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The association of body image perceptions with behavioral and health outcomes among young adults.

Graphical Abstract

1. Introduction

2. materials and methods, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Jiménez-Morcillo, J.; Ramos-Campo, D.J.; Rodríguez-Besteiro, S.; Clemente-Suárez, V.J. The Association of Body Image Perceptions with Behavioral and Health Outcomes among Young Adults. Nutrients 2024 , 16 , 1281. https://doi.org/10.3390/nu16091281

Jiménez-Morcillo J, Ramos-Campo DJ, Rodríguez-Besteiro S, Clemente-Suárez VJ. The Association of Body Image Perceptions with Behavioral and Health Outcomes among Young Adults. Nutrients . 2024; 16(9):1281. https://doi.org/10.3390/nu16091281

Jiménez-Morcillo, Jorge, Domingo Jesús Ramos-Campo, Stephanie Rodríguez-Besteiro, and Vicente Javier Clemente-Suárez. 2024. "The Association of Body Image Perceptions with Behavioral and Health Outcomes among Young Adults" Nutrients 16, no. 9: 1281. https://doi.org/10.3390/nu16091281

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Multiple Perspectives on Body Image Research

• Cosimo Urgesi

Department of Human Sciences, University of Udine and Scientific Institute (IRCCS) E. Medea, Udine, Italy

School of Psychology, Bangor University, UK

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Representation of the body is a nuclear aspect of self-image ( Berlucchi & Aglioti 2010 ; James, 2007 ). Visual self-recognition seems to be one of the earliest forms of self-awareness in human infants and nonhuman primates ( Gallup, 1982 ) and precedes the use of the personal pronouns “I” and “me.” However, our body is not a personal affair, since it does not only affect how we represent ourselves, but also how we appear to others ( Cazzato, Mian, Serino, Mele, & Urgesi, 2014 ); thus, body representation includes both subjective and intersubjective experiences. The importance of visual body representation in our social life is demonstrated by the time we spend to take care of our physical appearance, including use of plastic surgery, as well as by the severe mental disorders associated to its alteration, including eating disorders (EDs) and body dysmorphic disorders. In spite of these issues, (neuro)psychological research on body representation has so far mainly focused on the body as a motor device, devoted to the perception of and interaction with objects. Research on body image disturbances in mental disorders, however, has mainly focused on the subjective, explicit perception of body image (in particular of body weight). For example, until now, most models and treatments for EDs stem from approaches based on psychodynamics or motivation, personality and social factors. However, recent advances in cognitive neuroscience of visual body representation could offer new insights into the etiopathogenesis of the disorders and have the potential to provide more efficacious treatments. While a purely neuroanatomical view of EDs and other body image disorders is unlikely to explain their development and maintenance, these results point to the need for integrating different approaches into the study of body image representation, including at least psychiatry and clinical psychology, social psychology, cognitive psychology, personality psychology, anthropology, philosophy, and cognitive neuroscience and biological psychiatry.

Psychiatry and clinical psychology studies may provide better descriptions of the type of representation disturbances that characterize the different forms of EDs, clarifying which forms of body image are altered in ED patients within and across different diagnostic categories. Social psychology perspectives may highlight how ideals of body beauty are conveyed through the media and social teasing. Although the role played by mass media in determining EDs has not yet been thoroughly analyzed, there is evidence that the constant parade of ultrathin models in the media helps to internalize an ideal of beauty of an extremely lean body, contributing to an increase in the degree of body dissatisfaction in adolescent girls and young women ( Benowitz-Fredericks, Garcia, Massey, Vasagar, & Borzekowski, 2012 ). Cognitive psychology approaches may try to explain the perceptual processes involved in the influence of media exposure on body perception and representation disorders. For example, studies of face ( Langlois et al., 2000 ; Rhodes, Jeffery, Watson, Clifford, & Nakayama, 2003 ) and body ( Glauert, Rhodes, Byrne, Fink, & Grammer, 2009 ; Mele, Cazzato, & Urgesi, 2013 ; Winkler & Rhodes, 2005 ) attractiveness have shown that familiarity is crucial for esthetic appreciation of others and that perceptual experience increases what we find attractive and normal in other individuals’ faces and bodies. The effects of visual familiarity on esthetic perception have been attributed to either perceptual after-effects that occur when exposure to certain features of a stimulus modifies perception in the opposite direction to that of the adapted features (i.e., bodies appear rounder after repeated exposure to extremely thin bodies; Mele et al., 2013 ), or to the change of the template used for norm-based coding of individual exemplars of bodies that share a very similar structure ( Rhodes et al., 2003 ). The exact consequences of these two mechanisms on body esthetic appreciation, however, are still not clear and need to be clarified ( Mele et al., 2013 ), also taking into account individual differences in the preferred strategies used in processing social stimuli ( Urgesi et al., 2012 , 2014 ). In this regard, personality psychology studies may determine the dimensions predicting a greater susceptibility of some individuals to the influence of socially driven body ideals. Anthropology studies may allow us to understand the cultural binding of EDs, which affect young women ( Stice, Marti, & Rohde, 2013 ), rather than men, in Western, industrialized countries more than in those non-Western countries that have been less affected by cultural globalization accompanying the gradually increasing influence of mass media ( Makino, Tsuboi, & Dennerstein, 2004 ). Cognitive neuroscience studies may show the neural underpinning of these processes. In particular, neuroimaging evidence has shown that body representations engage brain regions that are at least partially different from those dedicated to the representation of non-corporeal objects and space ( Berlucchi & Aglioti, 2010 ). Visual perception of the human body activates selected areas in the lateral (extrastriate body area, EBA) and medial (fusiform body area, FBA) occipito-temporal cortex ( Peelen & Downing, 2007 ). These areas respond to visual presentation of whole bodies and single body parts, but not of faces or any other objects, suggesting that the visual appearance of the human body is special in the brain. Although the functional role played by these body-selective areas in social perception is still not clear, there is evidence that they are important in processing body morphology ( Moro et al., 2008 ; Urgesi, Berlucchi, & Aglioti, 2004 ) and contribute to the esthetic appreciation of human figures ( Calvo-Merino, Urgesi, Orgs, Aglioti, & Haggard, 2010 ; Cazzato, Mele, & Urgesi, 2014 ). These findings have boosted research into the cognitive neuroscience of visual body representation, which complements research on the representation of body ownership, sense of agency, and self-other distinction in the temporo-parietal cortex ( Berlucchi & Aglioti, 1997 ) and to the understanding of body actions in the fronto-parietal areas ( Rizzolatti & Craighero, 2004 ). Biological psychiatry studies may show what are the neural bases of body image disturbances in ED patients, considering different levels of alterations spanning from the molecular level, which is linked with the psychological description of what makes patients more susceptible to developing body image disturbances, to system level, identifying which brain networks are altered in ED and how. For example, recent studies have documented structural and functional alterations of occipito-temporal ( Suchan et al., 2010 , 2013 ) and temporo-parietal ( Uher et al., 2005 ) cortices during body processing in patients with anorexia nervosa (AN), which might be related to their altered body perception ( Urgesi et al., 2012 , 2014 ).

The complexity of factors involved in the development, maintenance, and plasticity of body image representations requires an integrated approach that facilitates the evaluation and treatment of EDs with novel, evidence-based, and more efficacious protocols. This special issue of European Psychologist aims to advance such an integrative approach, with a collection of papers that gather different perspectives on the phenomenological, cognitive, (neuro)psychological, and cultural aspects of body representation disorders. Eight contributions from leading researchers in the field are included in the collection; the contributors work in six different European countries and investigate, from different perspectives, how body image representations and their disturbances are established, maintained, and altered in healthy and patient populations.

The first two papers start from the consideration that our body is special because it is always present to us and mediates almost all types of perceptual, motor, cognitive, and emotional processes, thus affecting not only how we represent the self, but also how we interact with the physical and social world. The body representation used during perceptuo-motor and cognitive processes is likely to be implicit and to rely on different neural mechanisms than the explicit representation of our body image.

From an experimental psychology approach, Longo (2015) explores how multiple representations of the body emerge from sensory and perceptual processing. He reviews studies showing that basic information processing, in particular in the somatosensory modality, relies on referencing to an implicit model of the body and that investigating abilities such as tactile localization, tactile size perception, and position sense reveals surprisingly large distortions of represented body size and shape that are reliable across different individuals. These large distortions of implicit body representation, as estimated by the pattern of somatosensation performance, markedly contrast with the approximate accuracy of our explicit body image, at least in healthy individuals. How the body image disorders observed in patients with EDs may derive from the alteration of one or more of these body representations is an important issue for future research.

The second paper ( Candidi & Aglioti, 2015 ) explores the neural underpinnings of visual and sensorimotor body representations and how these representations may contribute to the esthetic appreciation of body form, motion, and emotion. Their final claim is that the esthetic value we attribute to physical and social objects is strictly dependent on how these objects alter visual, sensorimotor, and affective body representations in our brain. Thus, alteration of self-body representations may affect how we perceive and appreciate what is in and around us. Understanding the neural basis of esthetic body appreciation is helpful when attempting to identify which are the neurocognitive alterations underlying body representation disorders in EDs.

