Written evidence submitted by Professor Lynda Boothroyd, Dr Elizabeth Evans
and Ms Katy Jacques (MISS0012)

Who we are

LB is Professor of Psychology at Durham University and conducts both experimental and cross-cultural work on body ideals. EE is a Lecturer in Psychology at the Newcastle University and conducts research on body image and eating attitudes in children, and on weight loss maintenance in adults. LB and EE also train undergraduate students to run the body-positive programme Succeed in peer-led interventions. They are currently working together on a Wellcome Trust funded project to develop eating disorder prevention materials for rapidly developing populations. KJ is a high school Psychology teacher and a doctoral candidate at Durham University, who is investigating how muscularity ideals are shaped by experience and across childhood.

We focus below on how our research (with each other and/or other co-authors), and the literature we draw on, may help inform the inquiry.

The impact of poor body image

Who is particularly at risk of poor body image? (groups protected by the Equality Act) 

Women, particularly young women, are often considered to be at elevated risk of body dissatisfaction compared to men. For instance, our work with the Gateshead Millennium Study found that girls had greater body dissatisfaction and/or poorer body esteem than boys by age 6 and the effect size for this difference became even larger at 12 years of age (Evans et al, 2017). In fact, the median score for boys in this sample was zero, indicating that at least half of the boys interviewed expressed no dissatisfaction at all, which was not the case for the girls. Body dissatisfaction in girls is typically investigated in terms of body weight and the pursuit of thinness. In our research we have found this drive for thinness becomes stronger across childhood (Evans et al., 2017) but does become weaker in later adulthood (Evans et al., 2015) such that young women are most at risk.

Sexuality may intersect with gender, however. The literature shows a mixed picture on body image and sexuality in women. While some earlier studies found better body image in lesbians than in heterosexual women (Strong et al., 2000; Morrison et al., 2004; Peplau et al., 2009), other recent studies found no difference (e.g., Davids and Green, 2011; Antfolk et al., 2017). Our own research found that ’non-heterosexual’ women showed less implicit bias towards thinness than women who reported being predominantly or exclusively heterosexual, but their attitudes to food and eating was no less unhealthy (Kant et al., 2019).

In contrast there is good evidence that body concerns are elevated in sexual minority men. We would highlight here, the work of Frederick & Essayli (2016) who found gay men to be less satisfied with their bodies in a massive, representative sample of US men and Alleva et al (2018) and Calzo et al (2018) who found similar patterns in high quality samples of British men and boys.

Research into ethnicity and body image shows mixed results. Some authors have found that BAME men have elevated drive for muscularity in the UK (a common aspect of body dissatisfaction in men) compared to White men (Swami, 2016). However, we recently documented a higher drive for muscularity amongst While British men than Black British men (and Black men in Uganda or Nicaragua) (Thornborrow et al., 2020).

For women, being Black has often been considered a protective factor against body dissatisfaction. Calzo et al (2018) found that ethnic minority girls (and boys) showed lower eating disorder symptoms than White participants. Similarly amongst our cross-cultural work in Nicaragua, lower weight ideals were typically seen amongst Mestizo participants who are culturally and ethnically more ‘European’ than Black and indigenous ethnic groups in the area (Boothroyd et al., 2016,19).

We would note, however, that the tendency to focus on body satisfaction in terms of weight (and increasingly muscularity for men) likely misses important aspects of appearance concern in British ethnic minority populations. For instance, it obscures concerns and external pressures regarding hair, skin tone, and the objectification that Black women may be subject to (see e.g. Tate, 2015).

Finally we also note that in the UK the group most at risk of poor body image is those of high body weight – and this is true in children as young as 6 years of age (Evans et al., 2013). Although weight and obesity are not protected characteristics, people who fall into this group are highly stigmatised and highly likely to have poor body image. This stigma itself also predicts subsequent weight gain and poor health behaviours, so is a public health priority.

What contributes to poor body image? What is the impact of media consumption on people’s body image, does it impact their mental health?

Our research has focused in part on general visual media in particular, how viewing idealised bodies in the media shapes our internalised body ideals, which in turn can cause body dissatisfaction when we ourselves deviate from those ideals. Through a combination of experimental work in the UK, and long term fieldwork in communities newly accessing visual media in rural Nicaragua, we have extremely strong evidence to show that media does indeed lead to a preference for lower weight female figures. Showing 40 images of typical, low-weight models to women in the lab, or to ‘media naïve’ participants in Nicaragua, both resulted in a shift in body preferences towards thinner figures (Boothroyd et al., 2012, 2019). Furthermore, we found that across 7 villages in Nicaragua, with differing levels of TV access, those who watched more TV preferred thinner figures (Boothroyd et al., 2019). We also found that women in villages with more TV were more likely to be trying to lose weight (Boothroyd et al., 2016).  These data suggest that one of the main routes through which media induces body dissatisfaction in women is by shifting their perceptions of the ideal body towards a thinner extreme.

