Body Image – What we already know


BODY IMAGE

 Summary

Many people in Scotland, and around the world, are dissatisfied with their appearance; however, women generally have higher levels of body dissatisfaction than men. This negative body image is important because it is a direct threat to mental and physical wellbeing and can lead to a number of negative behaviours, including unhealthy physical activity and disordered eating.

The underpinnings determining why this gender disparity exists are complex, however they revolve, primarily, around a core theme of sociocultural expectations and pressure.

From a very young age girls are bombarded with images and videos of other women and girls with specific body shapes as Western culture tends to equate thinness and particular body dimensions with attractiveness, power and success. In adolescence girls bodies start to physically mature, often with increased deposition of body fat in areas which are not consistent with these cultural body shape norms. This, coupled with physical appearance-based bullying that often accompanies this stage of life, helps initiate body image issues which may continue well into adulthood for many women.

While there is some evidence of racial differences in perceptions of bodily attractiveness, the majority of the available data suggests that thin-ideal and body shape messaging, prevalent in the media, has a significant impact on women’s body image regardless of their ethnicity, background or sexual orientation.

Body image issues that women face are often exacerbated by a particularly unequal presentation in the media and pressures at home from friends and family. Women are both underrepresented and over-sexualised in television and print media. On top of this traditional gender roles teach women to place more importance on outward appearance leading many to self-objectify and attempt to conform to societal beauty norms.

These Western cultural beauty norms and their relationship to negative body image have been studied for decades, however, there is increasing evidence to suggest that social media, although distinct in design and nature, is strongly associated as well. Most young people in Scotland use social media regularly with young women accessing social media networks more often than men. Through this medium women and girls are subjected not only to traditional beauty norms via advertisements and other traditional media sources, but also to physical appearance comparisons with their peers. Many girls use applications and filters to alter their appearance before posting photographs so that they might better fit within these narrowly defined beauty parameters and, unfortunately, this can contribute to the perpetuation of these norms as ‘acceptable’ for themselves and others.

The representations of thin, attractive people in the media and the pressure that many people feel to meet these often unattainable standards has given rise, particularly in social media, to appearance-based trends such as ‘Thinspiration’ and ‘Fitspiration’. These trends encourage and promote bodily thinness and muscularity through unhealthy eating habits (including eating disorders such as anorexia) and physical exercise regimens. They demonise body fat and weight gain and often portray images of extremely thin women in sexually suggestive poses, further emphasising the importance of appearance. Exposure to both ‘Thinspiration’ and ‘Fitspiration’ messages has been shown to decrease body satisfaction, lower self-esteem and exacerbate eating disorder symptoms amongst women.

Media portrayed representations of female nudity are also of particular concern as, while common, they are often inaccurate and misleading in their portrayal of the true variety of genitals in terms of size, shape and appearance. This has led some women to seek to alter the appearance of their genitals through surgery called labiaplasty. There is some evidence to suggest that labiaplasty can improve initial self-perceived genital appearance and sexual satisfaction among adults, but there is worrying evidence about the rise of labiaplasty surgery amongst adolescents, with girls as young as nine seeking it. In response, the British Society for Paediatric and Adolescent Gynaecology released a statement positing that labiaplasty does not address the root factors giving rise to distress around genital appearance, and there is no credible evidence to suggest lasting effectiveness along physical, psychological or sexual parameters.

As a result of the dominant appearance-focused messages in traditional and social media and the detrimental impacts they have, the Body Positivity movement has risen to prominence in recent years. Body Positivity promotes fat acceptance and increased visibility and normalisation of otherwise underrepresented bodies. It has gained significant momentum on social media platforms and led to improved body image for many people, however there are signs that some Body Positivity influencers have been co-opted to promote commercial products and capitalise off their influence. Some influencers have even been promoting harmful beauty modification practices thereby deviating from the initial message. Women of colour, women with disabilities and transwomen have also been pushed from the spotlight as more ‘conventional’ beauty standards have taken root and, as a result, a new idea called Body Neutrality, has begun to circulate. This idea suggests that for people who find loving and/or promoting their bodies too difficult, feeling neutral about them instead can, at the very least, remove anxiety and pressure, and promote a healthier body image.

Providing women with a greater diversity of appearances in media and advertising and focusing on positive, non-appearance based qualities improves body image at a macro level. Positive body image through acceptance, or at the very least neutrality, is related to greater emotional, psychological, physical and social wellbeing and should be fostered as much as possible.

