Written evidence submitted by Dr Alison Owen (IBI0001)

Introduction

My name is Dr Alison Owen, and I am a Lecturer in Health Psychology at Staffordshire University. My main research interest is the relationship between people’s perception of their body image, and the impact it can have on their mental and physical health. I have published various pieces of work in this area and feel that my findings would be of interest to this inquiry.

What is the relationship between people’s perception of their body image and their physical and mental health?

I have carried out a number of pieces of research looking into the impact of body image perception on mental and physical health, in different areas, and the results have revealed some interesting and sometimes worrying conclusions. I will outline some of the research I have undertaken in this area below.

Body image and breastfeeding: We have conducted a systematic review to examine female body image in relation to the intention, initiation and duration of post-partum infant feeding methods. A search of ten databases was conducted to identify studies, with a total of nine studies included in the systematic review. All studies were of a non-randomised control design with a total of 13,046 participants. Findings suggested that exclusive breastfeeding was more likely in pregnant women with a higher body image, while those with body concerns had less intention to breastfeed or initiate breastfeeding, with those who start having a shorter duration than those with a higher body image.

The systematic review is just one piece of evidence that shows how important a positive body image is for people – breastfeeding is of great benefit to both the baby and the mother, so for people to make the decision not to provide their baby with this vital start in life, purely because of how they feel about their body, is extremely concerning. Training needs to be given to people working in maternity services, both pre and postnatally, to enable them to support mothers who are experiencing body image issues or negative body image, so that this does not limit their decision to both initiate and continue to breastfeed.

I am currently carrying out research exploring the impact of body image and breastfeeding in more detail, by carrying out interviews with women asking them about their breastfeeding experiences in relation to their body image, with the hope that this will lead us to be able to make more detailed suggestions as to factors that impact on a woman’s body image in relation to breastfeed, and therefore methods of improving this. Interviews are complete and we will soon be beginning the analysis of the data.

Body image and skin cancer risk behaviours: A study I carried out with colleagues2 examined links between appearance evaluation and skin cancer risk behaviours in men and women. Data (n = 1,535) were extracted from Wave 4 of the National Longitudinal Study of Adolescent Health, a US nationally representative, longitudinal dataset of adolescents and young adults. The results showed that skin cancer risk (i.e., number of hours spent outside for those with a history of severe sunburn and who were unlikely to use sunscreen) was significantly associated with participant gender, appearance evaluation, and their interaction. Both men and women who negatively evaluated their appearance (had poor body image) were at significantly increased skin cancer risk, and this was particularly true for men. We concluded that negative appearance evaluation appears to be a correlate of engaging in behaviours that place individuals at risk of developing skin cancer.

Body image and the aesthetic industry: Women working within the aesthetics industry have been identified as being vulnerable to body dissatisfaction and disordered eating; however, research exploring this population is scarce, with the majority of research focussing on the people who make the decision to have the treatments themselves. This research3 aimed to investigate the body image experiences of women working in the aesthetics sector (both medical aesthetics and beauty sector). Online surveys and interviews were used to explore the body image experiences of 41 women. Thematic analysis highlighted that all participants felt that looking ‘good’ was necessitated by their profession – they all spoke about how working within the aesthetics sector necessitated them looking a certain way in terms of their physical appearance, with the main reason for this being described as a ‘need’ to promote their business/treatments to patients and clients. Participants also talked about the ubiquitous and inevitable nature of appearance comparisons, with them feeling they compared themselves to both their clients as well as their colleagues, with this often leaving them feeling negatively about their appearances. The body image experiences of women working in the aesthetic sector are mixed and can be complex, but it is clear that women working in this industry do experience real pressures in terms of their body image. The main area that seems to be considered when thinking of the aesthetics industry is the individuals who are choosing to have aesthetic treatments, but this research shows that it is important not to forget the people who are working in those industries and administering the treatments.

Body image and athletes: We have investigated body image in a group of British female athletes4 to find out their thoughts and feelings about their appearance, and if they felt this impacted on their athletic careers in any way. The athletes were interviewed individually about their perception of their body image. Four key themes were identified which were analysed using thematic analysis: body image pressures, gender differences, body comparisons and the media. All of the participants reported feeling they had to maintain a certain appearance, and all felt pressure from outside influences, including the media and from the uniforms they had to wear for their sports. A number of suggestions and recommendations have arisen from the findings, including a need for interventions to maintain a positive body image in female athletes, as well as considerations for factors such as uniform choice, and support from coaches.

