couples in advertisements). Some of our non-binary participants, for example, wanted to see more representation of people not adhering to binary gender systems in the media.

4.1 The media and brands were found to exert an influence on body image in both our primary research and findings from the REA

The sociocultural theory^{[footnote 68]} in psychology purports that the mass media plays a prominent role in the communication of cultural stereotypes about the aesthetics of body image, and that individuals tend to internalise the media’s portrayal of unrealistic beauty images. Research suggests this may be especially prominent for women, as a content analysis of advertisements on websites aimed at adolescents found that most figures portrayed in the advertisements were female, young, thin and attractive.^{[footnote 69]}

Participants in our primary research reported being aware of the influence of mass media on their beauty ideals and conceptions of attractiveness. When we asked our participants to describe the ‘perfect’ body, many of these descriptions reflected body types and shapes commonly seen in the media (for example, a V shaped body for men; hourglass figures for women). This awareness of the media’s influence stemmed in large part from our participants’ familiarity with the narrative that the media and brands play a huge role in determining what beauty ideals (and body shapes and sizes) are ‘on trend’. While participants told us they would like to think they are not influenced by these factors, most admitted that it does influence how they feel about themselves.

“I’d like to think I’m not influenced by what I see in the media but that’s silly…Of course I am. It’s hard not to be influenced by the things that are pushed onto you from a young age. The media tells you what’s attractive and what’s not. What’s in and what’s out”- Heterosexual female, 41

“I first became aware of my body when I saw Kate Winslet in Titanic. I thought she looked so gorgeous and I wanted to look like her so badly” – Heterosexual female, 45

“Calvin Klein is often advertised to me and is another major influence. Their models often have what I see as a ‘good’ body, which is aspirational for me. So that drives me to use this as inspiration when thinking about my diet and exercise regime.” – Gay male, 34

Our participants also told us that brands could have a positive impact on their body image and applauded specific brands for paving the way towards more diversity and body positivity in advertising.

“One of the campaigns I can think of would be the Dove campaign of body positivity. They put across the message that everybody of every skin colour, size, shape, height, and so many other differences were valid and should be happy with themselves. I think that since Dove is such a widely-known and trusted brand, its impact was very big as many people would have seen it and acknowledged it as something to act upon.” – Heterosexual female, 34

“I have recently seen advertisements for clothing companies such as H&M and River Island who have used alternative models, for example models with disabilities or visible stretch marks rather than these being hidden or edited out. I think this was deliberately aimed at all people, to realise you don’t need to be perfect or not to have what people consider imperfections or flaws to achieve your dreams or goals.” – Gay female, 38

That said, our participants also reported feeling that more diversity in the media could sometimes feel ‘tokenistic’ and that more could still be done for the media to become truly inclusive. As one of our non-binary participants put it:

“I’d really like to see more gender-nonconforming people in the media, especially those with body shapes that aren’t conventionally attractive. I think that gender norms have a big impact on the way we perceive our bodies, and presenting people with examples of what can be perceived as attractive outside of gender binary norms would be really cool” – Gender Non- binary Participant, 29

4.2 Peers and partners play a huge role in influencing body image

The social comparison theory^{[footnote 70]} asserts that people evaluate themselves by comparing themselves with people they perceive as similar, as a shortcut to gauge how well they ‘measure up’ compared to people of similar age, social status, and so on. Across our sample, participants talked about the importance of peers and partners in influencing their body image, in both positive and negative ways. In our primary research, it became clear that the approval and validation of peers and partners had a huge impact on body satisfaction, and our participants gave ample examples of when peers and partners had boosted their confidence and body image.

“My friends play an importance on how I view myself, if my friends say I look great then I believe them also.” – Heterosexual female, 18

“My boyfriend has influenced me by being positive, noticing changes and encouraging me to keep going. Positive reinforcement is very useful for me and pushes me to keep going. It also makes me feel better about myself.” – Gay male, 22

“My boyfriend has definitely had the biggest impact in the way that I view my body. I’ve always been insecure about my body and the way I look to other people, but Nick tells me I’m beautiful all the time and that I am the perfect shape. He has helped me accept the way I look within myself.” – Heterosexual female, 25

And where they had (often inadvertently) had a negative impact:

“My close friend has the body type I wish I had. She eats healthily, and it shows. She has a lot of willpower to say no to fattening or junk food and so stays very skinny and healthy. She also works out occasionally and takes brilliant care of herself. I find it difficult to stay motivated and sometimes being around her makes me feel worse about myself” – Heterosexual female, 17

We discuss how these comparisons to peers play out in more detail on social media in Chapter 5.

4.3 Families also play a huge role in influencing body image; relationships between mothers and daughters play a pivotal role

Much like peers, family plays a huge role in shaping and influencing body image. Interestingly, in our primary research, it became clear that mothers play a disproportionate role in influencing their daughter’s relationships with their bodies. Many of our participants told us that while their mothers’ intentions were often positive, any criticism tended to have a negative long-term impact. A few of our female participants also told us that the way their mothers conceptualised their own bodies when they were growing up had a profound impact on how they viewed their bodies later in life.

As one of our participants told us:

“From a young age I have watched my mum and have picked up on her bad eating habits and her relationship with her own body. She would always be following the newest fad diet or exercise regime to try and lose a few pounds. She would always talk about herself and her body in a negative way. This has certainly had an impact on how I view my own body as I know I use the same language to describe myself and we openly talk negatively to each other about our bodies and imperfections. I don’t think I can ever recall having a positive conversation about my body with my mum. My mum has never had any self-respect for her body and now this is how I am with mine and once you are in a mindset it is next to impossible to change it fully. “- Heterosexual female, 27

4.4 Our participants reported being influenced by highly visual dating apps like Tinder

Dating apps tend to be very focused on images, allowing users to make snap judgments based on appearance by ‘swiping left’ or ‘swiping right’. Our participants told us that these types of dating apps could have a huge influence on how they felt about themselves, with ‘matches’ resulting in an immediate rush of excitement and validation and rejection resulting in immediate feelings of inadequacy and low self-esteem.

“Being newly single and using dating apps like Tinder and Bumble definitely made me feel like I needed to step up my game and get in better shape” – Heterosexual male, 32

These findings are supported by a 2017 study which investigated the impact of the dating app Tinder on body image. The study found that Tinder users, regardless of gender, self-reported significantly lower levels of satisfaction with their face and body and higher levels of appearance comparisons, body shame and surveillance than non-users. On the measure of self-esteem, the study found that male Tinder users scored significantly lower than male and female non-users. The researchers assert that this suggests that Tinder usage is associated with a variety of negative perceptions of the body and the self and increases a person’s likelihood to make comparisons to others.^{[footnote 71]}

Question 7

5.  The influence of social media on body image: a complex picture

Accepted Answer

The evidence in the chapter indicates that there is a connection between social media usage and certain harmful outcomes, including body dissatisfaction. It was also clear from our primary research (see chapter 2.6) that our sample felt there was a link between social media and body image, even if they struggled to pinpoint how or even if it might impact them personally.

However, some researchers are more sceptical about the link between social media and negative body image. For example, a recent meta-analysis^{[footnote 72]} raised concerns about a publication bias (that statistically significant results are more likely to be published than null findings). The meta- analysis called for researchers to be more conservative in their assertions of a relationship between social media and body dissatisfaction, due to factors such as inflated effect sizes, study design limitations and publication bias.

Social media is relatively new, and more research is needed to investigate causality and paint a clearer picture of how and when social media impacts body image. Future research should also be clear on the dependent variable it is trying to measure (for example, body dissatisfaction, body functionality, eating pathology, depression, etc.). Furthermore, almost all studies outlined below (and included in the REA) explored the impact of social media on (mostly) white, university-aged females.

Nevertheless, a considerable number of research studies have found several negative effects on body image associated with the use of social media. We outline these in the sections to follow.

Chapter summary: Implications/hypotheses for interventions

As will be evidenced below, the relationship between social media and body image is complex and not always necessarily negative. Thus, when thinking about interventions, it will be important to isolate the elements, behaviours, and personal dispositions that have been found to be harmful. For example, the fact that users are currently not in control of the content they are exposed to may need to be considered when thinking about interventions.

Variation in vulnerability to the negative impacts of social media may need to be considered when targeting and prioritising audiences. Not everyone is affected by social media in the same way. Most of the research has been conducted with female samples, and some studies indicate that females are more likely to be negatively affected than males. However, even within the female population there is huge variability in vulnerability to harmful impacts of social media and social media behaviours (for example, active vs passive engagement; amount of time spent engaging in photo-based activities; and pre- existing vulnerabilities such as extreme dieting behaviours or depression).

The increase of face, hair and skin comparisons may need to be considered.

The fact that social media may be ‘changing’ the ways people think about their bodies will need to be considered when designing interventions. Specific elements of the face, as well as the physical body, may need to be included in future definitions of ‘body image’.

The way ‘fitspiration’ content is uploaded and shared may need to be considered, to avoid spreading inaccurate information.

The below findings suggest that ‘fitspiration’ content may be just as harmful as ‘thinspiration’ content. In addition, findings from the REA suggest that the influencers and bloggers often share inaccurate information, which can do further harm. Interventions may need to consider how this type of content can be regulated in the future.

