Written evidence submitted by Stonewall (MISS0058)

Introduction

1.      Stonewall welcomes the opportunity to respond to this Inquiry. Many lesbian, gay, bi and trans (LGBT) people experience poor and unrealistic body image, which can have a significant impact on their mental health and wellbeing. This can contribute to mental health challenges including anxiety and depression, which LGBT people are at higher risk of experiencing. 

2.      Stonewall is Britain’s largest LGBT organisation. We commission high-quality independent research into LGBT people’s experiences, including health and wellbeing. We work with over 750 employers – including the Department for Health and Social Care, NHS England and national media organisations – to support them to deliver LGBT-inclusive services.

The risk of poor body image to LGBT people

3.      LGBT people are particularly vulnerable to experiencing poor body image, with 40 per cent of LGBT adults more likely to experience shame due to their body image, compared to 18 per cent of their non-LGBT counterparts (Mental Health Foundation). The ways in which poor body image is internalised and experienced varies across the LGBT community, with studies showing that many gay and bi men may feel pressured to look ‘thin’, ‘athletic’ or ‘muscular’ and lesbian and bi women pressured to resemble the ‘ideal’ female body-type (which is contingent across time and space). Trans people also experience these pressures, compounded by the profound psychological distress of gender dysphoria.

4.      Poor body image can have a significant impact on the mental health of LGBT people. For example, research commissioned by Mental Health Foundation and YouGov (2019) found that:

• 53 per cent of lesbian, gay and bi people had experienced anxiety due to poor body image, and 56 per cent had experienced depression, as opposed to 33 per cent of their straight counterparts.

5.      Poor or unrealistic body image can be linked to eating disorders. Stonewall’s LGBT in Britain: Health Report (2018) found that:

• One in eight LGBT people (12 per cent) said they had experienced an eating disorder in the last year, with this figure rising to one in five trans people and one in four non-binary people.
• One in five LGBT people of colour (22 per cent) and 11 per cent of white LGBT people had experienced an eating disorder in the last year – highlighting how those with particular mental health stressors relating to societal pressures around body image.

What contributes to poor body image for LGBT people?

Social media & advertising

6.      Research commissioned by the Mental Health Foundation and YouGov has shown that social media and commercial advertising cause significant social harm and mental health issues in relation to body image by perpetuating unrealistic notions of the ‘ideal’ body type:

• One in five adults (21 per cent) said images used in advertising caused them to worry about their body image.
• One in five adults (22 per cent) and 40 per cent of teenagers said social media caused them to worry about their body image.

Bullying, harassment and discrimination in everyday life

7.      Everyday bullying, harassment and discrimination can have a significant impact on the health and wellbeing of the LGBT community, and may result in internalised feelings of shame which can fuel negative associations with body image (Mental Health Foundation; The LGBT Foundation). Many LGBT people experience abuse and discrimination due to their identity, both online and offline:

• Stonewall’s LGBT in Britain: Hate Crime and Discrimination Report (2017) found that almost half of LGBT people (45 per cent) had witnessed homophobic, biphobic and transphobic abuse or behaviour online in the last month.

• Stonewall’s School Report (2017) found that two in five LGBT young people (40 per cent) – including 58 per cent of trans young people – had been the target of individual homophobic, biphobic and transphobic abuse online; and two in three LGBT young people (65 per cent) think that online platforms are unlikely to do anything about tackling such abuse when it is reported to them.

• Stonewall’s LGBT in Britain: Health Report (2018) found that one in four (25 per cent) LGBT people experienced a lack of understanding of their specific needs from healthcare staff, with this figure rising to one in three LGBT people of colour.

8.      Any intervention by Government must therefore ensure that a strategy to tackle poor body image is inclusive of LGBT experiences.

Recommendations

9.      Stonewall welcomes policies put forward in the Online Harms White Paper (and the Government’s initial response to the consultation on this), including the creation of a new statutory duty of care for online companies, and the creation of a new independent regulator with enforcement powers to hold online companies accountable to this new duty. We welcome the duty placed on companies to take action to address harmful content, including self-harm content which encourages eating disorders, and that services must respond quickly and remove content upon reporting (para 7.35).

10.  It is also promising that the paper states that companies will be required to take steps to ensure that vulnerable users and users who search for content that encourages eating disorders are directed to and able to access support (7.35). We echo calls by the Mental Health Foundation that the paper should go a step further to also address harms relating to the promotion of unhelpful or idealised body image online. The independent regulator (Ofcom) should also improve practices on how social media platforms promote unhealthy body image.

11.  We echo the Mental Health Foundation’s recommendation that ‘the Advertising Standards Authority should consider pre-vetting high-reaching adverts from high-risk industries – such as cosmetic surgeries and weight loss products and services – to ensure all advertising abides by its codes. It should also make greater use of its ability to proactively instigate investigations’.

12.  NHS mental health services should train all staff on the mental health needs of LGBT people (including the relationship between anti-LGBT discrimination and unhealthy/unrealistic body image). Resources that are LGBT-inclusive and recognise this relationship should also be produced for patients who may need them.

13.  It is encouraging that RSE statutory guidance states that by the end of secondary school, pupils should have knowledge of internet and safety harms, including ‘the impact of unhealthy or obsessive comparisons with others online, including through setting unrealistic expectations for body image’ (paragraph 103). The Government must adhere to its commitments and invest the full £6 million committed for 2019-20 in RSE implementation, and build on this investment as implementation continues. The accompanying implementation guide and resources should also be fully LGBT-inclusive.

July 2020