7. Media and body image in children and adolescents

Rachel F Rodgers
Department of Applied Psychology, Northeastern University
United States
Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU
France

Media use in children and adolescents has increased significantly over the past decades, particularly screen media and more recently social media use. This has raised concerns as emerging research has suggested that, while low to moderate levels of media use may have positive outcomes for youth, high levels of media use for entertainment purposes (i.e. non-educational content) are broadly associated with reduced psychological functioning in children and adolescents. Among the indicators considered, body image, or youth’s own appraisal of their physical appearance, has been an aspect thought to be negatively impacted by media use, although some evidence exists for this being a bidirectional relationship. This chapter provides an overview of the theoretical frameworks that account for such an association as well as the empirical work that has examined the associations between media use and body image among children and adolescents.

Body image refers to the thoughts, feelings, perceptions, and behaviours related to one’s body and embodiment, that is the experience of inhabiting one’s body, and is a multidimensional concept (Keeton, Cash and Brown, 1990[1]). Although most generally conceptualised as negative thoughts and feelings about one’s external appearance in the empirical literature, problematic body image more broadly encompasses a number of additional elements including the centrality of appearance to self-worth and identity while holding unrealistic appearance standards (Table 7.1).

As illustrated in the table above, elements that are characteristic of problematic body image include:

  • The extent to which negative thoughts and feelings regarding appearance are preoccupying, take up mental and emotional space, and affect behaviours and daily life. Poor body image often includes intrusive thoughts regarding the body that are difficult to get rid of, and lead individuals to spend a large amount of time being preoccupied by their appearance.

  • A strong focus on appearance when evaluating aspects of the body rather than including additional aspects beyond the way the body looks.

  • An external and objectifying body perspective. In other words, individuals with poor body image tend to imagine how their body is appearing to other people, and to consider it as separate from “themselves” the individual (McKinley and Hyde, 1996[2]; Piran, 2017[3]).

  • Rigid behaviours focused on changing appearance, or minimising the negative impact of appearance concerns (for example by avoiding situations in which the body is visible to others).

  • Appearance occupying a central role in identity, and contributing a large amount to self-worth.

  • Narrow conceptualisations of beauty that are anchored to appearance ideals. In other words, beauty only lies in the thin and toned/muscular ideal.

  • Negative thoughts and feelings related to the body are experienced as steady and unyielding versus transitory.

  • Relatedly, efforts to reduce or regulate body-related distress mainly focus on changing the body, rather than changing the ways one feels towards one’s body, or the magnitude of and reactivity to those feelings.

In contrast, positive body image is characterised by:

  • Predominantly positive thoughts and feelings towards the body.

  • These thoughts and feelings are related to the body as a whole, including appearance but also functionality, in other words what the body can do, rather than how it looks, and other domains.

  • The tendency to view one’s body from within it, in other words an inner embodied perspective (Piran, 2017[3]).

  • Behaviours that are directed towards self-care and the honouring of needs and appetites (Tylka and Wood-Barcalow, 2015[4]).

  • While positive appreciations of the body exist, they do not affect overall self-worth. Appearance does not occupy an important place in an individual’s identity.

  • Positive body image results from realistic appearance standards or evaluations and acceptance of the ways in which the body is unique and different to the flawless appearance ideal.

  • Positive body image is flexible, and appearance-related distress is fluctuating and tolerable.

  • When negative body-related thoughts or feelings occur, they are experienced without reactivity and body-related behaviours continue to be directed towards self-care rather than changing appearance.

As described above, the appearance-focus in highly technological Western-style society has led to a disproportionate focus on understanding body image in terms of appreciations of physical appearance, particularly weight and shape. Body image concerns may differ between girls and boys, with girls tending to be most preoccupied with thinness, while muscularity concerns are an equal preoccupation for boys, in line with gendered appearance ideals (Paxton and Damiano, 2017[5]). Relatedly, dimensions related to physical competence and athleticism may also be important among boys.

