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“Everybody Knows That Mass Media are/are not [ pick one ] a Cause of Eating Disorders”: A Critical Review of Evidence for a Causal Link Between Media, Negative Body Image, and Disordered Eating in Females


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This article reviews research pertaining to mass media as a causal risk factor for negative body image and disordered eating in females. The specific purpose is to clarify the impact of mass media by applying seven criteria that extend those of Kraemer et al. (1997) and Stice (2002). Although media effects clearly meet a majority of the criteria, this analysis indicates that, currently, engagement with mass media is probably best considered a variable risk factor that might well be later shown to be a causal risk factor. Recommendations are made for further research, with an emphasis on longitudinal investigations, studies of media literacy as a form of prevention, and clarification of psychosocial processes that moderate and mediate media effects.
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Journal of Social and Clinical Psychology, Vol. 28, No. 1, 2009, pp. 9-42
Media, Negative Body Image and Disordered Eating
“everyBody knows tHat Mass MedIa
are/are not [pick one] a cause
of eatIng dIsorders”:
a crItIcal revIew of evIdence
for a causal lInk Between MedIa,
negatIve Body IMage, and
dIsordered eatIng In feMales
Kenyon College
This article reviews research pertaining to mass media as a causal risk factor for
negative body image and disordered eating in females. The specic purpose is to
clarify the impact of mass media by applying seven criteria that extend those of
Kraemer et al. (1997) and Stice (2002). Although media effects clearly meet a ma-
jority of the criteria, this analysis indicates that, currently, engagement with mass
media is probably best considered a variable risk factor that might well be later
shown to be a causal risk factor. Recommendations are made for further research,
with an emphasis on longitudinal investigations, studies of media literacy as a
form of prevention, and clarication of psychosocial processes that moderate and
mediate media effects.
Numerous professionals, parents, and adolescents find the media’s
status as a cause of body dissatisfaction, drive for thinness, and eat-
ing disorders to be self-evident: Of course, mass media contribute
to unhealthy beauty ideals, body dissatisfaction, and disordered
eating—haven’t you seen the magazine covers in the supermarket
newsstands lately? No wonder so many girls have body image is-
sues and eating disorders.” On the contrary, a growing number of
Correspondence concerning this article should be addressed to Michael P. Levine,
Ph.D., and Sarah K. Murnen, Ph.D., Department of Psychology, Kenyon College,
Gambier, OH 43022-9623. E-mail:;
10 levIne and Murnen
parents, biopsychiatric researchers, clinicians (e.g., Bulik, 2004), and
cynical adolescents find proclamations about media as a cause of
any disorder to be an irritating distraction. Their contention is, in
effect: Of course, we know now that eating disorders, like mood
disorders and schizophrenia, are severe, self-sustaining psychiatric
illnesses with a genetic and biochemical basis. So, of course, no sci-
entist seriously thinks that mass media and the escapades of actors,
models, and celebrities have anything to do with causing them.”
This article reviews the current status of research pertaining to
mass media as a causal risk factor for clinically significant levels of
negative body image and disordered eating in females. After con-
sidering the criteria for establishing a causal risk factor, we analyze
the evidence for the impact of mass media (e.g., fashion magazines,
television). The principal goals are to clarify (1) what is known with
relative certainty about media’s effects on females (2) what isn’t
known yet, or remains ambiguous; and (3) what methodologies and
studies are needed to advance the types of risk-factor knowledge
that should facilitate prevention, treatment, and support during re-
The relationships between mass media, negative body image,
and unhealthy behaviors (e.g., use and abuse of steroids and food
supplements) in males are receiving increasing attention (Pope,
Phillips, & Olivardia, 2000). This review, however, concentrates on
females. The gender differences (conservatively, 6 to 8 females for
each male) in the prevalence of anorexia nervosa, bulimia nervosa,
and eating disorder not otherwise specified (EDNOS) other than
Binge Eating Disorder are among the largest reported for mental
disorders (Fernández, Labrador, & Raich, 2007; Hoek & van Hoe-
ken, 2003; but see
Hudson, Hiripi, Pope, & Kessler, 2007).
MedIa as a cause of wHat?—wHat Is to Be exPlaIned?
Although the matter of dimensions and/or categories is complex
and unresolved (Gleaves, Brown, & Warren, 2004), substantial evi-
dence suggests that the serious and frequently chronic conditions
recognized as the “Eating Disorders” by the DSM-IV-TR (American
MedIa, negatIve Body IMage and dIsordered eatIng 11
Psychiatric Association, 2000) are composite expressions of a set of
dimensions, such as negative emotionality, binge eating, and un-
healthy forms of weight and shape management. The latter includes
restrictive dieting, self-induced vomiting after eating, and abuse of
laxatives, diuretics, diet pills, and exercise (Levine & Smolak, 2006;
Stice, Killen, Hayward, & Taylor, 1998; Tylka & Subich, 1999).
The adhesive drawing together and framing these intertwined
continua is negative body image. In most media effects research
the multidimensional construct of body image (Cash & Pruzinsky,
2002) is represented by various measures of what are essentially
perceptual-emotional conclusions (e.g., “I look too fat to myself
and others” + “I am disgusted by and ashamed of this” = “I hate
how fat I look and feel”). For females “body dissatisfaction” results
from—and feeds—a schema that integrates three fundamental com-
ponents: idealization of slenderness and leanness; an irrational fear
of fat; and a conviction that weight and shape are central determi-
nants of one’s identity (Levine & Smolak, 2006; Smolak & Levine,
1994, 1996).
The effects of media designed to reach and influence huge masses of
people are certainly a salient and thus tempting explanation for four
fairly well-established findings. First, the prevalence of discontent
and problems concerning weight and shape has been so high for so
long among girls and women that for 25 years it has been consid-
ered “normative” (Ricciardelli & McCabe, 2004; Rodin, Silberstein,
& Striegel-Moore, 1985). Second, a substantial percentage, perhaps
20%, of females ages 12 through 30 have levels of negative body im-
age and disordered eating high enough to create significant suffer-
ing for themselves and others (Cash, 2002; Levine & Smolak, 2006).
Third, weight and shape concerns, along with a “dieting mentality,”
tend to emerge in childhood for girls of varying sizes and back-
grounds—and children are heavy consumers of mass media (e.g.,
TV, children’s books, and videos; Comstock & Sharrer, 2007) that are
replete with clear messages about the positive features of thinness
and the many negative aspects of being fat. Finally, while there are
certainly ethnic and sociogeographic differences in risk for negative
body image and disordered eating, the fact that “fat talk” and these
12 levIne and Murnen
problems are found among youth and young adults of all social
classes and ethnicities, and in many highly dissimilar geographic
locations, is consistent with a general sociocultural model that in-
cludes a proliferating, influential mass media (Cash & Pruzinsky,
2002; Gordon, 2000; Levine & Smolak, 2006; Nichter, 2000).
crIterIa for evaluatIng tHe status
of a Mass MedIa as a “cause”
Researchers in many fields have stopped thinking about “the” cause
of a disorder as “the agent” that directly brings about the undesir-
able outcome. Instead, there is an emphasis on variables that are
reliably and usefully associated with an increase over time in the
probability of a subsequent outcome. Such variables are called risk
factors (Kraemer et al., 1997).
Thinking in terms of risk factors has two major implications for in-
vestigating mass media as a “cause” of eating disorders. The first
concerns the oft-heard “relative rarity” argument: How could mass
media be a cause when the vast majority of girls and young women
are exposed to ostensibly toxic influences, but only a small percent-
age develop eating disorders? This critique dissolves when one
considers multiple risk factors as multiplicative probabilities. As-
sume, conservatively, that 35% of adolescent girls are engaged with
those mass media containing various unhealthy messages. Assume
also that three other risk factors—such as peer preoccupation with
weight and shape; family history of overweight/obesity; and be-
ing socialized by parents and older siblings to believe firmly that
a female’s identity and worth are shaped primarily by appearance
(Smolak & Levine, 1996)—each have a probability of .35 of occurring
in the population. The probability of co-occurrence for these four
unweighted risk factors is .35
= .015, which is roughly the preva-
MedIa, negatIve Body IMage and dIsordered eatIng 13
lence of anorexia nervosa and bulimia nervosa among females in
the age range at greatest risk (Hoek & van Hoeken, 2003). Behavior
geneticists have long accepted that the presence of fairly common
risk factors in a population can account for fairly rare and extreme
conditions (Hanson, 2004).
