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Body Image and

Health
Contemporary Perspectives Journal of Health Psychology
Copyright © 2006 SAGE Publications
London, Thousand Oaks and New Delhi,
www.sagepublications.com
Vol 11(4) 523–530
DOI: 10.1177/1359105306065013

SARAH GROGAN
Staffordshire University, UK

Abstract
There has been a significant
increase in research into body
image in men, women and children
in the last 20 years. This editorial
reviews definitions of the concept
of body image, and considers
potential health consequences of
lowered body satisfaction and
increased body concern. The
articles that form this Special Issue
are contextualized within
AC K N OW L E D G E M E N T S . I hope that you enjoy reading this Special
contemporary research literature
Issue as much as we have enjoyed putting it together. I would like to
thank the authors who responded to the Call for Papers and who have
around relevant themes. These
contributed their work. I would also like to thank the team of include sociocultural influences,
established experts in the body-image area who have acted as peer gender, effects of weight and
reviewers. These are (in alphabetical order) the late Precilla Choi, appearance and perceptual factors.
Mark Conner, Helen Fawkner, Kate Gleeson, Diana Harcourt, Jenny
Implications of findings for health
O’Dea, Jane Ogden, Marita McCabe, Roberto Olivardia, Susan
Paxton, Lina Ricciardelli, Esther Rothblum, Linda Smolak, Kevin psychologists involved in designing
Thompson and Marika Tiggemann. It has been a pleasure working health promotion interventions are
with you all. discussed.
I would also like to say a special thank you to Kate Gleeson and
Hannah Frith for all their helpful guidance. Your help has been
invaluable, especially at the early stages of planning this Special Issue.

D E D I C AT I O N . This
Special Issue is dedicated to the memory of
Precilla Choi. Precilla made an important contribution to the study of
body image. She will be missed, both as a friend and as a valued
colleague.

COMPETING INTERESTS: None declared.

Keywords
■ gender
ADDRESS. Correspondence should be directed to:
S A R A H G R O G A N , Department of Psychology, Staffordshire
■ size perception
University, College Road, Stoke on Trent, ST4 2DE, UK. ■ sociocultural influences
[email: s.c.grogan@staffs.ac.uk] ■ weight
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THERE HAS been a noticeable increase in body and boys (see Grogan & Richards, 2002;
image research in the last 20 years. This is McCreary, Saucier, & Courtenay, 2005; Pope,
evidenced in a significant increase in citations Phillips, & Olivardia, 2000), as well as to older
relating to body image and body (dis)satis- women (Tiggemann, 2004), and the concept
faction on PsychINFO and PubMed between incorporates more than just concern about
1980 and 2000 (Cash, 2004), the development of shape and weight (Thompson, 2004).
a dedicated journal, Body Image: An Inter- Body image is operationally defined in differ-
national Journal of Research in 2004, a steady ent ways depending on the specific areas of
increase in the numbers of symposia relating to interest and aims of particular researchers, and
body image and health at international health there has been an exponential increase in the
psychology conferences and the setting up and number of new and revised measures that have
development of research centres, such as the been developed to assess dimensions of body
Centre for Appearance Research at University image in the last 10 years (Stewart &
of West of England in the UK, focusing on body Williamson, 2004). Body image has been opera-
image and appearance research related to tionally defined by some authors in terms of
health. This Special Issue continues this trend. perceptual, and by others of attitudinal factors;
After a brief review of definitions and health and those researchers working within an attitu-
implications, the articles that comprise this dinal paradigm have further distinguished
volume are contextualized below within four between evaluative-affective and cognitive-
themes that underlie research in body image: behavioural dimensions (Cash, 2002). Measures
sociocultural factors, gender, weight and appear- designed to tap the evaluative-affective dimen-
ance, and perceptual factors. sion (for instance, the well-validated and
popular Multidimensional Body-Self Relations
Questionnaire (MBSRQ) Appearance Evalu-
What is body image?
ation sub-scale; Brown, Cash, & Milulka, 1990)
Body image relates to a person’s perceptions, assess satisfaction with the appearance of the
feelings and thoughts about his or her body, and body. Those designed to assess the cognitive-
is usually conceptualized as incorporating body behavioural dimension (for instance the
size estimation, evaluation of body attractive- Appearance Orientation sub-scale of the
ness and emotions associated with body shape MBSRQ) measure investment in, or concern
and size (Grogan, 1999; Muth & Cash, 1997). with, appearance. Scores on these two sub-scales
Although body image is generally conceptual- tend to be independent of each other (Thomp-
ized as a broad, multifaceted construct, most son, 2004). Satisfaction measures cluster into
research is this area has focused on the much those designed to measure satisfaction with
narrower construct of dissatisfaction with specific body areas, and those designed to eval-
weight, particularly desire to be thinner uate satisfaction with appearance in general
(Grogan, 1999), and although recent work is (see Grogan, 1999; Stewart & Williamson, 2004;
focusing more on boys and men, most body Thompson, 2004 for reviews).
image research in the last 30 years has been This issue incorporates qualitative and quan-
conducted with young women (Tiggemann, titative work covering the full range of defi-
2004). This bias in definition and population is nitions of body image, including perceptual
largely because body image research has its (Mussap & Salton) and attitudinal factors
roots in clinical psychology and psychiatric work (Shroff & Thompson; Slater & Tiggemann;
focusing on eating disorders in young women Himelein & Thatcher; O’Dea; McCabe et al.);
(Orbach, 1993). Unfortunately, this has rein- and presents work with men and boys (Harg-
forced the idea that the psychology of body reaves & Tiggemann and Ricciardelli et al.;
image is only relevant to young women, and that McCabe et al.; Mussap & Salton) as well as work
the construct mainly encompasses weight and with women and girls, to enable a comprehen-
shape concern (Cash, 2004). Clearly body image sive understanding of some of the fascinating
and its consequences are of relevance to men contemporary work in this area.