Children as young as three or four have been shown to be able to understand and express social standards and stereotypes related to weight and appearance (Damiano et al., 2015[6]; Spiel, Paxton and Yager, 2012[7]). Body image concerns tend to appear and increase throughout childhood (Damiano et al., 2015[6]), and by age six a clear desire to be thinner has been shown to emerge among girls (Dohnt and Tiggemann, 2006[8]), with converging evidence that approximately half of seven year-old girls express a wish to be thinner (Clark and Tiggemann, 2006[9]).

Fewer data are available among boys and assessment in very young boys is further complicated by the need to parse out weight and muscularity when referring to body size. Nevertheless, 27% to 47% of preadolescent boys have been reported to express a desire to be thinner, although perhaps not always smaller (Ricciardelli et al., 2009[10]). In a more recent study, both muscularity and thinness related dissatisfaction were reported by six year-old boys, with a third of boys reporting a wish to be more muscular (McLean, Wertheim and Paxton, 2018[11]). Body image concerns may further increase during adolescence, a time of important physical changes that tend to move girls further away from ideals anchored to thinness, while boys may move closer to muscular ideals. For example, among children and adolescents aged 9-14 years, 50% of girls wanted a thinner shape compared with 36% of boys, while in contrast 21% of boys wanted a larger shape compared with 7% girls (Dion et al., 2016[12]). By late adolescence both rates and gender differences have increased (McCabe and Ricciardelli, 2001[13]).

Body image is an important dimension of mental health in its own right as the emphasis placed upon appearance results in negative appreciations of appearance being associated with high levels of distress for some individuals. In addition, poor body image has been shown to be a strong predictor of other mental health problems and harmful behaviours such as low self-esteem, depressive symptoms, unhealthy dieting and muscle building behaviours as well as eating disorders (Neumark-Sztainer et al., 2006[14]; Stice et al., 2017[15]).

Several different theoretical frameworks have been employed to ground the research examining the relationship between media use and body image in children and adolescents. The most frequently used include biopsychosocial theories and objectification theory.

Biopsychosocial theories build upon sociocultural theories that have been extensively used to examine the role of media in body image concerns. Sociocultural theories posit that attitudes and behaviours are transmitted to children and adolescents through the environment, including the media (Rodgers, Paxton and McLean, 2013[16]; McCabe and Ricciardelli, 2003[17]). Media images tend to provide a skewed and unrealistic view of appearance, weight, and shape by disproportionately depicting individuals that are attractive and extremely thin and muscular (Groesz, Levine and Murnen, 2001[18]). This media environment communicates to children and adolescents which appearances are valued and the centrality of appearance to self-worth and identity. Biopsychosocial theories build upon this by highlighting how personal characteristics, both biological or psychological, modulate the way in which pressures from the media environment are experienced by children and adolescents (Rodgers, Paxton and McLean, 2013[16]).

Objectification theory describes how in the mass media, individuals are reduced to objects through sexualisation and being dispossessed of their subjectivity. Objectification theory holds that the viewpoint offered by media in which individuals are considered only as bodies without individuality is gradually adopted by individuals who come to see themselves in this way, a process termed self-objectification. Self-objectification is then proposed to be associated with a range of negative psychological outcomes including depression but also body image and eating concerns (Fredrickson and Roberts, 1997[19]). Indeed, self-objectification leads to habitually considering one’s body from an external observer’s perspective, thereby monitoring and surveilling its appearance, and experiences of body shame when one’s appearance fails to meet social standards.