Second, if mass media constitute a causal risk factor (Kraemer et al.,
1997; Stice, 2002) for the spectrum of negative body image and dis-
ordered eating, then the following will be the case. Cross-sectional
studies will show that the extent of exposure to mass media, or to
various specific forms of mass media, is a correlate of that spec-
trum. Longitudinal studies will demonstrate that exposure to mass
media precedes and predicts development of negative body im-
age and disordered eating. Laboratory experiments should show that
well-controlled manipulation of the media risk factor (independent
variable) causes the hypothesized changes in “state” body satisfac-
tion and other relevant dependent variables, while controlled analog
(laboratory) or field experiments should demonstrate that prevention
programs designed to combat known risk factors do indeed reduce
or delay the onset of disordered eating.
These criteria are demanding in and of themselves (Stice, 2002).
Nevertheless, it is also important to incorporate the contributions
to knowledge of two further sources: common sense and people’s
"lived experience." Specifically, if mass media are a causal risk fac-
tor, then content analyses should document that media provide the
raw material from which children and adolescents could readily ex-
tract and construct the information, affective valences, and behav-
ioral cues necessary to develop the components of disordered eat-
ing. Similarly, surveys and ecological analyses will reveal that engage-
ment with mass media is frequent and intensive enough to provide
multiple opportunities for this type of social-cognitive learning.
Finally, surveys and qualitative studies should find that, beginning at
the age where they can think critically about themselves in relation
to personal and outside influences, children and adolescents will
report that mass media are sources of influence, and even pressure,
on themselves, their peers, and others.
14 levIne and Murnen
Thus, this review uses seven criteria to evaluate the status of mass
media as a causal risk for negative body image and disordered eat-
ing. Content and exposure are foundational, so we will consider
them criteria 1 and 2. The Kraemer-Stice standards are criteria 3
through 6, and the existence and impact of subjective experiences of
media pressures and influence constitute criterion 7.
crIterIa 1 and 2: content and exPosure
Mass media are a major part of the lives of many children, adoles-
cents, and adults (Comstock & Scharrer, 2007; Harris, 2004). Peo-
ple of all ages select and use media for many purposes, including
entertainment and distraction, but also exploration of significant
developmental issues pertaining to curiosity, education, popular-
ity, identity, gender roles, and sexuality (Arnett, 1995; Comstock &
Scharrer, 2007).
Appearance, status, sexuality, and buying and consuming are, for
many reasons (including the power of mass media), very important
aspects of life throughout many countries. Consequently, the con-
tent of mass media provides daily, multiple, overlapping, and, all
too often, unhealthy messages about gender, attractiveness, ideal
body sizes and shapes, self-control, desire, food, and weight man-
agement (Bordo, 1993; Currie, 1999; Spitzer, Henderson, & Zivian,
1999). These messages sometimes intentionally, sometimes inciden-
tally indoctrinate developing girls and boys with the following eas-
ily extracted themes: (a) being sexually attractive is of paramount
importance; (b) the sources of ideals about attractiveness (“being
‘hot’!”), style, and the best, most competitive practices for becoming
and staying beautiful are obviously located outside the self; and (c)
mass media are the most important and inherently enjoyable “ex-
ternal” source of the information, motivation, and products neces-
MedIa, negatIve Body IMage and dIsordered eatIng 15
sary to be attractive and fashionable (Ballentine & Ogle, 2005; Labre
& Walsh-Childers, 2003).
Thus, with respect to the cultural foundations of negative body im-
age and disordered eating, even girls (and boys) as young as 4 or 5
have no trouble finding in mass media the raw materials for various
maladaptive but entirely normative media-based schemata concern-
ing gender and attractiveness (Levine & Harrison, 2004; Smolak &
Levine, 1994, 1996; Smolak & Murnen, 2004, 2007). The thinness
schema” for females is a set of assumptions, “facts,” and strong feel-
ings that are organized so as to establish a readiness to think and
respond in terms of, for example, the following themes: (1) Women
are “naturally” invested in their beauty assets and thus beauty is a
woman’s principal project in life; (2) a slender, youthful attractive
“image” is really something substantive, because it is pleasing to
males and it demonstrates to females that one is in control of one’s
life; and (3) learning to perceive, monitor, and indeed experience
yourself as the object of an essentially masculine gaze is an impor-
tant part of being feminine and beautiful.
There is a wealth of evidence from content analyses that the ideal
female body showcased on television, in movies, in magazines, and
on the internet reflects, indeed embodies, the proposition that “thin
is normative and attractive” (Harrison & Hefner, 2006; Levine &
Smolak, 1996; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999).
While (because?) American girls and women are becoming heavier,
the current body ideal (idol) for women has become and remains
unrealistically thin (Grabe & Hyde, 2006; Sypeck, Gray, & Ahrens,
2004). In fact, mass media are one of many sociocultural sources
for the normative prejudice that fat is “horrible and ugly,” and that
“getting fatter” is a sign of at least 4 of the classic “7 deadly sins”—
extravagance, gluttony, greed, sloth, and, maybe, pride (see, e.g.,
research by Fouts & Burggraf, 2000, and Klein & Shiffman, 2006;
16 levIne and Murnen
see reviews by Greenberg, Eastin, Hofschire, Lachlan, & Brownell,
2003, and Puhl & Latner, 2007).
Criteria 1 and 2 are fulfilled. Mass media are saturated with poten-
tially unhealthy messages, and citizens of virtually all ages are mo-
tivated to use and be engaged with these media on a regular basis.
crIterIon 3: cross-sectIonal correlates
of exPosure to Mass MedIa
The presence of a positive correlation between level of exposure to
mass media, or to certain types of mass media, and the spectrum
of disordered eating is a necessary but not sufficient condition for
determination of causal agency. However, absence of a positive cor-
relation negates the argument for causality.
Consistent with Criterion 3, cross-sectional studies show that the
average amount of time adolescent girls spend viewing appearance-
focused media such as soap operas and music videos is positively
correlated with body dissatisfaction, drive for thinness, internaliza-
tion of the thin ideal, endorsement of surgery to attain a bust size
that is neither small nor too large, and bulimic symptomatology,
although there is conflicting evidence as to whether this relation-
ship applies to White as well as non-White girls (Borzekowski, Rob-
inson, & Killen, 2000; Botta, 2000; Harrison, 2003; Tiggemman, 2005;
Tiggemann & Pickering, 1996). Yet, there is substantial variability
in the survey-based empirical findings (Levine & Harrison, 2004,
in press; Murnen, Levine, Groesz, & Smith, 2007). To draw general
conclusions, we turn to two recent meta-analytic evaluations of the
relationship between exposure to television, body image, and dis-
ordered eating.
Grabe, Ward, and Hyde (2008) located 12 studies yielding 21 inde-
pendent effect sizes. Although these investigators did not calculate
the 4 individual ds from the complete cross of magazines versus
TV and correlational versus experimental design, the ds for the re-
lationship between TV exposure and body dissatisfaction ranged
from -.20 to +.61 (n = 11), while the ranges for internalization of the
thin ideal and for disordered eating were -.08 to +.43 (n = 4) and
+.12 to +.47 (n = 3), respectively. According to Grabe et al. (2008),
their meta-analysis definitely supports a positive relationship, with
“small to moderate effect sizes,” between TV exposure and body
dissatisfaction, thin-ideal internalization, and self-reported disor-
dered eating.
We also conducted a meta-analysis (Murnen et al., 2007; see Ta-
ble 1). Given that our focus was on media exposure as evaluated in
survey-based correlational research, many more unpublished and
published studies were identified (k = 30). We found smaller but
still statistically significant correlations (effect size rs range from be-
tween +.02 and +.09; ds = +.04 to +.18) for the relationship between
TV exposure in general and sets of criterion variables categorized
as thin ideal internalization, body dissatisfaction, weight and shape
control, and disordered eating.
TABLE 1. Media Exposure (Survey-Based) and Disordered Eating in Females: Effect Sizes
Exposure to k n r Heterogeneity: r Larger for
Thin Ideal 16 4606 0.21 Age < 18; non-US samples
Body Dissatisfaction 31 9398 0.12 None of the variables coded
Wt/Shape control 17 5927 0.19 Sample is < 80% White;
Disordered eating 20 11834 0.13 U.S. samples; sample is > 80%
Thin Ideal 10 3917 0.02 Age < 18; non-U.S. samples
Body Dissatisfaction 30 8212 0.09 age > 18
Wt/Shape control 17 5557 0.05 age > 18; sample is > 80%
White; assessed with EDI-DT
Disordered eating 21 9345 0.06 assessed with EDI-BU or EAT
Note: All rs (effect sizes) are statistically signicant, p < .01. Except for the correlations between TV
viewing and disordered eating (ns) and magazine reading and body dissatisfaction (p < .05), all hetero-
geneity statistics are signicant at p < .01. ES = effect size. EDI-DT and EDI-BU = Drive for Thinness
and Bulimia subscales, respectively, of the Eating Disorders Inventory. EAT = Eating Attitudes Test.