Suchan, Vocks, and Waldorf (2015) review studies showing that patients with ED, in particular with AN, present neurofunctional alterations of temporal and parietal areas involved in and specialized for sensory, cognitive, and affective representation of the body. These alterations may underlie the perceptual (e.g., overestimation of one’s own actual body size), cognitive (e.g., negative thoughts and attitudes regarding one’s own body), affective (e.g., fear and disgust toward one’s own body), and behavioral (e.g., body checking or avoidance of body-related situations) components of body image disturbances in EDs. An important claim made in this paper is that, besides alteration of the functional and structural organization of single brain areas, researchers need to take into account that altered connectivity between the areas that form the complex brain network specialized in visual body processing may underpin body image disturbances. This opens new fascinating perspectives in the biological psychiatry study of EDs. Importantly; the tight relation between body image disturbances and neurofunctional alterations of visual body processing is also supported by evidence of normalization of neural activity in the visual body processing network after treatment of EDs (e.g., exposure-based cognitive-behavioral body image therapy; Vocks et al., 2011 ). However, different subgroups of patients may present different levels of alteration in the different nodes of the network, pointing to a need for more extensive evaluation of patients with regard to both types of body representation tested and sample size. Although the relatively low prevalence of EDs, in particular of AN, does not favor large studies, collaborative efforts are encouraged to deepen our knowledge of how multiple body representations are altered and which are the mechanisms leading to these alterations.

The paper by Riva, Gaudio, and Dakanalis (2015) proposes a tentative model of the neurocognitive mechanisms involved in the establishment and maintenance of body image disturbances in EDs. It complements the objectification theory ( Fredrickson & Roberts, 1997 ), which claims that women adopt a self-objectified view of themselves as objects to be evaluated on the basis of their appearance, with the allocentric lock hypothesis ( Riva, 2012 ), which suggests that ED patients have difficulties in updating their body representation on the basis of perceptual input, thus being anchored to the memory of a “virtual body” that derives from outside (e.g., from peers’ or relatives’ teasing about being overweight). In other words, the egocentric representation of body image based on the perceptions and sensations that depart from the body does not integrate with the allocentric body representation that is conveyed by others. Thus, ED patients may be locked to an allocentric negative representation of their body that cannot be updated through perception even after weight loss. Although empirical evidence supporting the model is still scant, the allocentric lock hypothesis may help to provide an explanatory framework for integrating previous behavioral and neural studies in ED patients and to guide future investigations.

Swami (2015) directly addresses the issue of whether EDs are culturally bound to Western and industrialized countries or whether they are more specifically linked to socioeconomically developed, urban sites, independent of geographical location. The recent evidence of increased ED prevalence in countries previously considered relatively immune to EDs is here explained in the light of two key processes, namely Westernization and modernization. Westernization refers to the cultural globalization accompanying the gradually increasing influence of mass media, while modernization refers to the effects of socioeconomic development that allows more resource security and less need for physical protection from environmental hazards. Although the role of these broadly-defined processes is still ambiguous, the cultural binding of ED, related to either geographical origin or socioeconomic status, hints at the importance of social influences in the internalization of an extremely thin ideal of the female body.

Legrand and Briend (2015) investigate, with a philosophical perspective, how the experience of the body involves relations to others, thus being intersubjective in nature. In this view, the appearance of the body to others may be used by patients with AN as a form of communication to others. Furthermore, this objectified body (see Riva et al., 2015 ) may be refused by AN patients, who look for a more genuine and subjective body that is not immediately given to others. This philosophical perspective recalls neuropsychiatric models’ ( Kaye, 2008 ) viewing of AN symptoms as an expression of a pathological need to control, which finds in an individual’s body the most available and, apparently, personal object.

That social relations are crucial in EDs is also indicated by the empirical evidence reviewed by Martijn, Alleva, and Jansen (2015) , which shows that positive social feedback may attenuate dissatisfaction with one’s own body. The paper discusses the features and causes of body dissatisfaction, highlighting, in particular, the cognitive bias toward paying attention to one’s own negative aspects and others’ positive ones, sociocultural pressure through mass media, and direct parental and peer influence through modeling or teasing about being overweight. In keeping with this analysis, the authors review clinical studies showing a reduction of body dissatisfaction after guided mirror interventions, in which patients are trained to look at their body in a neutral fashion, as well as after exposure to a conditioning procedure in which images of one’s body are associated to positive social feedback (e.g., smiling faces or positive vs. negative adjectives). Taken together, these studies suggest the efficacy of treatments aimed at changing implicit representation of one’s body (see also Longo, 2015 ) as compared to standard cognitive-behavioral therapy interventions, which tackle more conscious and reflective levels of body image.

Finally, the paper by Mohr and Messina (2015) puts in relation ED symptomatology with that of other mental disorders that are often associated with EDs (e.g., obsessive-compulsive disorder, impulse control disorder, and addiction). The authors’ analysis shows that all these pathologies share obsessive-compulsive, addictive, and impulsive traits and suggests that they may not be independent, but reflect a common pattern of altered executive functions (see also Calderoni et al., 2013 ) that derives from neurofunctional alteration of the right frontal lobe. Furthermore, this pattern of alterations may also be shared by other psychiatric conditions, such as muscle dysmorphia (i.e., bigorexia), in which individuals (in particular men) are pathologically worried about their body muscularity, body dysmorphic disorder, characterized by preoccupation with an imagined body part defect, and body integrity identity disorder, in which the affected individual feels that a body part does not belong to his/her body and expresses a strong desire for amputation of the alien body part. Mohr and Messina suggest that all these diagnostic categories are characterized by traits of defective impulse control and/or addictive tendencies that may assume specific symptomatic features in interactions with the environmental situations people face in everyday life. The inevitable consequence of this line of argument is that treatment of these conditions should not focus on the symptoms of each diagnostic category, but on the nuclear vulnerability (i.e., right frontal lobe dysfunction) that is shared by different pathologies. The contribution of cognitive neuroscience studies to determining the behavioral and neural underpinnings of such vulnerability is, thus, crucial for the evaluation and treatment of body image disorders in various mental illnesses.

In conclusion, the papers included in this special section highlight a need to cross the boundaries between different disciplines to heighten our understanding of body image disorders in EDs and other related illnesses. Earlier versions of most papers were presented at the international conference on “Body representation and eating disorders: Basic and clinical research approaches” that was held in Udine, Italy, on April 19–20, 2013. The possibility to discuss and integrate different approaches to body image disturbances during live meeting among scholars from different disciplines seems crucial for the emergence of new protocols for the evaluation and treatment of EDs, thus allowing us to go beyond the current limitations of any single approach, which are often exasperated by reciprocal skepticism and apparent incompatibility of specific methodology and level of analysis. This special issue reflects an attempt at such an integrative approach and I hope it is helpful in boosting multidisciplinary research on the multiple and complex aspects of body image disturbances.

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• Tool-use: An open window into body representation and its plasticity 17 June 2016 | Cognitive Neuropsychology, Vol. 33, No. 1-2

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© 2015 Hogrefe Publishing

ORIGINAL RESEARCH article

Processing body image on social media: gender differences in adolescent boys’ and girls’ agency and active coping.

• School of Psychology, Trinity College Dublin, Dublin, Ireland

Although scholars continue to debate the influence of social media on body image, increased social media use, especially engaging in appearance-related behaviors may be a potential risk factor for body dissatisfaction in adolescents. Little research has investigated how adolescents process appearance-related content and the potential strategies they use to protect body image perceptions on social media. To investigate coping strategies used by adolescents, four qualitative focus groups were conducted with 29 adolescents (23 girls) aged 15–16 years ( M = 15.31, SD = 0.47) in mixed-gender Irish secondary schools. Thematic analysis revealed that adolescents employed many different behavioral strategies such as avoiding negative content and selecting positive content. Cognitive processing strategies such as critically evaluating body-related content, psychologically distancing from and positively reframing challenging content were also used, although less frequently. Boys appeared to exhibit greater positive agency over their bodies and social media use and tended to use more active coping styles than girls. Efforts to promote body image on social media such as body positive pages and exposing artificial social media content were considered limited in their effectiveness.

Introduction

Body dissatisfaction, defined as “a person’s negative thoughts and feelings about his/her body” ( Grogan, 1999 , p. 2) is a leading cause of eating disorders, disordered eating, low self-esteem and poor psychological wellbeing ( Stice and Shaw, 2002 ; Paxton et al., 2006 ; Cruz-Sáez et al., 2018 ). Relatively high prevalence rates of body weight dissatisfaction have been reported cross culturally among adolescent girls [Mean = 48%, Range (26–62%)] and boys [Mean = 31%, Range (15–44%)] in 26 countries ( Al Sabbah et al., 2009 ). Social media is extensively used by adolescents ( Pew Research Center, 2018 ; Rodgers et al., 2020 ) and has received a lot of research attention as a possible risk factor for body dissatisfaction ( Rodgers and Melioli, 2016 ).

While the causes of body dissatisfaction are considered multifaceted, and include biological, evolutionary, psychological and sociocultural factors ( Polivy and Herman, 2002 ; Ferguson et al., 2011 ; Fitzsimmons-Craft, 2011 ), social media is a sociocultural factor that has been suggested by some to be linked to body dissatisfaction. However, the extent to which social media influences body dissatisfaction is debated and the evidence is inconsistent; some studies find associations between social media use and body dissatisfaction ( Fardouly et al., 2017 ; Scully et al., 2020 ), others find that social media use is associated with positive body image ( Cohen et al., 2019 ), some observe no direct relationships ( Ferguson et al., 2014 ; Cohen et al., 2017 ) and others suggest that social media may indirectly influence body dissatisfaction by increasing opportunities for other predictors of body dissatisfaction such as peer competition ( Ferguson et al., 2014 ). Furthermore, the inferences that can be drawn regarding social media effects may also be limited by methodological issues in the literature, such as the inability to capture the dynamic, interactive, and personalized nature of social media within a controlled environment or failure to use appropriate controls and procedures to account for demand characteristics ( Fardouly and Vartanian, 2016 ).