The bodies represented in the media are, in the vast majority, very lean and toned, with an emphasis on extreme thinness for women, and hypermuscularity for men. These bodies represent a very small proportion of the range of appearances, shapes and sizes found among the general population. The construction of appearance ideals through the presentation of a narrow range of body types as desirable starts from an early age, with the presence of thin and muscular characters in media targeted to children and adolescents. This includes both television content (Hayes and Tantleff-Dunn, 2010[20]; Herbozo et al., 2004[21]) and digital content (Slater et al., 2017[22]; Tiggemann and Miller, 2010[23]), in addition to children’s toys such as dolls and action figures (Boyd and Murnen, 2017[24]). Furthermore, those images are almost without exception digitally manipulated in ways that render such appearances even more unattainable. Thus, media content for children and adolescents portrays highly unrealistic appearances.

The weight and shape of individuals portrayed in children’s media is an important aspect of the way in which media is thought to impact body image. However, a second important way in which media images may adversely affect body image is through the sexualisation of individuals, including children and adolescents, and their objectification, that is their reduction to objects and deprivation of their subjectivity image, as described in the context of objectification theory above (Fredrickson and Roberts, 1997[19]). Content analysis of tween and adolescent media has found high rates of sexualisation and objectification of characters in television content targeting these age groups (Malacane and Martins, 2016[25]; Ward, Moorman and Grower, 2018[26]).

In addition to the images themselves, media content constructs a number of strong messages related to the importance of and positive expectations associated with pursuing appearance ideals, as well as the negative consequences of failing. In this way, media content serves to reinforce the idea that appearance is a core dimension of self-worth and emphasises the ways in which it should be prioritised. A recent analysis of ten popular children’s television series found that attractiveness was associated only with thin characters (Tzoutzou, Bathrellou and Matalas, 2020[27]). Furthermore, a content analysis of children’s animated films released between 2004 and 2016 revealed a high presence of appearance-related content, and an increase in messages regarding the importance of muscularity for men (Harriger et al., 2018[28]).

In addition, in the narratives of digital content, individuals whose appearance is close to appearance ideals are attributed positive characteristics, while those whose appearance diverges from social ideals are attributed negative ones, a phenomenon referred to as the “beautiful is good” stereotype (Rodgers, Campagna and Attawala, 2019[29]). For example, a content analysis of popular children’s videos revealed that, in the vast majority of them (84%), female physical attractiveness was associated with sociability, kindness, happiness, or success (Herbozo et al., 2004[21]). These findings also highlight the gendered nature of appearance messages in children’s media content. Similarly, findings from a content analysis of children’s advertisements found that depictions of girls were more likely to be appearance-related and sexualised (Kim, Ahn and Lee, 2016[30]). Thus, the media constructs gendered appearance ideals that are most constraining for girls and young women and disproportionately tied to self-worth starting from childhood.

In contrast, individuals who do not conform to appearance ideals tend to be associated with negative traits and characteristics in media portrayals (Ata and Thompson, 2010[31]). In this way, for example, heavier characters are depicted as evil, unattractive, unfriendly and cruel (Herbozo et al., 2004[21]). In addition, weight stigmatisation has been shown to occur in high percentages of television programs targeting youth, even more so than programming directed towards the general population (Eisenberg et al., 2014[32]). In this way, the media increases the desirability of unrealistic body shapes and sizes by creating the expectation that achieving such an appearance will result in social rewards and prevent social exclusion or stigma.

Despite increasing media consumption among children, to date, comparatively little research has focused on the impact of exposure to media on body image among children specifically. Among girls, an emerging body of literature supports a relationship between media exposure and poorer body image. Correlationally, media exposure was related to body dissatisfaction among six year-old girls (Dohnt and Tiggemann, 2006[8]). Similarly, exposure to sexualised media content including television and magazines has been shown to be related to self-sexualisation through preferences for sexualised clothing among girls aged six to nine years, which was in turn associated with body dissatisfaction (Slater and Tiggemann, 2016[33]). In addition, evidence from experimental studies using exposure to images of toys has suggested that appearance-ideal promoting dolls may have negative effects on body image among girls (Dittmar, Halliwell and Ive, 2006[34]). Furthermore, among girls aged eight to nine years, playing a digital appearance-focused game for ten minutes was associated with greater body dissatisfaction as compared to playing a non-appearance focused game (Slater et al., 2017[22]). Thus, among young girls a relationship between media use and exposure and poorer body images seems to exist. Data on media consumption and body image among very young boys are overall lacking. However, some longitudinal evidence exists of exposure to video gaming magazines and later preoccupation with muscularity among boys aged eight years on average (Harrison and Bond, 2007[35]).