The impact of upward comparisons to celebrities and ‘past selves’ needs to be considered.

The findings indicate that social media has given users many more opportunities for ‘social comparisons’ with peers, celebrities and even their ‘past selves’. Users may need to be educated about the psychological mechanisms that lead to these comparisons and social media platforms may need to reconsider the value of functions that ‘push’ memories onto its users.

While this chapter details the more negative aspects of social media usage, our participants also gave ample examples of when social media had been beneficial to them. For example, it allows people to connect to niche communities of like-minded individuals, which can feel empowering and positive. Interventions should consider how to leverage these more positive elements of social media (for example, the sense of connection and shared purpose).

While the research is young, findings from the REA suggest that the impact of social media might be more harmful than that of traditional media.^{[footnote 73]} For example, use of Instagram and Snapchat has been linked to worsened body image and mental health among adolescents and young adults of both genders.^{[footnote 74]} A 2018 UK based study into social media activities among young people found that greater use related to poor sleep, low self-esteem and poor body image; in turn these related to higher depressive symptom scores. While this effect was found in both girls and boys, the effect was stronger for girls. Adolescents experiencing online harassment were also more likely to experience poor sleep, poor body image and low self-esteem.^{[footnote 75]}

There are multiple psychological theories that attempt to account for the complex interplay between social media and body image issues. Social comparison theory offers a useful lens through which to understand the powerful influence social media can exert on how people feel about and perceive their bodies. A 2016 review^{[footnote 76]} of the literature suggests that social media offers a platform for social comparisons to happen more frequently, due to the following factors:

The speed and ease with which individuals can connect to their peers provides greater opportunity for fast and frequent social comparisons
Sites like Facebook and Instagram allow users to ’like’ and make comments on photos, and academics argue that this creates a pervasive and intense form of ‘appearance conversations’ that have been shown to be associated with poorer body image
Social media allows peers and celebrities to inhabit the same space, which, some scholars have argued, leads people to view celebrities more like they would their peers, and engage in upward comparisons with them – In fact, research has found that exposure to images of attractive celebrities on social media has an immediate negative effect on women’s mood and body image^{[footnote 77]}

Our primary research supports the above findings. Many participants talked about envying their friends’ bodies on social media (and in some cases, feeling validation from positive comparison of their own bodies to their friends).

“I think social media has had a really significant impact on how I see my body because you have so much to compare yourself to. Everyone tailors their photos to make themselves look beautiful- friends and famous people. It makes you feel like ‘that’s where the bar is set and anything below that isn’t good enough’” – Heterosexual male, 31

Interestingly, the participants in our primary research also reported comparing themselves to images of their younger selves. Social media allows people to easily access past (often curated) images of the self, and some social media platforms (for example, Facebook) will also actively ‘push’ memories onto its users. Our participants told us that this type of easy access to a younger (and often idealised) version of the former self could make them feel badly about their bodies, almost immediately.

“I hate the way Facebook shares old photos with you. I don’t need to be reminded of how skinny and fit I was in Secondary school. Thanks a lot Facebook.” – Gay female, 27

Another psychological theory, known as the social objectification theory (originally put forward by Frederickson and Roberts^{[footnote 78]}) argues that the constant promotion of (often sexualised) beauty ideals in the media leads women and girls to ‘self-objectify’, viewing their own bodies as an object to be looked at, much like an observer would. Scholars argue that social media present greater opportunities for women and girls to internalise beauty ideals, and as a result, ‘self-objectify’.

The REA identified a wide body of evidence detailing the potentially harmful impact of health and wellness content on social media. Both ‘thinspiraton’ and ‘fitspiration’ content have been found to contribute to setting unrealistic body image expectations. We discuss the impact of both types of content below:

The REA suggests that ‘thinspiration’ content has resulted in a proliferation of thin- ideal imagery and greater body dissatisfaction

The REA suggests that thinspiration content and imagery is associated with a greater drive to be thin; greater appearance comparison and greater weight dissatisfaction.^{[footnote 79]} Scholars argue that the image-centred focus of social media and the constant exposure to thin bodies carries the suggestion that only thin and toned bodies are ‘fit and healthy’. Because these images tend to be of ‘every-day’ people (rather than celebrities), they are also likely to give way to greater social comparison.

Fitspiration content has been recognised to be a positive movement in the past, but more recent research suggests the impact on users may be similar to thinspiration content

Fitspiration content and imagery is generally recognised to be a positive and motivational movement, promoting a healthy lifestyle primarily through food and exercise content.^{[footnote 80]} However, recent research suggests that it promotes unhealthy and unrealistic practices that are not necessarily consistent with leading a healthy lifestyle. For example, one study analysed over 600 ‘fitspiration’ images and found that female bodies were always very thin and toned and tended to objectify the female body.^{[footnote 81]} It also found that the mere act of watching ‘fitspiration’ content on Instagram can have a negative impact on mood, body image and self-esteem.^{[footnote 82]} As such, fitspiration content has been compared to ‘thinspiration’ and ‘pro- ana’ (pro-anorexia/eating disorder) content, which idealises thin bodies and is designed to motivate viewers to lose weight. Moreover, recent research suggests that the bloggers and influencers who often dole out fitness and wellness-related advice might be giving inaccurate information to their followers. A recent study by a team at the University of Glasgow found that just one out of 9 leading UK bloggers making weight management claims provided accurate and trustworthy information. This is especially concerning given that many ‘followers’ use this content as a source of information and inspiration.^{[footnote 83]}

“I always get fitness motivation content from my sponsored posts on Instagram and to be honest it just makes me feel bad because I know that no matter how hard I work, my body will never look that skinny and muscular” – Heterosexual female, 23

Despite (or perhaps because of) the saturation of social media with thin and fitspiration content, the participants in our primary research reported actively attempting to reject and avoid this type of content in favour of more ‘natural’ (unfiltered) and ‘body positive’ content. This suggests a growing recognition that some of the images found on social media are unrealistic and potentially unhealthy. This is supported by the increase in social media accounts espousing body confidence and positivity^{[footnote 84]} and the number of celebrities that have been speaking out about the negative impact of social media in recent years.^{[footnote 85]} That said, our participants also felt that despite the increased awareness of and desire to avoid certain types of harmful content, they were still often exposed to it as a result of the way many social media algorithms work (for example, if one user ‘likes’ an image, this image can appear in the newsfeed of many of their followers). This means users may have little choice in the content they are exposed to. This is significant given that many participants in our primary research expressed a desire to be more in control of the types of content they engage with on social media.

“I personally don’t follow any influencers on social media because I find it all really fake and not at all inspirational. But a few of my friends follow that stuff so whenever I go into the ‘explore’ function on Instagram I am bombarded with images of influencers drinking fruity cocktails on the beach in their perfect swimsuit, living their perfect lives.” – Heterosexual female, 20

The REA found that social media may also be changing what components of appearance are salient during the ‘appearance-comparison’ process (see social comparison theory above).

Whereas traditional media forms have focused primarily on the body, women have been found to upload more portrait pictures than full-bodied pictures to their Facebook profiles, which provides women with more opportunities to make face, skin and hair-related comparisons. In fact, research suggests that facial features, skin and hair are also important aspects of attractiveness for women and form a basis for social comparison.^{[footnote 86]}

This is supported by our primary research, in which women frequently reported worrying about their skin and hair. One of our participants told us that during a particularly bad skin break-out in the exam period of university, she felt unable to focus on her studies because she was completely preoccupied with her skin.

“It was the exam period and I couldn’t focus on the uni work because I would literally be spending hours thinking about my skin, I would cry every day, go on the internet googling everything” – Heterosexual female, 21

While the academic literature has focused on women, our primary research suggests that hair loss is a key concern for men that can impact the way they feel about themselves and the way they interact with the world. As one of the men in our workshops told us:

“I won’t leave the house without my cap on” – Heterosexual male, 40

The relationship between social media and body image is complex and causality is hard to establish. However, recent research has focused on trying to tease apart the specific elements of social media usage that may make some users more vulnerable to negative body image. Holland and Tiggeman’s 2016^{[footnote 87]} review of the literature identified 3 key tenets of social media usage that appear to have a negative impact on users. These were:

time spent on social media^{[footnote 88]}
number of Facebook friends^{[footnote 89]}
time spent engaging in photo-based activities^{[footnote 90]}

It was found that young women who spend more time engaging in the above (and those who had more Facebook friends) were more vulnerable to a range of negative attitudes and behaviours, including higher endorsement of the ‘thin ideal’; more dieting behaviours and greater body dissatisfaction. Researchers have found that boys and girls living in lower income and one parent households tend to spend more time on social media and are therefore more at risk of being negatively affected.^{[footnote 91]}

In addition to specific negative behaviours on social media, certain personal dispositions have been found to make people more vulnerable to the negative effects of social media usage. The transactional model,^{[footnote 92]} for example, argues that women who are susceptible to low self-esteem, depression, perfectionism, and internalisation of the ‘thinness ideal’ tend to gravitate to appearance-focused social media content to seek reassurance and validation. They spend considerable time with social media, which leaves them feeling more dissatisfied with their bodies. Motivated to feel better, these young women expose themselves to social media yet again, engage in upward comparisons, obsess about parts of their bodies that make them look bad and, in most cases, end up feeling badly about their bodies once again.^{[footnote 93]} Thus, a negative cycle ensues – a cycle where women feel badly about themselves and while seeking validation and reassurance, feel badly yet again.