Nonetheless, concurring with previous systematic reviews (e.g., Holland and Tiggemann, 2016 ), a recent meta-analysis of 63 independent samples observed a small, positive, significant relationship between social media use and body image disturbance ( Saiphoo and Vahedi, 2019 ). It should be noted that the meta-analysis’ conclusions are constrained by the literature on which they are based, which as mentioned, has its limitations (i.e., demand characteristics, single-responder bias, common method variance, lack of preregistration, and the fact that many studies report simple bivariate correlations). These limitations may result in an over-estimate of the effect size; consequently, the small effects in this meta-analysis do not necessarily confirm the existence of effects and therefore must be considered as suggestive. 1 Even though the effect size was small, the authors noted that it is important to further explore the relationship between social media use and body dissatisfaction because social media is extensively used by adolescents. Adolescence is also a particularly vulnerable time for body image ( Voelker et al., 2015 ), and it is important to identify risk/protective factors for body dissatisfaction on social media to help foster more favorable body image during this sensitive developmental period.

Sociocultural theories of body image, such as the Tripartite model ( Thompson et al., 1999 ), propose that social media, influences body image perceptions by conveying messages that emphasize the importance of appearance and pressurize the attainment of unrealistic body ideals. These body-related messages are proposed to give rise to body dissatisfaction directly and indirectly via two mediating mechanisms: internalization of and appearance comparisons with body ideals. Body ideal internalization involves endorsing and pursuing body ideals as a personal body standard ( Thompson and Stice, 2001 ), while appearance comparisons involve evaluating one’s appearance relative to others ( Jones, 2001 ). Because the body ideals that individuals internalize are largely unrealistic and unattainable, failure to exemplify these ideals becomes a source of body dissatisfaction when these ideals are valued as a personal goal ( Thompson et al., 1999 ). Upward comparisons, comparisons with “superior” others highlight discrepancies between one’s own body and body ideals thereby giving rise to body dissatisfaction ( van den Berg et al., 2002 ).

Social media are highly visual, appearance focused platforms that extend opportunities to engage in these body dissatisfaction-inducing behaviors ( Rodgers and Melioli, 2016 ). Popular social media platforms used by adolescents such as Instagram and Snapchat ( Pew Research Center, 2018 ), contain a profusion of idealized body related content, which tend to endorse muscular ideals (characterized by a v-shaped torso, visible abs, large biceps, and low body fat,) and lean/athletic ideals (characterized by a toned body with low body fat,) for men/boys. Thin ideals (characterized by a lean physique with low body fat and a narrow waist), fit/athletic ideals (characterized by a lean and muscular physique), and curvy ideals (characterized by a thin waist and large bosom/bottom) are generally more relevant for women/girls ( Betz and Ramsey, 2017 ). Adolescents have been found to endorse and strive for these ideals, despite acknowledging the unrealistic nature of these bodies ( Edcoms and Credos, 2016 ; Burnette et al., 2017 ; Bell et al., 2019 ).

Consistent with the Tripartite model, comparisons with celebrities, sports stars, and peers who embody these ideals on social media have been reported by adolescents to give rise to feelings of body dissatisfaction ( Edcoms and Credos, 2016 ; Burnette et al., 2017 ). Additionally, posting and editing “selfies” (self-portraits of one’s face/body) on social media amplify adolescents’ tendencies to compare and critically evaluate their appearance ( Chua and Chang, 2016 ; Bell, 2019 ). Adolescent girls tend to engage more in these self-presentation behaviors than boys and tend to be far more invested and influenced by the feedback indices such as “likes” and “comments” received on these posts. Although boys tend not to be greatly affected by the number of “likes” they receive, they are concerned about receiving negative commentary from peers on social media ( Kenny et al., 2017 ).

Some studies suggest that girls’ body image perceptions are more strongly and negatively impacted by social media because they engage with and invest more in body-related content than boys ( Frisén and Holmqvist, 2010 ; McAndrew and Jeong, 2012 ; Chua and Chang, 2016 ). Boys have also been found to perceive social media as a more positive, motivating influence on their body image vs. girls who tend to report that social media exerts more negative effects on their body image ( Bell et al., 2019 ). Boys are also thought to be protected somewhat from exposure to aesthetic body ideals, because they value body functionality over aesthetics ( Grogan and Richards, 2002 ). However, recent meta-analyses suggest that the magnitude of social media’s influence on body image is the same for girls and boys ( Holland and Tiggemann, 2016 ; Saiphoo and Vahedi, 2019 ). It has also been suggested that social media’s impact on male body image may be underestimated because of boys’ tendencies to disclose or downplay body image issues because of stigma surrounding male body image ( Griffiths et al., 2014 ). However, given the methodological issues mentioned previously, the strength of relationship between social media and body image requires more robust examination.

Although appearance-related behaviors on social media have been suggested as a risk factor for body image ( Saiphoo and Vahedi, 2019 ), little research has investigated ways that adolescents manage challenging social media content or strategies they use to buffer the negative effects of these behaviors. It is important to understand the ways that users interact with social media, because the possible body-related outcomes arising from social media use are likely to be the result of complex, reciprocal transactions between the media content and the social media user ( Valkenburg and Peter, 2013 ; Perloff, 2014 ).

Additionally, while studies have investigated ways to protect and promote adolescent body image in general, social media is a unique sociocultural context that may require specific strategies to help improve body image ( Perloff, 2014 ). Existing approaches to addressing body-dissatisfaction on social media involve teaching social media literacy in order to reduce the credibility of media messages and subsequent body ideal internalization and appearance comparison behaviors ( McLean et al., 2017 ). Although one study found a social media literacy program to be effective in producing gains in body image outcomes in adolescent girls ( McLean et al., 2016b ), similar improvements were not observed in adolescent boys ( Tamplin et al., 2018 ); this is surprising because it would be anticipated that adolescent boys, who are largely unaware of photo-manipulation/editing of male bodies on social media ( Edcoms and Credos, 2016 ), would benefit from enhanced social media literacy. Although these findings are preliminary, meta-analyses from traditional media literacy interventions indicate that although media literacy programs are effective in increasing knowledge about the media, they do not substantially change body image outcomes ( McLean et al., 2016a ). This suggests that increasing knowledge about body ideals may not alone be sufficient to address body dissatisfaction and that other strategies/coping tools are required for adolescents to effectively manage problematic appearance-focused social media. Understanding the strategies (if any) that adolescents use can inform the design of interventions such that they target self-protective skills that are in need of cultivation or further development among adolescents. Probing adolescents’ self-protective strategies can also help identify the approaches that might be most effective in improving adolescent body image and can focus intervention efforts toward these.

Only one qualitative study (to the authors’ awareness) with 38 female adolescents aged 12–14 years has explored protective and promotive coping strategies used by adolescents on social media ( Burnette et al., 2017 ). While adolescents in this sample endorsed behaviors associated with body dissatisfaction on social media, including using photo-based platforms, engaging in appearance-related behaviors and making appearance comparisons ( Rodgers and Melioli, 2016 ), they identified several factors that helped protect their body image when using social media. Girls reported that they consciously avoided undesirable social media posts that invoked appearance comparisons or body image concerns as a way of protecting their body image. While this gave adolescents a sense of personal agency over social media use, it was not regarded as a wholly effectual strategy because it was difficult to avoid unsolicited body related content on social media. Participants also evinced high social media literacy levels as they were critical of the body ideals encountered on social media, regarding them as edited, photoshopped, and unrealistic. Participants were also aware of the concerted efforts that peers went to, to capture and post a “perfect” photo of themselves. The authors posited that adolescents’ skepticism and avoidance of idealized body-related content and their appreciation of diverse beauty standards was indicative of protective filtering.

Protective filtering is an aspect of positive body image that involves selectively internalizing messages that promote positive body image and rejecting negative body-related information ( Andrew et al., 2015 ). Protective filtering has been found to buffer the negative effects of exposure to idealized body-related content in the media in adults ( Andrew et al., 2015 ). Protective filtering also appeared to provide promotive benefits to adolescents’ body image in sample of Burnette et al. (2017) . However, it is unclear whether the findings of these focus groups are generalizable across adolescents because the sample was relatively small and came from a single-sex, private school that taught social media literacy and critical thinking skills and encouraged an ethos of body appreciation, diversity, and confidence, which was reported to facilitate this protective filtering of social media content. Outside of this study, little research has investigated if adolescents use protective filtering strategies on social media and whether these filtering skills can be fostered in adolescents, including those with negative body image.

It is also not known whether aspects of social media content may help encourage protective filtering; “body acceptance” and “body positive” messages have recently propagated the social media space and have been lauded by adult women as a promising way to buffer against problematic idealized content and decrease body dissatisfaction ( Convertino et al., 2019 ; Rodgers et al., 2019 ). It is not known whether adolescents engage with this content and whether it exerts protective effects on their body image perceptions ( Bell et al., 2017 ).

Furthermore, little is known about the strategies that adolescent boys use to protect and promote body image. To the authors’ awareness no study has investigated self-protective strategies used by adolescent boys on social media. This reflects a traditional research focus on female body image, as men/boys were thought to be less impacted by body-related issues ( Parent, 2013 ). However, body image has been recognized an increasingly important issue for boys ( Parent, 2013 ), and has been found to be influenced by social media to a similar extent in both boys and girls ( Saiphoo and Vahedi, 2019 ). Boys and girls may face different body-related challenges and pressures on social media ( Kenny et al., 2018 ; Rodgers et al., 2020 ), and subsequently may employ different strategies to manage these pressures.