A larger body of correlational empirical work has focused on clarifying the relationship between media and body image among younger and older female adolescents and supported greater media use being associated with poorer body image (Levine and Murnen, 2009[36]). In addition, however, some longitudinal and experimental research has further confirmed these relationships and supported the role of media exposure as a risk factor for poorer body image. Among adolescent girls, media use, including social media, has been found to predict increases in body dissatisfaction and concerns over time (Schooler, 2008[37]; Tiggemann and Slater, 2016[38]), as well as disordered eating that is often a behavioural consequence of body image concerns (Harrison and Hefner, 2006[39]). These findings have not always been confirmed, however, with some prospective studies failing to reveal a relationship between media use and exposure and body image (Clark and Tiggemann, 2008[40]; Presnell, Bearman and Stice, 2004[41]). In addition to these findings regarding relationships across time, a previous meta-analysis identified a significant effect of exposure to thin-ideal images in experimental studies on body dissatisfaction among female adolescents, that was stronger than the effects identified in young adult women (Groesz, Levine and Murnen, 2001[18]).

Among adolescent boys, research has lagged behind that examining these effects among girls. Nevertheless, correlational research has supported the presence of a cross-sectional relationship between media use and exposure and body image concerns among adolescent boys (Rousseau and Eggermont, 2017[42]), including social media use (Rousseau, Eggermont and Frison, 2017[43]), and sexualising behaviours (Trekels et al., 2018[44]). In addition, although sparse, some longitudinal research has shown evidence that media use and exposure predicted poorer body image over time among adolescent boys. Thus, perceived pressure from the media, particularly as related to muscularity, predicted increases in disordered eating, dysfunctional exercise behaviours, and unhealthy body change behaviours (McCabe and Ricciardelli, 2005[45]). In a large mixed gender sample of adolescents, self-reported consumption of tween media was associated with increases in attributing benefits to attractiveness, in the internalisation of the thin-ideal, and through that, to increases in dysfunctional beliefs related to appearance (Trekels and Eggermont, 2016[46]). Furthermore, these relationships were found to be present among both girls and boys separately.

Despite most of this literature being correlational, and therefore not informing directionality or causality in these relationships, a small number of longitudinal studies, as well as an increasing number of experimental studies in adolescents, and emerging adults, and qualitative studies describing individuals’ perceptions of the role that media plays in body image provide strong evidence for media use as a risk factor, if not formal evidence for causality (Levine and Murnen, 2009[36]).

The variation in findings across studies examining the relationships between media use and body image among children and adolescents, in conjunction with predictions from biopsychosocial theories, have suggested that a number of factors might moderate this relationship. Among these factors, media format, media content, and individual characteristics have been the most frequently considered.

Although most media consumed by contemporary children and adolescents is screen media, it has been suggested that differences may exist across different forms of screen media based in particular on their level of interactivity, as well as the level of perceived proximity and relatability of the individuals depicted. Social media is a highly interactive form of media that includes both user and commercially generated content. Accordingly, it has been proposed that social media might be in some ways more potent in terms of its effects on body image as children and adolescents may be more engaged with it, and experience more difficulty in critically evaluating the content presented as curated and created with intent, even when posted by their peers (Rodgers, 2015[47]). Indeed, although unlike celebrities and influencers, most children and adolescents do not directly benefit from individuals viewing or “liking” the content they post to social media, this content is still posted with some motivation, generally a social one of increasing one’s popularity.

