FINAL.pdf. 8. Griffiths S, Hay P, Mitchinson D, Mond J,. McLean S, Rodgers B, et al. Sex differences in the relationships between body dissatisfaction, quality.
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1.At the Mental Health Foundation, we are all about public health and prevention. We focus on bringing evidence into action that makes a real impact on people™s lives. This year™s theme for Mental Health Awareness Week is body image. It is a subject that has a direct relevance to all of us. We are all learning to live with the wonders and limitations of our bodies as they change through life. No piece of technology that we will ever buy will match the complexity, sophistication and regenerative powers of our bodies. And yet, for too many of us, our bodies are sources of shame and distress. Last year, our survey of respondents who had experienced high levels of stress revealed that 47% of 18-24-year-olds, 36% of all women, and almost one in ˜ve people (18%) aged 55+ had experienced stress over their body image to the extent of being overwhelmed and unable to cope in the last year. It was clearly an issue that needed more attention. This year™s report builds on the latest published research with one of the largest surveys ever completed to capture how we feel about our bodies. The report sets out the individual, family and cultural in˚uences that are coming together to mean that we often have a gnawing and debilitating sense of dissatisfaction with our own bodies. We also identify the heightened risks of mental health problems that too often accompany poor body image. There is a long tradition of Western philosophers who have shaped how we think about our bodies as di˛erent and separate from our mind. But the evidence has led us to question this form of dualism and instead embrace a holistic understanding about the inter-relatedness of our bodies and minds. This is vital to achieve a healthier population. And we are now clear that cultures that are focused on materialism, consumption and celebrity lifestyles fare worse both in terms of people™s body image and mental health. So, we make the case that the distress related to poor body image and the related mental health problems can be prevented. This report is clear that changes to culture, parenting styles, schooling approaches, use of technology, advertising standards and how we address discrimination will make a real di˛erence. We are not publishing this report simply for information. We are calling for action across all levels of society, which, if heeded, will help us to be kinder to our bodies and healthier in our minds. Mark Rowland, Chief Executive Mental Health Foundation FOREW ORD
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2.‚Body image™ is a term that can be used to describe how we think and feel about our bodies. Our thoughts and feelings about our bodies can impact us throughout our lives, a˛ecting, more generally, the way we feel about ourselves and our mental health and wellbeing. Having body image concerns is a relatively common experience and is not a mental health problem in and of itself; however, it can be a risk factor for mental health problems. Research has found that higher body dissatisfaction is associated with a poorer quality of life, psychological distress and the risk of unhealthy eating behaviours and eating disorders. Conversely, body satisfaction and appreciation has been linked to better overall wellbeing and fewer unhealthy dieting behaviours. Though feeling unsatis˜ed with our bodies and appearance is often more common among young women, body image concerns are relevant from childhood through to later life and a˛ect both women and men. The way in which our experiences and environment a˛ect our body image will be di˛erent for everyone. However, overall, the research suggests that body image can be in˚uenced by our relationships with our family and friends; how our family and peers feel and speak about bodies and appearance; exposure to images of idealised or unrealistic bodies through media or social media; and pressure to look a certain way or to match an ‚ideal™ body type. There are further issues relevant to body image and mental health that are speci˜c to certain factors and experiences, such as long- term health conditions, cultural di˛erences around body ideals, and gender and sexuality, which are often linked to other societal factors and discrimination. 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: BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES EXECUTIVE SUMMARY 20%Felt shame 34%Felt down or low 19%Felt disgusted One in ˜ve 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. ADULTS
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3.Clearly action is needed to build and promote positive body image and support good mental health and wellbeing in relation to our bodies. Everyone has a right to feel comfortable and con˜dent in their own bodies and our report highlights key recommendations for: EXECUTIVE SUMMARY 37%Felt upset Among teenagers, 37% felt upset, and 31% felt ashamed in relation to their body image 34%Felt anxious 35%Felt depressed 13%Experienced suicidal thoughts or feelings 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. Just over one in ˜ve adults (21%) said images used in advertising had caused them to worry about their body image. NEW!Just over one in ˜ve adults (22%) and 40% of teenagers said images on social media caused them to worry about their body image. E˚ective regulation of how body image is portrayed. The need for commitment from social media companies to play a key role in promoting body kindness. Taking a public health approach to body image by training frontline health and education sta˚. Individually being more aware of how we can take care of ourselves and others in relation to body image. 31%Felt ashamed TEENAGERS ADULTS ADVERTISING SOCIAL MEDIA
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4.BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES E˚ective regulation of how body image is portrayed Industry responsibility to promote body kindness 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 Œ such as cosmetic surgery companies and weight-loss products and services Œ to ensure all advertising abides by its codes. It should also make greater use of its ability to proactively instigate investigations. 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 F REC MMEN- DATI NS
