Research Report

1.

FOREWORD

A
t the Mental Health Foundation, risks of mental health problems that too often
we are all about public health and accompany poor body image.
prevention. We focus on bringing
There is a long tradition of Western philosophers
evidence into action that makes a real impact
who have shaped how we think about our
on people’s lives.
bodies as different and separate from our mind.
This year’s theme for Mental Health Awareness But the evidence has led us to question this
Week is body image. It is a subject that has a form of dualism and instead embrace a holistic
direct relevance to all of us. We are all learning understanding about the inter-relatedness of
to live with the wonders and limitations of our our bodies and minds. This is vital to achieve
bodies as they change through life. No piece a healthier population. And we are now clear
of technology that we will ever buy will match that cultures that are focused on materialism,
the complexity, sophistication and regenerative consumption and celebrity lifestyles fare worse
powers of our bodies. both in terms of people’s body image and
mental health.
And yet, for too many of us, our bodies are
sources of shame and distress. So, we make the case that the distress related
to poor body image and the related mental
Last year, our survey of respondents who had
health problems can be prevented. This report
experienced high levels of stress revealed that
is clear that changes to culture, parenting
47% of 18-24-year-olds, 36% of all women, and
styles, schooling approaches, use of technology,
almost one in five people (18%) aged 55+ had
advertising standards and how we address
experienced stress over their body image to
discrimination will make a real difference.
the extent of being overwhelmed and unable to
cope in the last year. It was clearly an issue that We are not publishing this report simply for
needed more attention. This year’s report builds information. We are calling for action across
on the latest published research with one of the all levels of society, which, if heeded, will help
largest surveys ever completed to capture how us to be kinder to our bodies and healthier in
we feel about our bodies. our minds.

The report sets out the individual, family and

cultural influences that are coming together
to mean that we often have a gnawing and
debilitating sense of dissatisfaction with our Mark Rowland, Chief Executive
own bodies. We also identify the heightened Mental Health Foundation
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 2.

EXECUTIVE
SUMMARY

‘B
ody image’ is a term that can be relevant from childhood through to later life and
used to describe how we think and affect both women and men.
feel about our bodies. Our thoughts
The way in which our experiences and
and feelings about our bodies can impact us
environment affect our body image will be
throughout our lives, affecting, more generally,
different for everyone. However, overall, the
the way we feel about ourselves and our mental
research suggests that body image can be
health and wellbeing. Having body image
influenced by our relationships with our family
concerns is a relatively common experience
and friends; how our family and peers feel and
and is not a mental health problem in and of
speak about bodies and appearance; exposure
itself; however, it can be a risk factor for mental
to images of idealised or unrealistic bodies
health problems. Research has found that
through media or social media; and pressure to
higher body dissatisfaction is associated with
look a certain way or to match an ‘ideal’ body
a poorer quality of life, psychological distress
type. There are further issues relevant to body
and the risk of unhealthy eating behaviours and
image and mental health that are specific to
eating disorders. Conversely, body satisfaction
certain factors and experiences, such as long-
and appreciation has been linked to better
term health conditions, cultural differences
overall wellbeing and fewer unhealthy dieting
around body ideals, and gender and sexuality,
behaviours. Though feeling unsatisfied with our
which are often linked to other societal factors
bodies and appearance is often more common
and discrimination.
among young women, body image concerns are

New online surveys were conducted by the Mental Health Foundation with YouGov in March
2019 of 4,505 UK adults 18+ and 1,118 GB teenagers (aged 13-19). The results highlighted that:

ADULTS
One in five adults (20%)
felt shame, just over one
third (34%) felt down or
low, and 19% felt disgusted
because of their body
image in the last year.
20 % Felt shame 34 % Felt down or low 19 % Felt disgusted
EXECUTIVE SUMMARY 3.

TEENAGERS
Among teenagers, 37%
felt upset, and 31% felt
ashamed in relation to
their body image

37% Felt upset 31% Felt ashamed

ADULTS
Just over one third of adults said
they had ever felt anxious (34%) or
depressed (35%) because of their
body image, and one in eight (13%)
experienced suicidal thoughts or
feelings because of concerns about
their body image. 34 % Felt anxious 35 % Felt depressed 13 % Experienced suicidal
thoughts or feelings

ADVERTISING SOCIAL MEDIA

NEW!
Just over one in Just over one in five
five adults (21%) adults (22%) and
said images used 40% of teenagers
in advertising had said images on social
caused them to media caused them
worry about their to worry about their
body image. body image.

Clearly action is needed to build and promote positive body image

Effective regulation
and support good mental health and wellbeing in relation to our
of how body image
bodies. Everyone has a right to feel comfortable and confident in is portrayed.
their own bodies and our report highlights key recommendations for:

The need for

Taking a public health Individually being more
commitment from social
approach to body image by aware of how we can take
media companies to play
training frontline health and care of ourselves and others
a key role in promoting
education staff. in relation to body image.
body kindness.
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 4.

SUMMARY F
REC MMEN -
DATI NS
Effective regulation of how body image is portrayed
The Online Harms White Paper should address harms relating to the promotion of
unhelpful or idealised body image online, beyond content related to eating disorders.
An improved practice on how social media platforms promote unhealthy imaging
should be enforced by the new independent regulator.

The Advertising Standards Authority should consider pre-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. It should also make
greater use of its ability to proactively instigate investigations.

Industry responsibility to promote body kindness

Social media companies should sign the Be Real Campaign’s Body Image Pledge and
investigate new ways of using their platforms to promote positive body image and to
ensure that a diversity of body types is presented positively to their users.

Social media companies should have clear systems for users to report bullying and
discrimination and targets for action to be taken. They should give users greater control
over the content they see in an accessible way.
SUMMARY OF RECOMMENDATIONS 5.

Public health and education approaches to body image

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.

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

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

A co-produced body image and media literacy toolkit should be a compulsory element
of what children learn in schools. This should include the development of a charter for
achieving a healthy and positive body image.

Individually being more aware of steps we can take for

ourselves and others

If your body image is a significant cause of stress, or if you’re being bullied about how your
body looks, consider talking to a friend, a trusted adult or a health professional.

Spring-clean your apps on your smartphone.

Notice the people and accounts you’re following on social media and be mindful of how
you feel about your own body and appearance when you look at them.

If you see an advert in a magazine, on television or online that you think presents an
unhealthy body image as aspirational, you can complain to the Advertising Standards
Authority.

At home, parents and carers can lead by example, by modelling positive behaviour around
body image, eating healthily and staying active.

In our daily lives, we can all be more aware of the ways in which we speak about our own
and other people’s bodies in casual conversations with friends and family.

Find the best way that works for you to stay active. 
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 6.

INTRODUCTION
What is body image?

‘B
ody image’ is a term that can be used opinions about our appearance affect our
to describe how we think and feel feelings about ourselves (1–4).
about our bodies.
Often, when we talk about ‘poor body image’,
Because these thoughts and feelings can be we are referring to a feeling of being unsatisfied
complex, approaches to define and understand with our body – either because of appearance,
body image are varied and can include: how or the way it functions. This is described as ‘body
we view our bodies and how accurate this dissatisfaction’. In contrast, positive body image
perception is; how satisfied we are with our can be described as being satisfied with our body,
bodies and appearance; how we experience holding respect, appreciation and acceptance of
our bodies in our environment; how much we its abilities, and having a healthy balance between
value what other people think about our bodies valuing our body and valuing the other aspects of
and appearance; and how much other people’s ourselves that make us ‘us’ (2,3,5).

How comfortable are we with our bodies?

F
eeling unhappy with our appearance is Social Attitudes Survey saying they were
a relatively common experience. The satisfied with their appearance was similar
Mental Health Foundation conducted a among those aged 18–34 and those over
survey with YouGov in March 2019 of 4,505 65 (6). This was similar in our survey, where
UK adults. Our survey found that while 21% 30% of adults aged 18–24 reported feeling
of adults felt ‘satisfied’ because of their body ‘satisfied’ because of their body image in
image, in the past year, one in five people (20%) the last year, compared to 24% of adults
have felt ‘shame’ and just over one third (34%) aged 55+.
have felt ‘down or low’ in the past year because
While women and girls are often more likely
of their body image. Our survey suggests
to report being unsatisfied with their bodies,
higher numbers compared to the 2013 British
men and boys are also affected by body
Social Attitudes Survey, where one in twenty
image concerns. A survey in 2016 found
men and one in ten women reported being
that 10% of secondary school boys have said
dissatisfied with their appearance (6).
they skipped a meal to change how they look
Body image and appreciation is relevant and 10% would consider taking steroids to
across our lives from youth through to later achieve their goals (7).
life. The proportion of women in the British
INTRODUCTION 7.