Social media has been shown to contain a high proportion of appearance-related content, including images that might promote appearance comparisons, and are selected and edited with the goal of presenting appearance ideals (McLean, Jarman and Rodgers, 2019[48]). These images are likely to promote appearance comparisons as they may be perceived as portraying appropriate targets for comparison (i.e. individuals who are considered to be part of someone’s “group”) and often make appearance the central focus of the image. In addition, social media encourages children and adolescents to create and share their own self-images. Doing so may engage youth in a process of increasingly evaluating their own appearance against that of their peers, social standards of attractiveness, and even their own unrealistic online self-presentation following the extensive editing of self-images, and thereby increase and sustain body image concerns. In addition, receiving appearance-related feedback and engaging in interactions with others on social media that centre on appearance may contribute to reinforcing the centrality of appearance to identity and self-worth.

Consistent with this, research has shown an association between social media use and body image outcomes among children and adolescents (Holland and Tiggemann, 2016[49]; Saiphoo and Vahedi, 2019[50]). To date, the majority of this research has been cross-sectional, however, a small number of studies have highlighted the likely bidirectional relationships over time between social media use and body image concerns among youth (Tiggemann and Slater, 2016[38]; Rousseau, Eggermont and Frison, 2017[43]). In addition, engagement with social media through the viewing and taking of self-images (selfies) has been shown to be associated with greater body image concerns in youth (See (McLean et al., 2019) for a review).

Media content has also been explored as a moderator of the relationship between media use and body image among children and adolescents that is whether the strength and direction of the relationships with body image might vary depending on the type of content seen, with particular attention paid to appearance-focused media content. Given the omnipresence of appearance ideals in the media, parsing this out in a way that is ecologically valid is challenging. However, correlational studies have approached this question by specifically inquiring about exposure to certain types of media (e.g. magazines, or certain television shows), or engagement with certain social media platforms or activities, and experimental studies have selectively exposed youth to appearance-focus content versus other types of images (e.g. travel images).

Overall, the findings from these studies have supported the idea that appearance-focused media content is most harmful to body image (Holland and Tiggemann, 2016[49]; Levine and Murnen, 2009[36]; Saiphoo and Vahedi, 2019[50]), in particular, for example, active engagement with photo-based activities on social media (e.g. (Mingoia et al., 2019[51])). In addition, the interactive nature of online media includes algorithms that identify user interests with the goal of presenting personalised content (mainly to generate profit). Such processes are likely to expose children and adolescents who engage with appearance-focused content to even more appearance-focused content, thereby further reinforcing existing preoccupations.

As predicted by biopsychosocial theories (Rodgers, Paxton and McLean, 2013[16]), a number of individual characteristics such as gender and age have emerged as moderators of the association between media use and body image. As described above, appearance ideals are gendered with a greater emphasis on thinness for girls and muscularity for boys, with greater pressure upon girls to invest in their appearance. Consistent with this, some work has found stronger relationships among media use and exposure and body image outcomes among girls as compared to boys (Hargreaves and Tiggemann, 2004[52]; Rodgers, Paxton and Chabrol, 2009[53]; McCabe and Ricciardelli, 2003[17]). However, other work, particularly more recent research, has suggested more similarities than differences (e.g. (Trekels and Eggermont, 2017[54]; Vandenbosch and Eggermont, 2016[55])).

Age and developmental period may also be important dimensions to consider as modulators of the relationships between media use and body image. Both of these may affect the relationship between media use and body image, firstly by impacting the perceived pressure from media as well as capacity to critically resist media messages, as well as through physical changes throughout childhood and adolescence that may move individuals closer or further away from appearance ideals. Consistent with this, it has been found for example that younger individuals, such as children and preadolescents, may be most susceptible to the effects of social media on body image (Saiphoo and Vahedi, 2019[50]). Further research into critical developmental periods in terms of media influence on body image is warranted.