18 levIne and Murnen
According to studies of undergraduate women and adolescent girls,
the extent of exposure to magazines that feature and glamorize
the thin ideal is positively correlated with disordered eating, even
when controlling for the young woman’s level of personal interest
in fitness and dieting (Harrison & Cantor, 1997; Thomsen, Weber, &
Brown, 2002). A path analytic study by Jones, Vigfusdottir, and Lee
(2004) found that for girls 11 through 14 the extent of exposure to
appearance-related magazines and to appearance conversations by
peers each predicted body dissatisfaction through the mediator of
internalization of the thin beauty ideal.
Grabe et al.’s (2008) meta-analysis identified 18 survey-based
studies of the correlates of magazine exposure, yielding 33 effects.
The ds for body dissatisfaction ranged from -.22 to +.63 (n = 12),
while those for internalization of the thin ideal and for disordered
eating were +.03 to +.81 (n = 9) and +.08 to +.63 (n = 9), respectively.
Once again, Grabe et al. concluded that, in general, there is a small
to moderate positive correlation between magazine exposure and
the key variables. We note, however, that the relationship between
magazine exposure and thin-ideal internalization may be stronger
than that. Of the 9 relevant ds, only one was < +.35, and 6 were >
Our meta-analysis (Murnen et al., 2007) of over 30 studies found
that the effect size rs (+.12 to +.21, equivalent to ds between +.24 and
+.44) were appreciably higher for magazines than for TV (see Table
1). Consistent with the findings of Grabe et al., we also discovered
that, compared to the other criterion measures, thin ideal internal-
ization was more strongly correlated with magazine reading and
TV viewing, especially for children and adolescents under age 18.
Meta-analytic studies show that there is a small to moderate posi-
tive correlation between level of exposure to mass media such as
TV and magazines and each of the important triad of body dissatis-
faction, thin-ideal internationalization, and disordered eating. This
fulfills Criterion 3.
MedIa, negatIve Body IMage and dIsordered eatIng 19
The two meta-analyses (Grabe et al., 2008; Murnen et al., 2007)
found a lack of consistency in potential moderators within and
across the two types of media. This suggests we have a lot to learn
about the relationship between frequency and intensity of natural-
istic media exposure and disordered eating.
crIterIon 4: longItudInal correlates
of exPosure to Mass MedIa
A causal risk factor precedes and predicts development of a prob-
lem. Consequently, longitudinal studies are critically important for
identifying causal risk factors.
In two quite different cultures, the Ukraine and Fiji, institution
of a market-based mass media was followed by increases in inter-
nalization of the slender beauty ideal and in body dissatisfaction
among adolescent girls (Becker, Burwell, Gilman, Herzog, & Ham-
burg, 2002; Bilunka & Utermohlen, 2002). In Fiji, 3 years after intro-
duction of television the level of disordered eating and self-induced
vomiting to control weight was significantly greater (Becker et al.,
Compared to cross-sectional studies, longitudinal research link-
ing media exposure with body image is sparse. The few published
studies do suggest that early exposure to thin-ideal television pre-
dicts a subsequent increase in body-image problems. For a sample
of Australian girls aged 5 to 8, viewing of appearance-focused tele-
vision programs (but not magazines) predicted a decrease in ap-
pearance satisfaction 1 year later (Dohnt & Tiggemann, 2006). For
European American and African American girls ages 7 through 12
greater overall television exposure predicted both a thinner ideal
adult body shape and a higher level of disordered eating 1 year later
(Harrison & Hefner, 2006). The results of both studies were valid
regardless of whether the children were heavy, or perceived them-
selves to be thin or heavy, at the outset of the research. The thrust of
these two studies is consistent with Sinton and Birch’s (2006) find-
ing that, among the 11-year-old American girls they studied, aware-
ness of media messages about thinness was related to the strength
of appearance schemas a year later.
The importance of a longitudinal design is revealed in recent
studies of older children and young adolescents conducted by
20 levIne and Murnen
Tiggemann (2006) and by Field and colleagues (1999, 2001, 2008).
In a sample of 214 Australian high school girls (mean age = 14),
Tiggemann found that the only measure of television exposure, in-
cluding total hours of exposure, to produce meaningful cross-sec-
tional and longitudinal correlations was the self-reported extent of
watching soap operas. Cross-lagged correlational analyses showed
that Time 1 exposure to soap operas predicted, to a small but sig-
nificant degree, internalization of the slender ideal and level of ap-
pearance schema at 1-year follow up (Time 2). Time spent reading
appearance-oriented magazines, but not other magazines, at Time 1
predicted, also to a small but significant degree, Time 2 levels of in-
ternalization, appearance schema, and drive for thinness. However,
none of the media exposure variables was a significant longitudinal
predictor of body dissatisfaction. Moreover, hierarchical regressions
controlling for Time 1 level of each of the four criterion variables
(e.g., internalization) found that none of the media exposure mea-
sures added significantly to prediction of the Time 2 criteria.
Although Field and colleagues used only single-variable mea-
sures of media exposure, their longitudinal research also casts
doubt on exposure as a causal risk factor for older children and
younger adolescents. Field et al. investigated a sample of over 6900
girls who were ages 9 through 15 at the 1996 baseline. Preliminary
cross-sectional work did produce the expected positive linear asso-
ciation between frequency of reading women’s fashion magazines
and intensity of weight concerns (Field et al., 1999). However, sub-
sequent longitudinal research revealed that over a 1-year period the
key predictor of the development of weight concerns and frequent
dieting was “making a lot of effort to look like same-sex figures in
the media” (Field et al., 2001, p. 54). A 7-year follow-up showed that
initiation of binge-eating, but not purging, in (now) adolescent and
young adult females was predicted independently by frequent diet-
ing and by Time 2 (1997) level of attempting to look like persons in
the media (Field et al., 2008).
The only longitudinal investigation of young adult women we
could locate was Aubrey’s (2006) 2-year panel study of college-age
women. In support of Criterion 4, the extent of exposure to sexually
objectifying media at Time 1 predicted level of self-objectification at
Time 2, especially in women with low self-esteem. Measures of the
tendency to self-objectify are positively correlated with eating dis-
order symptoms such as misperceptions of weight and shape, body
MedIa, negatIve Body IMage and dIsordered eatIng 21
shame, drive for thinness, and restrictive dieting (see, e.g., Smolak
& Murnen, 2004; Tylka & Hill, 2004).
Evidence from a very small number of longitudinal studies indi-
cates that for children and very young adolescents, extent of media
exposure does appear to predict increases in negative body image
and disordered eating. Tiggemann’s (2006) suggests that by early
adolescence the causal risk factor is not media exposure, or even
internalization of the slender beauty ideal, but rather the intensity
and extent of “core beliefs and assumptions about the importance,
meaning, and effect of appearance in an individual’s life” (p. 528).
Field et al.’s extensive work concurs, pointing to schematic feature
of paying attention to, and trying to look like, models and celebri-
ties in the mass media. In all, there is little support for Criterion 4 as
it applies to adolescence, and preliminary but inconclusive support
for this criterion in regard to children and college students.
crIterIon 5: exPerIMental ManIPulatIon of MedIa
exPosure exPerIMental evIdence: laBoratory
researcH and tHe contrast effect
Laboratory experiments cannot settle the question of correlation
and causal agency in a developmental sense. However, experimen-
tation can help determine whether, as predicted by a causal risk fac-
tor model, concentrated media exposure actually makes girls and
women feel immediately worse or better about their bodies and
their selves.
In a meta-analysis of 25 published and unpublished experiments
appearing between 1979 and 2000, Groesz, Levine, and Murnen
(2002) examined the effects of experimental exposure to media con-
tent on body dissatisfaction in female samples. Thirty-five (81%) of
the 43 d values were negative, and the overall d value was -0.31 (r =
-.65). Compared to participants randomly assigned to control con-
ditions, participants exposed to thin-ideal images from the media
experienced a moderately large drop in body satisfaction. The aver-
22 levIne and Murnen
age effect size was slightly greater for participants not yet in college
(d = -.36), suggesting heightened sensitivity among adolescents.
Grabe et al.’s (2008) meta-analysis identified an additional 19 ex-
perimental studies of magazine-based images and an additional 8
studies of images from TV shows and commercials. Sixteen of 19
magazine studies and all of the TV studies were published after the
Groesz et al. (2002) article went to press. Of the 24 magazine effect
sizes involving body dissatisfaction, half were over -.45 and four
were greater than -1.00. For the 9 TV effect sizes, the range was -.15
to -1.63, and four were greater than -.45. Grabe et al. (2008) also re-
ported that, although there was substantial heterogeneity, the ds for
experimental effects (across magazines and TV) on internalization
and eating behaviors and beliefs were -.21 and -.36, respectively.