As a society, we tend to place a great deal of depends on how you look’ (6). Therefore,
importance on our appearance. Nearly half how we think and feel about our bodies is
of adults (47%) in the British Social Attitudes something that can affect us throughout our
Survey felt that ‘how you look affects what lives and has far-reaching implications for our
you can achieve in life’ and nearly one feelings about ourselves, and on our mental
third (32%) felt that ‘your value as a person health and wellbeing.

How does body image link to mental health?

H
aving body image concerns is not a conditions (11). There is extensive research
mental health problem in and of itself; on the role body image plays in eating
however, it can be a risk factor for disorders, and body dysmorphia, and the
mental health problems. Research has found ways in which these conditions can best
that higher body dissatisfaction is associated be treated and prevented. In the current
with a poorer quality of life and psychological report, we focus on body image concerns in
distress (8), a higher likelihood of depression general, rather than specifically in relation
symptoms (9,10) and the risk of unhealthy to eating disorders or BDD. A review of
eating behaviours and eating disorders (10,11). the literature on eating disorders or BDD
Conversely, body satisfaction and appreciation treatment is therefore beyond the scope
have been linked to better overall wellbeing (12) of this report, but resources for further
and fewer unhealthy dieting behaviours (5,13). reading in this area can be found on the NHS
information pages for body dysmorphic
This is reflected in our survey, where just
disorder and eating disorders, as well as
over one third of adults said they felt anxious
from voluntary organisations such as Beat,
(34%) or depressed (35%) because of their
Anorexia & Bulimia Care and YoungMinds.
body image, and just over one in eight (13%)
More information on the recommended
experienced suicidal thoughts or feelings
guidance for treatment of eating disorders
because of concerns about their body image.
and body dysmorphic disorder can be found
In a second new survey conducted by the
in the National Institute for Health and Care
Mental Health Foundation with YouGov in
Excellence (NICE) guidelines.
March 2019 of 1,118 GB teenagers aged 13–
19, 40% felt worried, 37% felt upset, and 31% It is important to note that body image
felt ashamed in relation to their body image. research often looks at the characteristics
of a group of people at a single point in
Body image is closely linked to mental
time. This can make it hard to be sure
health problems such as body dysmorphic
which factors cause either poor body
disorder (BDD) and eating disorders like
image or common mental health problems.
anorexia and bulimia. BDD is a mental health
For example, feeling dissatisfied with your
problem where a person spends a lot of time
body may cause you to feel depressed, or
worrying about flaws in their appearance
it may be that you are more likely to feel
that are often unnoticeable to others, to
dissatisfied with your body if you are already
the point that it affects their daily life (14).
experiencing depression. The research
Poor body image is both a risk factor for,
that does look at these changes over time
and part of the diagnostic criteria of, these
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 8.

suggests it may be a combination of the two, of depression or anxiety symptoms (15,16)

and that sometimes body dissatisfaction may and in other contexts, symptoms may predict
predict or otherwise affect the development body dissatisfaction (15,17).

What affects body image?

T
he way in which our experiences and process of internalising a shamed body image.
environment affect our body image Shame is an emotion that we are all born
will be different for everyone. Overall, with the capacity to feel, and which, in its
however, the research suggests that body healthy form, can be adaptive, as it prompts
image may be influenced by our relationships us to attend to ruptures in our relationships
with our family and friends (18); how our with others by making amends and repairing
family and peers feel and speak about bodies interpersonal connections. In contrast,
and appearance (19); exposure to images of unhealthy shame is the feeling of being apart
‘idealised’ or unrealistic bodies through the or isolated from others due to a sense of being
media or social media (1,20,21); and pressure to inadequate, defective or not good enough
look a certain way or to match an ‘ideal’ body (22). Body shame can become internalised
type (21). and unhealthy when we experience consistent
shaming messages about our bodies either
Valuing and holding oneself against an
directly (through criticism, teasing or bullying)
unrealistic, ‘ideal’ body type is often referred to
or more indirectly (by being excluded or
in the research as ‘internalisation of the ideal’
avoided, or consistently exposed to non-
and is commonly linked to the development of
thoughtful language or unrealistic images of
poor body image through feelings of shame or
‘ideal bodies’). Once internalised, this sense of
distress when this ideal is not met (21). What
shame operates regardless of how our bodies
this ideal looks like will shift across cultures
actually look or function.
and can vary between genders. In Western
cultures, it is common for the ‘ideal’ for women All of this suggests that body image is a
to be thin body shapes, but with maintained complex, and often very personal, experience.
curves (referred to as the ‘thin ideal’), while for Its relationship to mental health is an
men the ‘ideals’ are being taller and having a important one, influenced by many aspects of
muscular body shape. our environment that shift and change across
our lives.
From a therapeutic perspective, ‘internalisation
of the ideal’ can be understood as part of a
BODY IMAGE IN CHILDHOOD 9.

B DY IMAGE IN
CHILDH D
How comfortable are children and young people with
their bodies?

W
hile exact estimates vary, depending body image causes them to worry ‘often’
on how body image is measured, or ‘always’ compared to 25% of boys. Body
concern and worries about image concerns can also affect very young
appearance are commonplace among young children. One review found studies identifying
people. One survey of 11–16-year-olds in the body dissatisfaction in children under the
UK by Be Real found that 79% said how they age of six, though estimates of the degree of
look is important to them, and over half (52%) dissatisfaction varied widely depending on how
often worry about how they look (23). In our it was measured (26).
survey of young people aged 13–19, 35% said
Young people also tell us that body image is
their body image causes them to ‘often’ or
a substantial concern, with 16–25-year-olds
‘always’ worry.
identifying it as the third biggest challenge
While body image concerns affect both boys currently causing harm to young people, with
and girls, there is research to suggest that girls lack of employment opportunities and failure
are more likely to be dissatisfied with their to succeed within the education system being
appearance and their weight than boys (24,25). the first two (27).
In our survey, 46% of girls reported that their

How does body image affect children and young people?

I
n young people, body dissatisfaction has taking steroids to achieve their goals (7).
been linked to risk-taking behaviours and
Poor body image may also prevent young
mental health problems. One survey of UK
people from engaging in healthy behaviours,
adolescents by Be Real found that 36% agreed
with some studies finding that children with
they would do ‘whatever it took’ to look good,
poorer body image are less likely to take part
with 57% saying they had considered going on
in physical activity (5,28) and survey data from
a diet, and 10% saying they had considered
Be Real finding that 36% of girls and 24% of
cosmetic surgery (23). Among secondary
boys report avoiding taking part in activities
school boys, 10% said they would consider
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 10.

like physical education due to worries about with youth people who are overweight or obese
their appearance (23). Among adolescents, reporting greater depressive symptoms and
research has found that those with greater lower self-esteem than their peers (30,31).
body appreciation are less likely to diet or use
Research conducted with young women also
alcohol or cigarettes (5).
found a higher likelihood of suicidal thoughts
Body dissatisfaction and a pressure to be thin among those women who reported extreme
have been linked to depressive symptoms weight control behaviours (e.g. taking diet pills,
(15, 29) and symptoms of anxiety disorders diuretics or laxatives) (32), with an additional
such as social anxiety or panic disorder (16), study suggesting that body image concerns
particularly in those children who do not match may be a risk factor for self-harm behaviour
societal views of the ‘ideal body’. Some studies among young people who are experiencing
have found that weight and body mass index emotional difficulties (33).
(BMI) are correlated with body dissatisfaction,

What affects body image in childhood?

Body ideal internalisation themselves identify the media, pressure from

family and friends, comparisons with peers, and
ne common contributor to poor body
personal factors like low self-esteem, feelings
image is feeling a pressure to live up
of depression, and a need for control as
to an ‘ideal’ body type or appearance
important influences on their own body image
and feeling shame or other uncomfortable
(36,37).
emotions when we perceive ourselves as not
meeting this standard. Internalisation of this The media and social media
ideal has been linked to body dissatisfaction ne commonly researched influence
and disordered eating and depressive on body image is exposure to
symptoms in children and young people (19, 34, unrealistic ‘ideal’ bodies through film,
35). These distressing emotions were reflected television, magazines, advertising and social
in our survey, where 37% of young people said media. Exposure to these images is thought
they felt upset, and 31% said they felt ashamed to facilitate the valuing of these ‘ideal’ and
in relation to their body image. unrealistic body types. One study, which
This ideal tends to be different between followed 14- and 15-year-olds over three years,
genders. Young women often report feeling a found that internalisation of these ‘ideal’ body
pressure to be thin, but to still maintain curves, shapes as presented in the media predicted
whereas young men often report pressure negative emotions about appearance, which
to be tall and muscular (19,23). Children who in turn predicted unhealthy eating behaviours
rejected appearance-related ideals reported (34). In our survey, 25% of young people (13%
being more confident about their appearance of boys and 37% of girls) said celebrities have
and were least likely to report body image caused them to worry in relation to their body
concerns (23). image, and 19% (10% of boys and 28% of girls)
said TV shows caused them to worry in relation
How young people develop their sense of
to their body image.
‘ideal’ appearance is varied, but young people
BODY IMAGE IN CHILDHOOD 11.