While the participants in our primary research agreed that social media could have a negative impact, they also told us that social media could provide a safe space that enables them to explore ideas and experiment with their online image and identities in an empowering and reassuring way.

We heard first-hand accounts of social media allowing our participants to share in ‘beautiful moments of humanity’, sharing positive and inspirational content with those close to them and of learning new things and forging new and genuine connections with new people or old friends.

We also heard stories of social media allowing our participants to connect with niche communities in a way they hadn’t been able to previously. For example, a few of our trans and non-binary participants reported being able to connect with like-minded individuals online. This was especially important for their sense of identity and belonging, as these individuals reported struggling to find those connections in real life. One of our trans participants told us that finding a like-minded community online had been central to lifting him out of his depression and helping him find his identity. It had also provided him with useful hints and tips about where to shop (for example, for chest binders).

“Online communities have been so pivotal to me finding myself and figuring out who I am. They taught me to accept who and what I am and to stop thinking of myself as an outsider, because there are other people who feel they way I do” – Trans male, 30

“The only support service/information that I have come across is on social media (Facebook) which is called the Body Image Movement (BIM). I came across it via a Facebook search and came across the group/page. I think it is a very thoughtful idea and have found it to be very positive. It has a lot of people who like the page, so it’s nice to know I’m not alone at feeling the way I do, for example feeling low about how I look and very body conscious. It makes me feel a lot better about myself to know that other people feel the same.” – Gay female, 35

This is supported by academic literature which has attempted to identify the key benefits in relation to the routine use of social media. One study identified 6 key benefits, as follows “(1) increased interactions with others, (2) more available, shared, and tailored information, (3) increased accessibility and widening access to health information, (4) peer, social, emotional support, (5) public health surveillance, and (6) potential to influence health policy.”^{[footnote 94]}

Thus, while the evidence suggests that social media usage can have clear harmful impacts on its users, it is important to note that research has also identified some potential benefits that may form part of the reason why it may be difficult for people to disengage from social media entirely.

Question 8

6.  Moving towards interventions

Accepted Answer

After the digital phase of our primary research and synthetisation of academic literature in the REA, we had a good understanding of the body image ‘state of play’ and the array of influences (social media, in particular) and experiences of our different audiences. We thus used our remaining co-creative workshops to fulfil 2 key goals: 1) to test and validate our existing hypotheses and 2) to co-create intervention ideas with participants. Figure 1 below outlines the flow of our co-creative workshops:

Figure 1. Workshop flow

Stage	Number	Activity
Hypothesis creation and testing	1	2CV formulate hypotheses based on REA and digital phase. Hypotheses tested and validated with workshop participants.
Co-creation	2	Booklets with key insights from previous research stages provided to workshop participants.
Co-creation	3	Workshop participants asked to brainstorm intervention ideas across 4 key policy areas: education, physical and mental health, social media, peer-to-peer/community support.
Co-creation	4	Participants vote for and debate ‘winning’ ideas.
Intervention principles	5	2CV formulate key intervention principles based on participants’ ideas and debate.

6.1 Testing hypotheses and moving towards interventions: co-creation and designing intervention principles

Across both the commercial and public spheres, there is a growing recognition that services, ideas, and policies work best when they are designed with their intended audience and with a clear vision of the desired outcomes. Whilst retaining many of the elements of traditional research techniques, co-design processes are uniquely collaborative and inclusive.

We started our workshops with an initial ‘hypothesis testing phase’. We discussed our key insights from the previous research phases (the REA and digital phase) and validated them with our participants, to ensure we had captured participant voices correctly (see appendix 4 for a summary table that outlines how we tested and validated our hypotheses).

Finally, as part of our final ‘co-creation’ phase, we ensured we allowed our participants ample time to design their own interventions to tackle body image, based on their unique needs. Asking participants to get involved in this manner gives them more of a stake in the research and allows us to identify the key intervention principles that will be important to consider when these early ideas are translated into policy ideas.

To give our participants a useful starting place for building interventions (and to avoid overwhelming them by having to start from scratch), we gave them 4 ‘intervention areas’ to build their ideas around. We ensured that these 4 key areas would allow participants to build interventions that were related to the key hypotheses we had generated from previous phases of research. The intervention areas were as follows:

education
physical and mental health
social media
peer-to-peer/community support models

We gave participants an hour to come up with ideas in each of these 4 intervention areas. They were given booklets that outlined ‘what already exists’ in each area, as well as key background information and existing insights on each of the topics (see Appendix 2.3 for an example). After they had worked on each idea, participants were asked to vote on the ideas they felt showed the most potential.

6.1.1 Key intervention themes

When analysing the ideas created by participants (see Appendix 5 for verbatims of participant ideas), a number of key themes emerged. We summarise these below:

interventions should focus on body functionality rather than aesthetics, helping people to appreciate what their body can do rather than how it looks
drawing comparisons between mental health and body image issues resonates
preventative support feels important – having a place to turn to before things get bad
there is a sense that more needs to be done to raise awareness of how body image issues may manifest (for example, body dysmorphia; extreme dieting; extreme exercising, disordered eating, etc.)
more anonymous online avenues for support have appeal, especially for men
exercise is perceived as a helpful route into feeling better about body image – making initiatives feel inclusive and targeted towards all ability and activity levels feels key
schools are felt to play an important role in tackling body image issues and building resilience
involvement and ‘buy-in’ from parents is likely to be important for interventions to work
education should be for people of all ages, not just school-aged young people
peer-to-peer models and community-based ideas have appeal
social media may form an important part of building awareness of and resilience to body image issues. For example, using its influence to spread body positive messages
there is a desire for less harmful media and more ‘responsibility’ from advertising companies for the types of content they broadcast
there is an appetite for more regulation of ‘harmful content’ on social media and for gentle sign-posting and warnings around harmful social media usage
there is an appetite for public engagement in social media regulation processes
interventions that blend elements from different areas (for example, education and physical health; education and peer-to-peer support, etc.) are welcomed and have wide appeal

Question 9

7.  Conclusion

Accepted Answer

Experiences of body image vary widely across life stages, genders, sexual orientations and ethnicities. This research aimed to paint a picture of the wide array of body image experiences and the different elements, both internal and external that influence these. While research on the influence of social media on body image is still young, there is clear evidence – from both the academic literature and our primary research- that its impact can be negative, both directly (viewing social media content leads to feelings of body dissatisfaction) or indirectly (eliciting a low mood and depressive symptoms, which in turn can lead to higher feelings of body dissatisfaction^{[footnote 95]}).

It is our hope that the intervention implications outlined in the chapters above provide a useful framework to inform evidence-based decisions regarding new policies aimed at tackling the causes, experiences and consequences of negative body image. It is also hoped that these insights and the identification of knowledge gaps in the research provide a useful springboard for future research.

Below we present a summary checklist of the key principles to bear in mind when designing interventions, based on the synthesis of our findings from all 3 stages of research:

The state of play and current perceptions of body image as an ‘issue’:

Within our sample, body image is perceived as an issue that is important to address
Men (especially heterosexual men) may need to be ‘eased into’ the conversation about body image – providing avenues of ‘anonymous’ support may be important for this group
While facilitating access to diet and exercise is important, interventions should also take into account the complex psychological and cultural factors that influence body image
Social media interventions are likely to be welcomed but may feel less relevant to individuals (as a result of the perceived chasm between impact on the self vs impact on others)
Any interventions that attempt to make healthy diet and exercise more attractive should be mindful not to appear ‘classist’ and should be accessible to all

Interventions may need to be tailored around different experiences:

Schools may increasingly need to play a role in preventing and managing negative body image (this is especially important given that people desire more preventative support)
Special attention should be paid to audiences that may experience social disadvantage on multiple levels (for example, race, gender, sexuality)
Different support/interventions may need to be considered for trans and non-binary individuals, as their experiences are very different from cisgender individuals
Different groups of people may require different levels and types of support at different life stages (for example, pregnant women; people going through divorce, etc.) and interventions may need to be targeted at specific life milestones, rather than just at particular age groups
Interventions may need to target the functionality of the body rather than aesthetics through, for example, health and mental wellbeing approaches

Important influences ‘outside’ of social media may need to be considered:

Peer-to-peer dynamics should be considered when creating ideas for potential interventions
Parents (and mothers in particular) play an important role in influencing body image – involving parents in any interventions targeting teenagers is likely to be fruitful
The influence of dating apps should be researched further and considered when designing interventions
Mass media can do more to feel truly inclusive, not merely ‘tokenistic’. Trans and non-binary individuals feel particularly strongly about this

The complex and varied influences of social media should be considered:

The specific elements of social media that are problematic may need to be considered when designing interventions (for example, the fact that many users report being exposed to content without choosing to)
Individual vulnerabilities to negative impacts of social media (for example, depression) may need to be considered when targeting and prioritising audiences
The increase of face, hair and skin comparisons may need to be considered; purely focusing on the ‘body’ may not be enough
Special attention may need to be paid to the way ‘fitspiration’ content is uploaded and shared, to avoid spreading inaccurate information and to ensure it is not merely promoting the ‘thinness’ ideal
The fact that social media allows greater space for harmful comparisons to peers, celebrities and ‘past selves’ may need to be considered when designing interventions

Question 10

8.  References

Accepted Answer

Ålgars, M., Alanko, K., Santtila, P., and Sandnabba, N. K. (2012). Disordered Eating and Gender Identity Disorder: A Qualitative Study. Eating Disorders, 20, 300–311.