Contents

1. Introduction

2. Representation and Expectations of Women

3. Adolescence, Bullying and Harassment 

4. Social Media

5. Thinspiration and Fitspiration

6. Labiaplasty

7. Body Positivity

8. Moving Forward

1. Introduction

This paper offers an overview of the current evidence about body image in Scotland and the UK, from a gendered perspective. Where direct information from Scotland or the UK was unavailable data have been drawn from international evidence.

Body image is how we think and feel about our body and having a good body image requires acceptance of how our body looks and acknowledgement that we are more than what we look like. Conversely, thinking negatively about one’s body can be a great source of unhappiness and anxiety. Throughout history the standard of female beauty has often been unrealistic and difficult to attain, with women often required to sacrifice comfort or endure pain in order to meet societal beauty norms. While there has been significant progress in recent years in combatting these unrealistic norms and standards, there is a large body of evidence to suggest that exposure to culturally-based beauty ideals in the media continue to be associated with body dissatisfaction, weight concern, thin-ideal internalisation, disordered eating behaviours and mental health strain in women and lie at the root of violence against women and girls[1],[2],[3],[4],[5],[6].

At the request of the Scottish Government, the Advisory Group on Good Body Image was established in August 2019 following the publication of the Scottish Government’s Children and Young People’s Mental Health Team report Exploring the reported worsening of mental wellbeing among adolescent girls in Scotland. The Advisory Group published a report in March 2020 detailing recommendations for Scottish Government to make in order to support the development of good body image and bring about positive lasting change.

2. Representation and Expectations of Women

It is clear that women are not treated equally to men in the media, facing both underrepresentation and over-sexualisation. There is very little Scottish-specific research and data on women and the media but what information is available aligns with international evidence on the topic[7]. Appearance dissatisfaction has become a normal part of many women’s lives due, in large part, to societal norms highlighting the importance of certain appearance criteria perpetuated, historically, by traditional media sources and, currently, by both traditional and social media[8]. In some cases this dissatisfaction starts at an alarmingly young age, with girls as young as eight having been shown to have higher body dissatisfaction scores when exposed to media messages around cultural ideals of thinness[9].

A meta-analysis, combining the results of multiple scientific studies examining the impact of exposure to media images of thin women on body image found that viewing thin models, as opposed to average-sized or overweight models, consistently led to decreases in body satisfaction in women[10]. While there is comparatively little research looking at the racial differences in perceived body image there is some evidence to suggest that different ethnic groups place greater emphasis on different aspects of the body and, as a result, have different body ideals[11],[12]. This can be limiting with regards to fully understanding body image across the population as concerns around body image may not always fall into the generally accepted categories of body weight and shape; for example some women may have concerns around skin tone, hair texture or size and shape of facial features[13],[14],[15]. However, in general, studies have shown that there are more similarities than differences with regards to body image and body satisfaction across different ethnic groups with body weight and proportions found to be the strongest predictor of negative body image, regardless of identity[16],[17].

There is little data surrounding sexual orientation and body image, however, there is some research to suggest that lesbian women have similar levels of concern around thin-ideal body image as heterosexual women, caused by the same stimuli[18],[19].

Another particularly damaging representation of women commonly portrayed in the media is chronic sexual objectification. Women are often exposed to sexual objectification from an early age, stemming from traditional gender roles, often perpetuated by friends and family, which teach women and girls to self-objectify and place more importance on outward appearance rather than inner qualities[20]. This self-objectification, in which women and girls view their own bodies as objects to be looked at, causes many to strive to conform to unrealistic or unattainable physical attractiveness ideals. Internalisation of these societal beauty norms and the behaviours required to attain them can severely negatively impact on body image and lead to unhealthy behaviour and disordered eating[21],[22].

3. Adolescence, Bullying and Harassment

A number of studies have shown that negative body image and body dissatisfaction tends to increase with the onset of adolescence and is considered a widespread phenomenon among young women[23],[24],[25]. Adolescence has been shown to be a pivotal stage in the development of positive or negative body image and many influences exist during this time that affect its status. Particularly salient influences are the societal pressures associated with western culture where thinness and particular body shapes are often equated with attractiveness, power and success amongst women[26]. These cultural body shape norms are often perpetuated by the media, helping shape beliefs about perceived body ideals and leading to internalization of thin-idealised female beauty as the standard to aim for. Physical maturation associated with puberty in girls, characterised by the increased deposition of body fat which is not necessarily consistent with the socially valued physical appearance, may help explain dissatisfaction with physical appearance[27], however another key factor determining body image perception amongst adolescent girls is peer bullying and harassment.