Using more social media has also been linked extends to the way that parents think, act and
to children and young people feeling less speak about their own bodies as well as their
satisfied with their bodies (38,39). In our children’s bodies. Reviews of the research
survey, 40% of young people (26% of boys suggest that parents can affect their children’s
and 54% of girls) said that images on social body image in both direct ways (comments or
media have caused them to worry in relation criticisms about weight and appearance) and
to their body image. One possible explanation more indirect ways (parental eating behaviours,
for this is that social media allows for negative and attitudes toward their own bodies and
comparisons with others based on appearance. appearance) (19,44).
This is something that has consistently been
Peers

A
linked to body dissatisfaction (40). There are
some studies that suggest time spent on social s children grow older, their peers begin
media is linked to frequency of appearance- to play more of a role in reinforcing
related comparisons (41) and peer competition what an ideal body looks like. This
(42), which in turn may be linked to body can be through pressure from friends to feel
dissatisfaction and mental health (41,42). accepted. In our survey, 40% of young people
(37% of boys and 42% of girls) agreed that
Parents and family members
things their friends have said have caused

T
he influence of the media on body them to worry in relation to their body image.
image may be lessened by parental Another survey found that 68% of boys cited
behaviour. One study found that the friends as a source of pressure to look good (7).
relationship between social media use and
The ways in which adolescents’ bodies change
body dissatisfaction was weaker for those
during puberty (a time of change in body
adolescents that had more positive maternal
height, weight and shape), how this compares
relationships (38), and another found that
with their peers, and how it compares to their
the children of parents who reported greater
own ideas of what an ‘ideal’ body looks like
control over time spent on social media
(which, in turn, can be influenced by the factors
reported spending less time online, making
outlined above) will therefore affect body
fewer appearance-related comparisons, and
image (45). This may especially be the case for
having better overall mental health (41).
girls who mature earlier than their peers, and
Parents and family can also have a negative boys who mature later than their peers (45).
effect on children’s body image and increase
The influence of peers can also be felt
the likelihood of difficulties in this area. One
through bullying. A survey by Be Real of UK
study of adolescent girls found that over half
11–16-year-olds found that over half of young
had experienced weight-based teasing from
people had experienced appearance-based
family members, particularly girls who weighed
bullying, with 40% of those young people
more, and these experiences were related
experiencing bullying at least once a week,
to higher levels of body dissatisfaction and
and 54% saying the bullying had started by
unhealthy eating behaviour (43). This was also
age 10 (46). Children who do not match body
reflected in our survey, where 29% of young
ideals may be more likely to be the target of
people (21% of boys and 37% of girls) agreed
bullying. One review of the research found
that things their family said have caused them
that young people who are overweight or
to worry in relation to their body image. This
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 12.

obese are more likely to be subject to bullying Some studies have found support for strong
than their peers (47). friendships being associated with decreased
body dissatisfaction (25,48,49). However,
Appearance-based bullying can be detrimental
children who are already feeling down about
to children’s mental health and body image.
their bodies may perceive their peers as having
Adolescents who were cyberbullied were twice
a greater influence (50), particularly as self-
as likely to consider themselves ‘too fat’ (25)
esteem and body image are closely linked
and, of those who were bullied about their
(24,51).
appearance, 53% felt anxious and 29% felt
depressed (46). In contrast, having supportive
friendships may be a protective influence.

BODY IMAGE IN
ADULTH D
How comfortable are adults with their bodies?
ur survey found that while 21% of dissatisfied with their appearance (6). For
adults (23% of men and 19% of pressures around weight and shape specifically,
women) felt satisfied because of this may be slowly changing. A review of data
their body image in the last year, 20% (15% from multiple studies taking place across 30
of men and 25% of women) felt shame, 34% years found evidence for body dissatisfaction
(25% of men and 43% of women) felt down or related to a desire to be thin decreasing slightly
low, and 19% (12% of men and 26% of women) and gradually over time among women and
felt disgusted in the last year because of their girls. When looking at body dissatisfaction
body image. Estimates from the British Social related to a desire to be muscular, however,
Attitudes Survey suggest that one in twenty rates among men and boys as well as women
men and one in ten women reported being and girls stayed consistent over time (52).

How does body image affect adults?

A
s in childhood and adolescence, and eating disorders (10,11,54). Positive body
increased body dissatisfaction in image in adulthood has been linked to better
adulthood has been linked to increased overall wellbeing and quality of life (8,12,55).
likelihood of depressive symptoms (9,10,53),
This is reflected in our survey, where 34%
psychological distress (8) and disordered eating
BODY IMAGE IN ADULTHOOD 13.

of adults (28% of men and 40% of women) cosmetic surgery, fillers or Botox in the last
said they felt anxious and 35% said they felt year because of their body image.
depressed (25% of men and 45% of women)
Body image in adulthood may also affect
because of their body image. Just over one
relationships and sexual wellbeing. There is
in eight (13% overall – 11% of men and 15%
some research to suggest that greater body
of women) experienced suicidal thoughts
satisfaction is linked to more positive sexual
or feelings because of concerns about their
experiences, particularly for women (56). By
body image.
contrast, body image concerns can raise self-
In our survey, body image was associated consciousness, which can impact negatively
with a desire to change physical appearance: on sexual experiences and responses (57). In
7% of adults (4% of men and 9% of women) our survey, one in five adults (20%) said their
said they had edited photos of themselves sex life has been negatively affected by their
in the last year to change the shape of their body image in the past year, and 15% said their
face or body because of their body image. relationship with a partner or spouse had been
Furthermore, 8% of adults (4% of men and negatively affected by their body image in the
13% of women) said they had considered past year.

What affects body image in adulthood?

A
s in childhood, the factors associated comparisons to others based on appearance
with body image in adulthood are (20). This was reflected in our survey, where
varied and linked to the degree to 32% of adults (22% of men and 41% of women)
which ideas about ‘ideal’ body types have been said they negatively compared themselves to
internalised, as well as how likely individuals others because of their body image.
are to compare themselves to others based on
Peers, partners, and the workplace
appearance.
While we often associate bullying and teasing
The media and social media
with childhood, appearance-based teasing
Exposure to idealised images of bodies in the also plays a role in body image into adulthood.
media has been linked to greater internalisation Weight-based and appearance-based teasing
of bodily ideals, and increased body have been found to be significantly linked to
dissatisfaction in both women (58) and men body dissatisfaction and unhealthy weight
(59). The same is true of social media (20,60). control behaviours among adults, though this
In our survey, around one in five adults said that relationship remains strongest in children and
images used in advertising (21%) and images adolescents (61). In addition, how we speak
used on social media (22%) caused them to more generally about bodies with friends,
worry about their body image. partners and peers can affect our body image.
One review of the literature found that ‘fat-
As with the research in children and young
talk’ – a term given to speaking about our
people, these effects may be most pronounced
bodies and weight in casual conversation in
for adults who already experience body
a way that reinforces traditional body ideals
dissatisfaction (59) and may be due in part to
– was significantly associated with body
the ways that media and social media facilitate
dissatisfaction (62). Concerns about appearance
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 14.