All Party Parliamentary Group on Body Image (2012) “Reflections on Body Image”, available online at: Reflections on body image

Alleva JM. Paraskeva N. Craddock N. Diedrichs PC (2018). Body appreciation in British men: Correlates and variation across sexual orientation. Body image.

Alvy LM (2013). Do lesbian women have a better body image? Comparisons with heterosexual women and model of lesbian-specific factors. Body image.

Andrew, Rachel and Tiggemann, Marika and Clark, Levina. (2015). Can body appreciation protect against media-induced body dissatisfaction? Journal of Eating Disorders.

Breitkopf, C., Littleton, H., and Berenson, A. (2007). Body Image: A Study in a Tri-Ethnic Sample of Low Income Women. Sex Roles, 56(5/6), 373-380.

British Youth Council (2017) “A Body Confident Future”, available online at: A Body Confident Future

Brown, Z, Tiggemann, M. (2016). Attractive celebrity and peer images on Instagram: Effect on women’s mood and body image. Body image.

Burrowes, N. (2013) “Body image – a rapid evidence assessment of the literature”, available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_dat a/file/202946/120715_RAE_on_body_image_final.pdf

Capodilupo, Christina and Kim, Suah. (2013). Gender and Race Matter: The Importance of Considering Intersections in Black Women’s Body Image. Journal of counselling psychology.

Chmielewski, Jennifer and R. Yost, Megan. (2013). Psychosocial Influences on Bisexual Women’s Body Image Negotiating Gender and Sexuality. Psychology of Women Quarterly.

De Vries, A. L. C., Mcguire, J. K., Steensma, T. D., Eva, C. F., Doreleijers, T. A. H., and Cohen- Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Paediatrics, 134, 1–9.

Eysenbach, G. (2013). Misleading Health-Related Information Promoted Through Video- Based Social Media: Anorexia on YouTube. Journal of medical health research.

Eysenbach, G. (2015). Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study. Journal of medical health research.

Fardouly, J. Diedrichs, P. Vartanian, L. Halliwell, E. (2014). .The impact of Facebook on young women’s body image concerns and mood.

Ferguson, C. J. (2013). In the eye of the beholder: Thin-ideal media affects some, but not most, viewers in a meta- analytic review of body dissatisfaction in women and men. Psychology Of Popular Media Culture, 2, 20-37.

Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7,

Fox, J., and Bailenson, J. (2009). Virtual Self-Modeling: The Effects of Vicarious Reinforcement and Identification on Exercise Behaviors. Media Psychology, 12(1)

Franzoi, S. and Shields, S. (1984). The body esteem scale: Multidimensional structure and sex differences in a college population, Journal of Personality Development, 48(2), 173-178.

Fredrickson, B. L., and Roberts, T.-A. (1997). Objectification Theory: Toward Understanding Women’s Lived Experiences and Mental Health Risks. Psychology of Women Quarterly, 21(2)

Girlguiding (2019). https://www.girlguiding.org.uk/social-action-advocacy-and- campaigns/research/girls-attitudes-survey/ ‘Girls’ Attitudes Survey’

Government Equalities Office (2013). ‘Body Image – A Rapid Evidence Assessment of the Literature’, available online at: https://docplayer.net/22038616-Body-image-a-rapid-evidence- assessment-of-the-literature.html

Haferkamp, Nina and Krämer, Nicole. (2010). Social Comparison 2.0: Examining the Effects of Online Profiles on Social-Networking Sites. Cyberpsychology, behavior and social networking. 14.

Holland, G. Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes.

Holmstrom, A.J (2004). The effects of the media on body image: A meta-analysis. Journal of Broadcasting and Electronic Media, 48.

Jackson KL, Janssen I, Appelhans BM, Kazlauskaite R, Karavolos K, Dugan SA, Kravitz HM (2014). Body image satisfaction and depression in midlife women: the Study of Women’s Health Across the Nation (SWAN) Archives of Women’s Mental Health.

Jones, BA., Haycraft, E., Murjan, S. and Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature

Kelly, Y. Zilanawala, A, Booker, C. Sacker, A. (2018). Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study.

Kraemer, B., Delsignore, A., Schnyder, U., and Hepp, U. (2007). Body image and transsexualism. Psychopathology, 41, 96–100.

L Smith, Marie and Telford, Elina and Tree, Jeremy. (2017). Body image and sexual orientation: The experiences of lesbian and bisexual women. Journal of Health Psychology.

Levitt, HM; Hiestand, K.R. (2004). A Quest for Authenticity: Contemporary Butch Gender. Sex Roles. Vol 50.

Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Kinzl J. (2014). Prevalence of eating disorders in middle-aged women. International Journal of Eating Disorders.

Mangweth-Matzek B, Rupp CI, Hausmann A, Assmayr K, Mariacher E, Kemmler G, Biebl W. Never too old for eating disorders or body dissatisfaction: a community study of elderly women. International Journal of Eating Disorders. 2006;39(7):583–586.

Meier,E.P. Gray, J. (2014). Facebook photoactivity associated with body image disturbance in adolescent girls.

Moorhead,S. A.,Hazlett,D. E.,Harrison, L.,Carroll, J. K.,Irwin, A.,and Hoving, C.(2013). A new dimension of healthcare: systematic review of the uses, benefits, and limitations of social media for health communication. Journal for medical internet research, 15(4).

Morrison, Melanie and Morrison, Todd and Sager, Cheryl-Lee. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A meta- analytic review. Body image.

Olsen, W., Gash, V. Kim, S., Zhang, M. (2018). The Gender pay gap in the UK: evidence from the UKHLS.

Perloff, R. (2014). Social Media Effects on Young Women’s Body Image Concerns: Theoretical Perspectives and an Agenda for Research.

Rimes, K. A., Goodship, N., Ussher, G., Baker, D., and West, E. (2017). Non-binary and binary trans gender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. International Journal of Trans genderism.

Royal Society Public Health, Vision, Voice and Practice. (2017). Status of Mind: Social media and young people’s mental health and wellbeing.

Rutledge,C.M.,Gillmor,K.L., and Gillen, M.M.(2013). Does this profile picture make me look fat? Facebook and body image in college students . Psychology of Popular Media Culture,2,251– 258.

Saltzburg, S., and Davis, T. (2010). Co-authoring Genderqueer Youth Identities: Discursive tellings and Retellings. Journal of Ethnic and Cultural Diversity in Social Work.

Slade, P., Dewey, M., Newton, T., Brodie, D., and Kiemle, G. (1990). Development and preliminary validation of the body satisfaction scale (BSS), Psychology and Health, 4(3), 213- 220.

Slater, Amy and Tiggemann, Marika and Hawkins, Kimberley and Werchon, Douglas. (2012). Just One Click: A Content Analysis of Advertisements on Teen Web Sites. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 50.

Smith ML. Telford E. Tree JJ (2017). Body image and sexual orientation: The experiences of lesbian and bisexual women

Strubel, Jessica and Petrie, Trent. (2017). Love me Tinder: Body image and psychosocial functioning among men and women. Body Image.

Thompson, J. K., Heinberg, L. J., Altabe, M., and Tantleff-Dunn, S. (1999). Sociocultural theory: The media and society. In J. K. Thompson, L. J. Heinberg, M. Altabe, and S. Tantleff-Dunn, Exacting beauty: Theory, assessment, and treatment of body image disturbance (pp. 85-124). Washington, DC, US: American Psychological Association.

Tiggemann, M. Slater, A. (2013). Selfie-Esteem: The Relationship Between Body Dissatisfaction and Social Media in Adolescent and Young Women.

Tiggemann, Marika and McCourt, Alice. (2013). Body appreciation in adult women: Relationships with age and body satisfaction. Body image.

Tiggemann, Marika and Zaccardo, Mia. (2015). “Exercise to be fit, not skinny”: The effect of fitspiration imagery on women’s body image. Body image.

Webb JB. Butler-Ajibade P. Robinson SA. (2014). Considering an Affect Regulation Framework for Examining the Association Between Body Dissatisfaction and Positive Body Image in Black Older Adolescent Females: Does Body Mass Index Matter?