The meta-analyses by Groesz et al. (2002) and Grabe et al. (2008)
provide strong support for Criterion 5. In this regard, multimethod
studies by Hargreaves and Tiggemann (2002, 2003, 2004) in Aus-
tralia produced compelling evidence for the contention that mass
media have negative and cumulative effects on body image in girls
and young women. The adolescent girls whose body image was
most negatively affected by experimental exposure to 20 television
commercials featuring the thin ideal tended to have greater levels of
body dissatisfaction and drive for thinness 2 years later, even when
initial level of body dissatisfaction was controlled statistically.
The most vulnerable girls may well have a self-schema dominat-
ed by the core importance of physical appearance. In a study of girls
ages 15 through 18 Hargreaves and Tiggemann (2002) found that
appearance-focused TV commercials did activate an appearance-
related self-schema, as reflected in several measures of cognitive
set. Moreover, as predicted, appearance-focused commercials gen-
erated greater appearance dissatisfaction for those girls who began
the study with a more extensive, emotionally charged, self-schema
for appearance. Interestingly, the negative impact of the thin-beauty
ideal in television commercials was, unlike previous findings with
magazine images, unaffected by either the girls’ initial level of body
dissatisfaction (see Groesz et al., 2002) or whether their viewing
MedIa, negatIve Body IMage and dIsordered eatIng 23
style was more personal (self-focused) or more detached (image-
focused; see next section).
Positive (Assimilation) Effects. Durkin and Paxton (2002) found that
32% of the 7
grade girls and 22% of the 10
grade Australian girls
who were exposed to images of attractive models from magazines
exhibited an increase in state body satisfaction. Similarly, two studies
of Canadian college students found that restrained eaters showed
moderate to large increases in body satisfaction following exposure
to similar magazine images, whereas unrestrained eaters had very
large decreases in body satisfaction (Joshi, Herman, & Polivy, 2004;
Mills, Polivy, Herman, & Tiggemann, 2002).
Two studies in the United States by Wilcox and Laird (2000) sug-
gest that young women who focus on the slender models in maga-
zines while defocusing attention on themselves are more likely to
identify with the models and thus to feel better about their own
bodies. Conversely, women who self-consciously divide their atten-
tion between the models and themselves are more likely to evaluate
themselves and reach a conclusion that leaves them feeling inferior
and worse. This finding is supported by research showing that self-
evaluative processes, as opposed to self-improvement motives, are
more likely to reflect and activate “upward” social comparison pro-
cesses, which themselves tend to generate negative feelings about
one’s body (Halliwell & Dittmar, 2005).
Pro-Ana Web Sites. The internet offers many pro-anorexia (pro-
ana) and pro-bulimia (pro-mia) web sites. Some of the most promi-
nent pro-ana sites defiantly and zealously promote AN as a sacred
lifestyle rather than a debilitating psychiatric disorder (Norris, Boy-
dell, Pinhas, & Katzman, 2006). Their ”thinspirational” images of
emaciation and their explicit behavioral instructions for attaining
and sustaining the thin ideal are intended to reinforce the identity
and practices of those already entrenched in AN or BN.
If concentrated exposure to typical images of slender models have
negative experimental effects, then we might well expect the im-
ages and messages from pro-anorexia web sites to have even more
negative effects. Two recent experiments by Bardone-Cone and Cass
(2006, 2007) examined the effects of a web site that they constructed
to feature the prototypical content of pro-ana sites. As predicted, ex-
posure to this site had a large number of negative effects on young
women, independent of their dispositional levels of thin ideal inter-
24 levIne and Murnen
nalization and disordered eating. At present, we do not know what
effects pro-ana and pro-mia sites have on the adolescent girls and
young women who avidly seek them out because they already have
a full-blown eating disorder.
crIterIon 6: exPerIMental evIdence:
PreventIon studIes
If media effects are a causal risk factor, then reduction or elimina-
tion of negative media influences should reduce or prevent nega-
tive body image and other processes that eventually result in eating
disorders. One way to test this proposition is to evaluate the impact
of interventions designed to promote “media literacy.” Media lit-
eracy (ML) is a set of knowledge, attitudes, and skills that enable
people to work together to understand, appreciate, and critically
analyze the nature of mass media and one’s relationships with them
(Levine & Harrison, 2004, in press; Levine & Piran, 2004; Levine &
Smolak, 2006). Systematic investigations of ML can be categorized
into analog laboratory studies, brief interventions, and longer, more
intensive programs.
This research has been reviewed in detail elsewhere (Levine, Piran,
& Stoddard, 1999; Levine & Smolak, 2006, chapter 13; Levine &
Smolak, 2008). Several controlled experiments show that very brief
written or video interventions can inoculate college-age women, in-
cluding those who already have a negative body image, against the
general tendency to feel worse about their bodies and themselves
after viewing slides or video containing media-based images of the
slender beauty ideal. The most effective ML “inoculation” high-
lights the clash between the artificial, constructed nature of the slen-
der, flawless, “model look” versus two stark realities: (1) the actual
shapes and weights of females (and males) naturally vary a great
deal across a population; and (2) dieting to attain an “ideal” and
MedIa, negatIve Body IMage and dIsordered eatIng 25
“glamorous” weight/shape that is unnatural for a given individual
has many negative effects, including risk for an eating disorder.
Three doctoral dissertations completed in the U.S. from 1998 to 2000
taught ML to girls ages 9 through 14 (see Levine & Smolak, 2006,
chapter 13). The content of these programs varied, but, consistent
with the findings of analog research, each emphasized the narrow
and constructed nature of beauty ideals, as well as the futility and
health costs of seeking to actualize this artificial “perfection.” These
projects demonstrated that ML lessons ranging in length from 40 to
135 minutes can have a number of positive effects lasting several
months, such as improving girls’ body image and reducing both the
glorification of thinness and social comparison tendencies.
Several programs for high-school and college-age females used
slide presentations or Jean Kilbourne’s video Slim Hopes (http:// to help
participants consider the history of changing, but consistently re-
strictive, beauty ideals and then to answer some fundamental ques-
tions: Do real women look like the models in advertising? Will buy-
ing the product being advertised make me look like this model?
These programs emphasize how fashion models, working with the
production staffs of magazines and movies, use “cosmetic” surgery,
computer graphics, and other technologies to construct idealized
images. Participants are encouraged to explore how these manipu-
lations are carefully orchestrated to stir up the desire to purchase
products, many of which will supposedly reduce the discrepancy
between such unreal, “perfect” images versus the body shapes and
weights of normal, healthy females.
These ML programs are brief, so positive effects are necessarily
limited. Nevertheless, it is noteworthy that they tend to reduce, at
least in the short run, one important risk factor for disordered eat-
ing (Thompson & Stice, 2001): internalization of the slender beauty
26 levIne and Murnen
Well-controlled studies of multi-lesson, multifaceted media literacy
programs that unfold over 1 to 2 months have shown that media
literacy training can help girls and boys ages 10 through 14 to reduce
risk factors such as internalization of the slender or muscular ideal,
while increasing the potentially protective factors of self-accep-
tance, self-confidence in friendships, and confidence in their ability
to be activists and thus affect weight-related social norms (Levine
& Smolak, 2006). In addition to spending considerable time work-
ing on the same components as those in the analog and brief inter-
ventions, intensive ML programs address the process and costs of
social comparison. They also get participants involved in working
within their ML groups, their school, and their larger community
to translate their increasing literacy into peer education, consumer
activism, and creating and promoting new, healthier media.
Recent investigations with college students also show ML to be a
promising form of prevention (Levine & Harrison, in press; Levine &
Smolak, 2007, 2008). For example, Watson and Vaughn (2006) devel-
oped a 4-week, 6-hour intervention consisting of psychoeducation
about the nature and sources of body dissatisfaction; group-based
content analysis of beauty ideals in popular women’s magazines;
discussion of media ideals and beauty enhancement techniques;
and a brief cognitive intervention designed to help participants
dispute negative beliefs and feelings activated by media images of
the thin ideal. Compared to a 1-day, 90-min version of this inter-
vention, a one-time viewing of a 34-min media literacy film, and
a no-intervention control, the extended intervention was the most
successful in reducing the following risk factors for disordered eat-
ing: unhealthy social attitudes, internalization of the slender ideal,
and body dissatisfaction.