may also negatively affect participation in the individuals who are overweight or obese
workplace, with one survey finding that 17% of (67). This may be due in part to not matching
women said they would not go to a job interview, societal ideals of body shape and weight and
and 8% would avoid going to work, if they felt experiences of appearance-related shaming
badly about their appearance (63). or stigma. One qualitative study suggests that
individuals who are overweight experience both
Pregnancy and new parenthood
direct discrimination (verbal abuse when out
For many, adulthood brings a transition to in public) and indirect discrimination (such as
parenthood. This transition, particularly more subtle comments and unaccommodating
for women, represents a unique change in environments) (68). Individuals described this
body and body image. In our survey, 41% of stigma as contributing to emotional distress,
women who had been pregnant said they causing social isolation and avoidance of
felt more negatively about their body image situations where they might experience
after pregnancy compared to before they discrimination, including participation in
were pregnant (23% slightly more negative health-promoting activities (68). Indeed,
and 18% much more negative), 12% said they some quantitative research also suggests
felt more positively about their body image that experiences of stigma around weight are
post-pregnancy (7% slightly more positive associated with less uptake of physical activity
and 5% much more positive). Many pregnant (69,70).
women report a shift in the way they relate
Studies investigating the impact of various
to their bodies across pregnancy, from a
obesity-related public health campaigns found
focus on appearance to a focus on ability and
that those campaigns perceived as stigmatising
functionality (64). However, they also report
or shaming were received least favourably by
pressure to continue to adhere to traditional
recipients, and were no more likely, or in some
bodily ideals, particularly around weight and
cases the least likely, to motivate people to
returning to their pre-pregnancy body shape
change their behaviour. These preferences were
following childbirth (64). Indeed, reviews of
the same regardless of the individual’s own
the research have found associations between
body weight (71,72). Campaigns that focused
increased body dissatisfaction, postpartum
more generally on themes of healthy eating and
weight and depressive symptoms during
health-promotion for all adults were received
pregnancy and new motherhood (65,66).
the most positively (71).
Physical appearance
Body image concerns and body dissatisfaction
have been found to be more prevalent among
BODY IMAGE IN LATER LIFE 15.

BODY IMAGE IN
LATER LIFE
How comfortable are adults with their bodies in later life?

C
oncerns about body image and among people in later life vary widely in the
appearance, while often associated literature (73). Estimates from the 2013 British
with younger people, are not exclusive Social Attitudes Survey found that, among
to youth. Though our appearance and our those adults over 65, 69% were satisfied with
relationship with our bodies change as we age, their appearance, compared to 67% of adults
we do not stop valuing our bodies, and body aged 18–34 (6).
image concerns can still remain.
In our survey, around one in five adults aged
People in later life report feeling dissatisfied 55+ felt anxious (20%) or depressed (23%)
with their bodies and having misconceptions specifically because of their body image,
of their body size and shape (73,74), although demonstrating that body image continues to
estimates of the degree of body dissatisfaction affect our mental health into later life.

What affects body image in later life?

B
ody image in people in later life is women’s experiences of their bodies, which
informed by a lifetime of experiences found that women’s perception of what body
throughout childhood, young adulthood image is evolves with age, often focusing more on
and middle age. As such, the factors discussed overall health and functionality with time (75,76).
in previous sections will all have played a role in For some, there may be a tension between this
shaping how people in later life understand and increase in focus on health and functionality, and
experience their bodies. a desire to maintain appearance (73,76).

Ageing As in both childhood and adulthood, the

degree to which individuals compare to an
One review of the research comparing how
‘ideal’ body type or appearance may also play
younger and older adults experience their bodies
a role in body image concerns in older adults
found that, in terms of body image, older adults
(77). In Western cultures, this ideal is commonly
tend to place a greater importance on how their
associated with youth (e.g. smooth skin) and
bodies function compared to younger people
older adults tend to be underrepresented in
(73). This is echoed in a qualitative study of older
the media (74). Ageing can therefore highlight
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 16.

differences between actual and ‘ideal’ points, including retirement, changing family
appearance. structures, bereavement and loss, downsizing
and moving into later-life housing. Such major
This may particularly be the case for women, who
transitions can present profound changes to
tend to express greater body image concerns
the routine, roles and responsibilities of people
than older men (73,74). One study of how women
in later life, and can result in mental health
speak about weight and age found that among
challenges to older adults (81). Indeed, a study
older women, conversations about the physical
that looked at mental wellbeing scores across
signs of ageing that reinforce the idea that youth
three age cohorts found that the oldest-age
is the ideal standard of beauty (referred to as ‘old
cohort experienced a slight decline in score,
talk’) were associated with anxiety around ageing
which was still significant after factoring in
and increased body image disturbance (78).
demographic information, physical ailments,
In some cases, women may feel disconnected
chronic conditions and mental health problems
from their bodies as they age, as their external
(82).
appearance no longer matches their perceptions
of themselves, such that they do not feel ‘old’ but For many women, age brings significant
are identified by other people as ‘old’ because transition in the form of menopause. The
of how they look (76). Women with poorer experience of menopause can contribute to
body image were also less likely to be socially changes in body image; however, its effect on
engaged and more likely to report depressive body image is a uniquely individual experience
symptoms (79). Age-based discrimination can and may vary among women with different
be a significant source of psychological distress cultural attitudes and backgrounds (83). One
among older adults, and experiences of ageism review of the research found that women
have been associated with poorer body image with higher self-esteem and positive attitudes
and psychological wellbeing among older women toward menopause experienced fewer negative
(80). symptoms, whereas women with negative
attitudes toward menopause experienced higher
Transition points in later life
levels of shame about their bodies, and lower
People in later life navigate many transition bodily esteem (84).
BODY IMAGE AND LONG TERM HEALTH CONDITIONS 17.

B DY IMAGE
AND L NG -
TERM HEALTH
C NDITI NS

B
ody image is an important issue for in previous sections as well as the often
many people affected by long-term significant changes to appearance and
health conditions, be they related to functioning that can accompany illness and
mental or physical health. The body image disability and affect the way we think about
of individuals with long-term conditions or and experience our bodies.
disabilities is informed by factors discussed

Body image and physical health conditions

Chronic illness mastectomy) may contribute to feelings of

shame or body dissatisfaction due to the
Experiences of chronic illness, particularly
way they can affect people’s self-perceived
those where the effects are physically visible,
identity, fertility and attractiveness, as well as
have been associated with greater body image
their impact on functionality and the ability to
concerns (85). There is a substantial body
perform daily tasks (87-89). This, in turn, can
of research on the ways that experiences of
negatively affect mental health and quality of
cancer specifically can affect body image
life (86,87,89).
(86,87). Cancer is associated with a range of
bodily changes as a result of both the illness While the research reviewed here focuses on
itself and its treatment. This can include hair experiences of cancer, experience of bodily
loss, scarring, swelling, sensory changes (e.g. changes and changes to functionality, and
pain or numbness) and functional impairment, the relationship this has to body image, will
all of which can affect the ways people with also apply to many other chronic conditions
cancer relate to and experience their bodies and disabilities. Furthermore, many long-
(86). Cancer symptoms and treatment term health conditions are associated with
(e.g. chemotherapy and surgery such as a experiences of chronic pain. One review of
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 18.

the research suggests that chronic pain may substantially limited their daily activities
affect the way we experience and perceive reported feeling shame (31%) or feeling down
our bodies, particularly the areas of the body or low in the last year (47%) because of their
where the pain is localised (90). Therefore, body image compared to individuals without a
the ability to change and manipulate bodily limiting condition (18% and 32% respectively).
perception may provide a route to the Similarly, 50% of adults with a health problem
management of some forms of chronic pain – or disability said their body image negatively
for example, the use of visual feedback for the affected their self-esteem, compared to 36% of
management of phantom limb pain (90). adults without a limiting condition.

In our survey, a higher proportion of adults

who had a health problem or disability that

Body image, mental health problems and learning disabilities

Learning disabilities area is still developing (95,96). One study, which

spoke with young people with autism about their
There is relatively little research looking
feelings about their bodies found that some
specifically at the body image of individuals with
young people expressed difficulties in feeling fully
learning disabilities. However, individuals with
aware of, in control of, and connected to their
learning disabilities are often at a greater risk of
bodies, especially in the context of challenges
obesity than their peers (91), which is something
with coordination and motor skills (97). Young
that has been linked to increased feelings of body
people who reported having functional strategies
dissatisfaction and poor body image among
for challenges in their daily lives related to their
both adults and young people in the wider
motor difficulties reported feeling more positively
research (31,67). There is also some evidence to
towards their bodies, and proud of their abilities,
suggest that children with learning disabilities
suggesting that this may be a potential avenue to
may have less awareness of their bodies and
support body awareness and body image (97).
limited opportunities for social engagement,
and that they are more likely to be bullied than Medication for severe mental health
their peers, which can lead to feelings of isolation problems
and low self-esteem (91,92). Some small studies Medications used to treat some severe mental
have looked at dance and movement therapy for health problems commonly have side effects
individuals with learning disabilities, which may that involve weight gain. This weight gain can
have positive effects on body awareness and have negative effects on body image and quality
wellbeing, though the research in this area is still of life. One review of the literature found that
developing (93,94). individuals taking psychotropic medication
Autism spectrum disorder reported weight gain as one of the most
distressing adverse effects of the medication,
There is some research to suggest that individuals
and expressed feelings of embarrassment,
with autism spectrum disorder can experience
shame and hopelessness, which negatively
their bodies differently than neurotypical peers,
affected their self-esteem and quality of life (98).
and that this may affect how they think and
Additionally, concern about weight gain, and
feel about their bodies, though research in this
the distressing emotions that can accompany
BODY IMAGE AND LONG TERM HEALTH CONDITIONS 19.