Similarly, our interviews with male participants in the region highlighted an increasing interest in muscularity amongst those men which they explicitly linked to watching action films and a desire to look like action heroes. We have recently demonstrated that presentation of muscular men in advertisements also increases preferences for muscularity in those viewing the images in the laboratory, in the same fashion as media images can induce a stronger bias towards thinness (Jacques & Boothroyd, 2019). This suggests that any bias in the bodies presented in the media is likely to lead to a shift in ideals in those viewing that media and thus increase the risk of body dissatisfaction amongst those who cannot meet these ideals.

What are the long-term effects of poor body image on people? What is the relationship between poor body image and mental health conditions including eating disorders?

Body dissatisfaction is strongly associated with negative affect – that is, symptoms of depression and anxiety, in children as young as 7 (Evans et al., 2013).  Body image is a well-established proximate predictor of both clinical and subclinical eating disorders (i.e. those with heightened body dissatisfaction tend to show higher rates of unhealthy eating behaviours and are more likely to have eating disorder symptoms.) Amongst the Gateshead Millennium cohort, body dissatisfaction was linked with eating disorder symptoms in girls and boys at 12 years of age although not across time (Evans et al., 2017). In contrast, other authors working with older adolescents have found that body image predicts the development of eating disorder symptoms over 1-3 year periods (e.g. Stice et al, 2017)This suggests that body image and eating disorders become causally linked during the later stages of puberty.  However, this does not mean that body dissatisfaction in younger children is not of concern, not only because the stress it may cause in itself, but for how the narratives of ‘fat talk’ and critical self-appraisal may be continued in later years.

Interventions aimed at increasing body image resilience and rejection of media ideals among young women have also been shown to reduce incidence of eating disorders for at least three years (e.g. Stice et al, 2008), which supports the suggestion that body image is causal in eating disorder aetiology. Regarding protected characteristics, we also found that one such intervention reduced disordered eating attitudes in both hetero- and non-heterosexual women (Kant et al, 2019)


Has Government policy had an impact on improving body image?

The two steps government could take which we consider most likely to succeed would be to:

  1. Incorporate body image resilience interventions into school curricula, as has been done with Sexual and Relationship education. As discussed above, body image programmes, such as Dove’s Confident Me (aimed at school aged children; Garbett at al., 2015) and the Succeed Body Image Program (aimed at female undergraduates; Becker & Stice, 2011) in the UK, are effective, and give benefits for boys and girls, and amongst sexually diverse samples. Both operate by providing media literacy education, discouraging ‘social comparison’, and giving participants practice in resisting media and other pressures to adhere to particular body types, as well as practice in positive affirmations regarding their own bodies. Verbal reports from participants in our Succeed program confirm that they find it empowering, and that it energises their desire to treat their bodies kindly and positively.
  2. Enforce the inclusion of diverse healthy bodies in media. This may be achieved by e.g. legislating minimum model BMIs, and requiring public media producers to audit and perhaps meet targets on body diversity.

Would proposals in the Online Harms White Paper protect people from potential harm caused by social media content in regard to body image?

The OHWP is currently fairly broad in what it targets. A key problem as regards body image, however, is that the harm from visual media (be it commercial or user-generated) is driven by the content producers rather than the platforms through which that content is delivered. Targeting media companies and advertisers is likely to do more to reduce presentation of unrealistic body ideals. The only key changes online platforms could take would be to a. eliminate selfie filters which distort bodies towards unrealistic weights/shapes, and b. operate a zero tolerance approach to ‘thinspiration’/’pro-ana’ and similar groups, sites and accounts.

How successful is the ASA at protecting the public from adverts that have a negative impact on body image?

We would note that in our research, we have in some experiments used images of women drawn from fashion advertisements and catalogues. We found that viewing just 40 images of typical, very thin fashion models, had the same (negative) impact on women’s preferences for body weight as viewing 40 images of emaciated anorexic women (Boothroyd et al., 2012). Given the prevalence of advertising on the internet as well as other visual media, women and girls are exposed to this level of effect on a daily basis. Other than a small number of campaigns, we have seen minimal evidence that model weights have changed in the last 10 years. As such, whatever the ASA has been trying to do, we believe that no real change in this regard has been achieved.


Citations drawn from our own research

Boothroyd, L. G., Jucker, J. L., Thornborrow, T., Jamieson, M. A., Burt, D. M., Barton, R. A., ... & Tovee, M. J. (2016). Television exposure predicts body size ideals in rural Nicaragua. British Journal of Psychology, 107(4), 752-767.

Boothroyd, L. G., Jucker, J. L., Thornborrow, T., Barton, R. A., Burt, D. M., Evans, E. H., ... & Tovée, M. J. (2019). Television consumption drives perceptions of female body attractiveness in a population undergoing technological transition. Journal of Personality and Social Psychology.

