The Meaning and Factors That Influence the Concept of Body Image: Systematic Review and Meta-Ethnography from the Perspectives of Adolescents
Abstract
:1. Introduction
2. Aim
3. Methods
3.1. Design
3.2. Search Strategy
3.3. Selection and Summary of the Studies
3.4. Quality Assessment
3.5. Synthesis
4. Results
4.1. Characteristics of Included Studies
4.2. Description of Themes
4.2.1. Self-Perception of BI
4.2.2. Relevance of the Opinions of Friends and Colleagues on BI
4.2.3. Relevance of the Opinions of Family and Parents on BI
4.2.4. Relevance of Specific Features of the School Environment That Influence the BI
4.2.5. Perceived Expectations on BI across the Mass Media
4.2.6. Strategies, Practices, and Self-Management for the Ideal BI: Diet and Physical Exercise
4.3. Explanatory Model
5. Discussion
- Self-perception of BI defines the way of thinking and feeling about oneself in relation to body image. Messages about the body can be interpreted in a distorted way [32]. Therefore addressing misperceptions about weight is not enough for the prevention and promotion of a healthy body image in adolescents [33,34]. The studies analyzed show that the problems of distortion of body image facilitate behaviors aimed at losing weight. Dissatisfaction with body image during the early stages of adolescence has been related to poorer self-esteem [7], more in adolescent girls than in boys [35].
- Relevance of the opinions of friends and colleagues on BI relates to the messages that adolescents receive from their friends. However, Willis et al. [36] provide results that contradict the common perception that overweight or obesity in adolescents is related to body dissatisfaction. Some of the overweight teens do not support the perception of friends or family about BI.
- Relevance of the opinions of family and parents on BI. Both the negative influence of friends and family members are considered barriers to a healthy BI; however, they can be facilitators when messages are received positively by the adolescent [37]. Adolescents with high levels of body dissatisfaction may also experience higher levels of depression and less positive social interactions that lead to a decrease in family connection [38]. Consequently, considering the point of view of each adolescent, it is essential to include the role of parents in health educational interventions to develop a healthy BI.
- Relevance of specific features of the school environment that influence BI. There are few studies which investigate the influence of school and teachers on the development of BI. Several studies show the benefits of including programs to promote a healthy BI in schools [39], thus evidencing the important role that school plays as a primary context of socialization [40].
- Perceived expectations of BI across the mass-media. Exposure of physical appearance in social networks is related to different factors: (1) dissatisfaction with weight; (2) drive for thinness and ideal internalization; (3) self-objectification, especially in adolescent girls [10,41]; and (4) increased concerns and beliefs related to appearance [42]. Some of them are aware of the manipulation of the media and are critical of the pressure exerted about obtaining the ideal BI [43]. Nevertheless, the influence of media on adolescent girls should also be considered. Consequently, media literacy is considered necessary [25], as well as the development of prevention strategies. The latter include promoting skills to use the internet and mass media and training adolescents to develop a healthy BI.
- Strategies, practices, and self-management for the ideal BI. The results of the synthesis agree with the study of Pollina et al. [44] in which it is shown that body dissatisfaction predicts unhealthy behaviors among boys and girls, with different patterns between gender. This dissatisfaction also generates problems of distortion of BI. Moreover, it facilitates behaviors aimed at losing weight (i.e., diets, food restrictions, and modification of eating habits), which are patterns of eating behavior that predict obesity in the future [45].