it, can contribute to choices to interrupt, adjust Therapy and counselling in aiding in offsetting
or otherwise stop taking medication and can some of these negative effects (100). Following
serve as a barrier to participation in physical good practice guidelines for maintaining
activity (98,99). Therefore, it is important to positive cardiometabolic health – for example,
consider the impact of medication on quality of through the use of tools such as NHS England’s
life, body image and self-esteem alongside its Lester Tool – may not only guide the effective
effectiveness for the treatment and management monitoring of physical health, but potentially also
of mental health problems. There is some support help to address body image concerns linked to
for approaches such as Cognitive-Behavioural weight gain (101).

B DY IMAGE AND
ETHNIC BACK-
GR UND
How does body image vary across people from different
ethnic backgrounds?

B
ody dissatisfaction or feeling negatively different ethnic backgrounds in levels of body
about appearance or abilities is a dissatisfaction are small and there appear to be
common experience across different more similarities between people from various
racial and ethnic groups. ethnic backgrounds rather than differences (1,
107). Ethnicity may have less of an influence on
Body image is a multi-dimensional construct;
body image than factors like age, gender or weight
however, the tools used to assess body image in
(1, 108). Rather, the way in which ethnic minority
research often focus on body weight or shape.
groups experience body image and the factors
This can be limiting when trying to understand
that can affect their own body image may be
body image and ethnicity, as people from
slightly different.
different groups have different body ideals
(102,103). Concerns around body image may While the differences across ethnicities may
not always fall into the categories of body weight be small, where such differences have been
and shape. For instance, some concerns may be observed, they tend to show that, in general,
around skin tone, hair texture or size and shape of Black women are more satisfied with their
facial features (104–106). bodies than White women. This is mirrored in
some analysis that looks at body image in Black
Generally, differences between people with
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 20.

British girls, which finds they are more likely to men and women (which is typically used to refer
express a positive body image and less likely to to Americans of East Asian descent) tend to have
show disordered eating behaviours than White lower body satisfaction than their White American
British girls (109). Similarly, Black males (adult and counterparts (105). Similar findings can be found
children) reported being more satisfied with their for Asian adolescents, who reported greater body
bodies compared to their White counterparts dissatisfaction than other racial groups (112).
(110,111). There is a suggestion that Asian American

Cultural influences on body image

L
ooking more broadly at culture as proposed that high self-esteem could serve as a
opposed to only ethnicity or race can protective factor against media influence in this
enhance our understanding of body image group (116).
across groups. Findings from a cross-cultural
Findings from a qualitative study with Dutch
study (103) highlighted significant differences
children of non-Western ethnic minorities
across world regions in body weight ideals and
suggest that they had, to some extent,
body dissatisfaction, though these differences
internalised the ‘thin ideal’, as they expressed
were small in terms of overall effect.
a preference for a thin body size that
Though researchers no longer believe that corresponded with Western bodily ideals in
body image is a concern only for White women contrast with their parents’ preference for a
in Western countries (107), research suggests fuller body size (117). This was echoed in a review
that body dissatisfaction is more pronounced of the research, which found greater body
in affluent countries where people lead a image dissatisfaction among individuals who
lifestyle more characterised by high levels of had emigrated from Africa to Europe compared
individualism and consumption (106,113). In to those who had not (113). In this way, the
these countries, people may experience greater level of acculturation (i.e. the degree to which
pressures to conform to the ‘ideal body’ due ethnic minorities adopt Western customs and
to having greater access to body-centred values) may negatively affect the way in which
information and images through the media. individuals view their bodies (113,118,119).

The impact of the media on body image may As well as exposure to the media, body
vary across different ethnic groups. Research image in immigrant communities may also
from the US found that the strongest sources be influenced by the experience of adapting
of thinness pressures for White women, are to a new culture, which is something that
from the media, peers and family, whereas, for can be very stressful (120). This stress and
Black women, peer attitudes (114) and family discrimination were found to be important
pressures are more pronounced (115). One study, risk factors in understanding the development
which examined whether there were differences and maintenance of eating disorder symptoms
in positive body image among British female among ethnic minority populations (121).
undergraduates of different ethnicities, found Discrimination was found to be associated
that Hispanic female undergraduates reported with greater eating disorder and depressive
the lowest score on media influence and the symptomology via body shame (122).
highest score on self-esteem; the authors
BODY IMAGE, SEXUAL ORIENTATION AND GENDER IDENTITY 21.

BODY IMAGE,
SEXUAL
RIENTATI N
AND GENDER
IDENTITY

W
hile people who identify as lesbian, to people who identify as heterosexual, their
gay, bisexual and transgender experience and relationship with their body is
(LGBT) experience body image likely to differ in specific ways.
concerns in ways that are generally similar

How does body image vary across the LGBT community?

H
eterosexual men have been found disorder symptoms. As in the wider research,
to report higher levels of body studies focused on gay and bisexual men have
appreciation than gay and bisexual found a connection between higher levels of
men (123,124). Some research suggests that body dissatisfaction, an increased likelihood
sexual minority men may be more likely of experiencing depressive symptoms and
to internalise an appearance ideal that is increased sexual anxiety and poorer sexual
centred around looking athletic (124) and that self-efficacy (123).
there may be a greater emphasis on physical
There is some research to suggest that
appearance in the gay community, which can
lesbian women have a similar level of concern
negatively affect body image (125) through
around their body image as heterosexual
pressure to match this ideal. One review of the
women (127,128), though research is mixed
research (126) found that gay men are more
on this point. One study suggested a small
likely than their heterosexual counterparts to
difference, finding that lesbian women may be
experience a desire to be thin, and this can
slightly more satisfied with their bodies than
sometimes manifest in higher levels of eating
heterosexual women (129). However, other
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 22.

studies find a similar level of concern between transitioning that is beyond the scope of the
heterosexual and lesbian women regarding current report. Further information about,
the perceptions of their bodies and their and support around, transitioning is available
perceptions of what an ‘ideal’ body looks like from organisations like the LGBT Foundation,
(128). A similar pattern was found for women Consortium and TransUnite.
who identify as bisexual (130).
Stigma and discrimination
In our survey, a higher proportion of individuals
The stigma, prejudice and discrimination that
who identified as gay, lesbian or bisexual
LGBT people can face often leads to higher
reported feelings of anxiety and depression
levels of stress (133). This ‘minority stress’,
because of their body image. Among adults
which not only encompasses experiences of
who identified as gay, lesbian, bisexual or
discrimination, harassment and victimisation,
other, 53% felt anxious and 56% felt depressed
but also more internalised feelings like shame,
because of their body image compared to
may be a contributing factor to the mental
one third (33%) of the adults who identified as
health problems reported within the LGBT
heterosexual.
community (133).
Similarly, in our survey, one third (33%) of
This ‘minority stress’ may also be linked to
adults who identified as gay, lesbian, bisexual or
body image. For young men who have sex
other reported experiencing suicidal thoughts
with men, one study found that internalised
or feelings because of concerns about their
negative attitudes towards homosexuality
body image, compared to 11% of the adults who
and sexual orientation predicted overall body
identified as heterosexual.
dissatisfaction, muscularity dissatisfaction and
Transgender people body fat dissatisfaction (134). Another recent
study looking at body image of non-binary
Transgender people may experience distress
and binary transgender people found that
resulting from the incongruity between their
harassment or rejection was associated with
biological sex and their gender identity. This
lower levels of body appreciation by reducing
can have an effect on their body image,
self-esteem and satisfaction with life (135).
and research suggests that levels of body
This was reflected in our survey, where 40%
dissatisfaction in transgender people tend
of the adults who identified as gay, lesbian,
to be higher prior to undergoing gender
bisexual or other said they felt shame because
confirmation treatments (131). Feelings around
of their body image, compared to 18% of the
one’s body can differ depending on the stage
heterosexual adults. Similarly, 54% of adults
at which a person is on their transition journey
who identified as gay, lesbian, bisexual or
(132). It should be noted that transitioning
other felt their self-esteem was negatively
does not just refer to medical intervention,
affected by their body image in the past year,
which is something that not all transgender
compared to 37% of the adults who identified
people want or are able to have. It refers
as heterosexual.
to the steps a person takes to live in the
gender with which they identify, which could
include things like telling friends and family
or dressing differently. There is a much larger
body of literature around gender dysphoria
and the psychological and physical effects of
HOW CAN WE PROTECT, PROMOTE, AND MAINTAIN BODY IMAGE? 23.