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Health behaviours and body planning targeted programmes. Articles in this

image issue cover body image in men, women and
children, and are directly relevant to health
Body image is implicated in a number of
promotion in children and adults.
unhealthy behaviours. For instance, body image
can affect the likelihood that we will engage in,
or avoid, exercise (Choi, 2000; Grogan, Evans,
Social factors: peer
Wright, & Hunter 2004). Although being dissat-
influence, media and sports
isfied with the way that we look and ‘feeling fat’
participation
can in some cases motivate us to exercise
(Grogan et al., 2004), it may also prevent us The first key theme underlying work in this
from engaging in organized sports activities volume is the importance of sociocultural
such as joining a gym or exercising at a sports factors on body image. There is growing
centre due to concern about revealing our body evidence that body image is subjective, and open
to others in sports clothes (Liggett, Grogan, & to change through social influence (Groetz,
Burwitz, 2003) and whether we have the right Levine, & Murnen, 2002). Models of
kind of body to fit in with a sports culture that antecedents of body image have implicated
promotes a very slender ideal (Choi, 2000). social factors in causation of body dissatis-
Body dissatisfaction and size underestimation in faction, weight concern and discrepancy
men may also lead to use of anabolic steroids between current and ideal body shape and size
and other drugs to try to increase muscularity (Bordo, 1993; Grogan, 1999; Thompson, Hein-
(Wright, Grogan, & Hunter, 2000), with associ- berg, Altabe, & Tantleff-Dunn, 1999). Socio-
ated risks of blood-borne diseases if these are cultural models of risk factors have tended to
injected, as well as liver, kidney and other health emphasize the importance of media, family and
problems associated with use (Pope et al., 2000). peer influences on body satisfaction (see
Body-image factors may also influence Thompson et al., 1999), with an overall preva-
whether we eat healthily and whether we lence of focus on effects of media images on
restrain our eating (Cooley & Toray, 2001; Stice, body image. Media imagery may be important
2002). Body dissatisfaction and excessive invest- in producing changes in the ways that the body
ment in the body have been linked with the full is perceived and evaluated, depending on the
range of unhealthy eating behaviours, including viewer’s perception of the importance of those
binge eating, restrictive dieting and self-induced cues (Groetz et al., 2002). Childhood experi-
vomiting (Levine & Piran, 2004). Body dissatis- ences are clearly crucial to an understanding of
faction and excessive body concern can affect social influences on body satisfaction and invest-
our decision to quit smoking if we fear that we ment in the body. Work reported in this issue
will gain weight as a result (King, Matacin, develops existing research, to look more closely
White, & Marcus, 2005). Body concern and at effects of peer influences on body image and
dissatisfaction can also lead us to undertake eating (Shroff & Thompson) and at effects of
unnecessary cosmetic surgery, putting our childhood media exposure and sports partici-
health at risk (Davis, 1995). pation on later body image development (Slater
Clearly body dissatisfaction and body concern & Tiggemann).
are linked with many key health behaviours, so Hemal Shroff and J. Kevin Thompson (this
are of importance to anyone with an interest in issue) present results suggesting that peer influ-
promoting health. Body image factors need to ence variables such as having friends who are
be taken into account when designing interven- preoccupied with dieting, and assigning import-
tions relating to any aspect of appearance, ance to friends’ beliefs about weight and
including exercise, healthy eating, weight appearance, may be risk factors for high body
management and quitting smoking, and an dissatisfaction, drive for thinness, bulimia and
understanding of the impact of antecedents of lower self-esteem in adolescent girls. Amy Slater
body image will help to ensure that factors such and Marika Tiggemann (this issue) found that
as sociocultural influences, gender, weight and women who had watched more television and
perceptual factors are taken into account when read more fashion magazines, and who had