At present there have been no direct, long-term studies of whether
media literacy in particular can prevent development of negative
body image and the spectrum of disordered eating. At this point
it seems fair to say that there is “some” encouraging evidence for
MedIa, negatIve Body IMage and dIsordered eatIng 27
Criterion 6 in that (1) brief forms of a critical social perspective can
mitigate the immediate negative effects of exposure to the thin ide-
al; and (2) more systematic interventions over days or weeks can re-
duce one important risk factor: internalization of the slender ideal.
crIterIon 7: suBjectIve Influence: MotIves,
Pressures, and Ideals
One sensible way to add to our understanding of media effects is
to ask people about their experiences with media “pressures” and
Field et al.’s (1999) survey of nearly 550 working class girls ages 11
through 19 revealed that almost 70% reported that the “pictures”
in magazines have an influence on their conception of the “perfect
body shape.” Over 45% indicated that those images motivated them
to lose weight, and the greater the frequency of reading “women’s
magazines,” the more likely these adolescent girls were to report
being influenced to think about the perfect body, to be dissatisfied
with their own body, to want to lose weight, and to diet.
As noted previously, subsequent cross-sectional and longitudi-
nal research by Field and colleagues revealed that “wanting to look
like” celebrities and models in the media was a strong predictor of
weight concerns, dieting behavior, and binge eating. A similar study
of nearly 800 Australian adolescent girls found that 88.5% said they
desired the “slender media-promoted ideal body shape” (Grigg,
Bowman, & Redman, 1996). Further, those who definitely and en-
thusiastically desired this shape had significantly higher levels of
extreme dieting and disordered eating. This finding is quite consis-
tent with the results of Levine, Smolak, and Hayden’s (1994) survey
of nearly 400 American girls ages 10 through 14. In this study the ex-
tent to which magazine articles and advertisements were important
to a young adolescent girl’s concept of the perfect body and how to
obtain it was very strongly correlated with greater investment in
thinness, use of weight management techniques, and level of disor-
dered eating. In a survey of college women Harrison (1997) found
28 levIne and Murnen
that “interpersonal attraction” (a composite variable representing
liking, wanting to be like, and feeling similar) to thin media person-
alities predicted disordered eating beyond mere media exposure.
Cross-Sectional Studies. Social-cognitive models of media influence,
including the prominent “cultivation theory” (see Levine & Smolak,
1996, for an application to body image and eating disorders), argue
that normative beliefs about the social world, as emphasized in mass
media, become beliefs and attitudes about the self. The most valid
and widely used measure of both passive awareness, and active in-
ternalization, of the media’s thin body ideal for females is the Socio-
cultural Attitudes Toward Appearance Questionnaire (SATAQ). In the
original version seven of the eight items forming the internalization
factor (subscale) pertained directly to the mass media (e.g., “I tend
to compare my body to people in magazines and on TV”; Smolak,
Levine, & Thompson, 2001). Two validation studies of the most re-
cent version (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda,
& Heinberg, 2004) demonstrated that, for undergraduate women,
self-reported levels of perceived pressure from media and of internal-
ization of the slender beauty ideal were (1) highly correlated with each
other; and (2) strong predictors of precursors of disordered eating.
In addition, as hypothesized, scores on those two subscales, as well
as that assessing awareness of the media’s thin ideal, all significantly
differentiated eating disordered women from among nondisordered
controls. Engeln-Maddox (2006) recently found that, as predicted,
some young women have the clear and strong expectation that look-
ing like a media ideal will transform their lives in multiple, positive
ways. Of that group, those who have internalized the media ideal of
slender beauty tended to have greater body dissatisfaction.
Internalization of the thin ideal is certainly understandable—
and probably rational and adaptive—in the current cultural con-
text (Gordon, 2000; Smolak & Levine, 1996). However, it is far
from harmless. For example, Smolak et al. (2001) found that, in 200
girls ages 11 through 14, only 7% of the variation in weight control
techniques was accounted for by body mass. However, when the
SATAQ awareness and internalization subscales were added to the
MedIa, negatIve Body IMage and dIsordered eatIng 29
regression equation, variance accounted for rose to 48%. Further, in
the final equation using all three variables, only internalization was
a statistically significant predictor of weight control behaviors.
A recent study of 14 to 16-year-old Swiss girls (Knauss, Paxton,
& Alsaker, 2007) also found that internalization, perceived pressure
from the media, and body dissatisfaction were highly intercorre-
lated (all rs > .61). This finding adds to a large body of research
demonstrating three key facts for girls and young women ages 8
through 22. First, perceived media pressure to be thin is correlat-
ed with increased weight- and body-dissatisfaction (Cusumano &
Thompson, 2000; Van den Bulck, 2000). Second, this experience of
pressure involves exposure to, and internalization of, the slender
ideal, which in turn increases the probability of various eating and
emotional problems (Blowers, Loxton, Grady-Flesser, Occhipinti,
& Dawe, 2003; Cusumano & Thompson, 1997; Thompson & Stice,
2001; Thompson et al., 2004). Third, in support of these correlation-
based findings, level of thin-ideal internalization has consistently
been identified in experimental studies as a moderator of media ef-
fects. In fact, several studies found that only “high internalizers”
experience heightened body dissatisfaction after exposure to thin
media models (Dittmar & Howard, 2004; Halliwell & Dittmar, 2004;
Heinberg & Thompson, 1995).
The medium to large effect sizes for the cross-sectional correlation
of internalization of the media-based thin ideal and negative body
image seen in the Smolak et al. (2001) and Knauss et al. (2007) stud-
ies appear to be representative of a general trend. Cafri, Yamamiya,
Brannick, and Thompson’s (2005) meta-analysis of 31 effect sizes
from 18 studies found an r of .50 (d = 1.15) for thin ideal internaliza-
tion and negative body image, which was significantly greater than
the r of .29 (d = .61, based on 25 effect sizes) for awareness of the
thin ideal. Although it is based on only 7 effects from 6 studies, the
composite effect size for the relationship between pressures experi-
enced from the media and body image was nearly the size of that
for internalization, r = .48 (d = 1.09).
Longitudinal Studies. It is difficult to evaluate the status of evidence
from longitudinal studies of internalization of the media-based thin
ideal. The Cafri et al. (2005) meta-analysis included only cross-
sectional studies, citing a paucity of longitudinal research with the
SATAQ. Stice’s own measure of “ideal body internalization,” while
30 levIne and Murnen
reliable and valid, is not directly connected to media ideals, and its
items load on the SATAQ awareness factor, not the internalization
factor (Thompson et al., 2004).
With those caveats in mind, Stice’s (2002) meta-analysis of 8 longi-
tudinal studies (including 6 of his own) found that, over follow-up
periods of 9 months to 5 years, thin-ideal internalization did predict
increases in body dissatisfaction, dieting, and bulimic pathology.
For example, Stice and colleagues have found that both internaliza-
tion of the slender beauty ideal and perceived pressure to be thin
(emanating from family, friends, dating partners, and media) pre-
dicted significant, short-term increases in body dissatisfaction in
girls ages 14 to 17. These factors were also concurrently associated
with body dissatisfaction, which in turn predicted increases in diet-
ing and negative affect (Stice, 2001; Stice & Whitenton, 2002; but see
Bearman, Presnell, Martinez, & Stice, 2006).
Several other longitudinal studies by Stice and colleagues (see, also,
e.g., McCabe & Ricciardelli, 2005) cast some doubt on the causal
role of mass media. For example, Stice (1998) found that neither per-
ceived pressure from media nor observational learning of unhealthy
weight-shape concerns played a role in the onset of bulimic symp-
toms in adolescents and young adults. Nevertheless, Stice’s (2002)
own meta-analysis of longitudinal studies and the meta-analysis
of cross-sectional studies by Cafri et al. (2005) collectively provide
evidence consistent with Criterion 7. More longitudinal research is
needed, but it appears that, in support of media as a causal risk fac-
tor, the following are consistent predictors of negative body image
and, to some extent, disordered eating: awareness of the importance
of the thin ideal in society; internalization of that ideal; and per-
ceived pressure from the media to be thin.
In thinking about the subjective experiences of media pressures
and influences, it is worth examining more closely the construct of
“awareness” of the thin ideal. The perception that peers and people
MedIa, negatIve Body IMage and dIsordered eatIng 31
in general (e.g., employers) are influenced by thin-ideal media can
itself be a form of subjective pressure that motivates young people
to diet in an attempt to meet that ideal (Milkie, 1999). In fact, it ap-
pears that the mere presumption of media effects on others may
exert its own effect, at least on older females. Park’s (2005) path ana-
lytic study of over 400 undergraduates found that the more issues
of beauty and fashion magazines a young woman reads per month,
the greater the perceived prevalence of the thin ideal in those mag-
azines. The greater this perceived prevalence, the greater the pre-
sumed influence of that ideal on other women; and in turn the great-
er the perceived influence on self, which predicted the desire to be
thin. More research of this type with younger samples is needed to
test this “cultivation of perceived social norms” hypothesis: Greater
consumption of beauty and fashion magazines or of appearance-fo-
cused TV and internet content will foster stronger, more influential
beliefs that the slender ideal is ubiquitous and normative for peers.