Question 11

Appendix 1: Sample

Accepted Answer

Digital diaries sample

Age and life stage: All were aged between 15-45. 15 participants aged 15-25; 10 participants aged 26-35; 5 participants 36-45
SEG: 50/50 split between BC1 and C2DE
Gender: 50/50 split of men and women
Ethnicity: We ensured a diverse ethnic mix representative of the research locations
Sexual orientation/gender identity: We included LGBT representation. We set quotas for x 5 of this audience across the sample
Disability type: We included a range of physical and cognitive/learning disabilities. We set quotas for x 5 of this audience across the sample
Vulnerability to negative body Image: We covered a range of vulnerabilities, using an attitudinal questionnaire to include a spread of less and more resilient
Locations: We drew participants from across the UK, including South, Midlands, North, Scotland, and West/Wales

Sample summary

Locations	Age ranges	SEG	Body image vulnerability
South	15-25 x 3, 26-35 x 2, 36-45 x 1	3 x BC1, 3 x C2DE	3 x medium impact, 3 x high impact
Midland/	As above	As above	As above
North	As above	As above	As above
Scotland	As above	As above	As above
Wales	As above	As above	As above

Co-design workshops sample

2 x half day (4 hour) long co-creation sessions with 10 x participants per session (recruit 12 for 10) = 24 recruits total
All were social media users (light to heavy users)

Session 1 (women)

All to be hetero women
Aged 20-40 (3 x 20-25; 2 x 25-30; 2x 30-35; 3 x 35-40)
Mix of vulnerabilities towards negative body image (see phase 1 screener for questions)
A representative mix of ethnicities
Good mix of BC1C2D

Session 2 (men)

All to be hetero men
Aged 20-40
Mix of vulnerabilities towards negative body image (see phase 1 screener for questions)
A representative mix of ethnicities
Good mix of BC1C2D

Question 12

Appendix 2: Fieldwork materials and stimulus

Accepted Answer

Digital diaries task overview

Task 1: Getting to know you

Quick personal intro – name, age, location, who they live with, interests, education/employment.

Image showing something important to them.

Biggest achievement/challenge in 2018 and why.

Introduce topic of physical appearance/body image:

immediate reaction to topic – which 3 to 5 emotions spring to mind?
how would they describe appearance vs. close friend or family member? How similar/different and why?
what (if any) bodily changes have they noticed in last 2 to 3 years and how does this make them feel? Made any intentional changes to body? Trigger/motivation?

Task 2: You and your self-image

In-depth exploration of self-image via creative exercises:

5 to 10 words to describe body and why
Upload one image to represent how they feel about body and one image to represent ‘best self’
‘My body journey’ – draw and upload timeline showing ‘highs’ and ‘lows’ and record audio clip describing how relationship with body has changed over time
Write love letter/break-up note to their body sharing their ‘best’ and ‘worst’ bits and upload photo of annotated drawing showing this
If they had to swap bodies with someone for one day, who would they swap with and why?

Task 3: Media and me

Explore overall media habits:

5 to 10 favourite things to watch/read/listen to
News consumption – what/how/why?

Explore social media habits:

List all social media channels they use (if any) and why
Share 5 to 10 people they follow on social media and why

Social media and body image:

What impact (if any) has social media/edited images had on personal body perceptions? Refer back to body journey timeline – did social media play a role at all?
Share one screenshot of ‘positive’ body-focused social media account and one ‘negative’ – how are they spreading positive/negative message?
Imagine a world without social media – how would they view their body? Similarly/differently? Positive/negative impact without it?

Task 4: My influences

In-depth exploration of key influences:

Role of key ‘players’: list up to 10 people, organisations and/or companies that they feel influence perceptions of their ‘body image’ and how impact perceptions/satisfaction
Top 2 ranking: Which 2 from the list are most influential and why? Have their changed anything about body as a result?
Who should speak up more? Who would they love to hear more from? Who could positively impact ‘body image’ conversation and how?
Body ‘perfection’: If they had to describe the ‘perfect body’, how would they describe it and why? Who is setting the rules? Where do expectations come from? Gender differences?

Task 5: Support and information

Support and information:

Share spontaneous examples of any support/info they’re aware of and where did they see it [Opportunity to upload website links/screenshots]

Campaigns:

Can they recall any campaigns related to ‘body image’ that really stand out in their mind? (for example, industry, gov, charity)
Why was it positive/impactful? Who did this message feel aimed at? Them or others?

Create their own campaign:

If they had to create their own ‘body image’ campaign in 2019, what would be the focus and why? What needs to change now? [Audio recommended]

Co-design workshops: session flow overview

1. Warm up and introduction

Introduction and warm-up exercises to create an environment where respondents feel comfortable. 15 to 20 minutes.

2. Body image: associations and influences

Understanding their definitions of, and associations with, body image – what influences this and how they personally feel. 30 minutes.

3. Body image: exploring the ‘size’ of the issue

Exploring their perceptions of the ‘size’ of the issue in society, and what can and should be done to tackle it. 30 minutes.

4. Co-design: exploring and creating ideas

To explore the different solution areas and get respondents to co-create ideas in teams (rotate teams every 20 minutes). 80 minutes.

5. Co-design: presenting ideas and prioritising

To present ideas back to the group, discuss implications and prioritise the ‘winning’ ideas. 60 minutes.

6. Thanks and close and answer any questions

5 minutes.

Co-design workshops: example of information and inspiration booklet

Question 13

Appendix 3: Challenges and recommendations for future research

Accepted Answer

While this research explored ‘body image’ from multiple angles with a diverse sample, budgetary constraints meant we had to make some pragmatic choices about the sample that the reader should bear in mind. This research also identified some key gaps in the academic literature that we recommend should be addressed in future research.

Many studies reviewed in the REA focus on the impact of social media on the body image of adolescent girls or young women. As a result, the second objective (how does negative body image impact different demographics?) was investigated independently of social media in the REA, looking at broader influences (for example, culture, mass media) and impacts of negative body image on these audiences. The sample in our primary research phase was too small to draw out the influence of social media on different demographics.

Our recommendations

Building on this research, future research should focus on investigating the relationship between social media and body image among a wider range of audiences – including ethnic minority, LGBT groups and people with disabilities. This is especially important given there is little academic research in this area.

Many studies reviewed in the REA focus on isolating the individual factors that make someone more vulnerable to negative body image. For example, whether a person has pre-existing conditions (for example, depression) that affect the way in which they engage with certain types of social media content; the amount of time they spend online; and the types of activities they engage with. This makes it difficult to draw firm conclusions about cause and effect, as many mediating factors play a role.

Likewise, the measures (dependent variables) studies choose to focus on are inconsistent (for example, some studies focus on measuring ‘body satisfaction’, whereas others might focus on ‘body appreciation’, both of which mean different things), adding a new layer of complexity to any attempt to establish causality.

Our recommendations

We recommend experimental research (for example, RCT) that manipulates exposure to social media may be a useful way to determine causal impact.

While the digital phase of our primary research included LGBT and ethnic minority audiences, our co-creative workshops focused on cisgender heterosexual men and women.

While LGBT audiences were included in the digital phase, we did not feel it was appropriate to include a mix of audiences in the face-to-face workshops, as the body image experiences of LGBT audiences tend to be so different to those of cisgender heterosexual people, potentially making a workshop dynamic uncomfortable and unproductive. We thus decided to run 2 workshops with a more homogenous sample of men and women who identified as heterosexual. Though our workshops did include a mix of ethnicities, we did not focus in depth on the different experiences of these ethnicities specifically in the workshops.

It is worth noting that our digital phase did include LGBT and ethnic minority representation, but our sample was not large enough to draw any firm conclusions around how different issues intersect. We thus only make observations about the unique experiences of ethnic minority and LGBT groups in this report if the findings of the primary research were also backed up by the academic literature reviewed in the REA.

Question 14

Appendix 4: Testing Hypotheses: how did we do it?

Accepted Answer

The table below summarises our key hypotheses from the previous chapters and outlines how we tested these with our participants and our key findings. All the hypotheses in the table below were validated in co-design workshops.

Hypothesis: Across the board, body image is perceived as an issue that is important to address

How did we test it?

We explored the perceived ‘size’ of body image as a societal issue, in relation to other issues.

Our findings

Participants confirmed that body image is an important issue to be tackled, especially in the context of social media.

Hypothesis: Men may need to be ‘eased into’ the conversation about body image (easiest way in may be the mental health angle)

How did we test it?

We held separate workshops with men and women to understand any key differences in how ‘easy’ or ‘relevant’ the topic felt.

Our findings

Men struggled more than women to articulate their feelings about body image and tended to ‘depersonalise’ the issue However, when exploring the issue from a ‘mental health’ rather than a ‘physical body’ angle, the men in our sample were able to sympathise with the issue more, and better articulate their own experiences. This suggests that approaching the issue from this angle with men may be effective.

Hypothesis: Any interventions that attempt to make healthy diet and exercise more attractive should be inclusive and accessible to all

How did we test it?

We explored the perceived influences on body image in the workshops.

Our findings

Class and ‘social status’ came up spontaneously in both the male and female workshops

Hypothesis: A holistic approach to body image may be needed

How did we test it?

We explored the different internal and external factors participants felt influenced their body image and their ‘wishes’ for what would need to be done to work towards a future free of body image concerns.

Our findings

It was clear that participants felt a holistic approach to tackling body image would be most effective.

When co-designing potential interventions for body image issues, participants tended to create interventions that tackled the issue from multiple angles (for example, school, social media regulations, community support, etc) (we discuss this further in section 6.2).

Hypothesis: As adolescence tends to be a particularly challenging time, schools may increasingly need to play a role in preventing and managing negative body image

How did we test it?

We explored the perceived role of education (or lack thereof) on body image.