6. Strengths and Limitations of the Review
7. Implications for Practice
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
---|---|
- Studies published in English | - Quantitative studies |
- Primary studies/ original research Qualitative studies | - Studies on clinical populations: e.g., people with eating disorders, malformations, and mental illnesses |
- Adolescents between 12 and 19 years old | - Studies on pregnant adolescents |
- Healthy population | - Studies on high-level adolescent athletes |
1. Self esteem | 9. Dissatisfaction |
2. Self-image | 10. Distortion |
3. BI | 11. 9 or 10 |
4. 1 or 2 or 3 | 12. 4, 8 and 11 |
5. Adolescent * | 13. Qualitative research |
6. Teenager | 14. Qualitative studies |
7. Young | 15. 13 or 14 |
8. 5 or 6 or 7 | 16. 12 and 15 |
Themes/Categories | Quotations from Participants Primary Studies | Interpretations of Findings Offered by Authors |
---|---|---|
Individual Factors: Self-Perception of Body Image | ||
Emotional self | When I eat something fattening I feel bad. I feel guilty that I am already fat and after eating this, I will become fat [23]. | Feeling guilty about myself |
I think I look pretty good. I′m not like very good-looking, but quite normal. It′s not that I′m ugly [24]. | Self-confidence | |
I get sad when I get chubby [9]. | Feeling sad | |
People degrade them, make them feel bad about them and that′s where they get more stressed and then they eat those foods [9]. | Get stressed | |
Everybody should be able to look the way they want to, and there should not be any things that make them feel that they need to change [25]. | Be yourself | |
Hayley: Some people it could happen to and others it would never. Roisin: Like if the person is confident. Researcher: OK, so you think that helps them not be affected by it? Roisi4: Yeah ′cos if they are really shy and all they would probably be but if they were confident they wouldn′t [26]. | Be confident | |
Thinking self | If you like yourself and you look in the mirror and like what you see in there, you′re confident with people [22]. | Self-confidence |
My weight gain is the main concern. I like the way my face is [23]. | My concern | |
I think there are greater differences between boys than there are between girls. I think most girls want the same things, they want to be slim and Yeah, like, be good looking and slim. But I think the boys here are more into beefing up than the west-end boys are. That′s what I think [27]. | As I want to be | |
It depends more on talking a lot, being clever and being knowledgeable. Then you can talk about status. I don′t think it′s about appearance. It′s more about being visible at our meetings. This goes for both boys and girls [27]. | Important values | |
I think most people, at least girls, have an inner wish to be thin and would love to have a body like Britney Spears. This is the goal, but then I think it varies between groups [27]. | Wish to be thin | |
Relational Factors: Relevance of the Opinions of Friends and Colleagues of Body Image | ||
Peer surveillance | People our age are very critical of other people and how they look. Like they′re very cruel and they don′t think they′ve got feelings and they make snap judgements about girls and give them low self-esteem [22]. | To be overly critical of appearance |
They put pressure on you to get the body they think is right, like soccer players, skinny strong and muscley [28]. Because you get judged. Like everybody judges you, wherever you walk really (…) I think just looking attractive so that people don′t talk about you and say like, ‘Oh she’s fat, she′s ugly, her hair looks ridiculous [29]. | Pressure for an ideal body | |
Peer acceptance | Guys don′t look at me. Nothing about me has changed but the weight gain. I feel that they are not looking at me because of the weight gain….Guys don′t look at me the way they used to [23]. | Without acceptance |
Some people in my class they are big and they get bullied a lot, but I stop that bullying [9]. | Get bullied | |
They like could be fat and everybody′s mocking them so they like exercise because exercise makes you thin [26]. | Fear of being mocked | |
They [my friends] think that I have strange toes. They usually sit and look at them at gymnastics at school. But I think they do so mostly just to tease me, just for fun. (How does it make you feel?) I don’t care. (Doesn′t it bother you at all?) No [24]. | Negative comments are not important | |
Relational Factors: Relevance of the Opinions of Family and Parents of Body Image | ||
Influence of parental opinion | My parents kept telling me, “Go to the gym.” My mom said, “You are leading a sedentary lifestyle”. (Mom) is concerned about my health. She says, “You eat unhealthy food, you keep sitting around [23]. | Concerned about my health. |