This qualitative study explored adolescents’ processing and protective filtering of social media content and whether these strategies were perceived to provide protective benefits for body image. Both adolescent boys and girls were included in the study because little is known about coping or management strategies used, especially by boys, to address gender-specific issues on social media. This study aimed to inform intervention and prevention efforts in the area of body image on social media.

Materials and Methods

Focus groups investigated how adolescents managed challenging body-related content and promoted positive body image on social media. Focus groups were used because they provide a rich and ecologically valid insight into the opinions and lived experiences of participants in their own words and from their own perspectives ( Greene and Harris, 2011 ). Focus groups were favored over one-to-one interviews for this kind of exploratory work because they facilitate greater elaboration of ideas and provide a vocabulary to discuss topics ( Heary and Hennessy, 2006 ; Greene and Harris, 2011 ). In accordance with guidelines ( Heary and Hennessy, 2002 ), single sex focus groups consisting of 6–9 participants were conducted as adolescents have been found to be more comfortable about opening up and discussing sensitive issues in single rather than mixed sex groups.

Focus groups were guided using an interview schedule, which asked adolescents about their experiences and perceptions of body image on social media, the appearance-related challenges they faced on social media and the ways they manage these challenges. The results presented below will focus on adolescents’ management of challenging appearance-related content on social media, however; a brief outline of adolescents’ perceptions/experiences of social media will be provided to contextualize adolescents’ coping strategies. Given the exploratory nature of the research, conversations were allowed to flow freely, and the researcher was free to pursue related topics if they were mentioned.

Participants

A convenience sample of 29 participants, 23 girls, and 6 boys, aged between 15 and 16 years ( M = 15.31, SD = 0.47) were recruited from two mixed sex Irish secondary schools, one urban private school and one rural community school for a study investigating adolescents’ experiences and perceptions of body image on social media. The study was only open to fourth year students who used social media and who received parental consent to participate. Participants’ ethnicity and other sociodemographic information were not recorded. Four focus groups were conducted, three with girls only and one with boys only (see Table 1 ).

Table 1 . Composition and duration of adolescent focus groups.

Focus groups were audio recorded using an Olympus WS853 voice recorder and qualitative analysis software, MAXQDA (Version 2018.1) was used to analyze the data. The interview schedule included questions such as; (1) What social media activities/behaviors do you think help/harm body image perceptions? (2) What characteristics of social media platforms promote positive body image/negatively impact body image? and (3) How do you manage challenging appearance-focused content on social media?

Full ethical approval was received from the ethics committee at Trinity College Dublin. Permission from school principals was obtained to allow the study to be hosted in schools and for students to participate in the study. Informed consent from parents and informed assent from participants was obtained prior to study commencement. Focus groups were conducted on the school premises and participants were assigned to focus groups based on their class group. Participants’ gender, age, and school attended were obtained in demographic questionnaires that participants completed prior to the focus groups. Focus groups were conducted by two female researchers; the primary researcher led the discussion, while the secondary researcher took notes and kept track of time. Focus groups lasted approximately 30–50 min and participants were offered refreshments, thanked and debriefed afterward.

Data Analysis

Focus group discussions were transcribed verbatim by the primary researcher (CM) and were analyzed using thematic analysis. The analysis was guided by six step procedure of Braun and Clarke (2006) , which involved firstly becoming familiar with the data by transcribing data, reading transcripts and listening to audio recordings (Step 1). Then, initial semantic codes were generated and assigned to the data using MAXQDA software (Step 2). Semantic coding, which involves characterization of explicit, surface meaning of content was deemed the most appropriate form of coding of the personal experiences pertinent to the research question. Data was also coded according to an essentialist/realist perspective, which assumes a unidirectional relationship between meaning and experience. This approach allows for a straightforward exploration of motivations, experiences, and meaning, which were the focus of the research questions. These codes were organized into a coding frame containing concise labels and descriptions for codes was established. Related codes were grouped together to form themes and subthemes (Step 3). An inductive approach, which allows themes to emerge from the data rather than being informed by pre-existing literature, was applied to generate themes ( Thomas, 2006 ). These themes were refined by reviewing the data at the level of the coded extracts and entire data sets to ensure that distinct, coherent themes were generated (Step 4). Themes and subthemes were assigned names and definitions (Step 5).

To verify whether these themes characterized the data, inter-rater agreement was conducted both on codes within the coding frame and final themes identified in the data. As recommended by Breen (2006) , an independent researcher (not involved in hosting focus groups) used MAXQDA to review the coded transcriptions and indicate their agreement or disagreement with each of the pre-existing codes and themes; they could also suggest additional codes and themes. The primary researcher reviewed the additional codes/themes suggested by the independent researcher and adjusted coding schemes where appropriate, in consultation with the project lead (DH). According to Breen (2006) , to attain adequate consistency (reliability), code-to-sentence matches should occur for at least 80% of cases. Agreement between coders was calculated using the Kappa Coefficient ( Brennan and Prediger, 1981 ) was high, K = 0.92, indicating good inter-rater agreement. Finally, themes were described and contextualized within relevant literature on social media and body image in adolescents (Step 6). These steps were conducted in an iterative, recursive manner.

The researcher adopted a reflexive approach and acknowledged that their own biases and backgrounds shaped the data obtained and the way it was interpreted. The researcher recognized that as a white, Irish, educated woman in her mid-twenties, she could resonate with the struggles of body image and social media pressures to pursue body ideals (insider position) and could recognize that the body-related pursuits and pressures of men/boys and adolescents may differ from her own, and that adolescents’ experience of social media content and affordances may also be divergent (outsider position; Berger, 2015 ). She also recognized that her adult and female status may have affected adolescents’ interactions and the ways they disclosed information about body image and social media ( Berger, 2015 ; Dodgson, 2019 ).

Adolescents reported that they were prolific, habitual users of social media, showing preferences for appearance focused platforms; adolescents, especially girls explicitly reported that they felt social media exerted a mostly negative influence on their body image. Girls strove to attain female body ideals, while boys largely endorsed functionality ideals; appearance comparisons tended to induce body dissatisfaction when these appearance-related goals were not met. Adolescent girls were perceived to invest more in appearance-related behaviors on social media and to experience greater levels body-related pressure, dissatisfaction and self-criticism than boys. Appearance comparisons with peers, social media influencers, and celebrities were identified as the main sources of body dissatisfaction on social media. Thematic analysis revealed two key themes, and various subthemes pertaining to the management of body image on social media by adolescents.

Theme 1: Behavioral Strategies Used to Manage Problematic Social Media Content

Avoidant strategies.

Adolescents reported using avoidant strategies and unfollowing content that contained body-ideals and reducing their social media use. Female 22 “ stopped using [social media as much] ,” while Female 21 “ unfollowed all the celebrities and people with unrealistic body goal standards ” and it was commonly reported that “ not seeing it [social media] as much helped ” (Female 21).

Avoiding social comparisons was emphasized as a core strategy to protect body image. However, some participants felt that avoidance strategies were limited in their effectiveness because it was difficult evade appearance comparisons as body-related images “ were always just popping up ” (Female 2) and body-related content was “ kind of pushed at [them] sometimes ” (Female 2) irrespective of whether they were interested in it or not.

Active Selection of Positive Content

Boys believed that they could control the outcomes of social media use by selecting content that promoted their self-image. Boys reported that they “ [did not] really get negative thoughts from looking at [social media], usually [they] just look[ed] at positive stuff ” (Male 4).

However, girls reported that they did not actively select positive content as they felt that all body-related content on social media was damaging. Even content designed to improve body image, such as body-positive content, was viewed skeptically by girls. While girls acknowledged and lauded increased efforts to promote body-acceptance, they held reservations about the effectiveness of these efforts. Participants felt that there was a huge disparity between “ the picture ,” which “ portrays a different message to what it’s captioned ” (Female 22). Participants noted that while a picture may be accompanied by a wholesome caption advocating ostensibly positive messages, the picture itself, which was often appearance/body-focused and objectified, was sending the opposite message.

Female 16 “I think that, what people say when they post something, like what they say might be positive and well-meaning but nearly the pictures themselves speak for themselves and maybe what they are promoting in the pictures isn’t healthy even though they are saying ‘self-love’.”

Participants also found it difficult to endorse messages of body acceptance when they were delivered by individuals who embodied body ideals. Participants found it difficult to reconcile “ See[ing] a very skinny woman and she says ‘love your imperfections’ ” (Female 23) because they felt that it was easy for individuals who had perfect bodies to promote the notion of body acceptance as they seemingly had reason to be happy with their bodies. Participants found it difficult to believe that these individuals struggled with body image concerns and thus were reluctant to buy into the notions of acceptance that these individuals were promoting.

Female 7 “A lot of influencers do promote like body confidence and all that but that’s kind of easy for them to say at the same time because they do have the perfect body say for Instagram and all that sort of stuff.”

Other self-acceptance content was recently noted to contain diverse body types including “ plus size models rather than just the really stick thin skinny ones ” (Female 5), which was lauded because it provided a more realistic representation of body image and body types on social media. However, body ideal content with “ skinnier ones [sic: individuals] ” was observed to “ get more positivity back than the plus size ones [individuals] would ” (Female 2) and body ideals were the main attentional draw that influenced bodily self-perceptions. Furthermore, some participants still felt that this body-diversity content reflected extreme body types such as overweight bodies and therefore failed encompass “normal” bodies such as their own.

