Body image in childhood
How comfortable are children and young people with their bodies?
While exact estimates vary, depending on how body image is measured, concern and worries about appearance are commonplace among young people. One survey of 11–16-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 13–19, 35% said their body image causes them to ‘often’ or ‘always’ worry.
While body image concerns affect both boys and girls, there is research to suggest that girls are more likely to be dissatisfied 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 affect 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 16–25-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 first two (27).
How does body image affect children and young people?
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 finding that children with poorer body image are less likely to take part in physical activity (5,28) and survey data from Be Real finding that 36% of girls and 24% of boys report avoiding taking part in activities like physical education due to worries about their appearance (23). Among adolescents, research has found that those with greater body appreciation are less likely to diet or use alcohol or cigarettes (5).
Body dissatisfaction and a pressure to be thin have been linked to depressive symptoms (15, 29) and symptoms of anxiety disorders such as social anxiety or panic disorder (16), particularly in those children who do not match societal views of the ‘ideal body’. Some studies have found that weight and body mass index (BMI) are correlated with body dissatisfaction, with youth people who are overweight or obese reporting greater depressive symptoms and lower self-esteem than their peers (30,31).
Research conducted with young women also found a higher likelihood of suicidal thoughts among those women who reported extreme weight control behaviours (e.g. taking diet pills, diuretics or laxatives) (32), with an additional study suggesting that body image concerns may be a risk factor for self-harm behaviour among young people who are experiencing emotional difficulties (33).
What affects body image in childhood?
Body ideal internalisation
One common contributor to poor body image is feeling a pressure to live up to an ‘ideal’ body type or appearance and feeling shame or other uncomfortable emotions when we perceive ourselves as not meeting this standard. Internalisation of this ideal has been linked to body dissatisfaction and disordered eating and depressive symptoms in children and young people (19, 34, 35). These distressing emotions were reflected in our survey, where 37% of young people said they felt upset, and 31% said they felt ashamed in relation to their body image.
This ideal tends to be different between genders. Young women often report feeling a pressure to be thin, but to still maintain curves, whereas young men often report pressure to be tall and muscular (19,23). Children who rejected appearance-related ideals reported being more confident about their appearance and were least likely to report body image concerns (23).
How young people develop their sense of ‘ideal’ appearance is varied, but young people themselves identify the media, pressure from family and friends, comparisons with peers, and personal factors like low self-esteem, feelings of depression, and a need for control as important influences on their own body image (36,37).
The media and social media
One commonly researched influence on body image is exposure to unrealistic ‘ideal’ bodies through film, television, magazines, advertising and social media. Exposure to these images is thought to facilitate the valuing of these ‘ideal’ and unrealistic body types. One study, which followed 14- and 15-year-olds over three years, found that internalisation of these ‘ideal’ body shapes as presented in the media predicted negative emotions about appearance, which in turn predicted unhealthy eating behaviours (34). In our survey, 25% of young people (13% of boys and 37% of girls) said celebrities have caused them to worry in relation to their body image, and 19% (10% of boys and 28% of girls) said TV shows caused them to worry in relation to their body image.
Using more social media has also been linked to children and young people feeling less satisfied with their bodies (38,39). In our survey, 40% of young people (26% of boys and 54% of girls) said that images on social media have caused them to worry in relation to their body image. One possible explanation for this is that social media allows for negative comparisons with others based on appearance. This is something that has consistently been linked to body dissatisfaction (40). There are some studies that suggest time spent on social media is linked to frequency of appearance-related comparisons (41) and peer competition (42), which in turn may be linked to body dissatisfaction and mental health (41,42).
Parents and family members
The influence of the media on body image may be lessened by parental behaviour. One study found that the relationship between social media use and body dissatisfaction was weaker for those adolescents that had more positive maternal relationships (38), and another found that the children of parents who reported greater control over time spent on social media reported spending less time online, making fewer appearance-related comparisons, and having better overall mental health (41).
Parents and family can also have a negative effect on children’s body image and increase the likelihood of difficulties in this area. One study of adolescent girls found that over half had experienced weight-based teasing from family members, particularly girls who weighed more, and these experiences were related to higher levels of body dissatisfaction and unhealthy eating behaviour (43). This was also reflected in our survey, where 29% of young people (21% of boys and 37% of girls) agreed that things their family said have caused them to worry in relation to their body image. This extends to the way that parents think, act and speak about their own bodies as well as their children’s bodies. Reviews of the research suggest that parents can affect their children’s body image in both direct ways (comments or criticisms about weight and appearance) and more indirect ways (parental eating behaviours, and attitudes toward their own bodies and appearance) (19,44).
As children grow older, their peers begin to play more of a role in reinforcing what an ideal body looks like. This can be through pressure from friends to feel accepted. In our survey, 40% of young people (37% of boys and 42% of girls) agreed that things their friends have said have caused them to worry in relation to their body image. Another survey found that 68% of boys cited friends as a source of pressure to look good (7).
The ways in which adolescents’ bodies change during puberty (a time of change in body height, weight and shape), how this compares with their peers, and how it compares to their own ideas of what an ‘ideal’ body looks like (which, in turn, can be influenced by the factors outlined above) will therefore affect body image (45). This may especially be the case for girls who mature earlier than their peers, and boys who mature later than their peers (45).
The influence of peers can also be felt through bullying. A survey by Be Real of UK 11–16-year-olds found that over half of young people had experienced appearance-based bullying, with 40% of those young people experiencing bullying at least once a week, and 54% saying the bullying had started by age 10 (46). Children who do not match body ideals may be more likely to be the target of bullying. One review of the research found that young people who are overweight or obese are more likely to be subject to bullying than their peers (47).
Appearance-based bullying can be detrimental to children’s mental health and body image. Adolescents who were cyberbullied were twice as likely to consider themselves ‘too fat’ (25) and, of those who were bullied about their appearance, 53% felt anxious and 29% felt depressed (46). In contrast, having supportive friendships may be a protective influence. Some studies have found support for strong friendships being associated with decreased body dissatisfaction (25,48,49). However, children who are already feeling down about their bodies may perceive their peers as having a greater influence (50), particularly as self-esteem and body image are closely linked (24,51).