My mom gets magazines and we would look through them. if we like it [celebrity look] I′d do something like and copy (them) [26]. My mom is mad at me because I (weigh) less than her [9]. | Mother pressure | |
[We] might talk about that I had my hair cut and [mother says] Oh, that haircut really suits you (...) or if I buy a new top she usually says ‘well, that’s nice′ [24]. | Opinions about clothes | |
So if you see your parents going on Atkins Diet or something then you′re going to be thinking ‘oh should I be having carbs? Like is it not good to have carbs?’ So then you just think it′s normal to just cut things out of your diet [29]. | Pressure from family | |
Opinion on parental control | My parents, like, tried to make a lot of restrictions and, like, I don′t listen to them anymore [30]. | Parental restrictions on social media |
It like gives me anxiety whenever my parents are like ‘okay, I′m gonna just like check something’ and they like actually check my computer history a lot and so like I start to like freak out like even though I′ve done like nothing wrong which makes them like get a message that like I did something even though I′ve done nothing. And so I’m like constantly worried about what I use [30]. | Parental vigilance on social media | |
Environmental factors: Relevance of Specific Features of the School Environment of Body Image | ||
Opinion on teachers | If you go to a teacher, they′re going to give you the ‘well it′s wrong and you know what can happen’ [29]. | Teacher support |
At this school, they teach us how to like yourself and self-confidence and stuff. This is a really inclusive school and it teaches you how you shouldn′t care how other people think of how you look but in other public schools… Our teachers in health class, like all the umm teachers help us with confidence [and] teach us to build a really thick wall so that this stuff does not get to you and I guess you are more immune to it because you know you are fine and so does your class, too [30]. | Positive school environment | |
Environmental Factors: Perceived Expectations Across the Mass-Media of Body Image | ||
Celebrities | A lot of the boys talk about what celebrities they like and then the girls would look up that celebrity and how they look, what they wear and everything and might copy them [26]. You would want to be as skinny as them [22]. If I’m following a female celebrity. they do all these, like, photo shoots and stuff and they look really pretty. So, sometimes, I guess that makes me not feel good? [30] Then everybody started to aspire for it. You become conscious that you have to be a size zero. Earlier you were size 1.Now you are relatively fatter [23]. | Copying fashion trends from celebrities |
Mas media | Accepting compliments is so much easier than being like [30]. | Pressure to get likes |
I feel pretty confident in myself. I mean, I might. look at somebody and be like, ‘Yeah, she′s really pretty’ but. I′m happy with who I am, like I wouldn’t want to be anybody else [30]. | Confident in myself | |
Like I know sometimes I′ll look at pictures and it′ll make me feel like not happy with myself cause sometimes I′ll wanna look like them [30]. | Comparison/unhappy with myself | |
Buy this top and it will make you look this thin [25]. | Coping fashion trends | |
Outcomes: Strategies, Practices, and Self-Management | ||
Acting self: diet | Both self-devised diets and prescribed fad diets would be executed, normally for short periods of time [22]. | Dieting and prescribed fad diets |
They say something like ‘I′m so fat, I need to get on a diet!’ or something like that, and then people who are actually like more overweight might think like ‘oh they′re saying that and they′re skinnier than me, which means that I′m even worse than them’ [29]. | Dieting | |
I tend to stick to whole wheat and I don′t have white rice and white bread. I stay away from sugar, cheese. I don′t like oily things. I think it has become a habit because I have stuck to this for quite a while. I never deny myself [23]. | Healthy diet | |
You know the vinegar, she drinks that and it kind of stops her from eating and it actually just makes her stomach feel full [26]. | Dieting and prescribed fad diets | |
Acting self: sport | My brother, he′s only 15, his team the under 17 s, they are, they have to start working in the gym now and they have to be on this diet, and my brother′s friend plays for Munster and they have to be on this proper diet like they can’t eat chocolate bars [26]. | Sport practice |
Like if you were kind of fat they wouldn′t really like talk to you. They′d leave you out of all the games and say picking teams for a match you′d always be the last picked just because you′re fat and you weren′t sporty [28]. | Not to be sporty | |