Female 3 “Nothing’s like normal if you know what I mean.”

Researcher “Right ok, so it’s extremes of all of them kind of?”

Female 3 “Yeah, yeah.”

Researcher “So, nothing in the middle?”

Female 3 “Yeah.”

Active Selection of Alternative Platforms

Although girls felt limited in their ability to engage in positive body-related content, especially on Instagram, some girls actively chose to engage with VSCO, an alternative social media platform that was considered less damaging for body image. VSCO was favored because it was not considered to be as “serious” as Instagram and did not contain feedback indices “likes,” “comments” or hierarchical structures such as “followers,” which were problematic features of Instagram. Girls felt that they “did not feel pressure ” and could post “ a picture on VSCO with no makeup on … but would not put [the same photo] up on Instagram ” (Female 2). Female 1 noted that on “ Instagram ‐ you have to look perfect because you can see how many likes you get and people feel pressured into, they want more likes and that, but you cannot see that on VSCO .”

VSCO appeared to provide an alternative venue for girls to safely explore their body image without fears of overt judgment from others. However, its use was mentioned by girls in one school, and even among this group Instagram surpassed VSCO in terms of popularity despite the negative effects associated with Instagram.

Theme 2: Cognitive Strategies

Psychological distancing strategies.

Psychologically distancing oneself from comparison targets was a common strategy utilized by both boys and girls. Focusing on differences between the goals and values of comparison targets vs. themselves served to increase the psychological distance from these targets in boys and lessen their desire or drive to attain these bodies. Male 1 reconciled that “ They’re [celebrities/sports stars/social influencers] kind of devoting their whole life to it ,” while Male 4 concurred “ Yeah that’s their job like .” Boys felt that they too could attain these ideals if they devoted themselves to this extent but felt secure in their own bodies because they did not hold the same investment or commitment as individuals who possessed body ideals.

Some girls attained psychological distance from targets by focusing on the manipulated, edited nature of the images. Female 10 noted that celebrities/social influencers on social media “use filters ” and reconciled that “ if [she] used them[filters] [she] would look way better . ” “Know[ing] that they [celebrities/social influencers] are photoshopped ” helped her to be less affected by them because she knew they were “ unrealistic looking .” Some girls also attempted to distance themselves from comparison targets by acknowledging that although they often liked the appearance of these individuals, they felt that their features were too extreme and ill-suited to their own appearance.

Female 10 “I like the way they look but I don’t think I’d like to look as … extreme as they do. I don’t think it looks normal. But I think it looks normal with them because they all look like that, but if I walked in like them, I’d look weird, I’d look like an alien.”

While this distancing strategy worked for some, most girls noted that idealized images negatively affected them regardless of the knowledge of their manipulation and this limited the effectiveness of psychological distancing.

Reframing Strategies

Both boys and girls reported that reflective practices such as taking a step back, conducting reality checks and looking at the bigger picture enabled them to reassure themselves. Other strategies mentioned by adolescents involved reframing or putting a positive spin on challenging content. One boy suggested that focusing on goals and achievement rather than focusing on discrepancies and feeling self-pity enabled him to process social media content in a healthier way.

Male 4 “Depends on what way you view it really. If you look at it like, saying they’re this and they’re that and I’m just here, you’re not – you’re always just going to be feeling shite like. You are not going to move forward at all. If you just take – just watch whoever, take inspiration, try work yourself, if you want to be like them, work yourself towards being like them.”

In addition, accepting one’s uniqueness and viewing difference as a good rather than negative thing was identified by a female participant as a way of framing body image in a positive light.

Female 21 “I think the problem overall is that we are looking at difference as if it were a problem, we are saying “Why don’t I look like that? Why can’t I be that person?” But I think we all just have to learn to accept that we are all different and we know these facts, but we chose to ignore them!”

Ceasing to judge others and oneself was also mentioned by a few participants, however, it was acknowledged that this was difficult to achieve. Although boys appeared to be less judgmental and more accepting of their bodies with Male 4 noting “ I am grand just the way I am ,” girls struggled to accept their bodies and avoid negative critical self-evaluations, with Female 5 stating “ You have to get a certain amount of likes … or else it’s not like good enough .”

Female 19 “The more you look at the photo you’re like ‘God I hate it’ you see things that other people wouldn’t see and you’re like ‘I hate everything about it’.”

One girl stressed the value of maintaining a compassionate mindset and endorsed the notion that everyone struggles with the same issues and not to be so harsh and critical toward oneself.

Female 21 “I think we always compare ourselves to the people we see on social media, so we don’t see their flaws, because we are busy pointing out our own in comparison to theirs. We don’t realise that not everyone is perfect as well. And because of that we are kind of blind.”

Female 21 “I just think that young girls need to stop comparing themselves and to take a minute to realise that we are all the same, we are all doing the exact same thing; We are all sitting at home, scrolling. And all the likes we receive, it’s just a double tap of the finger, that person probably doesn’t probably even look at it for more two seconds, we need to stop overthinking everything.”

However, these reframing strategies were only mentioned by a few individuals in focus groups and did not typically reflect the whole groups’ responses to body-related content on social media.

Some participants, particularly girls, reported that they felt social media negatively influenced their body image perceptions. Aligning with the literature, adolescents reported that appearance-focused activities like photo sharing/editing practices and appearance comparisons with celebrities, social media influencers, and peers led to feelings of body dissatisfaction ( Edcoms and Credos, 2016 ; Rodgers and Melioli, 2016 ; Burnette et al., 2017 ).

Limiting their social media use and avoiding, unfollowing, or ignoring problematic body related content were the strategies most used by adolescents to protect their body image on social media. However, as found by Burnette et al. (2017) , these strategies were considered limited in their effectiveness because of the difficulty in avoiding ubiquitous body-related content on social media. Adolescents were aware of targeted advertising and the fact that their newsfeeds were often propagated with content that they did not necessarily want or chose to see; this limited their perceived control over social media use, especially among girls.

Aligning with these control beliefs, girls tended to report more passive responses to social media such as “putting up” with problematic content. Some boys, on the other hand, reported that they actively sought out and selected positive content that inspired them to exercise or helped them improve in some way. It should be noted that the number of boys in the present study was relatively small. Adolescent girls did not appear to engage in such active selection strategies as they felt that any content related to body image exerted negative effects on them, including content designed to promote positive body image. Adolescent girls’ reservations about body positive/acceptance content is notable as it contrasts with the endorsement of the protective effects of this content for body image in the literature (e.g., Convertino et al., 2019 ; Rodgers et al., 2019 ); given the recency of its emergence, the limitations of body positive content may not have been extensively documented in the literature or it may be the case that this kind of content resonates with adult women but not adolescents. Although the influence of body positive content on adolescent body image perceptions requires further research, these findings indicate that adolescent girls experienced social media as a largely negative and disempowering space for body image.

However, VSCO was a photo-sharing platform that was preferred by some girls to Instagram because it did not contain feedback indices such as likes, comments, followers and subsequently did not put as much appearance-related pressure on girls. VSCO has not previously featured in body image research and is worthy of further research attention because it represents a platform that may contain protective features for body image, namely the lack of hierarchical popularity structures or feedback indices.

Some girls distanced themselves from body ideals by reminding themselves that body ideals were not attainable – a strategy also noted by Burnette et al. (2017) . However, most girls reported that their knowledge of unrealistic body ideals did little to protect their body image perceptions and they continued to compare despite this awareness. Girls also achieved psychological distance from body ideals by reasoning that while they admired certain body features on others, they did not desire them themselves because these features would be incompatible with their own appearance. Adolescent boys in this sample reported deprioritizing the importance of the muscular ideal and distancing themselves from comparison targets as a way of protecting body image perceptions. This low investment in body-related content was also identified by Holmqvist and Frisén (2012) as a feature that supported adolescent boys’ body image.

Adolescents exhibited a repertoire of strategies to protect and promote body image. The use of these strategies by adolescents and their perceived effectiveness varied. Passive and avoidance strategies were most commonly used but were limited in terms of perceived effectiveness, while active and acceptance strategies were considered effective but were least commonly employed, especially by girls. As these active and acceptance-focused strategies are considered components of positive body image ( Holmqvist and Frisén, 2012 ), enabling adolescents to employ more active cognitive processing and reframing strategies may enhance their resilience to social media content.

Adolescents in this sample did exhibit aspects of protective filtering (as observed by Burnette et al., 2017 ), in that they were critical of the extreme natures of body ideals and attempted to psychologically distance from and reduce comparisons with these ideals. They also expressed an appreciation of body diversity on social media. However, protective filtering involves both the rejection of negative body-related messages and the endorsement of positive messages ( Andrew et al., 2015 ). Contrasting with the findings of Burnette et al. (2017) , high social media literacy levels did not always serve protective effects for body image and adolescent girls in this sample were largely unable to internalize positive body-related messages and struggled to accept/appreciate their own bodies.

Boys appeared to hold more positive perceptions of social media’s influence on body image, processed body-related content in “protective ways” and exhibited higher levels of body-acceptance than girls. Mirroring the findings of the national study of adolescent boys in the United Kingdom of Edcoms and Credos (2016) , boys in this sample were less aware of photo-editing and manipulation of images of male bodies on social media and viewed body ideals as attainable with sufficient hard work and effort. It may be the case that social media is experienced as a less pressurizing and more motivating space for boys, encouraging them to hold these more positive evaluations of social media. Alternatively, boys may have deemed it acceptable to report beliefs that body ideals were attainable and that they were not negatively affected by social media in order to adhere to masculine gender roles of self-reliance and dominance ( Gattario and Frisén, 2019 ). Boys may also be less aware of manipulation/editing strategies or less critical in perceptions of body ideal attainability and this might protect them from feelings of disempowerment and dissatisfaction when exposed to body-related content.