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6.‚Body image™ is a term that can be used to describe how we think and feel about our bodies. Because these thoughts and feelings can be complex, approaches to de˜ne and understand body image are varied and can include: how we view our bodies and how accurate this perception is; how satis˜ed we are with our bodies and appearance; how we experience our bodies in our environment; how much we value what other people think about our bodies and appearance; and how much other people™s opinions about our appearance a˛ect our feelings about ourselves (1Œ4). Often, when we talk about ‚poor body image™, we are referring to a feeling of being unsatis˜ed with our body Œ either because of appearance, or the way it functions. This is described as ‚body dissatisfaction™. In contrast, positive body image can be described as being satis˜ed with our body, holding respect, appreciation and acceptance of its abilities, and having a healthy balance between valuing our body and valuing the other aspects of ourselves that make us ‚us™ (2,3,5). Feeling unhappy with our appearance is a relatively common experience. The Mental Health Foundation conducted a survey with YouGov in March 2019 of 4,505 UK adults. Our survey found that while 21% of adults felt ‚satis˜ed™ because of their body image, in the past year, one in ˜ve people (20%) have felt ‚shame™ and just over one third (34%) have felt ‚down or low™ in the past year because of their body image. Our survey suggests higher numbers compared to the 2013 British Social Attitudes Survey, where one in twenty men and one in ten women reported being dissatis˜ed with their appearance (6). Body image and appreciation is relevant across our lives from youth through to later life. The proportion of women in the British Social Attitudes Survey saying they were satisfied with their appearance was similar among those aged 18Œ34 and those over 65 (6). This was similar in our survey, where 30% of adults aged 18Œ24 reported feeling ‚satisfied™ because of their body image in the last year, compared to 24% of adults aged 55+. While women and girls are often more likely to report being unsatis˜ed with their bodies, men and boys are also a˛ected by body image concerns. A survey in 2016 found that 10% of secondary school boys have said they skipped a meal to change how they look and 10% would consider taking steroids to achieve their goals (7). INTR ODUCTI ONBODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES What is body image? How comfortable are we with our bodies?
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7.Having body image concerns is not a mental health problem in and of itself; however, it can be a risk factor for mental health problems. Research has found that higher body dissatisfaction is associated with a poorer quality of life and psychological distress (8), a higher likelihood of depression symptoms (9,10) and the risk of unhealthy eating behaviours and eating disorders (10,11). Conversely, body satisfaction and appreciation have been linked to better overall wellbeing (12) and fewer unhealthy dieting behaviours (5,13). This is re˚ected in our survey, where just over one third of adults said they felt anxious (34%) or depressed (35%) because of their body image, and just over one in eight (13%) experienced suicidal thoughts or feelings because of concerns about their body image. In a second new survey conducted by the Mental Health Foundation with YouGov in March 2019 of 1,118 GB teenagers aged 13Œ 19, 40% felt worried, 37% felt upset, and 31% felt ashamed in relation to their body image. Body image is closely linked to mental health problems such as body dysmorphic disorder (BDD) and eating disorders like anorexia and bulimia. BDD is a mental health problem where a person spends a lot of time worrying about ˚aws in their appearance that are often unnoticeable to others, to the point that it a˛ects their daily life (14). Poor body image is both a risk factor for, and part of the diagnostic criteria of, these conditions (11). There is extensive research on the role body image plays in eating disorders, and body dysmorphia, and the ways in which these conditions can best be treated and prevented. In the current report, we focus on body image concerns in general, rather than speci˜cally in relation to eating disorders or BDD. A review of the literature on eating disorders or BDD treatment is therefore beyond the scope of this report, but resources for further reading in this area can be found on the NHS information pages for body dysmorphic disorder and eating disorders, as well as from voluntary organisations such as Beat, Anorexia & Bulimia Care and YoungMinds. More information on the recommended guidance for treatment of eating disorders and body dysmorphic disorder can be found in the National Institute for Health and Care Excellence (NICE) guidelines. It is important to note that body image research often looks at the characteristics of a group of people at a single point in time. This can make it hard to be sure which factors cause either poor body image or common mental health problems. For example, feeling dissatis˜ed with your body may cause you to feel depressed, or it may be that you are more likely to feel dissatis˜ed with your body if you are already experiencing depression. The research that does look at these changes over time As a society, we tend to place a great deal of importance on our appearance. Nearly half of adults (47%) in the British Social Attitudes Survey felt that ‚how you look a˛ects what you can achieve in life™ and nearly one third (32%) felt that ‚your value as a person depends on how you look™ (6). Therefore, how we think and feel about our bodies is something that can a˛ect us throughout our lives and has far-reaching implications for our feelings about ourselves, and on our mental health and wellbeing. INTRODUCTION How does body image link to mental health?