H W CAN
WE PR TECT,
PR M TE, AND
MAINTAIN B DY
IMAGE?
Individual actions of social connection and overall psychological
wellbeing, rather than as a route to building
Everyone has a right to feel comfortable
muscle or losing weight, may also be a good
and confident in their own skin and we can
approach to building up our body image.
take small actions in our daily lives to help
Reviews of the research have found support for
foster a more accepting environment. For
the relationship between physical activity and
example, it may be helpful to be mindful of the
positive body image (137–139).
ways in which we speak about our bodies in
casual conversations with friends and family. If body image concerns are causing significant
Consistently speaking about our bodies, or distress, it may be appropriate to seek out
others’ bodies, in ways that imply weight and further support in the form of psychological
youth are central to attractiveness and value therapies. Reviews of the research have found
(e.g. “I feel fat today”, “They don’t have the some support for cognitive and behavioural
body to wear that”, “You look great, did you interventions such as Acceptance and
lose weight?”, “Ugh, look at my wrinkles”) may Commitment Therapy (ACT) and Dialectical
feel harmless in the moment, but can make us Behaviour Therapy (DBT) in improving body
feel worse about our bodies in the long run (62). image (140–142).
Instead, focusing more on the functionality of Community actions
our body, and the positive things that it can do
for us, may help to support and improve body In order to maximise outcomes and reduce
image (136). the risk of stigma, public health campaigns
should focus on messages of healthy eating
Focusing on physical activity and healthy and exercise for all adults, regardless of weight,
eating for the benefits they provide in terms and avoid making weight the key focus of their
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 24.

messaging (71,72). However, creating a less participants felt that, even with a label, the
shaming culture can also start at a community intent of the edited photo is still a message
level with grassroots action to encourage more that the body type presented is ‘desirable’
inclusive and accepting cultural norms around and that reactions to such images are often
bodily appearance. automatic or sub-conscious (150). Instead, they
felt that media should focus on the inclusion
A common response to the research linking
of more varied body types and sizes, ages and
body dissatisfaction with exposure to
ethnicities to encourage a more wide-ranging
idealised bodies in the media is to suggest
and inclusive ideal of beauty (150). Social
the inclusion of ‘disclaimer’ or ‘warning’
media may be one potential route to achieving
labels on advertisements in which models
this diversity of representation. One study of
have been edited. However, much of the
social media accounts that specifically focus
literature looking at the effect of such labels
on body positivity found that these types
on responses to fashion advertisements
of account depict a broad range of body
suggests labels may not have any beneficial
types and appearance (though the images
effects on body dissatisfaction. Several
are still predominantly of younger women)
experimental studies have presented young
alongside messages of body appreciation and
women with advertisements that have a
acceptance (151).
variety of disclaimer labels and found no
effect of labels on body dissatisfaction In their advertisements, companies should aim
compared to un-labelled photos (143–149). In to be inclusive in terms of age, gender, ethnicity
some instances, labels had negative effects, and size, so as to encourage a more diverse
increasing a tendency to compare self to bodily ideal, and use advertising messages
others (145,149), or resulting in higher levels that prioritise overall wellbeing rather than
of body dissatisfaction among women already just physical appearance. Calls for advertisers
more likely to compare themselves to others to support these aims have been launched by
(147). One qualitative study in this area with organisations like Be Real via their Body Image
British adults suggests that such policies Pledge (152).
are generally met with scepticism. Some

Supporting body image in children and young people

At home: value and deserve respect regardless of their

body shape or size; support children to express
One study seeking to gain expert consensus
emotions and communicate their feelings
on ways for parents to support healthy body
about their bodies; help children develop
image and eating habits found that parents
strategies for coping with comments about
should seek to: model positive behaviour
appearance; and avoid placing unrealistic
around body image (avoid criticising their
expectations on appearance or conveying that
own appearance or that of others, and model
they would be more likeable if they changed
healthy eating and activity); praise their
their weight or shape (153).
children on qualities unrelated to physical
appearance; teach children that people have
HOW CAN WE PROTECT, PROMOTE, AND MAINTAIN BODY IMAGE? 25.

In schools: In the media:

One review of the research found some Young people participating in MH2:K, a peer-
support for classroom-based body image led programme about youth mental health and
programmes that address media literacy, wellbeing, have recommended that, in order to
self-esteem and peer influences; however, address the influence of the media and social
where it was measured in the longer-term, few media, we should: provide resources to parents
studies showed sustained results (154). There that help them to support young people online
is some survey data from Be Real to support in a way that balances independence and
classroom-based body image programmes, safety, and encourage social media sites to
with 76% of students saying that learning about include an option to hide followers, likes and
body confidence in school made them feel comments (156). It may also be important to
more confident about themselves (23). Whole- help support young people to be media-critical,
school approaches that create supportive as media literacy may be a protective factor for
spaces for students, coupled with health body image (37,157).
promotion approaches that focus on the social
and wellbeing benefits of physical activity
(rather than benefits for weight loss and muscle
building), may also be effective (155).

Supporting body image across long-term conditions

and disabilities

F
or individuals with chronic physical with autism who reported having functional
illnesses such as cancer, there is evidence strategies for challenges in their daily lives
to support the use of Cognitive- reported feeling more positively towards their
Behavioural Therapy and psychotherapeutic bodies, and proud of their abilities, suggesting
interventions as well as some support for that this may be a potential avenue to support
educational approaches for improving body body awareness and body image (97).
image in cancer patients (86,158). In addition,
For individuals with longer-term mental
when considering cancer treatment, patients
health conditions who have been prescribed
should be informed about the potential side
medication, it is important to consider the
effects of treatment on sexuality and fertility
impact of medication on quality of life,
and the ways this can affect body image. It
body image, and self-esteem alongside
may be beneficial to include partners in this
its effectiveness for the treatment and
decision-making process (159).
management of mental health problems.
For individuals with learning disabilities and There is some support for approaches such
autism spectrum disorder, some studies have as Cognitive-Behavioural Therapy and
trialled dance and movement therapy, which counselling in aiding in offsetting some of
may have positive effects on body awareness these negative effects (100). Following good
and wellbeing, though the research in this practice guidelines for maintaining positive
area is still developing (93,94). Young people cardiometabolic health – for example, through
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 26.

the use of tools such as NHS England’s Lester also help to address body image concerns
Tool – may not only guide the effective linked to weight gain (101).
monitoring of physical health, but potentially

Supporting body image across cultures and ethnic groups

G
iven that body image concerns are body image for minority ethnic people
likely to be experienced in childhood, (162,121). There is, however, a clear need to
including for ethnic minority increase representation and diversity among
children and adolescents (160), school-based participants as interventions and campaigns
programmes that educate and encourage have mostly targeted predominantly White,
all students to have a positive body image female and middle-class populations and few
may help to prevent body image concerns are culturally specific (111). This would help us
developing (109). Strategies promoting to understand whether these interventions
body appreciation or enhancing a positive are effective for different groups. This also
body image rather than simply decreasing reinforces the need for greater diversity in
body dissatisfaction may also be effective advertising and the images used in the media
(109,161). Having a strong self-identity and and social media in order to support and foster
connection with one’s culture could serve a more diverse view of bodily ideals.
as protective factors to pressures around

Supporting body image in the LGBT community

S
upport for the LGBT population should and help to bolster self-esteem could also be
undoubtedly be tailored for the specific beneficial (133,134). Peer approaches should
group and a more holistic stance on be explored further, as they have the potential
body image that makes sure to address the to help transgender young people to develop
psychological and social aspects of body image healthy coping strategies (132). Furthermore,
would be welcome (134,163). There is evidence training for staff on LGBT-specific issues could
that behavioural interventions might be enhance the sensitivity and appropriateness of
effective in reducing body dissatisfaction (123). interventions (135).
Interventions that focus on minority stressors
IMPLICATIONS AND RECOMMENDATIONS FOR POLICY AND ACTION 27.