Nonetheless, some boys and girls reported self-criticism, self-blame, and body-dissatisfaction from social media comparisons and for perceived failures to adhere to desired body standards. Knowledge/information about body ideals did not always appear to change how individuals felt about their body image. This suggests that enhancing social media literacy and knowledge is not alone sufficient to mitigate tendencies to engage in appearance comparison and body ideal internalization behaviors and help individuals to internalize positive body-related messages. Furthermore, relying on body positive/body acceptance content to promote positive body image is also not sufficient given adolescent girls’ skepticism of this content and its ability to improve their body image perceptions.

Self-compassion approaches are purported to target and change how individuals feel about their bodies by addressing self-criticism and shame at the root of body dissatisfaction ( Gilbert and Irons, 2005 ; Gilbert, 2010 ). Instead of trying to inhibit appearance comparisons like media literacy approaches, compassion focused approaches (e.g., Neff, 2003 ; Gilbert, 2009 , 2014 ) try to reduce the self-criticism arising from comparisons – an approach, which may be particularly beneficial in light if the highly self-critical attitudes held particularly by adolescent girls about their bodies. Compassion focused approaches have been found to be effective in reducing body dissatisfaction and disordered eating, in addition to promoting body appreciation and positive body image in adults ( Braun et al., 2016 ; Rahimi-Ardabili et al., 2018 ). However, the ability of compassion-focused approaches to improve body image outcomes has not been investigated in adolescents ( Rahimi-Ardabili et al., 2018 ).

Compassion-focused approaches may be particularly useful for improving adolescent body image on social media, as they can provide individuals with the skills to reframe self-critical thoughts and enhance their resilience to negative body-related messages on social media. Self-compassion may also enable adolescents, especially girls, to internalize positive body-related messages and foster greater levels of body appreciation ( Andrew et al., 2016 ). They therefore represent a new and potentially promising alternative for tackling body image concerns in adolescents.

Limitations

Although this study sought to capture a diversity of viewpoints by recruiting from heterogenous schools that differed in terms of school status (private vs. public) and school size (medium-large and small), the sample size of this study was small which limits the transferability of the findings. Furthermore, very few boys participated in the study, which further limits the conclusions that can be made about social media’s influence on their body image perceptions. Due to study, time pressures a pragmatic decision was made to proceed with the analysis and write-up with the imbalanced gender split. This difficulty in recruiting male participants has been noted in the research in this area, and it may be indicative of male stigma around body image and a reluctance among adolescents to discuss it as a topic ( Griffiths et al., 2014 ; Edcoms and Credos, 2016 ). Future research needs to identify ways of circumventing this stigma and encouraging boys to discuss body image and social media, because far less is known about adolescent boys’ experiences of social media and body image vs. girls, despite the finding that body dissatisfaction is a prevalent and problematic issue among boys and one that is influenced by social media use ( Saiphoo and Vahedi, 2019 ).

The focus group design may have influenced participant’s responses such that they may have provided socially desirable answers that may not have reflected personal opinions, or their opinions may have been swayed by or suppressed because of dominant members of the group. 2 This may be particularly true of boys, who are less likely to disclose body image concerns because of social norms, which dictate that body image is not an issue for males ( Hargreaves and Tiggemann, 2006 ; Yager et al., 2013 ). Furthermore, as the focus groups were conducted by female researchers only, boys may have been reluctant to discuss gender differences related to body image ( Allen, 2005 ), while girls, may have been more expressive of their concerns because they tend to prefer same-sex female facilitators ( Yager et al., 2013 ).

Some adolescents, especially girls, indicated that social media led them to feel dissatisfied with their bodies. Boys and girls appeared to employ different strategies to manage to address the gender-specific challenges they encountered online. Boys appeared to exhibit more agency and active coping strategies, which contrasted with girls who were less optimistic about their ability to control social media outcomes and who struggled to interpret body-related information in a positive, self-protective way. Future research should examine these gender differences in larger samples across diverse contexts.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by School of Psychology, Trinity College Dublin. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

Author Contributions

CM conceived, planned, and carried out the study, analyzed the data, and wrote the manuscript with input from DH, who was involved in the planning and supervision of the study. Both the authors contributed to the article and approved the submitted version.

This research did not receive any specific grant from funding agencies in the public, commercial and not-for-profit sectors.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to acknowledge colleagues Ms. Selin Akkol-Solakoglu who assisted with focus groups and Ms. Molly Light who assisted with inter-rater agreements and the School of Psychology, Trinity College Dublin for their support.

1. ^ We wish to thank a reviewer of the paper for highlighting this issue.

2. ^ We would like to thank the reviewer for highlighting that demand characteristics may have influenced participant responses such that respondents are likely to just go with the theme of the questions, rather than spontaneously come to the conclusion that social media influences them in negative ways.

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Keywords: body image, adolescent(s), social media, body dissatisfaction, positive body image, coping strategies

Citation: Mahon C and Hevey D (2021) Processing Body Image on Social Media: Gender Differences in Adolescent Boys’ and Girls’ Agency and Active Coping. Front. Psychol . 12:626763. doi: 10.3389/fpsyg.2021.626763

Received: 06 November 2020; Accepted: 19 April 2021; Published: 21 May 2021.

Reviewed by:

Copyright © 2021 Mahon and Hevey. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Ciara Mahon, [email protected]

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How Positive Body Image Spreads

New research shows promoting positive body image is good for both you and others..

Posted September 16, 2024 | Reviewed by Devon Frye

• What Is Body Image?
• Take our Disordered Eating Test
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• Promoting positive body image led to improvements in one's own positive body image.
• Promoting positive body image also led to improvements in their friends' positive body image.
• There was also evidence for positive changes in the control group, though to a lesser extent.
• Common underlying mechanisms may explain shared positive effects (e.g., expressing unconditional acceptance).

Positive body image refers to an overarching appreciation and respect for one’s own body—regardless of whether it meets society’s expectations for how a body “should” look and/or function. A wealth of research shows that having a more positive body image is good for you: It is related to, and may cause, many aspects of better health and well-being (e.g., higher self-esteem , adaptive eating behavior, engaging in joyful physical activity).

An important question then is: How does one go about developing a more positive body image? This is a question that continues to inspire me and my colleagues.

In attempting to answer it, we learned from the existing literature that people with a more positive body image choose to surround themselves with others who also have a more positive body image. In addition, they actively promote positive body image to others by being a positive role model (e.g., engaging in positive self-talk , openly criticizing societal body norms).

By promoting positive body image to others, those individuals may in turn develop a more positive body image, which could have feedback effects as well (e.g., when one’s friend also supports their positive body image in return). This cyclical process, whereby people with a positive body image promote positive body image to others and may be supported by others to have a more positive body image, has been called reciprocity .

In a recently published study , my colleagues and I wanted to test this process of reciprocity in an experiment to determine whether promoting positive body image to others can cause improvements in one’s own body image as well as in the other person’s body image. That is, does the very act of promoting positive body image cause improvements in your own body image, as well as in others?

The Experiment

We recruited 124 pairs of female friends (i.e., 248 participants) to participate in the experiment. Each pair of friends was randomly assigned to be in the “experimental” or “control” (i.e., placebo ) group. Within each pair, one friend was randomly assigned to be the “letter writer” and the other to be the “letter receiver.”

In the experimental group, writers wrote a letter to their friend wherein they described many different things their friend’s body can do, and why those things were important or meaningful (e.g., “Your body is able to dance, and dancing with you makes me so happy,” or, “Your body can give the best hugs, and this makes me feel comforted when I am sad”). This was chosen as the present expression of “promoting positive body image” based on research showing that focusing on body functionality (i.e., everything the body can do) and why that is important, is the most effective technique for improving positive body image.

In the control group, letter writers wrote a letter to their friend wherein they described some of their favorite shared memories. This topic was chosen because it also pertained to their friendship and was positive, but was not directly related to the body.

After writing their letters, the letter writers were asked to read their letter to their friend, and were given the opportunity to discuss the letter together.

All of the participants completed measurements of positive body image at the start of the experiment (pre-test), after the letter was written (mid-test), and after the letter was read aloud (post-test). At the end of the experiment, they could also provide feedback about their experience of taking part in the study.

The Key Findings

Among the letter writers, the experimental group reported higher positive body image at mid-test (after writing their letter) and at post-test (after reading their letter) compared to the control group. This supports that promoting positive body image to others (one’s close friend) can cause improvements in one’s own body image.

At the same time, we also found that participants across both groups reported improvements in positive body image from mid-test to post-test. So, while the experimental group had a clear advantage, the control group who wrote about favorite shared memories also experienced benefits to their body image.

Among the letter receivers, both groups reported improvements in positive body image from before to after having received their friend’s letter, with no clear advantage to either group. Receiving a letter about body functionality or about favorite memories both led to positive changes.

The Take-Home Messages

Our study provided an experimental test of one “piece of the puzzle” of the positive body image process called “reciprocity.”

The very act of promoting positive body image to others can cause improvements in one’s own body image.

In this study, promoting an appreciative focus on body functionality could have caused the letter writers to shift their personal focus from appearance to functionality. Indeed, key theories in the body image field propose that an appearance-based focus on the body and self contributes to poor outcomes, and re-shifting one’s focus towards body functionality is important.