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8.suggests it may be a combination of the two, and that sometimes body dissatisfaction may predict or otherwise a˛ect the development of depression or anxiety symptoms (15,16) and in other contexts, symptoms may predict body dissatisfaction (15,17). BODY IMAGE: HOW WE THINK AND FEEL ABOUT OUR BODIES The way in which our experiences and environment a˛ect our body image will be di˛erent for everyone. Overall, however, the research suggests that body image may be in˚uenced by our relationships with our family and friends (18); how our family and peers feel and speak about bodies and appearance (19); exposure to images of ‚idealised™ or unrealistic bodies through the media or social media (1,20,21); and pressure to look a certain way or to match an ‚ideal™ body type (21). Valuing and holding oneself against an unrealistic, ‚ideal™ body type is often referred to in the research as ‚internalisation of the ideal™ and is commonly linked to the development of poor body image through feelings of shame or distress when this ideal is not met (21). What this ideal looks like will shift across cultures and can vary between genders. In Western cultures, it is common for the ‚ideal™ for women to be thin body shapes, but with maintained curves (referred to as the ‚thin ideal™), while for men the ‚ideals™ are being taller and having a muscular body shape. From a therapeutic perspective, ‚internalisation of the ideal™ can be understood as part of a process of internalising a shamed body image. Shame is an emotion that we are all born with the capacity to feel, and which, in its healthy form, can be adaptive, as it prompts us to attend to ruptures in our relationships with others by making amends and repairing interpersonal connections. In contrast, unhealthy shame is the feeling of being apart or isolated from others due to a sense of being inadequate, defective or not good enough (22). Body shame can become internalised and unhealthy when we experience consistent shaming messages about our bodies either directly (through criticism, teasing or bullying) or more indirectly (by being excluded or avoided, or consistently exposed to non- thoughtful language or unrealistic images of ‚ideal bodies™). Once internalised, this sense of shame operates regardless of how our bodies actually look or function. All of this suggests that body image is a complex, and often very personal, experience. Its relationship to mental health is an important one, in˚uenced by many aspects of our environment that shift and change across our lives. What a˚ects body image?
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9.While exact estimates vary, depending on how body image is measured, concern and worries about appearance are commonplace among young people. One survey of 11Œ16-year-olds in the UK by Be Real found that 79% said how they look is important to them, and over half (52%) often worry about how they look (23). In our survey of young people aged 13Œ19, 35% said their body image causes them to ‚often™ or ‚always™ worry. While body image concerns a˛ect both boys and girls, there is research to suggest that girls are more likely to be dissatis˜ed with their appearance and their weight than boys (24,25). In our survey, 46% of girls reported that their body image causes them to worry ‚often™ or ‚always™ compared to 25% of boys. Body image concerns can also a˛ect very young children. One review found studies identifying body dissatisfaction in children under the age of six, though estimates of the degree of dissatisfaction varied widely depending on how it was measured (26). Young people also tell us that body image is a substantial concern, with 16Œ25-year-olds identifying it as the third biggest challenge currently causing harm to young people, with lack of employment opportunities and failure to succeed within the education system being the ˜rst two (27). In young people, body dissatisfaction has been linked to risk-taking behaviours and mental health problems. One survey of UK adolescents by Be Real found that 36% agreed they would do ‚whatever it took™ to look good, with 57% saying they had considered going on a diet, and 10% saying they had considered cosmetic surgery (23). Among secondary school boys, 10% said they would consider taking steroids to achieve their goals (7). Poor body image may also prevent young people from engaging in healthy behaviours, with some studies ˜nding that children with poorer body image are less likely to take part in physical activity (5,28) and survey data from Be Real ˜nding that 36% of girls and 24% of boys report avoiding taking part in activities BDY IMAGE IN CHILDH DHow does body image a˚ect children and young people? How comfortable are children and young people with their bodies? BODY IMAGE IN CHILDHOOD
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