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JOURNAL OF HEALTH PSYCHOLOGY 11(4)

engaged in a larger number of sporting activities et al., 2000) and other body-building drugs such
in childhood had higher levels of body concern as human growth hormone (Pope et al., 2000).
in adulthood, supporting work implicating However, there has been a general lack of
media influence on body image (Groetz et al., research looking at body dissatisfaction in boys,
2002), but contrary to suggestions that sports and factors that may be important in predicting
participation has a generally positive impact on satisfaction in males. Social pressure on men is
body image (Frederickson & Roberts, 1997). quantitatively and qualitatively different from
Clearly these relationships are complex, and pressure on women (Grogan, 1999; Pope et al.,
these findings need to be borne in mind by those 2000). Men and boys are, on average, most likely
of us designing body-image interventions, to to want to become more muscular (Grogan &
ensure that body concern and dissatisfaction are Richards, 2002; McCreary et al., 2005), whereas
not increased through these interventions. Peer women and girls are likely to want to be thinner
support is clearly crucial for effective body- (Grogan & Wainwright, 1996; Tiggemann, 2004).
image interventions, and future work needs to Data derived from women and girls can there-
investigate why early sports participation may fore not be generalized to men, and it is import-
lead to increased body concern, especially in the ant to investigate boys’ and men’s experience of
light of the fact that it was not just ‘lean’ sport body satisfaction.
participation (see Petrie, 1996) that predicted Lina Ricciardelli and colleagues (this issue),
increased body concern in adulthood. and Duane Hargreaves and Marika Tiggemann
(this issue) attempt to develop our understand-
ing of factors influencing body image in
Gender and body image
adolescent boys. Hargreaves and Tiggemann, in
The second key theme underlying work in this their focus groups with 14–16-year-old boys,
issue is the impact of gender on body image. found these young men were resistant to talking
Various authors, working within feminist and about body image as it was considered not to be
broader socio-cultural paradigms, have gender appropriate to do so. Their apparent low
suggested that socio-cultural pressure on level of investment in their bodies was belied by
women in western societies to attain an unreal- their behaviour, and the authors suggest that
istically slender ideal leads to dissatisfaction quantitative studies on body-image investment
(Bordo, 1993; Groetz et al., 2002; Thompson et may underestimate boys’ concern. This is
al., 1999), and to negative health behaviours supported by Ricciardelli et al., who found that
such as dietary restraint (Keery, van der Berg, & talking about sport provided adolescent men
Thompson, 2004), eating disorders (Benveniste, with a socially acceptable context for discussing
LeCouteur, & Hepworth, 1999; Levine & Piran, openly what they liked and what they did not
2004), smoking (King et al., 2005) and cosmetic like about their bodies. A particular concern was
surgery (Davis, 1995; Sarwer & Crerand, 2004). desire for muscularity, which links with negative
There is a less robust literature on body image health behaviours such as over-exercise and
in girls although body concern has been steroid use (Cafri et al., 2005). Health-
reported in girls from age five upwards (e.g. promotion work with men and boys, whether
Williamson & Delin, 2001), and many authors directly addressing body dissatisfaction or
have argued that women’s body dissatisfaction addressing body-image-related behaviours such
remains remarkably stable across the lifespan as exercise, healthy eating and drug use needs to
(Tiggemann, 2004). take into account boys’ reluctance to talk about
Work on body image in men has a more the look of their bodies, and to find ways to work
recent history. Authors such as Pope et al. (2000) with boys in gender-appropriate ways.
have suggested recently that men in western One of the key challenges for researchers
societies are under increasing pressure to attain involved in body-image work is the quest for
and maintain a slender but muscular body, and effective interventions to improve body image
other authors have linked men’s body dissatis- in girls and boys (Cash, 2004). In the article by
faction with problems such as low self-esteem, Marita McCabe and colleagues (this issue), a
depression and eating disorders (Cafri et al., direct attempt was made to improve body satis-