For the letter writers, it could also be that promoting positive body image to a friend acted as “proof” that one personally holds those positive attitudes, which may affect how one sees oneself (e.g., “I’m telling my friend that I appreciate her body functionality. I must be a person who stands for a more positive perspective toward the body”). This is in line with broader theories in psychology showing that people often form their attitudes about themselves by observing their actions.

An important caveat is that letter writers in the control group also reported improvements in positive body image—albeit to a lesser extent. It could be that these changes were due to similar working mechanisms.

For example, writing about shared memories with a close friend could cause people to shift their personal importance away from appearance, and toward other valued life domains instead, such as their friendships. This is supported by one letter writer participant in the control group who described, “It makes me feel good and appreciate her, our friendship, and my life even more.”

The findings with respect to the letter receiver participants are also nuanced, as both groups reported improvements in positive body image. One working mechanism to explain these changes relates to the “acceptance model” (Avalos & Tylka, 2006), which proposes that unconditional (body) acceptance from important others (e.g., friends, family) is a crucial factor in developing positive body image.

Indeed, letter receivers in both groups described that their friend’s letter reminded them that their friend unconditionally accepted them, for example: “I felt worshipped despite of how strong/fit I am, and she made me feel happy by telling me how much I mean to her. It made me feel like my outer look is not that important” (control group) and, “It made me feel really loved and important and grateful to have her as a friend. We also discussed how physical appearance is such a small part of why we love each other and it made what I perceive to be imperfections in a beauty sense feel much less important” (experimental group).

Interestingly, letter receivers in both groups described feeling like they wanted to “pay it forward” by doing something kind for their friend(s) in return. For example, one participant described, “I now want to also write a letter to her and tell my friends more often how much I love and appreciate them.” Though we did not measure this directly, these descriptions suggest that reciprocity may indeed have feedback effects, whereby others may promote positive body image back to the individual.

In summary, this was the first experiment to test whether the very act of promoting positive body image to others can cause improvements in one’s own and in others’ body image. Future research is needed to confirm these findings and to investigate other valuable questions and nuances as well—for example, to see whether other “expressions” of promoting positive body image have similar effects, and to see whether friends indeed return positive gestures back toward their friend in the future.

Tentative conclusions are that promoting a positive body image to one’s friend (e.g., by promoting an appreciative focus on body functionality) could be a useful tool for improving body image, which could also lead to wider-scale benefits beyond the individual and into their social circle. We are excited to continue this research line and hope that others feel inspired to conduct research on reciprocity as well.

Alleva, J. M., Custers, M., Chatzi, N., Vogt, J., Lukan, C., Annerbo, V., Hartmann, S., & Martijn, C. (2024). The feeling is mutual: A randomized controlled trial testing the positive body image process of reciprocity among close friends. Body Image, 51, 101794. https://doi.org/10.1016/j.bodyim.2024.101794

Alleva, J. M., Medoch, M. M., Priestley, K., Philippi, J. L., Hamaekers, J., Salvino, E. N., Humblet, S., & Custers, M. (2021). “I appreciate your body, because…” Does promoting positive body image to a friend affect one’s own positive body image? Body Image, 36, 134-138. https://doi.org/10.1016/j.bodyim.2020.11.002

Alleva, J. M., & Tylka, T. L. (2021). Body functionality: A review of the literature. Body Image, 36 , 149-171. https://doi.org/10.1016/j.bodyim.2020.11.006

Avalos, L. C., & Tylka, T. L. (2006). Exploring a model of intuitive eating with college women. Journal of Counseling Psychology, 53(4), 486. https://psycnet.apa.org/doi/10.1037/0022-0167.53.4.486

Guest, E., Costa, B., Williamson, H., Meyrick, J., Halliwell, E., & Harcourt, D. (2019). The effectiveness of interventions aiming to promote positive body image in adults: A systematic review. Body Image, 30 , 10-25. https://doi.org/10.1016/j.bodyim.2019.04.002

Linardon, J., McClure, Z., Tylka, T. L., & Fuller-Tyszkiewicz, M. (2022a). Body appreciation and its psychological correlates: A systematic review and meta-analysis. Body Image, 42 , 287-296. https://doi.org/10.1016/j.bodyim.2022.07.003

Linardon, J., Messer, M., & Tylka, T. L. (2023). Functionality appreciation and its correlates: Systematic review and meta-analysis. Body Image, 45 , 65-72. https://doi.org/10.1016/j.bodyim.2023.02.002

Tylka, T. L., & Piran, N. (Eds.) (2019). Handbook of positive body image and embodiment: Constructs, protective factors, and interventions . Oxford University Press. https://doi.org/10.1093/med-psych/9780190841874.001.0001

Wood-Barcalow, N. L., Tylka, T. L., & Augustus-Horvath, C. L. (2010). “But I like my body”: Positive body image characteristics and a holistic model for young-adult women. Body Image, 7 (2), 106-116. https://doi.org/10.1016/j.bodyim.2010.01.001

Jessica Alleva, Ph.D ., is an assistant professor of psychology at Maastricht University in the Netherlands, and a Visiting Fellow at the Centre for Appearance Research in the U.K.

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Positive body image: a qualitative study on the successful experiences of adolescents, teachers and parents

G tort-nasarre.

a Calaf Primary Care Center, SAP Anoia-Gerència Territorial Catalunya Central, Institut Català de la Salut (ICS), Calaf, Barcelona, Spain

b Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain

c AFIN, Research Group and Outreach Centre, Universitat Autònoma de Barcelona, Barcelona, Spain

M Pollina-Pocallet

d Bellpuig Primary Care Center, Diputació, Lleida, Gerència Territorial Lleida, Catalan Health Institute (ICS), Barcelona, Spain

e Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain

Y Ferrer Suquet

M ortega bravo.

f Cappont Primary Care Center, Lleida, Gerència Territorial Lleida, Catalan Health Institute (ICS), Barcelona, Spain

g Department of Medicine, Faculty of Medicine, University of Lleida, Lleida, Spain

M Vilafranca Cartagena

h Department of Nursing, Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Manresa, Spain

E Artigues-Barberà

i Balafia Primary Care Center, Lleida, Gerència Territorial Lleida, Catalan Health Institute (ICS), Barcelona, Spain

Purpose Body image encompasses body-related self-perceptions and personal attitudes. Dissatisfaction with body image during the early stages of adolescence is negatively related to self-esteem and other health problems. A few publications focused on positive body image and directly related to the experiences and interactions of adolescents themselves. To explore positive body image in adolescents and describe the familial and educational factors that contribute to its development.Methods A qualitative study was conducted. Purposive sampling was used, and 9 adolescents, 6 families, and 8 teachers participated in semi-structured interviews, which were then theme analyzed. Results Self-care, body acceptance, confronting messages that attack body image, and the influence of social media have been identified as emerging themes in adolescents’ positive body image experiences. Therefore, the pubertal period, family values, fostering, and educational actions as well as media literacy were identified as factors promoting self-esteem and positive body image in the family and educational environment. Conclusions Their parents also expressed aspects such as those that contribute to the development of healthy self-esteem, confidence, and positive body image. Alternatively, the teachers indicated educational activities to work on self-image and self-esteem when faced with situations of concern in the classroom.

Introduction

Adolescence is a transitional period between childhood and adulthood, and it is divided into early adolescence (from 10 to 14 years old) and late adolescence (from 15 to 19 years old) (Unicef Nations Cildren’s Fund, 2011 ). This period is characterized by significant physical, psychological and social changes that affect the adolescent’s growth and can pose challenges for developing and/or maintaining positive body image (Parent et al., 2003 ; Rogol et al., 2002 ). In addition, these biological, cognitive and psychosocial changes tend to be more prominent and abrupt during adolescence in comparison to adulthood (Markey, 2010 ) as adolescents are positioned to accept or reject their maturing body and participate in self-care or dangerous behaviours (Sundgot-Borgen et al., 2019 ). Various social agents have strong interactions with adolescents, such as their family, peers, groups, educational institutions and the media, which helps to construct a system of values and beliefs that are the basis for the adolescent’s self-confidence (Rosenberg, 1989 ). The quality of these relationships has a key role in their psychosocial development (Mota & Matos, 2014 ).

Body image (BI) is conceptualized as the internal representation that someone has of their external appearance (Grogan, 2016 ) and encompasses self-perceptions related to the body and personal attitudes, including thoughts, beliefs, feelings and behaviours (Cash & Smolak, 2011 ; Sands, 2000 ). At the same time, body image is a complex phenomenon that includes several components with gender, ethnic and sociocultural influences (Cash, 2012 ; Cash & Smolak, 2011 ).

Alternatively, body dissatisfaction is defined as a person’s negative thoughts and feelings about their body. It is related to negative assessments of the size, shape and weight of the body, and generally involves a perceived discrepancy between the person’s assessment, their body and their ideal body (Grogan, 2016 ; Tiggemann et al., 2011 ). Likewise, dissatisfaction with body image during the early stages of adolescence has been related to lower self-esteem and predicts depressive symptoms, a higher body mass index, less physical activity, clinical eating disorders, a poorer quality diet, disordered eating (i.e., diet behaviours based on trends, food and use of ingredients for emotional regulation), behaviours aimed at losing weight (through diets, food restrictions and modification of dietary habits), which at the same time foster problems with the distortion of self-image (Vaquero-Cristóbal et al., 2013 ). Also, some authors have associated certain internal factors with body dissatisfaction and the concept of the body (Heidelberger & Smith, 2018 ), the perception of beauty and ideals of appearance transmitted by society and the media (Meier & Gray, 2014 ), the attitude towards the self and towards others (Heidelberger & Smith, 2018 ) and gender differences and perspectives (Ramos Valverde et al., 2010 ). Other authors have identified the media together with family and friends as part of the external factors that influence BI (Heidelberger & Smith, 2018 ; Ramos Valverde et al., 2010 ; Vaquero-Cristóbal et al., 2013 ). Tort-Nasarre et al. (Tort-Nasarre et al., 2021 ) suggest that the construct of body image in adolescents has multiple meanings and that it does not necessarily involve dissatisfaction when there is a mismatch between the real and desired image. The concept of body image is established in a much more complex way than simply through the messages received by the mass media and the pressure experienced from friends. The family and the school environment also play a determining role in terms of protective factors when work is done to provide tools to help them develop self-esteem, assuredness and confidence.