Exercise as a natural part of life. Exercise as joyful and health-promoting [24]. | Healthy exercise |
N° | Author YEAR País | Aim | Sample Sampling Method | Methodology Data Analysis Data Collection | Emergent Themes | Main Results |
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1 | 2017 USA [30] | To explore relations between social media use and body image in early adolescent girls | n = 38 girls Age 12–14 years Purposive sampling | Mixed-methods approach using Sociodemographic dates. Mass media usage survey. Six focus group Semi-structured Interview for 50 min. After focus group individual surveys were completed. | Five Themes emerged:
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2 | 2011 India [23] | To identify the factors recognized as contributing to weight dissatisfaction in Indian adolescent girls and young women | n = 10 girls Age 15–21 years Purposive Sampling | A structured interview during 60 to 90 min. | Six themes emerged:
|
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3 | 2010 Sweden [24] | To investigate positive body image during adolescence. | n = 30 15 boys and 15 girls Age 10–13 years Purposive Sampling | Semi-structured Interview for 60 min. | Four themes emerged:
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4 | 2018 USA [9] | To determine which characteristics of a American Indian and African American children prefer and to gather their opinions on body image. | n = 51 25 girls, 26 boys Age 8–13 years Ethnic group Purposive Sampling | Mixed-methods approach using body image assessment instruments. Eight focus group separated by age and ethnicity. Semi structured questions lasted 75 min. | Two themes emerged:
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5 | 2012 Sweden [25] | To examine the topic of appearance ideals from the perspective of 14-year-old adolescents with a positive body image. | n = 30 15 girls and 15 boys Age 14 years | Individually Semi-structured interview was used. Lasting 1 h. | Two themes emerged:
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6 | 2017 Ireland [28] | To investigate how peers influence adolescent body image and whether this influence was positive and/or negative from young peoples′ perspectives | n = 111 59 females and 52 males Age 13–18 years Purposive Sampling | 17 focus group with single-gender groups. | Seven themes emerged:
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7 | 2016 Ireland [26] | To explore common perceptions and influential processes occurring within current Irish appearance culture. | n = 39 20 girls and 19 boys Age 12–14 years Purposive Sampling | Eight Focus Groups, four groups of each sex. A semi-structured interview guide. Lasting 30–40 min. | Three themes emerged:
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8 | 2013 Norway [27] | To investigate how body ideals are discussed and conceptualized among groups of Norwegian youth. | n = 63 48 girls and 15 boys Age 16–20 years | Nine focus group. A semi-structured interview guide. Lasting approximately 50–60 min. | Three themes emerged:
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9 | 2009 Ireland [22] | To investigate the opinions of female adolescents living in Ireland on issues relating to body image and dietary practice | n = 124 girls Age 15–16 years Purposive Sampling | 16 focus group sessions lasted approximately 40 min. A semi-structured interview guide. | Two themes emerged:
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10 | 2013 UK [29] | To explore adolescents′ views on causes of body dissatisfaction and dieting and recommendations for prevention. | n = 22 girls Age 13–15 years Purposive Sampling | 4 Focus Groups lasted 1 h. A semi-structured interview guide. | Four themes emerged:
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Tort-Nasarre, G.; Pollina Pocallet, M.; Artigues-Barberà, E. The Meaning and Factors That Influence the Concept of Body Image: Systematic Review and Meta-Ethnography from the Perspectives of Adolescents. Int. J. Environ. Res. Public Health 2021, 18, 1140. https://doi.org/10.3390/ijerph18031140
Tort-Nasarre G, Pollina Pocallet M, Artigues-Barberà E. The Meaning and Factors That Influence the Concept of Body Image: Systematic Review and Meta-Ethnography from the Perspectives of Adolescents. International Journal of Environmental Research and Public Health. 2021; 18(3):1140. https://doi.org/10.3390/ijerph18031140
Chicago/Turabian StyleTort-Nasarre, Glòria, Mercè Pollina Pocallet, and Eva Artigues-Barberà. 2021. "The Meaning and Factors That Influence the Concept of Body Image: Systematic Review and Meta-Ethnography from the Perspectives of Adolescents" International Journal of Environmental Research and Public Health 18, no. 3: 1140. https://doi.org/10.3390/ijerph18031140