This logic will, in turn, be a source of pressure and inspiration for
the person’s own desire to be thin(ner).
conclusIons and recoMMendatIons
Based on the weight of the empirical evidence in relation to criteria
1, 2, 5, and 7, a defensible conclusion is that the content, use, and
experience of mass media—in and of themselves, and in the context
of synergistic messages from peers, parents, and coaches—renders
them a possible causal risk factor. Further, although the strength
of the relationship is relatively weak to modest, the extent of ex-
posure to mass media in general and to thinness-depicting media
(Harrison & Cantor, 1997) in particular is correlated concurrently
and prospectively with negative body image and disordered eat-
ing (criteria 3 and 4). In fact, because the hypothesized paths of in-
fluence between media exposure (engagement) and the outcomes
of interest are mediated and moderated by several variables, we
should probably expect effect sizes that are modest at best. Stronger
evidence (criterion 5) for a causal relationship between mass media,
negative body image, and disordered eating comes from the exten-
sive experimental literature (Grabe et al., 2008; Groesz et al., 2002).
32 levIne and Murnen
And, yet, in light of the important research by Tiggemann (2006)
and by Field et al. (1999, 2001, 2008) there remains a need to dem-
onstrate more conclusively that either (1) direct engagement with
mass media or (2) media effects that are mediated by parents and/
or peers precede development of the more proximal risk factors such
as negative body image (criterion 4). Similarly, despite the prelimi-
nary but encouraging evidence from media literacy interventions of
varying intensities, to date no studies have tested the deceptively
simple proposition (see criterion 6) that prevention programs can
increase media literacy and thereby reduce or eliminate negative
media influences—and in turn reduce or delay development of
proximal risk factors (e.g., internalization of the thin ideal, social
comparison tendencies) and attendant outcomes such as EDNOS.
In sum, of the 7 criteria, there is strong evidence for Criteria 1, 2, 5,
and 7, and solid evidence for Criterion 3. However, the evidence for
two of the most important criteria—4 (factor precedes and predicts)
and 6 (reducing the risk factor prevents the disorder)—is encourag-
ing but complicated, preliminary, and inconclusive. Consequently,
engagement with mass media is probably best considered a variable risk
factor that might well be later shown to be a causal risk factor (Kraemer
et al., 1997; Stice, 2002).
This review suggests five principal gaps in our knowledge about
mass media as a potential causal risk factor for the spectrum of
disordered eating. The first three are derived from the conclusion
immediately above. First, there is a need for longitudinal research
(see, e.g., Tiggemann, 2006) that examines the predictive validity
of media exposure, motives for media use, and the subjective ex-
perience of media influences. Second, as noted by an anonymous
reviewer of this manuscript, there remains a dearth of information
about whether it is the thinness-depicting aspects of magazine, TV,
and other media content that exert negative effects. Thus, survey-
based longitudinal investigations of media exposure should strive
to determine as precisely as possible not only frequency and inten-
sity of consumption, but also the nature of the images, articles, pro-
grams, and such to which participants are exposed (again, see, e.g.,
Tiggemann, 2006). Third, there is a need for prevention research
MedIa, negatIve Body IMage and dIsordered eatIng 33
that capitalizes on and extends the promising findings of extended
media literacy interventions.
The fourth research direction concerns the relationship, particu-
larly from a developmental perspective (Smolak & Levine, 1994,
1996; see also Levine et al., 1994), between engagement with mass
media and other causal risk factors. We need to learn much more
about the ways in which body image disturbance and disordered
eating are influenced by perceived social norms (Park, 2005), by the
confluence of media, family, and peer messages about weight and
shape (Levine et al., 1994; Peterson, Paulson, & Williams, 2007), and
by indirect media exposure, such as acquisition of body ideals and
eating behaviors via interactions with family, peers, and significant
adults (e.g., coaches) who learned them directly from television and
magazines (Clark & Tiggemann, 2006; Harrison & Hefner, 2006;
Krayer, Ingledew, & Iphofen, 2007). Direct media effects may be
small to modest (Groesz et al., 2002; Murnen et al., 2007), but the
combination of direct and indirect effects, that is, the cumulative
media effect, may be substantial (Harrison & Hefner, 2006; Levine
et al., 1994).
Finally, the transactions between the developing child (or adoles-
cent) and media constitute another set of important research ques-
tions to address. A cross-sectional study by Gralen, Levine, Smolak,
and Murnen (1990) indicated that the correlates of negative body
image and disordered eating in young adolescents tended to be
more concrete and behavioral (e.g., onset of dating, pubertal devel-
opment, teasing about weight and shape), whereas the predictors
in middle to later adolescence were more psychological, such as
the experience of a discrepancy between perception of one’s own
shape versus an internalized ideal shape. More recently, a longitu-
dinal study by Harrison (2000) found that the number of hours that
children ages 6 through 8 watched television per week predicted
an increase in disordered eating without predicting idealization of
a slender body. This raises the interesting and testable proposition
that exposure to various salient media messages, including those
contained in the onslaught of advertisements for diet-, fitness-, and
weight-related products, might have little effect on the “thinness
beliefs” of young children, while leading them to vilify fat, glam-
orize dieting as a grown-up practice, and yet still think of fatten-
ing, non-nutritious foods as desirable in general and useful for as-
34 levIne and Murnen
suaging negative feelings (Harrison, 2000; Harrison & Hefner, 2006;
Levine & Harrison, in press).
With respect to the transformation of relevant psychological pro-
cesses over late childhood, early adolescence, and later adolescence,
Thompson and colleagues have developed and validated various
features of the Tripartite Model in which media, family, and peers
influence directly internalization of the slender beauty ideal and
social comparison processes (Keery, van den Berg, & Thompson,
2004; Thompson et al., 1999; van den Berg et al., 2007). This valuable
model reminds us that, after nearly 25 years of research on media
and body image, we still know relatively little about the automatic,
intentional, and motivational processes involved in the role of so-
cial comparison in media effects (Halliwell & Dittmar, 2005; Levine
& Harrison, 2004; Trampe, Stapel, & Siero, 2007). Basic questions
remain: What dispositional and situational factors determine when
people will make upward social comparisons with highly dissim-
ilar fashion models whose “image” has been constructed by cos-
metic surgeons, photographers, and computer experts? And under
what circumstances will such comparisons result in negative effects
(contrast) or positive effects (assimilation)?
Multidimensional models such as Thompson’s also emphasize
the need to determine when and how in the developmental process
a number of important mechanisms such as appearance schematic-
ity, thin-ideal internalization, social comparison processes, and self-
objectification begin to play key roles (see also Tiggemann, 2006).
Further experimental and longitudinal studies of these mediators
will be a very positive step toward understanding the emergence,
particularly around puberty, of attentiveness and vulnerability to
thin-ideal media images and to the many other potentially negative
influences that emanate from family, peers, and influential adults
such as coaches (Smolak & Levine, 1996; Thompson et al., 1999).
Since the publication of our earlier reviews (see, e.g., Groesz et al.,
2002; Levine & Harrison, 2004; Levine & Smolak, 1996), there has
been an exciting, if daunting, upsurge in studies of the role of vari-
ous media in the development of negative body image, weight and
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This dramatic growth has brought with it a number of important
improvements in attention to methodology. We encourage research-
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of (in alphabetical order) Dittmar and Halliwell, Durkin and Pax-
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TABLE 2. Important Methodological Issues in the Improvement of Media Effects Research
Articulation, in text and with visual gures, of the model demonstrating how mass media •
inuences mediators and outcomes, and how mass media is inuenced by moderators such
as family and peer factors
Attention to validity of constructs such as media exposure and state body dissatisfaction•
Careful consideration of demand characteristics in regard to use of pre-post designs to •
investigate phenomena (e.g., impact of pictures of the slender beauty ideal) that are well-
known to participants
Development of control conditions to rule out confounds, such as that between the slender-•
ness (or muscularity) of a model in an advertisement and the model’s perceived attractive-
In investigations of media literacy-as-prevention, careful measurement of the chain of •
mediators (was literacy increased? Was internalization of the thin ideal reduced?) and
arrangement for long-term follow-up to determine if onset of target problems was indeed
Precise description, in the Method section, of how ethical issues were addressed, notably •
the risks posed by (1) experiments that present vulnerable people with images known to
have negative effects; (2) the deceptions that are often necessary to address threats to inter-
nal validity; and (3) the desirability paradox recently identied in connection with media
literacy training (Austin, Pinkleton, & Funabiki, 2007)
36 levIne and Murnen
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... Results of the current study support both the eighth and nineth hypotheses: individuals who spent more time on social media and watching TV also spent more time enhancing their attractiveness. Most researchers agree that the media often conveys unrealistic physical ideals (Barlett, Vowels, and Saucier, 2008;Levine and Murnen, 2009;Thompson and Stice, 2001), that are also often unattainable for the average person (Grogan, 2016). Confronting one's body with the photoretouched silhouettes of models may trigger many negative feelings and behaviors, including anxiety, depressive symptoms, body dissatisfaction, and eating disorders Mills, Musto, Williams, and Tiggemann, 2018). ...