Peer bullying is often focused on physical appearance and this is particularly common amongst adolescent girls[28],[29]. A third of girls in the UK report experiencing bullying frequently both online and offline with almost half of all bullying being about appearance[30]. This type of bullying has a significant effect on perceived body image, shame surrounding negative body image and disordered eating, with a marked increase as time goes on[31]

4. Social Media

The relationship between gender, race, class and media construction of idealised forms of male and female bodies, as well as the internal psychological factors that mediate these connections, are complex[32],[33]. There has been decades of research documenting the negative impact that traditional media has on body image[34],[35],[36] however, due to its relatively novel nature, there is a smaller but growing body of evidence surrounding social media. Much of the research is correlational, meaning that it is not possible to prove that social media use leads to poor body image rather than people who have poor body image tending to use social media, however the evidence available indicates that overall time spent on social media is strongly associated with body image issues and disordered eating[37],[38].

There are a number of unique aspects of social media that differentiate it from traditional media with regards to individual wellbeing and body image perceptions. Social media features the users themselves (as opposed to models and celebrities used in traditional media) and allows the users to present themselves as they wish to be seen. Social media is also based, primarily, around interactions with friends, family and peers. This means that social networking websites have the potential to improve subjective well‐being through the increase of social capital and feeling of connectedness with friends and family as well as networks of like-minded people[39]. For example, a third of girls aged 11-16 responding to the Girlguiding survey on girls’ attitudes in the UK reported that using social media makes them feel happy[40]. Social media also allows for a more democratic, user-controlled/influenced approach to content generation compared to traditional media outlets, and this has allowed for more diverse depictions of beauty[41].

Social media can also, however, be a significant cause of distress and elicit social comparisons and envy[42]. Research has shown that appearance comparisons made through the use of social media have a strong correlation with negative body image[43]. Extended exposure to social media has also been found to be associated with a variety of mental health problems including emotional disorders such as depression, anxiety, sleep disturbance and obsessive compulsive symptoms, some of which tie in directly with self-perceived body image[44]. There is also a widely accepted and studied sociocultural theory suggesting that social media, similar to traditional media, transmits sociocultural influences in the form of beauty ideals for women, particularly through photo and video content, with demonstrated links to body dissatisfaction and disordered eating among adolescents and young adults[45],[46],[47],[48],[49]. There are far fewer studies looking at the effects of social media on body image amongst older adults[50] however, there is some evidence to suggest that older women are judged in relation to an ideal of female beauty that emphasises youthfulness and thinness[51] and exposure to traditional media depictions of women who have bodies that are the shapes and sizes of younger women is associated with negative body image and disordered eating[52].

In Scotland there is evidence to suggest that adolescents’ mental wellbeing has worsened in recent years, particularly amongst adolescent girls who reported poorer mental wellbeing than boys of a similar age across a range of indicators[53]. This could be due to recent trends in mobile technology and social media use, which has increased significantly across the population in the last decade but particularly amongst the young. Across the UK, girls aged 10-15 were twice as likely as boys to report spending more than 3 hours on social networking sites on a normal school day. Twice as many girls as boys in the same age range also reported being unhappy with their appearance[54]. According to the latest Girl Guiding survey on girls’ attitudes in the UK almost half of girls from 11-16 reported feeling pressure to check their mobile phone as soon as they wake up and before they go to sleep every day[55].

Social media interaction among 10-15 year olds in the UK has been found to be related to lower satisfaction with physical appearance and all five of the most commonly used social media platforms (YouTube, Snapchat, Facebook, Instagram and Twitter) have a negative net result impact on body image. On top of this a third of girls and young women reported that they will not post images of themselves without using a filter or app to change their appearance[56],[57].

5. Thinspiration and Fitspiration

Social media is also a growing source of fitness and diet-related information often aimed directly at people who are unhappy with their body image. At the forefront of this are the appearance-based trends known as ‘Thinspiration’ and ‘Fitspiration’[58].

Thinspiration refers to image-based social media content containing inspirational messages that idealise and promote bodily thinness by providing tips on how to lose weight. Fitspiration emerged a few years after Thinspiration with a similar structure and a focus not just on bodily thinness but on overtly fit bodies (i.e. thin bodies with visible muscularity)[59],[60].

Thinspiration is often found on pro-eating disorder (‘pro-ana’) websites dedicated to promoting eating disorders as a lifestyle choice and offering advice to individuals with anorexia nervosa[61]. Thinspiration content often features images of extremely thin or underweight women, often in sexually suggestive poses. Message themes often revolve around the demonization of body fat and weight gain as well as harmful strategies for weight loss[62],[63],[64]. While it was initially more prominent on social media platforms, many have now banned all Thinspiration content[65].

By comparison Fitspiration is a much more widely promulgated trend offered across a range of websites. Fitspiration has been positioned as a healthy alternative to Thinspiration because it promotes health and fitness rather than thinness and weight loss, however research has demonstrated that it consists of similar guilt-inducing messages stigmatising fat, promoting unhealthy dieting and typically portraying thin women wearing little clothing in sexually objectifying positions[66].