IMPLICATI NS
AND REC MMEN -
DATI NS F R
P LICY AND
ACTI N

E
veryone, whatever their age and more negative’ about their bodies after being
background, has the right to feel pregnant than before, and 23% said they felt
comfortable and confident in their own ‘slightly more negative’.
body. Yet, as evidenced by our review and the
Overall, the main picture that emerges from
YouGov survey we commissioned for Mental
our survey is one of societal pressures on
Health Awareness Week 2019, a substantial
body image, driven by the commercial sector,
number of women, LGBT+ people, and, to a lesser
particularly the fashion and cosmetic industries,
extent, men are far from feeling this comfort and
which predominantly use ‘idealised’ images to
confidence.
sell their products. This is having serious limiting
This includes feelings connected to one of the effects on the day-to-day lives of millions and
most natural human processes: pregnancy. Of cannot be ignored. Action is needed in many
the 66% of women in our YouGov survey who areas; below, we set out the priorities, as we see
had been pregnant, 18% said they felt ‘much them, for regulation, policy and practice.

1. REGULATORY ACTION

T
he literature shows that one of the and of internalising an ‘ideal’ body image that is
primary drivers of body dissatisfaction unrealistic or unattainable.
is comparing oneself negatively to
This social harm has been allowed to develop
others based on appearance (40). Exposure
largely unchecked. Despite some positive
to idealised bodies in the media and social
initiatives from individual companies, poor
media provides significant risk of this (1,20)
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 28.

practice persists in advertising, and social aspirational in order to increase the desirability
media companies have been unwilling to take of products or lifestyles. Social media use also
the necessary steps to protect their users from carries social incentives for users to present
harmful content. Of the 21% (12% of men and themselves in a positive way, including through
30% of women) of respondents to our survey photo selection or even image manipulation,
who said that images used in advertising had which can encourage unhealthy and unrealistic
caused them to worry about their body image, appearance-based comparisons.
72% cited adverts for fashion brands, 46%
Of the respondents to our survey, 59% said
adverts for weight-loss products/programmes
that the government needs to do more to
and 31% adverts for cosmetic surgery.
protect the public from unhealthy body images
All such industries with the capacity to cause in advertising and social media. It is now time
harm need structured regulation. If left for the government to improve regulation to
unregulated, advertising is driven by incentives prevent the promotion of harmful body images.
to present unattainable ‘idealised’ bodies as

1a. Social media regulation

The Online Harms White Paper should consider the potential to address harms
relating to the promotion of unhelpful or idealised body image online, beyond
content related to eating disorders. 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.

ur YouGov survey identified social regulator for online platforms hosting user-
media use as one of the most reported generated content, underpinned by a new
sources of body dissatisfaction, statutory duty of care. The new codes of
especially among young people. Of young practice will need to create a framework that
people aged 13–19, 40% reported that images can deliver a graduated and proportionate
on social media made them worry in relation to response to online harms, ranging from illegal
their body image, which was tied for the most activity to more loosely defined social harms.
reported factor along with things their friends
As part of this process, the Home Office and
said. This supports findings from our literature
Department for Digital, Culture, Media and
review, which found associations between
Sport (DCMS) should carefully consider the
body image and social media use (20,38).
promotion of unhealthy body images online
In April 2019, the UK government published its beyond the promotion of material related to
Online Harms White Paper (164). The proposals eating disorders. The new codes of practice
lay the groundwork for a future independent should commit social media companies to
IMPLICATIONS AND RECOMMENDATIONS FOR POLICY AND ACTION 29.

ensuring that the content they promote to content, and algorithmic targeting – does not
users – through advertising, trending and viral exacerbate body image concerns.

1b. Advertising regulation

The Advertising Standards Authority should consider pre-vetting high reach

broadcast adverts from high-risk industries – such as cosmetic surgery
companies and weight-loss products and services – to ensure that all advertising
that reaches the public abides by its codes. It should also make greater use of its
ability to proactively instigate investigations.

A
dvertising, both online and offline, because of images used in advertising shows
is regulated by the Advertising that there is still room to improve.
Standards Authority (ASA). The ASA
While the ASA has existing codes and
is a strong example of industry self-regulation
guidelines on body image, adverts can be in
and the vast majority of advertisers abide by
circulation for a long time before the ASA
its codes and rulings. Last year, the ASA upheld
receives complaints and makes a ruling. This
the Mental Health Foundation’s complaint in
means that harmful adverts can achieve
connection with cosmetic surgery adverts
significant reach and therefore spread
during ITV’s Love Island programme (165).
significant harm before they are taken down.
Application of the ASA’s social responsibility
The ASA should make greater use of its ability
code prevents advertisers from using models
to pre-vet advertising and proactively instigate
in a way that makes them look unhealthily thin
investigations. The ASA should also consider
or from presenting unhealthy body images
extending its power to pre-vet non-broadcast
as aspirational (166). This avoids some of the
advertising to broadcast advertising, and pre-
pitfalls of using a BMI-based approach, which
vet all adverts from high-risk industries, such as
has been taken in some other countries, and
cosmetic surgery companies and weight-loss
captures the use of photo editing and lighting.
products and services, to ensure all advertising
However, our YouGov survey finding that 21%
that reaches the public abides by its codes.
of UK adults worried about their body image

2. INDUSTRY ACTION

I
n order to achieve meaningful cultural beyond regulatory efforts to minimise the
change, industry has a responsibility to negative consequences of advertising and
work together to find solutions that go social media.

2a. Diversity in media

Social media companies should sign the Be Real Campaign’s Body Image Pledge
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 30.

and investigate innovative ways of using their platforms to promote positive

body image and to ensure that a diversity of body types is presented positively
to their users.

ne potential way to lessen the impact and preventing harm online. It is a welcome
of advertising on body image is to first step to compel companies to recognise
achieve greater exposure to diversity that they have a duty of care to their users, but
in media and advertising. This is an area where change will be most effective if social media
industry collaboration could be particularly companies are fully engaged in the process.
meaningful.
The causes of body image dissatisfaction are
We recommend that DCMS convenes multifactorial and complicated, and regulation
roundtable meetings with advertisers, is not going to be able to capture all the drivers
broadcasters, and body image campaigners to of poor body image. Social media carries the
explore ways to promote diversity in advertising potential to deliver some innovative solutions to
and media and to widen sign-up to the Be Real the problem above and beyond what is possible
Campaign’s Body Image Pledge (152). through the application of sanctions alone.
Social media companies should investigate
The Online Harms White Paper should be an
positive and innovative ways of promoting
opportunity for government to engage with
healthy body image and protecting their users
social media companies that have so far been
from body-image-related harm.
reluctant to acknowledge their role in causing

2b. Discrimination and stigma

Social media companies should have clear systems for users to report bullying
and discrimination and targets for action to be taken. Social media platforms
should give users greater control over the content they see and create
accessible tutorials to show users how to exercise this control.

ur review of the literature found that The growth of online life, and particularly social
stigma and shaming, including through media, has increased exposure to experiences
appearance-based bullying, puts of bullying and discrimination. As digital citizens,
people at greater risk of experiencing body people have a right to expect freedom from bullying
dissatisfaction. Discrimination, stigma and and discrimination online, as well as a responsibility
shaming disproportionately affect people from to treat others well. As part of the Online Harms
minority ethnic groups, LGBT people, people White Paper process, social media companies
in later life, people with disabilities, and people should be expected to have clear systems for users
who are overweight and obese. Stigma and to report bullying and discrimination and effective
shaming can take direct forms, such as bullying means to take down offending content. Users should
and appearance-based teasing, as well as more have greater control over the content they see and
indirect forms, such as unaccommodating should be able to hide likes and comments, as well as
environments and isolating behaviour. filter content that they consider undesirable.
IMPLICATIONS AND RECOMMENDATIONS FOR POLICY AND ACTION 31.