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People across the world and throughout history have gone to great lengths to enhance their physical appearance. Evolutionary psychologists and ethologists have largely attempted to explain this phenomenon via mating preferences and strategies. Here, we test one of the most popular evolutionary hypotheses for beauty-enhancing behaviors, drawn from mating market and parasite stress perspectives, in a large cross-cultural sample. We also test hypotheses drawn from other influential and non-mutually exclusive theoretical frameworks, from biosocial role theory to a cultural media perspective. Survey data from 93,158 human participants across 93 countries provide evidence that behaviors such as applying makeup or using other cosmetics, hair grooming, clothing style, caring for body hygiene, and exercising or following a specific diet for the specific purpose of improving ones physical attractiveness, are universal. Indeed, 99% of participants reported spending >10 min a day performing beauty-enhancing behaviors. The results largely support evolutionary hypotheses: more time was spent enhancing beauty by women (almost 4 h a day, on average) than by men (3.6 h a day), by the youngest participants (and contrary to predictions, also the oldest), by those with a relatively more severe history of infectious diseases, and by participants currently dating compared to those in established relationships. The strongest predictor of attractiveness-enhancing behaviors was social media usage. Other predictors, in order of effect size, included adhering to traditional gender roles, residing in countries with less gender equality, considering oneself as highly attractive or, conversely, highly unattractive, TV watching time, higher socioeconomic status, right-wing political beliefs, a lower level of education, and personal individualistic attitudes. This study provides novel insight into universal beauty-enhancing behaviors by unifying evolutionary theory with several other complementary perspectives.
... Media imagery that emphasizes women's bodies through cropping, revealing clothing and sexualized posture has been widely blamed for perpetuating a sexually objectifying culture which undermines the value, and jeopardizes the wellbeing, of women (Behm-Morawitz, 2017;Downs & Smith, 2010;Karsay et al., 2017;Karsay & Matthes, 2016;Tylka & Kroon Van Diest, 2014). Research on media imagery has repeatedly supported these assumptions by linking social media and fashion imagery exposure in women to lower mood, self-esteem, body dissatisfaction, and disordered eating (Brown & Tiggemann, 2016;Homan et al., 2012;Levine & Murnen, 2009;Prichard et al., 2018). However, online apparel shopping offers some unique characteristics when compared to more generic forms of idealized imagery exposure (e. g., social media). ...
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Online apparel shopping is popular amongst women and offers salient visual information for making body image and self-worth judgements. Apparel segments which emphasize the value of women's bodies are particularly effective for eliciting low body image and self-worth. Across two studies, we investigated the association between self-reported and experimental online activewear exposure on women's self-worth, body image, appearance attitudes, mood and gaze behavior. In Study 1, participants (N = 399) completed a survey collecting their online apparel shopping habits, body appreciation, self-esteem, appearance comparison tendencies and self-objectification attitudes. Activewear was the second-most popular apparel segment amongst women (after casualwear) and weekly activewear browse time was positively correlated with appearance comparison tendencies, desires to be muscular/athletic and body shame. In Study 2, participants (N = 126) were randomly allocated to browse an activewear, casualwear or homewares website and completed pre and post measures of mood, body image, implicit self-esteem and body gaze behavior. In the activewear condition, there was a significant reduction in positive body image and implicit self-esteem scores. There were no experimental effects for body gaze behavior. These findings illustrate that apparel choices have value for understanding the aetiology of maladaptive body image attitudes and low self-esteem in women.
... Most notable is the potentially counterproductive role that online apparel shopping activities might play for women who are vulnerable to or are diagnosed with, clinical disorders. Research has consistently pointed to idealized media exposure as a risk factor for the development and maintenance of eating and affective disorders (Levine & Murnen, 2009;Tiggemann & McGill, 2004). While these factors are likely well understood by informed clinicians, it may be important to specifically recognize the potential harm that some apparel retailers pose to clients who may be receiving treatment. ...
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Online apparel shopping is popular among women, with possible negative body image consequences, particularly when the website imagery is body‐focused. We investigated both correlational and experimental effects of online apparel shopping on women's (N = 113) explicitly and implicitly measured self‐worth, appearance attitudes and body gaze behaviour. Self‐reported online apparel shopping behaviour positively correlated with self‐objectification and a tendency to value and compare one's appearance. Following a simulated online shopping activity, women who browsed a body‐focused activewear website felt worse about their looks, when compared with women who browsed a non‐body‐focused casualwear website. The activewear condition also primed lower subsequent visual attention towards female bodies in a gaze task, when compared with the casualwear condition. Given that women tend to naturally gaze at faces, the deprivation of facial stimuli in the activewear condition presumably led to a compensatory gaze effect, whereby subsequent attention towards bodies was comparably low. Importantly, dollars spent in the activewear condition correlated positively with appearance comparison and body shame attitudes. These results suggest that online apparel imagery exposure may negatively impact women's well‐being. We also find evidence suggesting that gaze behaviour plays a role in how apparel marketing influences subsequent attention.
... Another Iranian study reported that issues regarding self-esteem, dissatisfaction with body image, and matters pertaining to conformity influence the acceptance of cosmetic procedures [8]. A recent study shows that social media negatively impacts body satisfaction, especially in adolescents and young adults, i.e., they tend to compare their appearance with celebrities and social media, which often leads to negative perceptions about their own bodies and appearance [9]. ...
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Background and objective Aesthetic procedures are one of the most commonly performed medical procedures. Surgical and non-surgical cosmetic treatments that are routinely performed include breast augmentations, rhinoplasty, botulinum toxin, and fillers. Several factors contribute to the increase in the popularity of these procedures, including body image dissatisfaction, the opinion of peers, and surgeon-related factors such as the surgeon's reputation, board certification, or years of experience. In addition, recent evidence suggests that active and passive usage of highly visual social media that focus on appearance-centric content have been positively associated with the acceptance of, and desire for, cosmetic procedures. In this study, we aimed to investigate the influence of social media on individuals' decision-making in terms of cosmetic procedures. Method The setting for this population-based cross-sectional study was public places in Makkah City, Saudi Arabia, and it was conducted from September to November 2021. Our study included adults above the age of 18 years. The exclusion criteria were as follows: non-Arabic speakers and individuals with congenital anomalies or dysmorphic dermatological diseases. The final sample consisted of 364 participants. All analyses were carried out using IBM SPSS Statistics version 28 (IBM Corp., Armonk, NY). Continuous and categorical variables were compared using ANOVA and Pearson's Chi-squared test. Result A total of 364 participants were included in the study, and 80% of them used their phones on a daily basis for >4 hours per week. The mean age of the participants was 27.4 ± 8.3 years, and they had a mean BMI of 25.0 ± 6.4 kg/m2; 60% of the participants were female. Participants with a history of cosmetic procedures or a desire to undergo cosmetic procedures reported a similar pattern of daily phone use. There was no significant association between the reported history of cosmetic procedures and the daily duration of selected social media platform use. Conclusion We found no significant correlation between the hours spent on social media and the participants' history or desire for cosmetic procedures. Only 54 subjects compared themselves to social media celebrities. These findings could be attributed to the fact that the Makkah population is conservative in their religious attitudes and traditions, which makes them less susceptible to social media influences.
... In the interest of space, we will only briefly mention here the (evident and evidenced, though not directly causal) effects of the fashion and media industry on women's identity and the links that have been made to eating disorders and body dysphoria (Levine and Murnen, 2009). ...