In addition, a number of psychological variables such as individuals’ beliefs around appearance and its importance and pre-existing levels of body image concerns have been supported as moderators of the effects of media on body image, such that those with higher existing concerns may be most vulnerable (Want, 2009[56]). While further research is needed, it is likely that the ways in which youth attend to and process media stimuli is also an important vulnerability factor (Rodgers and DuBois, 2016[57]).

While the individual characteristics above are mainly factors that increase susceptibility to media influences, characteristics that may be protective have also been investigated. One that has received particular attention is media literacy, or social media literacy when related specifically to social media (McLean, Paxton and Wertheim, 2016[58]). Media literacy, and social media literacy, refer to the capacity to critically appraise media content in terms of the images themselves, and the messages that they send, bearing in mind who may profit and benefit from the influence of media messages. Although there is not always consistency in the research to date regarding the relationships between different facets of media and social media literacy and body image in youth (McLean, Paxton and Wertheim, 2016[58]; Rodgers, McLean and Paxton, 2018[59]), intervention programs that aim to increase media literacy (McLean, Paxton and Wertheim, 2016[58]) and social media literacy have been developed and show initial promise (Gordon et al., 2020[60]; McLean et al., 2017[61]).

The conceptual frameworks used to guide the investigation of the effects of media use on body image among children and adolescents describe theoretical pathways and mechanisms for these effects. These mechanisms have been empirically explored and received support to some extent, thus increasing our understanding of how and why media use impacts body image.

Briefly, sociocultural theory describes how the appearance ideals and associated positive expectations set up by media images and messages lead individuals to adopt them as their own personal standards (appearance ideal internalisation), and engage in appearance comparisons that, due to being largely unfavourable, result in body dissatisfaction (Keery, Van den Berg and Thompson, 2004[62]). The roles of appearance ideal internalisation and appearance comparisons as mediators of the relationships among media use and exposure and body image among children and adolescents have been supported in cross-sectional research (Keery, Van den Berg and Thompson, 2004[62]; Knauss, Paxton and Alsaker, 2008[63]), but also increasingly in longitudinal and experimental research (Hargreaves and Tiggemann, 2004[52]; Rodgers, McLean and Paxton, 2015[64]).

Importantly, media influences exist within a broader sociocultural context that includes the interpersonal environment of children and adolescents. Peers and parents have been described as capable of relaying and amplifying media messages, or, in contrast, buffering them (Nathanson and Botta, 2003[65]). In this way, for example, peer conversations and internalisation of media messages have been shown to mutually reinforce each other over time, and serve as mediators of the relationship between exposure to tween television and body image outcomes (Rousseau and Eggermont, 2017[42]). Similarly, among adolescent boys the effects of tween television exposure on body image related variables has been found to be strongest among those whose parents most strongly reinforced stereotypical gender norms (Rousseau, Rodgers and Eggermont, 2018[66]).

Objectification theory holds that exposure to sexualised and objectified bodies in the media leads individuals to adopt an externalised evaluative viewpoint of their bodies, termed self-objectification, that in turn is associated with body image concerns (Fredrickson and Roberts, 1997[19]). Consistent with this, research has found support for the association between media exposure and self-objectification both cross-sectionally (Vandenbosch et al., 2015[67]), and over time (Vandenbosch and Eggermont, 2016[55]). Therefore, the harmful nature of sexualised image on body image among children and adolescents is supported, and objectification is a useful framework for additional future work.

In conclusion, media use in children may be related to body image both through exposure to unrealistic appearance ideals with associated expectations, as well as the sexualisation of individuals in media. Social media is increasingly used by youth, and has been shown to be linked to body image through similar pathways, although other ones may exist that are less well described due to the unique features of social media such as its interactivity. Importantly, these relationships may be qualified by the individual characteristics of children, the media content and format. Given these documented relationships, the dissemination of programmes that have been shown to help protect youth from the effects of media is important (Richardson and Paxton, 2009[68]), at the same time as advocating for change in media content, particularly content targeted to youth (Bell, Rodgers and Paxton, 2017[69]).

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