3. HEALTHCARE AND PUBLIC HEALTH ACTION

3a. Training of frontline practitioners

Training for GPs, health visitors, dietitians and other frontline practitioners
advising parents and carers on both parenting and healthy eating should include
information about how parents and carers can, from a very early age, positively
influence their children’s feelings about their bodies through the behaviours and
attitudes they express when they are with them. Training on this issue should
also be given to the early years childcare workforce, including childminders,
nursery nurses, nannies and others who care for young children in loco parentis,
whose comments and behaviours are also strongly likely to influence young
children’s developing sense of their bodies.

ur survey found that ‘things my family body esteem and reduce the potential for harm
have said’ were the third most likely and can be built into their everyday interactions
factor to have caused teenagers to with their children, starting from an early age
worry in relation to their body image. Overall, and continuing through their childhood and
29% of teenagers aged 13–19 said this. The adolescence (153). A public health approach to
figure was much higher for girls (37%), but it promoting positive body image therefore needs
also affected 21% of boys. Our internalised to start early in life. It must recognise that our
feelings about our body develop from a very body image and body esteem is formed, to a
early age, and, as our report shows, parents’ large extent, by the attitudes to food, weight
behaviours and attitudes in relation to diet, and body shape of those closest to us, and their
weight and body shape have a powerful associated behaviours. The influence of those
influence on their children’s feelings about their closest to us can be both direct (in comments
bodies and themselves. they make to and about us), and indirect (in
comments made about themselves and others,
The advice parents receive should focus on using
and associated behaviours) and this influence
simple evidence-based phrases, techniques and
continues in later childhood and adolescence.
behaviours that have been shown to increase

3b. Supporting those in crisis and distress

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

R
esearch suggests that young adults with depression, anxiety and suicidal feelings
negative body image concerns are more (33,167). We know that people often face
likely to self-harm and/or experience barriers in receiving the right support when
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 32.

they need it. All parts of the UK should learn nurturing environment. However, we need new
from the Distress Brief Intervention model thinking and innovation, alongside investment,
currently being piloted in five sites across to revolutionise how young people, who are
Scotland, which enables front line services to struggling but fall below the threshold for the
provide a consistent, compassionate response specialist mental health treatment provided
to people presenting in distress (168). While this by CAMHS are supported by people in youth
is an adult service, we support efforts to lower and community settings. More must be done
the age criteria with a view to widening access. to lessen the impact of early experiences of
poor mental health and help those who are
Often, young people’s existing support
struggling to adopt positive help-seeking
networks – their families, schools and peers –
strategies.
will provide the most effective support and a

3c. Obesity campaigns

Public campaigns focusing on nutrition, obesity and being overweight should

avoid the potential to create stigma and indirectly contribute to appearance-
based bullying by not making weight the main focus of their messages. Instead,
they should focus on healthy eating and exercise for all members of the
population, regardless of weight.

T
he prevalence of obesity in the governments and public health bodies across
population is a major public health the UK should actively consider these effects
concern (169,170) and we support efforts when developing their campaigns and other
to improve the physical health of people with messaging on obesity (71,72).
mental health problems, who, according to
This should include consideration of the
research, will die, on average, 20 years younger
psychological effects on children of child
than the rest of the population. However, much
measurement programmes in schools, and
less attention has been paid to the psychological
their influence on how parents respond to and
and cultural impact of this increasing focus on
interact with their children about their weight.
people’s weight and size. The NHS, national

3d. Education, schools and media literacy

A body image and media literacy toolkit, co-produced by young people, should
be a compulsory element of what children learn in schools. This should include the
development of a charter for achieving a healthy and positive body image. In England,
we recommend that this is used within the new Health Education Curriculum being
introduced in September 2020. In Scotland, the Scottish Government should
implement this as part of its ongoing personal and social education (PSE) review.
IMPLICATIONS AND RECOMMENDATIONS FOR POLICY AND ACTION 33.

ur education system must do more The PSHE Association, Be Real Campaign, and
to address some of the root causes National Citizen Service have all created toolkits
of emotional distress in children and and guidance on teaching about body image (3,
young people, and we know that body image is 171–173). We have created a body image module
a concern, with 35% of 13–19- year-olds telling to add to our UK Peer Education Project (174)
us that it always or often causes them to worry. and our Scottish Stress Less programme, which
We previously highlighted this as part of our run in secondary schools (175).
Make it Count campaign.
In addition to developing pupils’ media literacy
Media literacy can help young people critically through the curriculum, it’s also important
explore the influences of popular culture to embed a range of mental health support
on everyday life. For example, pupils could workers, including counsellors and family liaison
be encouraged to discuss and question the workers, in every school to provide children and
objectives of media products such as adverts young people with a safe and trusted space in
or magazines, considering the techniques that which to discuss their feelings. Encouraging
are used, their target audiences and commercial young people to express concerns about their
ambitions. The image of perfection that is often body image and the way that they look is an
portrayed by advertising and social media important first step in valuing who they are as
platforms can be challenged by exposing their a person and acknowledging the importance of
hidden motivations and helping young people their non-appearance-based traits as a way to
identify the overt and more coded messages boost their self-esteem.
that might be detrimental to their self-esteem,
As bullying often starts early in life, early
especially on how genders are objectified and
intervention in schools can be an effective way
stereotyped.
to reduce the impact of appearance-based
A body image and media literacy toolkit could bullying on people’s body image and wider
also address the negative consequences mental health, and this should be an explicit
of comparing ourselves to idealised, often focus of programmes to tackle bullying. Schools
‘perfected’, images, as well as unhealthy should also seek to identify the root causes of
comparisons with peers. In our survey, over half bullying behaviour, which can often present as a
(53%) of 18–24-year-olds reported that they result of a bully’s own unmet needs.
compared themselves negatively to others
Beyond the school gate, while it’s crucial that
because of their body image – a statistic that
we continue to invest in specialist service
is higher than in any older age group. Pupils
provision, we also need to prioritise the right
could be shown how to become more aware
early intervention services for young people
of when they are comparing themselves to
who begin to struggle. We need to do more to
others, both online and offline, and consider the
lessen the impact of early experiences of poor
length of time they spend doing it and whether
mental health and help those who are struggling
the content is an accurate portrayal of reality.
to adopt positive help-seeking strategies.

4. INDIVIDUAL ACTION

There are some actions we can take to improve how we feel about our bodies and help
us to protect, promote and maintain a positive body image throughout our lives.
BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES 34.

1 If your body image is a significant cause of stress, or if you’re being bullied about how
your body looks, consider talking to a friend, a trusted adult or a health professional. It’s
especially important to do this if you’re feeling any pressure to make drastic decisions
– for instance, having cosmetic surgery, starting extreme dieting or trying drugs and
supplements – or if you are having thoughts of harming yourself.

2 Spring-clean your apps on your smartphone. Be aware of how you feel when using them
and, if you find them stressful in relation to your body image, consider uninstalling them.

3 Look at the people in the accounts you’re following on social media and be mindful of how
you feel about your own body and appearance when you look at them. Consider muting
or unfollowing accounts or hashtags that cause you to feel negatively about your body or
appearance or encourage you to compare yourself unfavourably to others. Be considerate
of the impact of your own posts on other people.

4 If you see an advert in a magazine, on television, or online that you think presents an
unhealthy body image as aspirational, you can complain to the Advertising Standards
Authority. This can start the process of investigation and action. Information on how to
complain is set out here: https://www.asa.org.uk/make-a-complaint.html.

5 At home, parents and carers can lead by example by modelling positive behaviour around
body image, eating healthily and staying active. You can: praise children for qualities
unrelated to physical appearance; avoid criticising your own or other people’s appearance;
and avoid placing unrealistic expectations on how people look. In addition, you can support
children to express their emotions and communicate their feelings about their bodies.

6 Our language is important. In our daily lives, we can all be more aware of the ways in which
we speak about our own and other people’s bodies in casual conversations with friends
and family. Consistently saying things that reinforce youth and being slim as the essence
of beauty (for instance: “I feel fat today”, “They don’t have the body to wear that”, “You
look great, did you lose weight?”, “They look so old” or “It highlights my wrinkles”) may feel
harmless in the moment, but can make us feel worse about our bodies in the long run.

7 Find the best way that works for you to stay active. A healthy amount of exercise every
week can make us feel better about our bodies, encourage good mood and decrease stress.
But don’t overdo it. The best workout programmes are the ones you actually enjoy.
CONCLUSION 35.

C NCLUSI N
ur poll and evidence review show and complementary ways – individually,
that, while we have been exploring professionally and corporately – strive to shape
the topic of body image in research a society that embraces and champions the
for several years, systematic action at a diversity of the human race. How our bodies
whole-society level to address the threats of change throughout our lives, during puberty,
consumerism to our mental health has been pregnancy and ageing, and how we see our
lacking. We are hoping that governments, bodies in terms of our family, cultural and
companies and the public will use our report gender identities is a fundamental part of who
to raise more awareness and call for clear we are and what makes us valued members of
action. Overall, instead of striving towards a our communities.
single body ideal, we should all, in our different

Recommended citation:

Mental Health Foundation. (2019). Body Image: How we think and feel about our
bodies. London: Mental Health Foundation.

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