Written evidence submitted by the Mental Health Foundation (MISS0019)

The Mental Health Foundation

Our vision is for a world with good mental health for all.

The Mental Health Foundation works to prevent mental health problems.

We drive change towards a mentally healthy society for all, and support communities, families and individuals to live mentally healthier lives, with a particular focus on those at greatest risk. The Foundation is the home of Mental Health Awareness Week.

Website:              www.mentalhealth.org.uk


Changing the perfect picture: an inquiry into body image


1.      In May 2019, The Mental Health Foundation ran Mental Health Awareness Week around the theme of body image, for which we produced a research report and policy recommendations focusing on the relationship between body image and mental health. This submission summarises and builds on the elements of this report that are relevant to the Committee’s terms of reference.

2.      Since Mental Health Awareness Week, we have begun to work on the impact of image-manipulation apps on body image and mental health.  We will soon be publishing a position statement on this, which is supported by foremost experts in the UK at the University of Birmingham and the Cochrane Common Mental Disorders centre, and will send this to the Committee when it is available, and hope the Committee will be able to consider the implications of such apps and software during the course of its body image inquiry.

3.      We are also working with the Joint Council of Cosmetic Practitioners to develop policy and guidance to make cosmetic procedures more psychologically safe, both in the ways they are marketed and practised.

The impact of poor body image

4.      In March 2019 the Foundation conducted a survey with YouGov of 4,505 UK adults to explore the relationship between body image and people’s mental health. Our survey found that, while 21% of adults felt ‘satisfied’ with their body image, in the previous year one in five people (20%) hade felt ‘shame’, and just over one third (34%) hade felt ‘down or low’ because of their body image. Our survey found higher numbers than the 2013 British Social Attitudes Survey, where one in twenty men and one in ten women reported being dissatisfied with their appearance.[1]

5.      Having body image concerns is not a mental health problem in and of itself; however, they can be a risk factor for mental health problems. Research has found that higher body dissatisfaction is associated with: a poorer quality of life and psychological distress[2], a higher likelihood of depression symptoms[3] and the risk of unhealthy eating behaviours and eating disorders[4] [5]. Conversely, body satisfaction and appreciation have been linked to better overall wellbeing[6] and fewer unhealthy dieting behaviours[7] [8].

6.      This was reflected in our survey, where just over one third of adults said they felt anxious (34%) or depressed (35%) because of their body image, and just over one in eight (13%) experienced suicidal thoughts or feelings because of concerns about their body image.

Body image and protected characteristics


7.      Concerns about body image and appearance, while often associated with younger people, are not exclusive to youth. Though our appearance and our relationship with our bodies change as we age, we do not stop valuing our bodies, and body image concerns can still affect us.

8.      People in later life report feeling dissatisfied with their bodies and having misconceptions of their body size and shape[9] [10], although estimates of the degree of body dissatisfaction among people in later life vary widely in the literature. Estimates from the 2013 British Social Attitudes Survey found that, among adults aged over 65, 69% were satisfied with their appearance, compared to 67% of adults aged 18–34.

9.      In our survey, around one in five adults aged 55+ felt anxious (20%) or depressed (23%) specifically because of their body image, demonstrating that body image continues to affect our mental health into later life.


10.  Experiences of chronic illness, particularly those where the effects are physically visible, have been associated with greater body image concerns[11]. There is also a substantial amount of research on the ways that experiences of cancer specifically can affect body image[12] [13].

11.  In our survey, a higher proportion of adults who had a health problem or disability that substantially limited their daily activities reported feeling shame (31%) or feeling down or low in the last year (47%) because of their body image, compared to individuals without a limiting condition (18% and 32% respectively). Similarly, 50% of adults with a health problem or disability said their body image negatively affected their self-esteem, compared to 36% of adults without a limiting condition.

12.  There is relatively little research looking specifically at the body image of individuals with learning disabilities. However, individuals with learning disabilities are often at a greater risk of obesity than their peers[14], which is something that has been linked to increased feelings of body dissatisfaction and poor body image among both adults and young people in the wider research[15] [16]. There is also some evidence to suggest that children with learning disabilities may have less awareness of their bodies and limited opportunities for social engagement, and that they are more likely to be bullied than their peers, which can also lead to feelings of isolation and low self-esteem[17] [18]. Some small studies have looked at dance and movement therapy for individuals with learning disabilities, which may have positive effects on body awareness and wellbeing, though the research in this area is still developing[19] [20].