Our findings

Participants identified secondary school as a key life stage when they would have welcomed more support and interventions. Personal, Social and Health Education (PSHE) lessons were felt to be particularly appropriate for this type of content.

Hypothesis: Different groups of people may require different levels and types of support at different life stages

How did we test it?

We tested the ‘life-stage’ moments at which men and women may require different levels of support. Note: again, we were not able to test this with LGBT or ethnic minority audiences.

Our findings

Men and women identified needing support at different key milestones in their lives. Women, for example were more likely to identify adolescence, pregnancy and menopause as ‘life moments’ when they would have welcomed or would welcome more support in the future Men, on the other hand, were less consistent in their responses, instead mentioning the onset of physical changes such as hair loss and weight gain as difficult body image ‘moments’.

Hypothesis: Encouraging a focus on body functionality through health and mental wellbeing approaches may be effective

How did we test it?

We explored how participants conceive of their bodies and what constitutes a ‘perfect body’.

Our findings

Women were more likely to focus on the aesthetics of a ‘perfect body’, whereas men were more likely to talk about what a perfect body could achieve (for example, running 10km) When designing interventions, women were drawn to mindfulness and yoga approaches to encourage people to become more in sync with their bodies. This indicates that a shift in focus to body functionality may be fruitful.

Hypothesis: Peer-to-peer dynamics should be considered when creating ideas for potential interventions. The influence of parents (and mothers in particular) may need to be considered when designing interventions

How did we test it?

We explored peer and family dynamics with participants.

Our findings

Participants cited peers and parents (especially mothers) as important influences on body image. They also came up with lots of ideas for interventions that contained a peer-to-peer element and included the involvement of parents.

Hypothesis: Mass media can do more to feel truly inclusive of all types of people – especially LGBT and non-binary audiences

How did we test it?

We explored the perceived influence of mass media on body image and the different brands that are perceived to be doing well/less well to encourage a more positive body image.

Our findings

Participants felt that the mass media is moving in the right direction but that more can still be done for the media to be truly inclusive of a wider range of people, bodies and shapes.

Hypothesis: multiple hypotheses

Social media interventions are likely to be welcomed but may feel less relevant to individuals.
Interventions may need to consider the specific elements of social media that are problematic.
Interventions may need to consider a way to ‘identify’ users who may be particularly vulnerable to social media.
The increase of face, hair and skin comparisons may need to be considered.
The way ‘Fitspiration’ content is uploaded and shared may need to be considered, to avoid spreading inaccurate information.
The impact of upward comparisons to celebrities and ‘past selves’ as a result of social media may need to be considered.

How did we test it?

While we did not discuss the specifics of each of these hypotheses in detail, we explored the perceived role of social media in influencing body image. We also ensured that ‘social media’ was one of the ‘intervention areas’ our participants could work on to come up with their own interventions for tackling body image (we discuss this further in section 6.2).

Our findings

Participants agreed that social media plays a huge role in influencing body image and spontaneously mentioned it as one of the key influences.

The role of ‘fitspiration’ and ‘celebrity influencers’ were mentioned spontaneously by our female participants, with many stating that being exposed to such content could make them feel worse about themselves.

Our female participants also expressed a preoccupation with their skin, and while they did not explicitly link this to social media, they did express feeling that ‘everyone’s skin’ was better than their own and that the media never portrays anyone with less than perfect skin.

In addition to the hypotheses mentioned above, there were a few hypotheses generated by the REA and the digital phase of research that were not suitable for validation in the co-design workshops. This does not mean these hypotheses are any less valid; it simply means we felt the workshop environment was not conducive to testing these or that our audiences (as cisgender heterosexual males and females) were not the right audience to validate these. We suggest further research to explore these hypotheses in more detail:

Hypothesis: Special attention should be paid to audiences who may experience oppression on multiple levels

Why it was not validated in this research

We did not test these hypotheses in the workshops as our sample consisted of cisgender heterosexual men and women.

Recommendations

We recommend future research with LGBT and ethnic minority audiences exclusively.

Hypothesis: Different support/interventions may need to be considered for trans and non-binary individuals as their experiences are very different from those of cisgender individuals

Hypothesis: The influence of new media such as highly visual dating apps should be researched further and considered when designing interventions

Why it was not validated in this research

We did not feel the workshop environment was appropriate to have a detailed discussion around the impact of dating apps, as we did not want to skew our sample towards those using dating apps – it was not the main focus of this research.

Recommendations

We recommend future research explores the impact of dating apps on body image in greater detail.

Question 15

Appendix 5: Intervention ideas created by participants in our co-creation workshops

Accepted Answer

Education ideas

“The name of our idea is ‘peer-to-peer education. For topics such as body image, period awareness, etc. there should be a training programme to teach the older kids how to teach these issues to younger students. Kids don’t want to hear about bodies and sex from their maths teacher. It would also have the added benefit of helping the older kids build other important skills such as education skills” – Female workshop

“The name of our idea is ‘body positive morning classes’. Kids nowadays have to study so hard and have such a massive focus on education that it would be better to spend time on themselves, their wellbeing, their mental and physical health. This idea would be to have morning sessions where students can come in slightly before class starts to do meditation, mindfulness, yoga, etc. an additional thought: instead of detention – meditation! This could also be collaborative session with parents/family members as we feel their involvement is important to help take care of their children’s mental health” – Female workshop

“Our idea is about having regular parents evenings throughout the year to not just talk about your child’s academic progress, but also to talk about how your child is faring in terms of resilience and bullying, to make sure parents are aware and can intervene if they need to” –

Male workshop

“Our idea is to have lots of external speakers come into school to talk about body image to children from a young age and to bring in experts that specialise in fields such as body dysmorphia and eating disorders to increase awareness. We also think it would be good if this was extended to the workplace, because body image issues can affect anyone, no matter what their age is” – Female workshop

Peer-to-peer/community support ideas

“The name of our idea is ‘body-safe’. It is a charity that concerns itself with mental health and body image. The charity would create leaflets, community drop-in centres, and a phone line specifically for advice about mental health and body image. At the moment, it feels there is only support for when things get really extreme (for example, Samaritans or even A and E) but there is no preventative support, it’s only when things are already bad. We’d create a charity that’s there for people before things get really bad, and make it clear that this helpline is also there for anyone who wants to call, even if you are just feeling a little bit down” – Female workshop

“Our idea would be a bit like alcoholics anonymous but for body image. it would be an online community where people can go and talk about their issues and share inspiring content with one another”- Female workshop

Mental health ideas

“Our idea is to link body image more to the NHS. We’ve come a long way. People need to be given the first step in finding help rather than having to go and seek it out. So it would include receiving texts from your GP asking how you’re feeling and proactively checking in on you” –

Female workshop

“Our idea involves target hashtags. Stigma and lack of talking openly are the main reasons we have body image issues. If we could talk more frankly and openly about the concerns and worries we all have, we’d realise that we are not alone and everyone is suffering from these issues to a certain degree. We could start a movement similar to the ‘metoo’ hashtag where people can candidly discuss their body image and mental health issues on social media” –

Female workshop

“Our idea involves creating a wellbeing bot – it would keep an eye on how people are feeling about their bodies. And if a doctor senses the person has issues, he or she might then prescribe the wellbeing bot. – Male workshop

Physical health ideas

“Our idea was to have community trainers at park workout facilities (instead of personal trainers). So for example, every Saturday there is a personal trainer at the outdoor free health facilities in parks that can help people improve their physical health, promoted as something for everyone of all shapes and sizes” – Male workshop

“Our idea was around more community yoga and meditation sessions to help people get more in tune with their bodies, so they come to appreciate them more” – Female workshop

“Our idea was to create some sort of social media stamp of approval. It would involve giving people the opportunity to vote on adverts before they go live. This means that adverts have to be approved by the public (crowdsourced) in order to get the stamp. It could be aspirational for brands to have a stamp of approval that their advertising is positive and promoting positive body image.” Male workshop

“Our idea is called ‘pop-up therapy’. There would be some sort of algorithm that signposts users following harmful hashtags to mental health support” – Female workshop

“Our idea was to have more ‘warnings’ targeted at people who are using social media in an unhealthy way. So for example, some sort of ‘digital warning’ might pop up if people have spent too much time on social media on one day. We’d also want the harmful adverts that pop up on social media that users have no control over to be banned and for celebrities and influencers to stop advertising things like diet teas and shakes” – Female workshop