Body image and social media: The effects of social media on personal wellbeing have been controversial in recent years, with research highlighting links between social media use and body esteem. I carried out a study with colleagues5 to explore relationships amongst social media use, body esteem, and gender amongst UK university students (n = 100). Participants completed measures of social media use and body esteem. It was hypothesized that social media intensity and usage would negatively predict body esteem, with high social media intensity relating to lower body esteem. We found that gender was the only significant predictor of body esteem, with women having lower body esteem compared to men. Interestingly, we were unable to replicate previous findings, as our findings showed no relationships amongst social media intensity, use, and body esteem.

Body image and female adolescents: I have also carried out research exploring body image in a group of adolescent females, who were all members of the Girlguiding community6. The study used focus groups, with participants between the ages of 12 and 17, to conduct an exploratory thematic analysis of the participants’ body image and the factors that they felt influenced it. The results of the study found that on the whole, the participants reported having a positive body image and feeling about their bodies; however, they also identified areas that made them feel more negatively about their appearance, including social media and the media in general. Implications include the need for further education in schools and at home about body image and appearance.

What methods can we use to improve peoples’ body image?

It has been suggested by researchers working within a positive body image framework, that interventions that encourage body appreciation and acceptance of a range of body types are likely to be effective in promoting body satisfaction, and research has suggested that a focus on body function rather than aesthetics may be effective in increasing body satisfaction though reducing self-surveillance and self-objectification. I worked on a study7,8 that was designed to investigate qualitatively young people’s experiences of a dance movement psychotherapy session in relation to their body image. Young people aged 17 years old took part in a dance session based on a therapeutic intervention informed by dance movement psychotherapy. After the session, they gave accounts of the experience in focus groups and interviews. Their accounts were analysed using an inductive thematic analysis, and three themes were identified: Connectedness, Lack of Self-consciousness, and Body Acceptance. The session impacted positively on these young peoples’ body image, leading them to feel more connected to their bodies, freer, less self-conscious, and more accepting of their bodies after the session. Positive body image, and factors such as body functionality, focusing on what our body can do, rather than things that we do not like about it, is a really important step in moving forward and getting people to think differently, and more positively, about their bodies.

Using body image for health promotion

For my PhD, I carried out research looking at the impact of using people’s appearance concerns to encourage them to stop using sunbeds, and to use more sun protection9,10,11,12,13,14,15. The intervention used computer technology called APRIL® Age Progression Software, which shows the progression of ageing from a person’s current age to the age of 72, and allows the viewer to compare the differences in facial ageing between if they have been protecting their skin from UV, or if they have been exposing their skin to UV without using protection. The intervention was investigated through a series of focus groups, individual sessions, open-ended, closed questionnaires and experiments. These revealed that the appearance-focussed intervention was effective in improving participants’ immediate sun protection and UV exposure attitudes and intentions, and that the majority of people were shocked at viewing the differences in their facial ageing when comparing if they have been protecting their skin from the sun, and exposing their skin to the sun without using sun protection. When looking at six-month follow-up data, the changes in attitude and intentions were not as strongly sustained as at the immediate post-intervention follow-up. There were a number of gender differences, for example that for males there were no significant differences in effectiveness post-intervention between the appearance-focussed intervention and a health-focussed literature intervention.

I have also carried out research using similar software16, to show people the damage that binge drinking can do to their skin. Research is ongoing, but we have published qualitative work on 17 women (Owen et al., 2019), who were shown that binge drinking could have on their skin. The women were shocked about the possible impact of alcohol consumption on their skin and appearance, and all of the women stated that the intervention had made them think about changing their alcohol consumption behaviours in the future, after viewing the images of themselves which were morphed to show the effects of both moderate and excessive alcohol consumption.

These findings do have implications for health promotion campaigns, by utilising the knowledge that people do have concerns about their appearance, and when viewing the impact that UV exposure/alcohol consumption can have on the skin, people feel more positive towards sun protection and safer UV exposure.

Conclusion

This is just a sample of my published work and research exploring the relationship between people’s perception of their body image, and the impact it can have on their mental and physical health. It is an area that I am passionate about, and having carried out many pieces of research exploring and speaking to people about their appearance, from their feelings about it, to work looking at ways of improving body image, to work trying to utilise appearance concerns as a way of encouraging people to make healthier lifestyle choices, I do feel that it is an area of vital importance for the government to be looking into.