Exposure to both Thinspiration and Fitspiration has been shown to decrease body satisfaction, lower self-esteem and exacerbate eating disorder symptoms[67],[68],[69].

6. Labiaplasty

Although representations of female nudity are common in mainstream media, detailed and accurate representations of female genitals are rare. Female genitalia vary hugely in terms of size and shape and yet many women with no underlying condition affecting their genital development seek surgery to alter the appearance of their genitals. This surgery is known as labiaplasty. The exact reasons for such requests are far from understood but implicit is a belief that their genitals are not normal and that surgery will allow them to achieve some level of normality, thereby improving personal wellbeing and/or sexual relationships[70]. While there is some evidence to suggest that labiaplasty can improve initial self-perceived genital appearance and sexual satisfaction among adults, it is hard to make definitive claims and there is limited evidence on the prevalence of potential side effects, both physical and psychological[71].

The prevalence of labiaplasty is increasing globally with a fivefold increase in the UK from 2000 to 2010 just within the NHS[72]; the number carried out in the private sector is likely to be much higher[73]. There is evidence that girls as young as nine have sought surgery on their genitals in the UK and in 2015-16 more than 200 girls under 18 had received labiaplasty on the NHS[74]. The British Society for Paediatric and Adolescent Gynaecology released a statement in 2013 amid growing concerns over labiaplasty being performed on girls under 18. The statement posits that surgery does not address the social and economic factors giving rise to distress around vulval appearance and that there is no credible evidence to suggest lasting effectiveness along physical, psychological or sexual parameters. The Royal College of Obstetricians and Gynaecologists has said that the operation should not be performed until a girl has finished developing physically, after the age of 18[75].

7. Body Positivity

In response to dominant appearance-ideal messages in traditional and social media, Body Positivity, a movement involving the rejection of unattainable and narrowly-defined beauty ideals, has gained momentum in recent years. Body Positivity encourages individuals to challenge mainstream societal messages regarding beauty and accept more diverse body sizes and appearances as attractive[76].

The Body Positivity movement can trace its initial roots back to the first wave of feminism in the 1850s to the 1890s and the Victorian Dress Reform Movement, aiming to put an end to the trend of women having to modify their bodies through the use of corsets and tight-lacing in order to meet societal beauty standards. In the 1960s a new feminist-grounded movement grew in the United States in reaction to anti-fat discourse with the goal of combatting fat-shaming and the belief that being fat was indicative of being unhealthy[77]. It was also this period in which the movement we see today stemmed. The fat acceptance movement aimed to increase debate and discourse around societal assumptions regarding body image and challenge the prevailing thin-ideal messaging in the media[78],[79]. In recent years the Body Positivity movement has been reignited by women of colour through blogging and posting images of plus-size bikini models; these posts were picked up by feminist websites in the UK and the movement spread[80]. Since then Body Positivity posts have become more common on photo-based social media and networking sites, particularly Instagram where, as of September 2020, the hashtags #bodypositive and #bodypositivity elicited over 7 million and 2 million posts respectively. The hashtags accompany a variety of imagery intended to increase the visibility and normalisation of otherwise underrepresented bodies in traditional media and share journeys of Instagram users from body hatred/disordered eating to body acceptance and appreciation[81].

As the popularity of body positivity messages has grown, there have also been some worrying trends. Some influencers (individuals with a large following on social media sites who have the ability to reach and influence a large audience) have started to use their influence and status to promote commercial products, capitalising off the movement. This commodification of body positivity has, in some cases, led influencers to promote weight loss and body-thinness achieving products, objectifying their own bodies and accepting harmful beauty modification practices, thereby deviating from the initial message[82]. Women of colour, women with disabilities and transwomen have also been pushed from the spotlight by more conventional beauty ideals and many feel that the movement has been co-opted. As a result a new idea that has begun to circulate, known as Body Neutrality, posits that, for those who find loving their bodies too difficult, they should instead seek to find peace with them. By allowing those with disabilities and otherwise unconventional body types to feel neutral about their bodies instead of overtly positive or negative, it can remove anxiety and pressure[83].

8. Moving Forward

Improving body image can be a difficult and lengthy task, combatting years of internalised appearance-focused messaging from the media as well as social pressure from friends, family and peers. It is, nonetheless, essential as recent literature has shown that increasing positive body image through acceptance and appreciation is related to greater emotional, psychological and social wellbeing, as well as physical health outcomes through healthier eating patterns among adolescent and adult women[84],[85],[86].

It is important to note that the body of evidence is continually growing and there is still much we do not know, however, recent evidence has shown that providing women with a greater diversity of appearances in media and advertising as well as focusing on positive, non-appearance focused qualities is a particularly successful way of promoting positive body image at a macro-level[87]. Focusing more on the functionality of our bodies and the positive things it can do for us, rather than its limitations, can help reduce anxiety and promote body acceptance and overall wellbeing[88]. Similarly, moving away from thin-ideal messaging and the sexual objectification of women will help to remove some of the internal and external pressures, that many women feel, to conform to the social norms surrounding body image.

Healthy exercise and healthy eating with the aim to improve psychological wellbeing, rather than as a route to build muscles or lose weight, may also help improve body image as it removes the appearance-based focus and shifts it to overall wellbeing[89]. This is in stark contrast to social media-based fitness trends such as Fitspiration and Thinspiration which do far more harm than good, further spreading thin-ideal and sexual objectification messaging[90].

Other key external factors that may prevent negative body image include the role that family and peers play. Improving relationships with friends and family as well as engaging in diverse social situations more often has been shown to prevent negative body image and improve body satisfaction[91],[92].

 

References

For the full list of references and a downloadable PDF please follow this link.

[1] Frederick, David A., et al. “Exposure to thin-ideal media affect most, but not all, women: Results from the Perceived Effects of Media Exposure Scale and open-ended responses.” Body image 23 (2017): 188-205.

[2] Tiggemann, Marika, and Janet Polivy. “Upward and downward: Social comparison processing of thin idealized media images.” Psychology of Women Quarterly 34.3 (2010): 356-364.

[3] Grabe, Shelly, L. Monique Ward, and Janet Shibley Hyde. “The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies.” Psychological bulletin 134.3 (2008): 460.

[4] Groesz, Lisa M., Michael P. Levine, and Sarah K. Murnen. “The effect of experimental presentation of thin media images on body satisfaction: A meta‐analytic review.” International Journal of eating disorders 31.1 (2002): 1-16.

[5] Bell, B. T., & Dittmar, H. (2011). Does media type matter? The role of identification in adolescent girls’ media consumption and the impact of different thin-ideal media on body image. Sex Roles, 65, 478–490. doi:10.1007/s11199-011-9964-x.

[6] https://www.gov.scot/publications/equally-safe-scotlands-strategy-prevent-eradicate-violence-against-women-girls/

[7] https://onescotland.org/nacwg-news/case-study-gender-equal-media-scotland/

[8] https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2018/04/equally-safe-scotlands-strategy-prevent-eradicate-violence-against-women-girls/documents/00534791-pdf/00534791-pdf/govscot%3Adocument/00534791.pdf?forceDownload=true

[9] Micali, Nadia, et al. “Adolescent eating disorder behaviours and cognitions: gender-specific effects of child, maternal and family risk factors.” The British Journal of Psychiatry 207.4 (2015): 320-327.

[10] L. M. Groesz, M. P. Levine, and S. K. Murnen, “The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review,” International Journal of Eating Disorders 31 (2002): 1–16.

[11] Roberts A, Cash TF, Feingold A, Johnson BT. Are black-white differences in females’ body dissatisfaction decreasing? A meta-analytic review. J Consult Clin Psychol. 2006 Dec;74(6):1121–31.

[12] Swami V, Frederick DA, Aavik T, Alcalay L, Allik J, Anderson D, et al. The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the international body project I. Personal Soc Psychol Bull. 2010 Mar 23;36(3):309–25

[13] Frederick DA, Forbes GB, Grigorian KE, Jarcho JM. The UCLA body project I: Gender and ethnic differences in self-objectification and body satisfaction among 2,206 undergraduates. Sex Roles. 2007 Aug 21;57(5–6):317–27.

[14] Holmqvist K, Frisén A. Body dissatisfaction across cultures: Findings and research problems. European Eating Disorders Review. 2010;18(1):133–46

[15] Grabe S, Hyde JS. Ethnicity and body dissatisfaction among women in the United States: A meta-analysis. Psychol Bull. 2006 Jul;132(4):622–40

[16] Xanthopoulos, M., Borradaile, K., Hayes, S., Sherman, S., Vander Veur, S., Grundy, K., & Foster, G. (2011). The impact of weight, sex, and race/ethnicity on body dissatisfaction among urban children. Body Image, 8(4), 385-389.

[17]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/202946/120715_RAE_on_body_image_final.pdf

[18] Kelly L. Lesbian body image perceptions: The context of body silence. Qual Health Res. 2007 Sep;17(7):873–83.

[19] Koff E, Lucas M, Migliorini R, Grossmith S. Women and body dissatisfaction: Does sexual orientation make a difference? Body Image. 2010 Jun;7(3):255–8.

[20] Calogero, Rachel M., and J. Kevin Thompson. “Potential implications of the objectification of women’s bodies for women’s sexual satisfaction.” Body image 6.2 (2009): 145-148.

[21] Fredrickson, B. L., & Roberts, T. (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173–206. doi:10.1111/j.1471-6402.1997.tb00108.x.

[22] Erchull, M. J., Liss, M., & Lichiello, S. (2013). Extending the negative consequences of media internalization and self-objectification to dissociation and self-harm. Sex Roles, 69, 583–593. doi:10.1007/s11199-013-0326-8.

[23] Bucchianeri, Michaela M., et al. “Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study.” Body image 10.1 (2013): 1-7.

[24] Bearman, Sarah Kate, et al. “The skinny on body dissatisfaction: A longitudinal study of adolescent girls and boys.” Journal of youth and adolescence 35.2 (2006): 217-229.

[25] Thompson, J. Kevin, et al. Exacting beauty: Theory, assessment, and treatment of body image disturbance. American Psychological Association, 1999.

[26] Ferreira, Cláudia, José Pinto‐Gouveia, and Cristiana Duarte. “Physical appearance as a measure of social ranking: The role of a new scale to understand the relationship between weight and dieting.” Clinical Psychology & Psychotherapy 20.1 (2013): 55-66.

[27] Ricciardelli, Lina A., et al. “A biopsychosocial model for understanding body image and body change strategies among children.” Journal of Applied Developmental Psychology 24.4 (2003): 475-495.

[28] Menzel, Jessie E., et al. “Appearance-related teasing, body dissatisfaction, and disordered eating: A meta-analysis.” Body image 7.4 (2010): 261-270.

[29] Frisén, Ann, Kristina Holmqvist, and Daniel Oscarsson. “13‐year‐olds’ perception of bullying: Definitions, reasons for victimisation and experience of adults’ response.” Educational Studies 34.2 (2008): 105-117.

[30] https://www.girlguiding.org.uk/globalassets/docs-and-resources/research-and-campaigns/girls-attitudes-survey-2019.pdf

[31] Duarte, C., J. Pinto-Gouveia, and R. J. Stubbs. “The prospective associations between bullying experiences, body image shame and disordered eating in a sample of adolescent girls.” Personality and Individual Differences 116 (2017): 319-325.

[32] Grogan, S. (2008). Body image: Understanding body dissatisfaction in men, women and children (2nd ed.). Hove: Routledge.

[33] Davison, T. E., & McCabe, M. P. (2005). Relationships between men’s and women’s body image and their psychological, social, and sexual functioning. Sex Roles, 52, 463–475. doi:10.1007/s11199-005-3712-z.

[34] Barlett CP, Vowels CL, Saucier DA: Meta-analyses of the effects of media images on men’s body-image concerns. J. Soc. Clin. Social Media and Body Image Concerns: Current Research and Future Directions Fardouly and Vartanian 3 www.sciencedirect.com Current Opinion in Psychology 2016, 9:1–5 Psychol. 2008, 27:279-310 http://dx.doi.org/10.1521/ jscp.2008.27.3.279.

[35] Grabe S, Ward LM, Hyde JS: The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies. Psychol. Bull. 2008, 134:460-476 http://dx.doi.org/10.1037/0033-2909.134.3.460.

[36] Groesz LM, Levine MP, Murnen SK: The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review. Int. J. Eat. Disord. 2002, 31:1-16 http:// dx.doi.org/10.1002/eat.10005.

[37] Holland G, Tiggemann M. “strong beats skinny every time”: disordered eating and compulsive exercise in women who post fitspiration on Instagram. Int J Eat Disord. 2017;50(1):76–9.

[38] Fardouly, Jasmine, and Lenny R. Vartanian. “Social media and body image concerns: Current research and future directions.” Current opinion in psychology 9 (2016): 1-5.

[39] Frith E (2017). Social Media and Children’s Mental Health: A Review of the Evidence. Education Policy Institute https://epi.org.uk/publications-and-research/social-mediachildrens-mental-health-review-evidence/

[40] https://www.girlguiding.org.uk/globalassets/docs-and-resources/research-and-campaigns/girls-attitudes-survey-2019.pdf

[41] Webb, Jennifer B., et al. “Fat is fashionable and fit: a comparative content analysis of Fatspiration and Health at Every Size® Instagram images.” Body image 22 (2017): 53-64.

[42] Verduyn, Philippe, et al. “Do social network sites enhance or undermine subjective well‐being? A critical review.” Social Issues and Policy Review 11.1 (2017): 274-302.