Gender reassignment

13.  Transgender people may experience distress resulting from the incongruity between their biological sex and their gender identity. This can influence their body image, and research suggests that levels of body dissatisfaction in transgender people tend to be higher prior to undergoing gender confirmation treatments[21]. Feelings around one’s body can differ depending on the stage at which a person is on their transition journey[22]. It should be noted that transitioning does not just refer to medical intervention, which is something that not all transgender people want or are able to have. It also refers to the steps a person takes to live in the gender with which they identify, which could include things like telling friends and family and dressing differently.

Pregnancy and maternity

14.  The transition to parenthood, particularly for women, represents a unique change in body and body image. In our survey, 41% of women who had been pregnant said they felt more negatively about their body image after pregnancy compared to before they were pregnant (23% were slightly more negative and 18% much more negative), while 12% said they felt more positively about their body image post-pregnancy (7% slightly more positive and 5% much more positive). Many pregnant women report a shift in the way they relate to their bodies across pregnancy, from a focus on appearance to a focus on ability and functionality. However, they also report pressure to continue to adhere to traditional bodily ideals, particularly around weight and returning to their pre-pregnancy body shape following childbirth[23]. Indeed, reviews of the research have found associations between increased body dissatisfaction, postpartum weight and depressive symptoms during pregnancy and new motherhood[24] [25].


15.  Body dissatisfaction or feeling negatively about appearance or abilities is a common experience across different racial and ethnic groups.

16.  It is important to note that body image is a multi-dimensional construct; however, the tools used to assess body image in research often focus on body weight or shape. This can be limiting when trying to understand body image and ethnicity, as people from different groups have different body ideals[26] [27]. Concerns around body image may not always fall into the categories of body weight and shape. For instance, some concerns may be around skin tone, hair texture or the size and shape of facial features [28] [29] [30].

17.  Generally, however, differences between people with different ethnic backgrounds in levels of body dissatisfaction are small and there appear to be more similarities between people from various ethnic backgrounds rather than differences[31] [32]. Ethnicity may thus have less of an influence on body image than factors such as age, gender and weight (1, 108). Rather, the way in which ethnic minority groups experience body image and the factors that can affect their own body image may be slightly different.


18.  Body image concerns affect both boys and girls, but there is research to suggest that girls are more likely to be dissatisfied with their appearance and their weight than boys[33] [34]. In our survey, 46% of girls reported that their body image causes them to worry ‘often’ or ‘always’, compared to 25% of boys. The same is true for adults. Our survey found that while 23% of men and 19% of women felt satisfied because of their body image in the last year, 15% of men and 25% of women felt shame, 25% of men and 43% of women felt down or low, and 12% of men and 26% of women felt disgusted in the last year because of their body image.

19.  While women and girls are often more likely to report being unsatisfied with their bodies, men and boys also experience body image concerns. A survey by Credos in 2016 found that 10% of secondary school boys have said they skipped a meal to change how they look and 10% would consider taking steroids to achieve their goals.[35]

Sexual orientation

20.  While people who identify as lesbian, gay, bisexual and transgender (LGBT) experience body image concerns in ways that are generally similar to people who identify as heterosexual, their experience and their relationship with their body differs in specific ways.

21.  Heterosexual men have been found to report higher levels of body appreciation than gay and bisexual men[36]. Some research suggests that sexual minority men may be more likely to internalise an appearance ideal that is centred around looking athletic[37] and that there may be a greater emphasis on physical appearance in the gay community, which can negatively affect body image[38] through pressure to match this ideal.

22.  There is some research to suggest that lesbian women have a similar level of concern around their body image as heterosexual women[39] [40], though research is mixed on this point. One study suggested a small difference, finding that lesbian women may be slightly more satisfied with their bodies than heterosexual women[41].

23.  In our survey, a higher proportion of individuals who identified as gay, lesbian or bisexual reported feelings of anxiety and depression because of their body image. Among adults who identified as gay, lesbian, bisexual or other, 53% felt anxious and 56% felt depressed because of their body image, compared to one third (33%) of the adults who identified as heterosexual.