Definitions related to gender and sexuality are taken from the Government Equalities Office National LGBT Survey (2019). ↩
All Party Parliamentary Group on Body Image (2012), Reflections on Body Image (PDF). ↩
British Youth Council (2017), A Body Confident Future (PDF). ↩
Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, ↩
Slater, Amy and Tiggemann, Marika and Hawkins, Kimberley and Werchon, Douglas. (2012). Just One Click: A Content Analysis of Advertisements on Teen Web Sites. The Journal of adolescent health: official publication of the Society for Adolescent Medicine. 50. ↩
Girlguiding (2019). https://www.girlguiding.org.uk/social-action-advocacy-and-campaigns/research/girls-attitudes-survey/ ‘Girls’ Attitudes Survey’ ↩
Tiggemann, M. Slater, A. (2013). Selfie-Esteem: The Relationship Between Body Dissatisfaction and Social Media in Adolescent and Young Women ↩
Note: research does not include trans women ↩
Body Image – A Rapid Evidence Assessment of the Literature” – Government Equalities Office, 2013. Available online at: https://docplayer.net/22038616-Body-image-a-rapid-evidence-assessment-of-the-literature.html ↩
Kelly, Y. Zilanawala, A, Booker, C. Sacker, A. (2018). Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study ↩
Andrew, Rachel and Tiggemann, Marika and Clark, Levina. (2015). Can body appreciation protect against media-induced body dissatisfaction?. Journal of Eating Disorders. ↩
Tiggemann, Marika and McCourt, Alice. (2013). Body appreciation in adult women: Relationships with age and body satisfaction. Body image. ↩
Morrison, Melanie and Morrison, Todd and Sager, Cheryl-Lee. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A meta-analytic review. Body image. ↩
Alvy LM (2013). Do lesbian women have a better body image? Comparisons with heterosexual women and model of lesbian-specific factors. ↩
Jones, BA., Haycraft, E., Murjan, S. and Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature ↩
De Vries, A. L. C., Mcguire, J. K., Steensma, T. D., Eva, C. F., Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Paediatrics, 134, 1–9. ↩
Rimes, K. A., Goodship, N., Ussher, G., Baker, D., and West, E. (2017). Non-binary and binary trans gender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. International Journal of Trans genderism. ↩
Meyer Ilan H. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychology of Sexual Orientation and Gender Diversity. 2013;1:3–26 ↩
Strubel, Jessica and Petrie, Trent. (2017). Love me Tinder: Body image and psychosocial functioning among men and women. Body Image. ↩
Holland, G. Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. ↩
Fardouly, J. Diedrichs, P. Vartanian, L. Halliwell, E. (2014). .The impact of Facebook on young women’s body image concerns and mood. ↩
Rutledge,C.M.,Gillmor,K.L., and Gillen, M.M.(2013).Does this profile picture make me look fat? Facebook and body image in college students . Psychology of Popular Media Culture,2,251–258. ↩
Eysenbach, G. (2013). Misleading Health-Related Information Promoted Through Video-Based Social Media: Anorexia on YouTube ↩
Tiggemann, Marika and Zaccardo, Mia. (2015). “Exercise to be fit, not skinny”: The effect of fitspiration imagery on women’s body image. Body image. ↩
Ibid ↩
Haferkamp, Nina and Krämer, Nicole. (2010). Social Comparison 2.0: Examining the Effects of Online Profiles on Social-Networking Sites. Cyberpsychology, behavior and social networking. 14. ↩
Olsen, W., Gash, V. Kim, S., Zhang, M. (2018). The Gender pay gap in the UK: evidence from the UKHLS. ↩
All Party Parliamentary Group on Body Image (2012) “Reflections on Body Image”, available online at: http://ymca-central-assets.s3-eu-west-1.amazonaws.com/s3fs-public/APPG-Reflections-on-body-image.pdf ↩
British Youth Council (2017) “A Body Confident Future”, available online at: http://www.byc.org.uk/wp-content/uploads/2017/11/Youth-Select-Committee-A-Body-Confident-Future.pdf ↩
Burrowes, N. (2013) “Body image – a rapid evidence assessment of the literature”, available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/202946/120715_RAE_on_body_image_final.pdf ↩
ibid ↩
Burrowes, N. (2013) “Body image – a rapid evidence assessment of the literature”, available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/202946/120715_R AE_on_body_image_final.pdf ↩
Franzoi, S. and Shields, S. (1984). The body esteem scale: Multidimensional structure and sex differences in a college population, Journal of Personality Development, 48(2), 173-178. ↩
Slade, P., Dewey, M., Newton, T., Brodie, D., and Kiemle, G. (1990). Development and preliminary validation of the body satisfaction scale (BSS), Psychology and Health, 4(3), 213-220. ↩
Tiggemann, M. Slater, A. (2013). Selfie-Esteem: The Relationship Between Body Dissatisfaction and Social Media in Adolescent and Young Women ↩
Girlguiding (2019). https://www.girlguiding.org.uk/social-action-advocacy-and-campaigns/research/girls-attitudes-survey/ ‘Girls’ Attitudes Survey’ ↩
Body Image – A Rapid Evidence Assessment of the Literature” – Government Equalities Office,2013. Available online at: https://docplayer.net/22038616-Body-image-a-rapid-evidence-assessment-of-the-literature.html ↩
Kelly, Y. Zilanawala, A, Booker, C. Sacker, A. (2018). Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study ↩
Brown, Z, Tiggemann, M. (2016). Attractive celebrity and peer images on Instagram: Effect on women’s mood and body image. ↩
Meier,E.P. Gray, J. (2014).Facebook photoactivity associated with body image disturbance in adolescent girls. ↩
Andrew, Rachel and Tiggemann, Marika and Clark, Levina. (2015). Can body appreciation protect against media-induced body dissatisfaction?. Journal of Eating Disorders. ↩
Alleva JM. Paraskeva N. Craddock N. Diedrichs PC (2018). Body appreciation in British men: Correlates and variation across sexual orientation. ↩
though it should be noted that there is little evidence on the body image experiences of middle aged and older women. ↩
Girlguiding (2019). ‘Girls’ Attitudes Survey’ ↩
Jackson KL, Janssen I, Appelhans BM, Kazlauskaite R, Karavolos K, Dugan SA, Kravitz HM (2014). Body image satisfaction and depression in midlife women: the Study of Women’s Health Across the Nation (SWAN) Archives of Women’s Mental Health. ↩
Mangweth-Matzek B, Rupp CI, Hausmann A, Assmayr K, Mariacher E, Kemmler G, Biebl W. Never too old for eating disorders or body dissatisfaction: a community study of elderly women. International Journal of Eating Disorders. 2006;39(7):583–586. ↩
Tiggemann, Marika and McCourt, Alice. (2013). Body appreciation in adult women: Relationships with age and body satisfaction. Body image ↩
Breitkopf, C., Littleton, H., and Berenson, A. (2007). Body Image: A Study in a Tri-Ethnic Sample of Low Income Women. Sex Roles, 56(5/6), 373-380. Aim and method: To explore ↩
Webb JB. Butler-Ajibade P. Robinson SA. (2014). Considering an Affect Regulation Framework for Examining the Association Between Body Dissatisfaction and Positive Body Image in Black Older Adolescent Females: Does Body Mass Index Matter? ↩
Capodilupo, Christina and Kim, Suah. (2013). Gender and Race Matter: The Importance of Considering Intersections in Black Women’s Body Image. Journal of counselling psychology. ↩
Alvy LM (2013). Do lesbian women have a better body image? Comparisons with heterosexual women and model of lesbian-specific factors. ↩
Levitt, HM; Hiestand, K.R. (2004). A Quest for Authenticity: Contemporary Butch Gender. Sex Roles. Vol 50. ↩
Smith ML. Telford E. Tree JJ (2017). Body image and sexual orientation: The experiences of lesbian and bisexual women ↩
L Smith, Marie and Telford, Elina and Tree, Jeremy. (2017). Body image and sexual orientation: The experiences of lesbian and bisexual women. Journal of Health Psychology. ↩
Smith ML. Telford E. Tree JJ (2017). Body image and sexual orientation: The experiences of lesbian and bisexual women ↩
Chmielewski, Jennifer and R. Yost, Megan. (2013). Psychosocial Influences on Bisexual Women’s Body Image Negotiating Gender and Sexuality. Psychology of Women Quarterly. ↩
Morrison, Melanie and Morrison, Todd and Sager, Cheryl-Lee. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A meta-analytic review. Body image. ↩
Jones, BA., Haycraft, E., Murjan, S. and Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature ↩
Girlguiding (2019). https://www.girlguiding.org.uk/social-action-advocacy-and-campaigns/research/girls-attitudes-survey/ ‘Girls’ Attitudes Survey’ ↩
Ålgars, M., Alanko, K., Santtila, P., and Sandnabba, N. K. (2012). Disordered Eating and Gender Identity Disorder: A Qualitative Study. Eating Disorders, 20, 300–311. ↩
Breast binding is the act of flattening breast, often using constrictive materials. ↩
De Vries, A. L. C., Mcguire, J. K., Steensma, T. D., Eva, C. F., Doreleijers, T. A. H., and Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Paediatrics, 134, 1–9. ↩
Kraemer, B., Delsignore, A., Schnyder, U., and Hepp, U. (2007). Body image and transsexualism. Psychopathology, 41, 96–100. ↩
Saltzburg, S., and Davis, T. (2010). Co-authoring Genderqueer Youth Identities: Discursive tellings and Retellings. Journal of Ethnic and Cultural Diversity in Social Work. ↩
Rimes, K. A., Goodship, N., Ussher, G., Baker, D., and West, E. (2017). Non-binary and binary trans gender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. International Journal of Trans genderism. ↩
Bhambhani, Yash and Flynn, Maureen and Kellum, Karen and Wilson, Kelly. (2019). Examining sexual racism and body dissatisfaction among men of color who have sex with men: The moderating role of body image inflexibility. Body Image. 28 ↩
Meyer Ilan H. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychology of Sexual Orientation and Gender Diversity. 2013;1:3–26 ↩
Thompson, J. K., Heinberg, L. J., Altabe, M., and Tantleff-Dunn, S. (1999). Sociocultural theory: The media and society. In J. K. Thompson, L. J. Heinberg, M. Altabe, and S. Tantleff-Dunn, Exacting beauty: Theory, assessment, and treatment of body image disturbance (pp. 85-124). Washington, DC, US: American Psychological Association. ↩
Slater, Amy and Tiggemann, Marika and Hawkins, Kimberley and Werchon, Douglas. (2012). Just One Click: A Content Analysis of Advertisements on Teen Web Sites. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 50. ↩
Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7. ↩
Strubel, Jessica and Petrie, Trent. (2017). Love me Tinder: Body image and psychosocial functioning among men and women. Body Image. ↩
Ferguson, C. J. (2013). In the eye of the beholder: Thin-ideal media affects some, but not most, viewers in a meta- analytic review of body dissatisfaction in women and men. Psychology Of Popular Media Culture, 2, 20-37. ↩
Holland, G. Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. ↩
Royal Society Public Health, Vision, Voice and Practice. (2017). Status of Mind: Social media and young people’s mental health and wellbeing. ↩
Kelly, Y. Zilanawala, A, Booker, C. Sacker, A. (2018). Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study ↩
Holland, G. Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. ↩
Brown, Z, Tiggemann, M. (2016). Attractive celebrity and peer images on Instagram: Effect on women’s mood and body image. ↩
Fredrickson, B. L., and Roberts, T.-A. (1997). Objectification Theory: Toward Understanding Women’s Lived Experiences and Mental Health Risks. Psychology of Women Quarterly, 21(2) ↩
Eysenbach, G. (2013). Misleading Health-Related Information Promoted Through Video-Based Social Media: Anorexia on YouTube. ↩
Fox, J., and Bailenson, J. (2009). Virtual Self-Modeling: The Effects of Vicarious Reinforcement and Identification on Exercise Behaviors. Media Psychology, 12(1) ↩
Tiggemann, Marika and Zaccardo, Mia. (2015). “Exercise to be fit, not skinny”: The effect of fitspiration imagery on women’s body image. Body image. ↩
ibid ↩
Eysenbach, G. (2013). Misleading Health-Related Information Promoted Through Video-Based Social Media: Anorexia on YouTube. ↩
For example: https://www.bbc.co.uk/news/uk-england-47693925 ↩
For example: https://www.instagram.com/i_weigh/?hl=en ↩
Haferkamp, Nina and Krämer, Nicole. (2010). Social Comparison 2.0: Examining the Effects of Online Profiles on Social-Networking Sites. Cyberpsychology, behavior and social networking. 14. ↩
Holland, G. Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. ↩
Fardouly, J. Diedrichs, P. Vartanian, L. Halliwell, E. (2014). .The impact of Facebook on young women’s body image concerns and mood ↩
Rutledge,C.M.,Gillmor,K.L.,and Gillen, M.M.(2013).Does this profile picture make me look fat? Facebook and body image in college students . Psychology of Popular Media Culture,2,251–258. ↩
Meier,E.P. Gray, J. (2014).Facebook photoactivity associated with body image disturbance in adolescent girls. ↩
Eysenbach, G. (2015). Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study. ↩
Perloff, R. (2014). Social Media Effects on Young Women’s Body Image Concerns: Theoretical Perspectives and an Agenda for Research. ↩
ibid ↩
Moorhead,S. A.,Hazlett,D. E.,Harrison, L.,Carroll, J. K.,Irwin, A.,and Hoving, C.(2013). A new dimension of healthcare: systematic review of the uses, benefits, and limitations of social media for health communication. Journal for medical internet research, 15(4). ↩
Holland, G. Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. ↩