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In this paper, we will attempt to outline the key ideas of a theoretical framework for neuroscience research that reflects critically on the neoliberal capitalist context. We argue that neuroscience can and should illuminate the effects of neoliberal capitalism on the brains and minds of the population living under such socioeconomic systems. Firstly, we review the available empirical research indicating that the socio-economic environment is harmful to minds and brains. We, then, describe the effects of the capitalist context on neuroscience itself by presenting how it has been influenced historically. In order to set out a theoretical framework that can generate neuroscientific hypotheses with regards to the effects of the capitalist context on brains and minds, we suggest a categorization of the effects, namely deprivation, isolation and intersectional effects. We also argue in favor of a neurodiversity perspective [as opposed to the dominant model of conceptualizing neural (mal-)functioning] and for a perspective that takes into account brain plasticity and potential for change and adaptation. Lastly, we discuss the specific needs for future research as well as a frame for post-capitalist research.
... Therefore, sociocultural influences on how an individual perceives herself may be more pervasive than previously envisioned. Pressures may be extended through family and peer relationships who present with an overconcern of how an individual's body looks; this phenomenon has been linked to increased body image dissatisfaction in individuals extending across various cultures (Levine et al., 2009;McCabe & Ricciardelli 2003). Parental pressure significantly correlated with body image disturbance in Korean adolescent women (You et al., 2017), Japanese women (Yamamiya et al., 2008), and Black women (Kelch-Oliver & Ancis, 2011;Rodgers et al., 2021). ...
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This phenomenological study explored the lived experiences of survivors of childhood sexual assault, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. Utilizing a social constructivist framework, the research team interviewed eleven (n = 11) participants from a variety of backgrounds who were gender assigned female at birth and had survived childhood sexual assault (CSA). Four major themes emerged from the narratives collected. These include sociocultural impacts which included four subthemes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences; meaning making of the critical event, i.e., childhood sexual assault; self-perception of their bodies; internal processes that have shaped their perceptions and meaning making, i.e., thoughts, feelings, and behaviors. Findings indicate major influence of sociocultural factors in shaping participant’s internal processes as survivors of CSA, meaning making, and subsequently self-perceptions of, and relationship with, their bodies. We discuss CSA and body image keeping the intersectionality of the individual, their experiences, and the impact of sociocultural contexts on that intersectionality.
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The present study aimed to analyze the differences between individuals diagnosed with obesity who are candidates for bariatric surgery, individuals in a post-surgical situation, and normal-weight individuals, regarding their PBI, their emotional regulation (ER) difficulties, as well as anxious and depressive symptoms. Additionally, associations between PBI and ER difficulties and anxious and depressive symptoms, as well as some sociodemographic and clinical variables were established. For this purpose, a sample of 89 individuals in a pre-surgical situation, 43 in a post-surgical situation, and 53 normal-weight individuals was used. The results point to lower levels of PBI in the individuals in a pre-surgical situation, when compared with the two other groups, and lower levels of PBI on the part of individuals in a post-surgical situation when compared to the normal-weight group. The groups showed no differences on most subscales of ER difficulties, apart from emotional clarity. The existence of negative associations between body appreciation, body acceptance by others, and self-care and the different domains of ER difficulties, in all clinical groups, was also identified.
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Introduction: Body image dissatisfaction is associated with psychophysical morbidity. Exposure to cultural messages about physical or beauty ideals is one of the studied factors which initiate body image dissatisfaction. This work explores the relationship between social media use and preoccupation with one's own body, the desire for a diet to lose weight, and the generation of obsessive thoughts about body shape and size during the period of Social Preventive and Mandatory Isolation (SPMI). Materials and methods: A cross-sectional study was carried out using an online questionnaire of participants over 18 years residing in Argentina. Demographic information, anthropometric data, conformity with body image and the influence of the use of social media on body image and conformity with one's own body were evaluated. Results: 2236 individuals participated in this study (85,5% women) with a mean age of 38.88±15.20 years and a mean IMC of 25.55±5.36 kg/m2. Thirty-four percent of the sample expressed that they never or hardly ever were satisfied with their bodies and 66% referred to a feeling of fault when they overindulge in food. Sixty-eight percent stated that they had been afraid of gaining weight at some moment in their life. The multivariate analysis showed an inverse relationship between age and perception of social media’s negative influence on their body image, and that they increased their desire to diet to lose weight. The negative social media effect was significantly higher in participants who presented body dissatisfaction previous to the SPMI. Conclusion: The increase in social media use during the pandemic was reflected in the level of body dissatisfaction in the most vulnerable group of this sample. Keywords: body image; social media; body image dissatisfaction; pandemic.
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Early research focused on the prevention and improvement of negative body image, but with the rise of positive psychology, researchers realized that positive body image and negative body image are not polar parts of body image. Positive body image is an important protective factor for an individual's mental health, and it is a multifaceted structure that includes but is not limited to body appreciation. In order to guide researchers to change the positive perspective of body image research and promote people's physical and mental health and self-improvement, this study summarized positive body image, sorted out the influencing factors, protective effects, and promotion strategies of positive body image, and looked forward to future research directions, so as to provide some theoretical reference for the research on the Sinicization of positive body image. This study believes that positive body image refers to the individual's cognitive acceptance of his own body, and the appreciation of the uniqueness and function of the body, as well as the active processing and protection of body evaluation information, which has the effect of internal and external gain on the individual. Taking the biopsychosocial model and the operational definition of body image as the theoretical framework, the study found that positive body image is affected by biological factors such as gender, age, and body mass index, psychological factors such as personality factors, cognitive mode, and interoception, as well as socio-cultural factors such as important others, mass media, and values, and has a protective effect on individual physical cognition, emotional experience, and behavior regulation, among which the body mass index, neuroticism, and perception of pressure from important others and mass media are prominent. Psychological and sociocultural factors have a greater influence on an individual's positive body image than biological factors. At the same time, functional-focused intervention and self-compassion-based intervention have become the two most commonly used promotion strategies, the former is more effective, while the latter has more advantages in the application and promotion. Specifically, existing studies have mostly focused on women, but ignored the gender differences in positive body image and the influence of men on women's positive body image construction. At the same time, positive body image is developmental, and current cross-sectional research cannot elucidate in detail the mechanism of transition from negative body image to positive body image and ignores the content integrity and object applicability of positive body image enhancement strategies, especially the influence of important others (especially parents) on individual positive body image. In addition, due to cultural differences in positive body image, the development of Sinicized measurement tools is particularly important. Future research can enrich the theoretical model of positive body image based on intersection theory, and deepen people's understanding of its antecedents and consequences by constructing the biopsychosocial model of positive body image. We can further explore the age characteristics of body image and its relationship with executive function through longitudinal tracking design combined with the recall method, such as recalling and retelling the experience of body image transformation, and clarify the occurrence mechanism of positive body image. Based on the complete characteristics of positive body image, future research should consider family factors and demographic differences of intervention targets to ensure the comprehensiveness, applicability, and timeliness of promotion strategies. At the same time, based on the cultural background of our country, we should construct the structure and assessment tools for positive body image with Chinese characteristics, guide the public to form healthy body image and promote the study of positive body image in China.
This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g., dieting). There was consistent support for less-accepted risk factors(e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors(e.g., social support) and factors that predict eating pathology maintenance(e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects.
Body image is defined as one’s perception of, affective reaction to, and cognitive appraisal of one’s body. It has become evident that the process of developing a body image as well as the nature of these perceptions and appraisals are marked by considerable gender differences. In addition, the consequences of negative body image seem to differ for men and women. More specifically, in the United States and in a variety of other countries (e.g., Grogan, 1999;Luo, Parish, & Laumann, 2005), women are more likely to be interested in obtaining a thin body while men are more interested in obtaining a muscular body.
This study investigated the effect of magazine use on the desire to be thin within the theoretical framework of presumed influence. Structural equation modeling supported the hypothesis that reading beauty and fashion magazines increased the drive for thinness both directly and indirectly. The indirect pathway included the perceived prevalence of the thin ideal in mass media, the presumed influence of the thin ideal on others, and the perceived influence of the thin ideal on self Social pressure to be thin may be based both on reality and the presumption of influence on others. Results suggest potential strategies for intervention.
This study examined the role of media body comparison as a mediator of the relationships between psychological factors and sociocultural pressures to be thin and body dissatisfaction in both females and males. Participants were 1,386 females (mean age = 19.37 years) and 1,130 males (mean age = 19-46) from diverse backgrounds who completed a self-report questionnaire. Path analysis was used to test a cross-sectional model in which media body comparison mediated the impact of self-esteem, depressive mood, parent dieting environment, friend dieting, TV exposure, magazine message exposure, weight teasing and body mass index (BMI) on body dissatisfaction. In females, media body comparison partially or fully mediated relationships between self-esteem, depressive mood, friend dieting, magazine message exposure and BMI, and body dissatisfaction. In males, media body comparison was not a significant predictor of body dissatisfaction. This research particularly highlights the need to further examine processes that are involved in the development of body dissatisfaction in males.
This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed.