How can we protect, promote, and maintain body image?
Everyone has a right to feel comfortable and confident in their own skin and we can take small actions in our daily lives to help foster a more accepting environment.
For example, it may be helpful to be mindful of the ways in which we speak about our bodies in casual conversations with friends and family. Consistently speaking about our bodies, or others’ bodies, in ways that imply weight and youth are central to attractiveness and value (e.g. “I feel fat today”, “They don’t have the body to wear that”, “You look great, did you lose weight?”, “Ugh, look at my wrinkles”) may feel harmless in the moment, but can make us feel worse about our bodies in the long run (62).
Instead, focusing more on the functionality of our body, and the positive things that it can do for us, may help to support and improve body image (136).
Focusing on physical activity and healthy eating for the benefits they provide in terms of social connection and overall psychological wellbeing, rather than as a route to building muscle or losing weight, may also be a good approach to building up our body image. Reviews of the research have found support for the relationship between physical activity and positive body image (137–139).
If body image concerns are causing significant distress, it may be appropriate to seek out further support in the form of psychological therapies. Reviews of the research have found some support for cognitive and behavioural interventions such as Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT) in improving body image (140–142).
In order to maximise outcomes and reduce the risk of stigma, public health campaigns should focus on messages of healthy eating and exercise for all adults, regardless of weight, and avoid making weight the key focus of their messaging (71,72). However, creating a less shaming culture can also start at a community level with grassroots action to encourage more inclusive and accepting cultural norms around bodily appearance.
A common response to the research linking body dissatisfaction with exposure to idealised bodies in the media is to suggest the inclusion of ‘disclaimer’ or ‘warning’ labels on advertisements in which models have been edited. However, much of the literature looking at the effect of such labels on responses to fashion advertisements suggests labels may not have any beneficial effects on body dissatisfaction. Several experimental studies have presented young women with advertisements that have a variety of disclaimer labels and found no effect of labels on body dissatisfaction compared to un-labelled photos (143–149). In some instances, labels had negative effects, increasing a tendency to compare self to others (145,149), or resulting in higher levels of body dissatisfaction among women already more likely to compare themselves to others (147). One qualitative study in this area with British adults suggests that such policies are generally met with scepticism. Some participants felt that, even with a label, the intent of the edited photo is still a message that the body type presented is ‘desirable’ and that reactions to such images are often automatic or sub-conscious (150). Instead, they felt that media should focus on the inclusion of more varied body types and sizes, ages and ethnicities to encourage a more wide-ranging and inclusive ideal of beauty (150). Social media may be one potential route to achieving this diversity of representation. One study of social media accounts that specifically focus on body positivity found that these types of account depict a broad range of body types and appearance (though the images are still predominantly of younger women) alongside messages of body appreciation and acceptance (151).
In their advertisements, companies should aim to be inclusive in terms of age, gender, ethnicity and size, so as to encourage a more diverse bodily ideal, and use advertising messages that prioritise overall wellbeing rather than just physical appearance. Calls for advertisers to support these aims have been launched by organisations like Be Real via their Body Image Pledge (152).
Supporting body image in children and young people
One study seeking to gain expert consensus on ways for parents to support healthy body image and eating habits found that parents should seek to: model positive behaviour around body image (avoid criticising their own appearance or that of others, and model healthy eating and activity); praise their children on qualities unrelated to physical appearance; teach children that people have value and deserve respect regardless of their body shape or size; support children to express emotions and communicate their feelings about their bodies; help children develop strategies for coping with comments about appearance; and avoid placing unrealistic expectations on appearance or conveying that they would be more likeable if they changed their weight or shape (153).
One review of the research found some support for classroom-based body image programmes that address media literacy, self-esteem and peer influences; however, where it was measured in the longer-term, few studies showed sustained results (154). There is some survey data from Be Real to support classroom-based body image programmes, with 76% of students saying that learning about body confidence in school made them feel more confident about themselves (23). Whole-school approaches that create supportive spaces for students, coupled with health promotion approaches that focus on the social and wellbeing benefits of physical activity (rather than benefits for weight loss and muscle building), may also be effective (155).
In the media:
Young people participating in MH2:K, a peer-led programme about youth mental health and wellbeing, have recommended that, in order to address the influence of the media and social media, we should: provide resources to parents that help them to support young people online in a way that balances independence and safety, and encourage social media sites to include an option to hide followers, likes and comments (156). It may also be important to help support young people to be media-critical, as media literacy may be a protective factor for body image (37,157).
Supporting body image across long-term conditions and disabilities
For individuals with chronic physical illnesses such as cancer, there is evidence to support the use of Cognitive-Behavioural Therapy and psychotherapeutic interventions as well as some support for educational approaches for improving body image in cancer patients (86,158). In addition, when considering cancer treatment, patients should be informed about the potential side effects of treatment on sexuality and fertility and the ways this can affect body image. It may be beneficial to include partners in this decision-making process (159).
For individuals with learning disabilities and autism spectrum disorder, some studies have trialled dance and movement therapy, which may have positive effects on body awareness and wellbeing, though the research in this area is still developing (93,94). Young people with autism who reported having functional strategies for challenges in their daily lives reported feeling more positively towards their bodies, and proud of their abilities, suggesting that this may be a potential avenue to support body awareness and body image (97).
For individuals with longer-term mental health conditions who have been prescribed medication, it is important to consider the impact of medication on quality of life, body image, and self-esteem alongside its effectiveness for the treatment and management of mental health problems. There is some support for approaches such as Cognitive-Behavioural Therapy and counselling in aiding in offsetting some of these negative effects (100). Following good practice guidelines for maintaining positive cardiometabolic health – for example, through the use of tools such as NHS England’s Lester Tool – may not only guide the effective monitoring of physical health, but potentially also help to address body image concerns linked to weight gain (101).
Supporting body image across cultures and ethnic groups
Given that body image concerns are likely to be experienced in childhood, including for ethnic minority children and adolescents (160), school-based programmes that educate and encourage all students to have a positive body image may help to prevent body image concerns developing (109). Strategies promoting body appreciation or enhancing a positive body image rather than simply decreasing body dissatisfaction may also be effective (109,161). Having a strong self-identity and connection with one’s culture could serve as protective factors to pressures around body image for minority ethnic people (162,121). There is, however, a clear need to increase representation and diversity among participants as interventions and campaigns have mostly targeted predominantly White, female and middle-class populations and few are culturally specific (111). This would help us to understand whether these interventions are effective for different groups. This also reinforces the need for greater diversity in advertising and the images used in the media and social media in order to support and foster a more diverse view of bodily ideals.
Supporting body image in the LGBT community
Support for the LGBT population should undoubtedly be tailored for the specific group and a more holistic stance on body image that makes sure to address the psychological and social aspects of body image would be welcome (134,163). There is evidence that behavioural interventions might be effective in reducing body dissatisfaction (123). Interventions that focus on minority stressors and help to bolster self-esteem could also be beneficial (133,134). Peer approaches should be explored further, as they have the potential to help transgender young people to develop healthy coping strategies (132). Furthermore, training for staff on LGBT-specific issues could enhance the sensitivity and appropriateness of interventions (135).