Cookies on GOV.UK

Glossary

Executive summary

Background and objectives

Methods and sample

Key findings and implications

Interventions aimed at tackling [negative/poor] body image are likely to be welcomed

Interventions need to take a holistic approach to tackling body image

Interventions should be mindful that experiences of body image vary amongst different groups, and change over time

Interventions may need to be targeted at specific life milestones rather than just particular age groups

Interventions should encourage a shift in focus from the aesthetics of the body to its functionality, particularly for women

Men may need to be eased into the conversation about body image through interventions which encourage them to feel they have ‘permission’ to discuss the issue

Special attention should be paid to individuals who may experience social disadvantage on ‘multiple levels’

It is important for brands and advertising aiming to promote body positivity to be truly inclusive

It is crucial for any initiative promoting positive body image through health and exercise to be accessible (and affordable) for everyone

The effect on body image of new media such as highly visual dating apps also needs to be considered, but requires further research

The specific elements of social media that are problematic may need to be independently addressed when designing interventions

Interventions may also need to consider ways of identifying users who may be particularly vulnerable to the negative effects of social media on body image

The way ‘thinspiration’ and ‘fitspiration’ content is uploaded and shared may need to be considered, to avoid spreading inaccurate information

The increased attention to face, hair and skin suggests that interventions may need to take into consideration more than just body shape and size.

1. Introduction

1.1 Background to the research

1.2 Methodology

Rapid Evidence Assessment (REA)

Digital diaries with participants

Stop and Think

Creative co-design workshops with participants

1.3 Challenges and recommendations for future research

We found little evidence on the impact of social media on a broad range of demographics.

There is also little evidence on how body image is experienced by different demographics and minority audiences in the academic literature.

The interplay between social media and body image is complex, making it difficult to establish a causal relationship.

2. Current perceptions of and attitudes towards ‘body image’

Chapter summary: Implications/hypotheses for interventions

Among our sample, body image was perceived as an issue that is important to address.

Men may need to be ‘eased into’ the conversation about body image.

While facilitating access to diet and exercise is important, a holistic approach to body image may be needed.

Social media interventions are likely to be welcomed but may feel less relevant to individuals.

Any interventions that attempt to make healthy diet and exercise more attractive should be inclusive and accessible to all.

2.1 Negative body image was recognised as a problem by most participants, and the trend towards body positivity and body neutrality reflects this.

2.2 Our participants recognised that body image hinges on more than just diet and exercise

2.3 Despite making links between body image and mental health, many men in our sample (especially heterosexual men) still reported feeling body image was more of a ‘woman’s issue’

2.4 There is a perception that boys and men are less empowered to speak out about body image issues than girls and women, but that they face similar struggles

2.5 Many participants linked body image issues to social media, but many felt they were not personally affected

2.6 Many of our participants also reported feeling body image is strongly linked to social class

3. Setting the scene: experiences of body image

Chapter summary: Implications/hypotheses for interventions

Special attention should be paid to audiences that may experience social disadvantage on multiple levels.

Different support/interventions may need to be considered for trans and non-binary individuals, as their experiences are very different from cisgender individuals.

Interventions may need to be targeted at specific life milestones, rather than just at particular age groups.

Interventions may need to encourage a focus on the functionality of the body rather than aesthetics through, for example, health and mental wellbeing approaches.

As adolescence tends to be a particularly challenging time, schools may increasingly need to play a role in preventing and managing negative body image.

3.1 Overarching audience insights

3.1.1 People do not experience body image as a linear journey – it is marked by ups and downs that are often linked to life events

3.1.2 Across our audiences, body image can impact behaviour and decision-making on a day-to-day basis

3.2 Audience specific insights

3.2.1 The evidence suggests that women (especially young women) are particularly affected by negative body image

Young women tend to spend more time (and engage in more photo-based activities) on social media than men.

Women tend to have lower body appreciation than men

The cultural idealisation of youth is more pronounced for women and young girls than for men

3.2.2 The REA suggests that black women may have historically been less affected by negative body image, though there are signs this may be changing

3.2.3 The REA found that lesbian and bisexual women face different body image pressures when compared to heterosexual women

3.2.4 The REA suggests that overall, gay men tend to have a more negative body image than heterosexual men

3.2.5 The REA suggests that trans individuals experience greater body dissatisfaction than their cisgender counterparts

3.2.6 The REA suggests that non-binary people and binary transgender people have different experiences of body image

3.2.7 The REA suggests that oppression or social disadvantage on multiple levels can lead to lower body satisfaction

4. The influences on body image

Chapter summary: Implications/hypotheses for interventions

Peer-to-peer dynamics should be considered when creating potential interventions.

The influence of parents (and mothers in particular) may need to be considered when designing interventions.

The influence of new media such as highly visual dating apps should be researched further and considered when designing interventions.

Mass media can do more to feel truly inclusive.

4.1 The media and brands were found to exert an influence on body image in both our primary research and findings from the REA

4.2 Peers and partners play a huge role in influencing body image

4.3 Families also play a huge role in influencing body image; relationships between mothers and daughters play a pivotal role

4.4 Our participants reported being influenced by highly visual dating apps like Tinder

5. The influence of social media on body image: a complex picture

Chapter summary: Implications/hypotheses for interventions

The specific elements of social media that are problematic should be considered when designing interventions.

Interventions may need to consider a way to ‘identify’ users who may be particularly vulnerable to social media.

The increase of face, hair and skin comparisons may need to be considered.