Boothroyd, L. G., Tovée, M. J., & Pollet, T. V. (2012). Visual diet versus associative learning as mechanisms of change in body size preferences. PLoS One, 7(11), e48691.

Evans, E. H., Adamson, A. J., Basterfield, L., Le Couteur, A., Reilly, J. K., Reilly, J. J., & Parkinson, K. N. (2017). Risk factors for eating disorder symptoms at 12 years of age: A 6-year longitudinal cohort study. Appetite, 108, 12-20.

Evans, E. H., Boothroyd, L. G., Muscariello, E., Stephan, B. C. M., Nasti, G., Colantuoni, A., & Siervo, M. (2015). Lower weight loss expectations and healthier eating attitudes in older overweight and obese women attempting weight loss. Clinical Obesity, 5(3), 136-144.

Evans, E. H., Tovée, M. J., Boothroyd, L. G., & Drewett, R. F. (2013). Body dissatisfaction and disordered eating attitudes in 7-to 11-year-old girls: Testing a sociocultural model. Body image, 10(1), 8-15.

Jacques, K., & Boothroyd, L. (2020). Experimental Manipulation of Muscularity Preferences Through Visual Diet and Associative Learning. PsyArxiv 10.31234/osf.io/se673

Kant, R. N., Wong-Chung, A., Evans, E., Stanton, E., & Boothroyd, L. (2019). The impact of a dissonance-based eating disorders intervention on women's implicit attitudes to thinness. Frontiers in psychology, 10, 2611.

Thornborrow, T., Onwuegbusi, T., Mohamed, S., Boothroyd, L. G., & Tovée, M. J. (2020). Muscles and the Media: A Natural Experiment Across Cultures in Men’s Body Image. Frontiers in psychology, 11, 495.

Broader literature cited

Alleva, J. M., Paraskeva, N., Craddock, N., & Diedrichs, P. C. (2018). Body appreciation in British men: Correlates and variation across sexual orientation. Body image, 27, 169-178.

Antfolk, J., Ålgars, M., Holmgård, L., and Santtila, P. (2017). Body dissatisfaction and disordered eating in androphilic and gynephilic men and women. Personal. Individ. Differ. 117, 6–10

Becker, C. B., and Stice, E. (2011). Succeed, body image programme manual. Oxford: Oxford University Press.

Calzo, J. P., Masyn, K. E., Corliss, H. L., Scherer, E. A., Field, A. E., & Austin, S. B. (2015). Patterns of body image concerns and disordered weight-and shape-related behaviors in heterosexual and sexual minority adolescent males. Developmental psychology, 51(9), 1216.

Calzo, J. P., Austin, S. B., & Micali, N. (2018). Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK. European child & adolescent psychiatry, 27(11), 1483-1490.

Davids, C. M., and Green, M. A. (2011). A preliminary investigation of body dissatisfaction and eating disorder symptomatology with bisexual individuals. Sex Roles 65:533.

Frederick, D. A., & Essayli, J. H. (2016). Male body image: The roles of sexual orientation and body mass index across five national U.S. Studies. Psychology of Men & Masculinity, 17(4), 336–351.

Garbett, K. M., Steer, R. J., Diedrichs, P. C., Atkinson, M. J., Steer, R., Garbett, K., …Halliwell, E. (2015). Effectiveness of a brief school-based body image intervention 'Dove Confident Me: Single Session' when delivered by teachers and researchers: Results from a cluster randomised controlled trial. Behaviour Research and Therapy, 74, 94-104.

Morrison, M. A., Morrison, T. G., and Sager, C. L. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women?: a meta-analytic review. Body Image 1, 127–138

Peplau, L. A., Frederick, D. A., Yee, C., Maisel, N., Lever, J., and Ghavami, N. (2009). Body image satisfaction in heterosexual, gay, and lesbian adults. Arch. Sex. Behav. 38, 713–725. doi: 10.1007/s10508-008-9378-1

Stice, E., Marti, C. N., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. Journal of consulting and clinical psychology, 76(2), 329.

Stice, E., Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM–5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of abnormal psychology, 126(1), 38.

Strong, S. M., Williamson, D. A., Netemeyer, R. G., and Geer, J. H. (2000). Eating disorder symptoms and concerns about body differ as a function of gender and sexual orientation. J. Soc. Clin. Psychol. 19, 240–255. 

Swami, V. (2016). Masculinities and ethnicities: Ethnic differences in drive for muscularity in British men and the negotiation of masculinity hierarchies. British Journal of Psychology, 107(3), 577-592.

Tate, S. A. (2015). Black women's bodies and the nation: race, gender and culture (p. 208). Palgrave Macmillan.


May 2020