References

1. Morley-Hewitt, A.G. & Owen, A.L. (2019). A systematic review examining the association between female body image and the intention, initiation, and duration of post-partum infant feeding methods (breastfeeding vs. bottle feeding).  Journal of Health Psychology, 1-20. DOI: 10.1177/1359105319833744
2. Blashill, A. J., Williams, A., Grogan, S., & Clark-Carter, D. (2015). Negative appearance evaluation is associated with skin cancer risk behaviors among American men and women. Health Psychology, 34, 93-96. DOI: 10.1037/hea0000100
3. Owen, A. & Taylor, J. (2021). The body image experiences of women working within the aesthetics sector: a thematic analysis of online survey and interview responses. Journal of Aesthetic Nursing, 10(8), 358-363. DOI: 10.12968/joan.2021.10.8.358
4. Allan, T. & Owen, A. (2019) ‘For athletes, there are many pressures to be strong and fit, but also have that feminine look’: a study of female athletes’ body image. Journal of Qualitative Research in Sports Studies, 13(1), 85-96.
5. Ormsby, H., Owen, A.L., Bhogal, M. (2018). A brief report on the associations among social media use, gender, and body esteem in a UK student sample. Current Psychology, 38 (2), 303–330. DOI: 10.1007/s12144-018-0089-z
6. Owen, A.L. & Griffiths, E. (2018). Body image: an exploration of a group of Girlguides' thoughts and feelings about their appearance. British Journal of School Nursing, 13(6), 282-287.  DOI: 10.12968/bjsn.2018.13.6.282
7. Bunce, J., Heyland, S., Grogan, S., Padilla, T., Williams, A., Kilgariff, S. (2013). The rationale behind a Dance Movement Psychotherapy intervention used in a small research pilot in a further education context to develop awareness about young people's body image. Body, Movement and Dance in Psychotherapy, 9(1), 4-15.
8. Grogan, S., Williams, A., Kilgariff, S., Bunce, J., Heyland, J.S., Padilla, T., Woodhouse, C., Cowap, L. & Davies, W. (2014). Dance and Body Image: Young People’s Experiences of a Dance Movement Therapy Session. Qualitative Research in Sport, Exercise and Health, 6, 261-277. DOI: 10.1080/2159676X.2013.79649
9. Owen, A.L., Grogan, S., Clark-Carter, S. & Buckley, E. (2018). The impact of an appearance-focused facial-ageing intervention on adolescents’ attitudes towards sun protection. British Journal of School Nursing, 13(9), 436-444. DOI: 10.12968/bjsn.2018.13.9.436
10. Owen, A. L., Grogan, S., Clark-Carter, D., & Buckley, E. (2016). Effects of an Appearance-Focussed Versus a Health-Focussed Intervention on Men’s Attitudes Towards UV Exposure. International Journal of Men’s Health, 15(1), 34-51. DOI: 10.3149/jmh.1501.34
11. Williams, A.L., Grogan, S., Buckley, E. & Clark-Carter, D. (2013). Men’s experiences of an appearance-focussed facial-ageing sun protection intervention: A qualitative study. Body Image, 10, 263-266. DOI: 10.1016/j.bodyim.2013.01.003.
12. Williams, A.L., Grogan, S., Clark-Carter, D. & Buckley, E. (2013). Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: A systematic review and meta-analyses. British Journal of Health Psychology, 18, 182-217. DOI: 10.1111/j.2044-8287.2012.02089.x
13. Williams, A.L., Grogan, S., Clark-Carter, D. & Buckley, E. (2013). Impact of a facial-ageing intervention versus a health literature intervention on women's sun protection attitudes and behavioural intentions. Psychology and Health, 28, 993-1008. DOI: 10.1080/08870446.2013.777965
14. Williams, A.L., Grogan, S., Buckley, E. & Clark-Carter, D. (2013). British adolescents’ experiences of an appearance-focussed facial-ageing sun protection intervention: a qualitative study. Education and Health, 31, 97-101.
15. Williams, A.L., Grogan, S., Buckley, E. & Clark-Carter, D. (2012). A qualitative study examining women’s experiences of an appearance-focussed facial-ageing sun protection intervention. Body Image, 9, 417-420. DOI: 10.1016/j.bodyim.2012.04.008.
16. Owen, A., Scholtens, K., Grogan, S. & Burgess, I. (2019). Students' experiences of a facial morphing intervention designed to encourage safer drinking. Psychology & Health, 34(8), 999-1010. DOI: 10.1080/08870446.2019.1584674

December 2021