[43] Fardouly, Jasmine, and Lenny R. Vartanian. “Social media and body image concerns: Current research and future directions.” Current opinion in psychology 9 (2016): 1-5.

[44] Dalbudak, Ercan, et al. “Relationship of internet addiction severity with depression, anxiety, and alexithymia, temperament and character in university students.” Cyberpsychology, Behavior, and Social Networking 16.4 (2013): 272-278.

[45] Cash, Thomas F., and Linda Smolak, eds. Body image: A handbook of science, practice, and prevention. Guilford Press, 2011.

[46] Webb, Jennifer B., et al. “Fat is fashionable and fit: a comparative content analysis of Fatspiration and Health at Every Size® Instagram images.” Body image 22 (2017): 53-64.

[47] Holland, Grace, and Marika Tiggemann. “A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes.” Body image 17 (2016): 100-110.

[48] Lonergan, Alexandra Rhodes, et al. “Me, my selfie, and I: The relationship between editing and posting selfies and body dissatisfaction in men and women.” Body Image 28 (2019): 39-43.

[49] Murray, Marisa, Danijela Maras, and Gary S. Goldfield. “Excessive time on social networking sites and disordered eating behaviors among undergraduate students: Appearance and weight esteem as mediating pathways.” Cyberpsychology, Behavior, and Social Networking 19.12 (2016): 709-715.

[50] Prieler, Michael, and Jounghwa Choi. “Broadening the scope of social media effect research on body image concerns.” Sex Roles 71.11-12 (2014): 378-388.

[51] Tunaley, J. R., Walsh, S., & Nicolson, P. (1999). “I’m not bad for my age”: The meaning of body size and eating in the lives of older women. Ageing & Society, 19, 741–759. doi:10.1017/S0144686X99007515.

[52] Hefner, Veronica, et al. “The influence of television and film viewing on midlife women’s body image, disordered eating, and food choice.” Media Psychology 17.2 (2014): 185-207.

[53] https://www.gov.scot/publications/exploring-reported-worsening-mental-wellbeing-adolescent-girls-scotland/

[54] Office for National Statistics (2015). Measuring National Well-being: Insights into children’s mental health and well-being. Understanding Society. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuringnationalwellbeing/2015-10-20#social-media

[55] https://www.girlguiding.org.uk/globalassets/docs-and-resources/research-and-campaigns/girls-attitudes-survey-2019.pdf

[56] The Children’s Society (2017). The Good Childhood Report 2017. Available at:

https://www.childrenssociety.org.uk/what-we-do/resources-and-publications/thegood-childhood-report-2017

[57] Royal Society for Public Health (2017). #StatusOfMind Social media and young

people’s mental health and wellbeing. Available at:

https://www.rsph.org.uk/uploads/assets/uploaded/62be270a-a55f-4719-ad668c2ec7a74c2a.pdf

[58] https://www.forbes.com/sites/andrewarnold/2018/11/26/fitspiration-on-social-media-is-it-helping-or-hurting-your-health-goals/#4e3f47747f0f

[59] Alberga, Angela S., Samantha J. Withnell, and Kristin M. von Ranson. “Fitspiration and thinspiration: a comparison across three social networking sites.” Journal of Eating Disorders 6.1 (2018): 39.

[60] Ghaznavi, Jannath, and Laramie D. Taylor. “Bones, body parts, and sex appeal: An analysis of# thinspiration images on popular social media.” Body image 14 (2015): 54-61.

[61] Arseniev-Koehler, Alina, et al. “# Proana: Pro-eating disorder socialization on Twitter.” Journal of Adolescent Health 58.6 (2016): 659-664.

[62] Boepple, Leah, and J. Kevin Thompson. “A content analytic comparison of fitspiration and thinspiration websites.” International Journal of Eating Disorders 49.1 (2016): 98-101.

[63] Ghaznavi, Jannath, and Laramie D. Taylor. “Bones, body parts, and sex appeal: An analysis of# thinspiration images on popular social media.” Body image 14 (2015): 54-61.

[64] Harris, Jenine K., et al. “Peer reviewed: Messengers and messages for tweets that used# thinspo and# fitspo hashtags in 2016.” Preventing chronic disease 15 (2018).

[65] Casilli, Antonio A., Fred Pailler, and Paola Tubaro. “Online networks of eating-disorder websites: why censoring pro-ana might be a bad idea.” Perspectives in Public Health 133.2 (2013): 94-95.

[66] Boepple, Leah, et al. “Strong is the new skinny: A content analysis of fitspiration websites.” Body image 17 (2016): 132-135.