2005), and the use of anabolic steroids (Wright faction in boys and girls aged 8–12 years.
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Although the programme itself was of limited concerns and low self-esteem (Carlson, 2004).
effectiveness, results are useful in delineating However, until O’Dea’s study, there had been
areas to target for future interventions for use very few longitudinal studies investigating the
with children in this age group. Results are also development of self-concept in overweight
interesting in that they showed that body image adolescents. O’Dea’s work shows that all self-
was clearly gendered in children as early as 8 concept domains were significantly poorer in
years of age. Girls were significantly less satis- girls with higher Body Mass Index (BMI),
fied with their weight than boys, and weight was including those not directly related to physical
significantly more important to girls in the older appearance and social acceptance, such as
age group. Boys placed more importance on, scholastic competence and intelligence, and job
and were less satisfied with, their muscles. competence, and that self-concept deteriorated
Heavier children were significantly less satisfied over the observation period. Clearly, interven-
with their weight. These results support and tions designed to help overweight adolescent
develop previous work (Grogan & Richards, girls to manage their weight need to be handled
2002; Grogan & Wainwright, 1996; Ricciardelli sensitively to avoid further weight concern, as
& McCabe, 2001) in showing that body concerns these girls are already likely to have appearance
are evident in eight-year-olds, and in reinforcing concerns and lowered self-concept. Focusing on
suggestions that boys and girls have very differ- improving self-concept (O’Dea, this issue) in
ent body-image concerns as early as eight years addition to sensible and well-timed weight
of age. Exercise and healthy eating interven- management advice (Chadwick & Croker, 2005)
tions may need to be targeted slightly differently may be most likely to lead to improved weight
for boys and girls to take account of these control and more positive body image.
gender differences. Unwanted physical changes to our bodies due
to illness, accident and ageing can affect our
body image, resulting in reduced quality of life
Impact of weight and
and self-esteem (Anderson, 2000; Gannon, 2000;
appearance
Rumsey & Harcourt, 2004; Thomas-McClean,
The third theme in this issue is the impact of 2000). Women with endocrine disorders such as
weight and appearance on body image. There is polycystic ovary syndrome (PCOS) may also be
a growing literature on the effects of body size faced with particular challenges in relation to
and weight on body image. Although objective maintaining a positive body image. PCOS often
body size and shape does not necessarily have a leads to obesity and hirsutism, both of which
straightforward relationship with body image, take women further away from the western
there is some evidence that women and girls cultural ideal of the slender, body-hair-free
who are objectively heavier tend to be less satis- woman (Grogan et al., 2004). Melissa Himelein
fied with their bodies, and also have lower global and Samuel Thatcher found that women with
self-esteem than thinner women (O’Dea, this PCOS scored higher on depression and body
issue; Schwartz & Brownell, 2004). Overweight dissatisfaction than those in control groups, and
is stigmatized in western cultures, which may body image was associated with depression, even
lead to lowered mood, self-esteem and body after controlling body mass and demographic
dissatisfaction in people who are considered variables. The authors suggest that the psycho-
overweight (Grogan, 1999). Lowered self- logical effects of obesity need to be considered
concept may result in increased eating in over- when health care professionals are working with
weight people, and to other unhealthy outcomes these groups of women. Any focus on dieting
(Schwartz & Brownell, 2004). and weight loss must be supported by work to
Jenny O’Dea (this issue) investigates the improve body image in order to be effective.
development of self-concept in adolescence
relating to body weight. Adolescent overweight
Perceptual factors and body
has been associated with numerous health risks
malleability
such as diabetes, high blood pressure and abnor-
mal blood lipids (Freedman, Dietz, Srinivasan, Although physical characteristics may affect
& Berenson, 1999), as well as body-image body image (see O’Dea, and Himelein &
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JOURNAL OF HEALTH PSYCHOLOGY 11(4)