24.  Exposure to idealised images of bodies in the media has been linked to greater internalisation of bodily ideals, and increased body dissatisfaction in both women[42] and men[43]. However, girls and young women are more commonly the target of such imaging (e.g. through fashion advertising) which can be relentless and impact on their wellbeing. The same is true of social media[44] [45]. In our survey, around one in five adults said that images used in advertising (21%) and images used on social media (22%) caused them to worry about their body image. These effects may be most pronounced for adults who already experience body dissatisfaction[46] and may be due in part to the ways that media and social media facilitate comparisons to others based on their appearance. This was reflected in our survey, where 32% of adults (22% of men and 41% of women) said they negatively compared themselves to others because of their body image.

25.  Social media use is of interest to researchers looking at the body image and mental health of children and young people in particular, and using more social media has been linked to children and young people feeling less satisfied with their bodies[47] [48]. In our survey, 40% of young people (26% of boys and 54% of girls) said that images on social media have caused them to worry in relation to their body image. One possible explanation for this is that social media allows for negative comparisons with others based on appearance, which is something that has consistently been linked to body dissatisfaction[49]. There are some studies that suggest time spent on social media is linked to frequency of appearance-related comparisons[50] and peer competition[51], which in turn may be linked to body dissatisfaction and mental health.

26.  It is important to recognise however that media are not the only driver of poor body image. Body image may also be influenced by: our relationships with our family and friends[52]; how our family and peers feel and speak about bodies and appearance[53]; and pressure to look a certain way or to match an ‘ideal’ body type[54]. Importantly, this influence starts from a very early age, so measures to tackle poor body image and promote confidence in and satisfaction with our bodies needs to begin with very young children – see paragraph 34, below.


27.  Exposure to idealised bodies in the media and social media represents a significant risk of internalising an ‘ideal’ body image that is unrealistic or unattainable. This social harm has been allowed to develop largely unchecked. Despite some positive initiatives from individual companies, poor practice persists in advertising, and social media companies have been unwilling to take the necessary steps to protect their users from harmful content.

28.  All industries with the capacity to cause harm need structured regulation. If left unregulated, advertising is driven by incentives to present unattainable ‘idealised’ bodies as aspirational in order to increase the desirability of certain consumer products or lifestyles, including cosmetic surgery. Social media use also carries social incentives for users to present themselves in a positive way, including through photo selection or even image manipulation, which can further encourage unhealthy and unrealistic appearance-based comparisons.

29.  We recommend stronger regulation and action in the following areas: effective regulation of how body image is portrayed; industry responsibility to promote body kindness; and public health and education approaches to body image.

Effective regulation of how body image is portrayed

30.  The Online Harms White Paper is a significant opportunity to address some of the drivers of poor body image. The workstream should address harms relating to the promotion of unhelpful or idealised body images online, beyond the white paper’s existing content related to eating disorders. An improved code of practice on how social media platforms promote healthy and diverse body images should be enforced by the new independent regulator.

31.  The Advertising Standards Authority (ASA) should consider more stringently vetting high-reach broadcast adverts from high-risk industries – such as cosmetic surgery companies and weight-loss products and services – to ensure all advertising abides by its codes at the time they are on-air. The ASA should also make greater use of its ability to proactively instigate investigations.

Industry responsibility to promote body kindness

32.  Social media companies should sign up to the Be Real Campaign’s Body Image Pledge and investigate new ways of using their platforms to promote healthy, realistic, undoctored body images and to ensure that a diversity of body types is presented positively to their users.

33.  Social media companies should have clear systems for users to report bullying and discrimination, and publish specific algorithmic and platform design actions to be taken. These should give users greater control over the content they see in an accessible way. The new codes of practice should include an expectation that social media companies should improve their practice in relation to how their platforms are used to propagate unhealthy body image through advertising and algorithmic promotion and commit them to ensuring the content they promote to users does not exacerbate body image concerns. This should be enforced by the new independent regulator

Public health and education approaches to body image

34.  Training for frontline health practitioners and the early years childcare workforce should include information about how parents and carers can, from a very early age, positively influence their children’s feelings about their bodies through their behaviours and attitudes[55] [56].

35.  Children and adults in mental distress should receive fast and empathetic support when they need it, regardless of where they live in the country.

36.  Public campaigns on nutrition and obesity should avoid the potential to create stigma and indirectly contribute to appearance-based personal dissatisfaction, mental health problems and bullying. They should focus on healthy eating and exercise for all members of the population, regardless of their weight.

37.  The Department for Education should develop a co-produced body image and media literacy toolkit, and this should be a compulsory element of what children learn in the new Health Education curriculum. Such a toolkit should include the development of a charter for achieving a healthy and positive body image.


June 2020


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