[67] Griffiths, Scott, et al. “The contribution of social media to body dissatisfaction, eating disorder symptoms, and anabolic steroid use among sexual minority men.” Cyberpsychology, Behavior, and Social Networking 21.3 (2018): 149-156.

[68] Turja, Tuuli, et al. “Proeating disorder websites and subjective well‐being: A four‐country study on young people.” International Journal of eating disorders 50.1 (2017): 50-57.

[69] Robinson, Lily, et al. “Idealised media images: The effect of fitspiration imagery on body satisfaction and exercise behaviour.” Body image 22 (2017): 65-71.

[70] Lloyd, Jillian, et al. “Female genital appearance:‘normality’unfolds.” BJOG: An International Journal of Obstetrics & Gynaecology 112.5 (2005): 643-646.

[71] Veale, David, et al. “Psychosexual outcome after labiaplasty: a prospective case-comparison study.” International urogynecology journal 25.6 (2014): 831-839.

[72] Runacres, Sean A., and Paul L. Wood. “Cosmetic labiaplasty in an adolescent population.” Journal of Pediatric and Adolescent Gynecology 29.3 (2016): 218-222.

[73] Veale, David, et al. “Psychosexual outcome after labiaplasty: a prospective case-comparison study.” International urogynecology journal 25.6 (2014): 831-839.

[74] https://www.bbc.co.uk/news/health-40410459

[75] https://www.rcog.org.uk/globalassets/documents/guidelines/ethics-issues-and-resources/rcog-fgcs-ethical-opinion-paper.pdf

[76] Cohen, Rachel, et al. “# bodypositivity: A content analysis of body positive accounts on Instagram.” Body image 29 (2019): 47-57.

[77] http://www.powerfulhunger.com/powerful_hunger_blog/history-of-fat-acceptance-lew-louderback-1967-article/

[78] Afful, Adwoa A., and Rose Ricciardelli. “Shaping the online fat acceptance movement: Talking about body image and beauty standards.” Journal of Gender Studies 24.4 (2015): 453-472.

[79] Cwynar-Horta, Jessica. “The commodification of the body positive movement on Instagram.” Stream: Interdisciplinary Journal of Communication 8.2 (2016): 36-56.

[80] https://www.theguardian.com/lifeandstyle/2018/jul/23/the-rise-of-the-body-neutrality-movement-if-youre-fat-you-dont-have-to-hate-yourself

[81] Cohen, Rachel, et al. “# bodypositivity: A content analysis of body positive accounts on Instagram.” Body image 29 (2019): 47-57.

[82] Cwynar-Horta, Jessica. “The commodification of the body positive movement on Instagram.” Stream: Interdisciplinary Journal of Communication 8.2 (2016): 36-56.

[83] https://www.theguardian.com/lifeandstyle/2018/jul/23/the-rise-of-the-body-neutrality-movement-if-youre-fat-you-dont-have-to-hate-yourself

[84] Tylka, Tracy L. “Overview of the field of positive body image.” Body positive: Understanding and improving body image in science and practice (2018): 6-33.

[85] Swami, Viren, et al. “Positive body image is positively associated with hedonic (emotional) and eudaimonic (psychological and social) well-being in British adults.” The Journal of social psychology 158.5 (2018): 541-552.

[86] Andrew, Rachel, Marika Tiggemann, and Levina Clark. “Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study.” Developmental Psychology 52.3 (2016): 463.

[87] Paraskeva, Nicole, Helena Lewis-Smith, and Phillippa C. Diedrichs. “Consumer opinion on social policy approaches to promoting positive body image: Airbrushed media images and disclaimer labels.” Journal of Health Psychology 22.2 (2017): 164-175.

[88] Alleva JM, Diedrichs PC, Halliwell E, Martijn C, Stuijfzand BG, Treneman-Evans G, et al. A randomised-controlled trial investigating potential underlying mechanisms of a functionality-based approach to improving women’s body image. Body Image. 2018 Jun 1;25:85–96.

[89] Campbell A, Hausenblas HA. Effects of exercise interventions on body image: A meta-analysis. J Health Psychol. 2009 Sep 17;14(6):780–93.

[90] Campbell, A., & Hausenblas, H. (2009). Effects of exercise interventions on body image: a meta-analysis. Journal Of Health Psychology, 14(6), 780-793

[91] Caccavale, L., Farhat, T., & Iannotti, R. (2012). Social engagement in adolescence moderates the association between weight status and body image. Body Image, 9(2), 221-226.

[92] Holsen, I., Carlson Jones, D., & Skogbrott Birkeland, M. (2012). Body image satisfaction among Norwegian adolescents and young adults: a longitudinal study of the influence of interpersonal relationships and BMI. Body Image, 9(2), 201-208