Thatcher, this issue), there is not a straight- Stoppard, & V. Anderson (Eds.), Women’s bodies,
forward relationship between a person’s subjec- women’s lives (pp. 29–42). Toronto: Sumach Press.
tive perceptual experience of their body and Benveniste, J., LeCouteur, A., & Hepworth, J. (1999).
what is perceived by the outside observer. Lay theories of anorexia nervosa: A discourse
analytic study. Journal of Health Psychology, 4(1),
Although most work in the body-image litera-
59–70.
ture focuses on body satisfaction rather than
Bordo, S. (1993). Unbearable weight: Feminism,
perception of the body, excessive exercise and western culture, and the body. Berkeley, CA:
anabolic steroid use in men (Pope et al., 2000) University of California Press.
and unhealthy eating in women (Thompson & Brown, T. A., Cash, T. F., & Milulka, P. J. (1990). Atti-
Tantleff, 1992) have been linked with subjective tudinal body image assessment: Factor analysis of
over- and under-estimation of body size. Clearly the Body–Self Relations Questionnaire. Journal of
body perception needs to be considered when Personality Assessment, 55, 135–144.
planning programmes to improve body image Cafri, G., Thompson, J. K., Riciardelli, L. A., McCabe,
and to reduce unhealthy behaviours. Computer- M. P., Smolak, L., & Yeselis, C. (2005). Pursuit of the
muscular ideal: Physical and psychological conse-
imaging techniques are enabling more and more
quences and putative risk factors. Clinical Psychol-
sophisticated measures of body size perception
ogy Review, 25, 215–239.
to be produced, and there has been a prolifera- Carlson, J. D. (2004). Body image among adolescent
tion of excellent computer programs designed girls and boys: A longitudinal study. Developmental
to measure over- and under-estimation in the Psychology, 40(5), 823–835.
last few years (see Stewart & Williamson, 2004). Cash, T. (2002). Cognitive-behavioural perspectives
In an interesting and original article in this on body image. In T. F. Cash & T. Pruzinsky (Eds.),
issue, Alex Mussap and Nancy Salton argue that Body image: A handbook of theory, research, and
individual differences in apparent body clinical practice (pp. 38–46). New York: Guilford.
malleability (as evidenced through a novel Cash, T. F. (2004). Body image: Past, present and
future. Body Image: An International Journal of
‘rubber-hand illusion’ paradigm) predict
Research, 1(1), 1–5.
unhealthy behaviour such as binging and
Chadwick, P., & Croker, H. (2005). Obesity manage-
purging behaviour in both men and women, and ment: Worth the effort? The Psychologist, 18(4),
use of chemical supplements and exercise to 220–223.
increase muscularity in men. On the basis of Choi, P. (2000). Femininity and the physically active
their results they suggest that instability in the woman. London: Routledge.
processes that maintain perceptual body image Cooley, E., & Toray,T. (2001). Body image and person-
may predispose some individuals to engage in ality predictors of eating disorder symptoms during
unhealthy body change behaviours. Future the college years. International Journal of Eating
research will help us to understand the Disorders, 30, 28–36.
Davis, K. (1995). Reshaping the female body: The
processes operating here.
dilemma of cosmetic surgery. London: Routledge.
Frederickson, B. L., & Roberts, T. (1997). Objectifica-
Concluding comments tion theory: Towards understanding women’s lived
experience and mental health risks. Psychology of
This Special Issue presents a snapshot of Women Quarterly, 21, 173–206.
contemporary international research on body Freedman, D. S., Dietz, W. H., Srinivasan, S. R., &
image. In addition to being of interest to those Berenson, G. S. (1999). The relation of overweight
health psychologists already involved in to cardiovascular risk factors among children and
research into body image, this issue will hope- adolescents: The Bogalusa Heart Study. Pediatrics,
fully interest readers who have no specific back- 103, 1175–1182.
Gannon, L. (2000). Psychological well-being in aging
ground in this area, and will enable body-image
women. In J. Ussher (Ed.), Women’s health:
issues to be considered, where appropriate, Contemporary international perspectives
when health-related interventions are designed. (pp. 476–485). Leicester: BPS Books.
Groetz, L. M., Levine, M. P., & Murnen, S. K. (2002).
The effect of experimental presentation of thin
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Author biography
S A R A H G R O G A N is Professor of Health
Psychology at Staffordshire University where
she heads the Centre for Health Psychology
and the MSc in Health Psychology. She has
been involved in research into body image in
men, women and children for the last 15 years.
She is currently involved in projects
investigating motivations for body piercing,
tattooing, anabolic steroid use and cosmetic
surgery. She is also engaged in work
investigating the impact of body image on
initiation and quitting smoking in adolescents.
She is currently preparing a second edition of
her book Body image: Understanding body
dissatisfaction in men, women, and children
(Taylor & Francis) due for publication in 2007.

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