There are plenty of studies on body dissatisfaction in adolescents all over the world and also in Catalonia (Pollina Pocallet et al., 2019 ; Pollina-Pocallet et al., 2021 ), however during recent decades, in the context of research into body image there has been a call to focus on positive body image and its links to wellbeing (Tylka et al., 2018 ). Positive body image has been conceptualized as a multidimensional construct that represents love and respect, acceptance and appreciation of individuals and feeling comfortable with their body, independently of their actual physical appearance, as well as their ability to interpret messages in a way that protects the body (i.e., internalizing positive messages, rejecting or reformulating negative messages (Tylka & Wood-Barcalow, 2015b ). The response to this perspective has been to develop a multidimensional conceptualization of positive body image among adults (e.g., Tylka & Wood-Barcalow) (Tylka & Wood-Barcalow, 2015a ) but among adolescents it has still been scarcely studied (Frisén & Holmqvist, 2010 ) even though, as mentioned previously, the formation of positive attitudes and perceptions of the body is important during adolescence both for girls (Wertheim et al., 2011 ) and for boys (Ricciardelli & Cash, 2012 ).

Due to the relative scarcity of research on positive body image and the need to clarify the interactions between some protective and risk factors related to this construct during adolescence, this qualitative study aims to explore positive body image in adolescents and describe the familial and educational factors that contribute to its development. The specific questions that guided the investigation are: What characterizes positive body image in adolescents? Which factors in the familial and educational environment influence positive body image in adolescents?

We used a qualitative descriptive design, an approach that is suited to reaching a deeper understanding of practice in applied disciplines (Colorafi & Evans, 2016 ). This design is especially pertinent when the goal is to understand the participants’ perspectives and experiences (Morse & Field, 1995 ).

Participants

Purposive sampling was used with the aim of recruiting good informants who meet the research objectives (Moser & Korstjens, 2018 ). The participants were part of three groups: students, teachers and parents of students at a school in Bellpuig, Lleida, Catalonia, Spain. The inclusion criteria for participants were being students in the Compulsory secondary education, being considered by their peers as someone with high self-esteem, good body image and assuredness. Being teachers at the school and considered by the students as references. Being parents of students chosen by their peers as references.

The school nurse helped to recruit the participants. The recruitment process was complex as there were three groups of participants to recruit: adolescents, parents and teachers. To recruit the adolescents, a questionnaire (ad hoc) was given in which the students were asked to write the names of three classmates that they thought had high self-esteem, assuredness and good self-image, and another questionnaire (ad hoc) to write down the names of the three most important teachers of their school year. Both questionnaires were anonymous. 324 adolescents responded to the questionnaires, based on the list obtained a definitive list was drawn up and the adolescents who received the most votes from each year group were asked to participate, as well as the teachers who were the most highly rated. Lastly, the parents of the students who received the most votes were invited to take part in the study. Finally, 9 students, 8 teachers and 6 mothers/fathers were chosen.

One of the team’s researchers (MPP) invited the candidates to participate in the study via telephone. Those who accepted were sent the informed consent and information sheet for the study that was collected by the same researcher.

Data collection

The data were collected using semi-structured interviews with the students, teachers and parents. The team of researchers created a set of interview questions based on the existing literature and adapted to the three profiles of participants. During the interviews, the participants were encouraged to add additional information on their experience. The interviews were carried out by three members of the team: MPP, GTN and EAB from July 2021 to March 2022. The interviews were carried out firstly via video call through Teams due to the lockdown situation as a result of COVID-19 and the latest ones were carried out face-to-face with the teachers and parents. During the interviews, notes were taken on the non-verbal communication of the participants. The interviews lasted approximately 30–45 minutes. All the interviews were recorded on a tablet and were transcribed. All the interviews were anonymized, assigning them an alphanumeric code. They were encrypted and stored in a dissociated manner on a secure server at the Institution. The transcribed interviews were also returned to the participants for their approval. All the participants accepted the transcription.

Data analysis

The thematic analysis method was followed (Braun & Clarke, 2006 ) and it was organized using Atlas-ti version 7. GTN and EAB carried out the data analysis. They began to familiarize with the data to obtain a complete view of them. Later, meaning units of the text were identified. Similar expressions were put together, sub-themes and later main themes were created. In doing so, they remained faithful to the participants’ expressed perspectives (Patton, 1990 ). Quotes were also extracted to illustrate the results, indicating the participant’s code at the end of each of these. Data saturation was reached when we detected that no relevant new information was emerging (Saunders et al., 2018 ).

The study complied with credibility, transferability, dependability and confirmability which ensures the trustworthiness of the qualitative research (Johnson et al., 2020 ). Credibility was ensured due to the constant review process of the process of analysis. Transferability was ensured through the detailed description of the phenomenon in sufficient detail to be transferable to other settings and people. Dependability was ensured in this study due to the review by each of the researchers of the process of analysis as well as the final product. Confirmability was assured through the reflective work of each researcher who made field notes during the interviews to offer the most objectivity possible in the data collection and analysis. We completed the Consolidated Criteria for Reporting Qualitative Research (COREQ) (Tong et al., 2007 ). This study was approved by the ethics and clinical research committee at the Institut d’Investigació IDIAP Jordi Gol under the code 20/154-P.

23 participants took part in the study: 9 students between 12 and 16 years old (77.8% female and 22.2% male), 8 secondary school teachers who were references for the students (62.5% female and 37.5% male) and 6 parents of the students (83.3% female and 16.7% male) ( Table I ).

Characteristics of the participants.

The participants are coded as follows: A1-A9: Adolescents, P10-P16: Parents and T17-T22: teachers.

In the data from the interviews 2 themes and 8 sub-themes were identified. See Table II

Themes and sub-themes.

Theme 1: experiences regarding the adolescents’ positive body image

The adolescents express the aspects that characterize positive body image and they are summarized in the following sub-themes: doing self-care, acceptance of one’s own body, confronting messages that attack body image and the influence of social networks.

Doing self-care

The majority of the adolescents talk about actions aimed at caring for the body, such as doing sport and having a good diet:

I am well looked-after. I play tennis 5 days a week. I like it a lot. I do lots and lots of sport. A3.

They value the advantages and benefits that looking after the body brings to their physical and psychological wellbeing:

I have always considered sport to be something you need, not for getting thin, but for distracting yourself and getting rid of everything that’s happened when you have a very dark and busy day, doing sport airs you out and goes really well. A6.

In addition, they identify diets that are not appropriate for their development:

I think that when there are people who are fine and they go on diets to be thinner because they are obsessed with their body, I think that it’s not good, if you eat well and do sport it’s better. A1.

And they give healthy advice to friends who want to get thinner and discourage risky behaviours:

Sometimes, when one day they aren’t feeling good, they want to lose weight… then most of us say that there’s no need, that they’re fine and not to do silly things like stopping eating, vomiting… and all of that. And that if they have to do it, that they do it right by eating and doing sports. A5.

Acceptance of one’s own body

The adolescents show aspects related to the acceptance and appreciation of their own body. Many of them like their body:

I like my body, I wouldn’t change anything right now, I am how I would like to be. A1.

Others explain that you have to accept yourself as you are physically and not put too much importance on the body:

You have to accept yourself as you are and you mustn’t put much importance on the body and try to be like another person to be better, rather that, sometimes, what you think is better. A4.

There are also adolescents that believe that it is more important how you are internally as a person:

I put a normal amount of importance on it, not a lot and not very little. The most important thing is how you are, your personality. A1.

In this manner, the adolescents indicate that you have to be secure in yourself:

If you don’t feel well with yourself others won’t like you either and you have to appear secure in yourself. A3.

good self-esteem as a protective measure:

I believe that you can be physically not so perfect, but if you have good self-esteem and you like yourself, you’ll see yourself as perfect and it won’t matter to you what other people say about you, alternatively, maybe you’re fine but you have very low self-esteem, and you’ll give the slightest hurtful comment they make more importance than the 30 positive ones they make. A5.

They also highlight the relationship between accepting the body and accepting yourself as inseparable aspects:

I believe that if you feel good with your body, you’ll also feel good with yourself because it is part of you. And I think that it is important but not very, we shouldn’t give it much importance because there are people who are obsessed with their body, and it’s not necessary. A4.

Others explain the need to normalize body image and accept different canons of beauty and health:

Normalizing that being fat or being very thin is not a very bad thing. Maybe, let’s see, being very, very fat might be harmful for the health, but equally we have to normalize everything, that it’s not bad that someone is fatter or that someone else is thinner. A1.

However, a few adolescents express aspects related to the appreciation or acceptance of the image of others:

I think that you have to respect everyone. A3.

Alternatively, there are young people who don’t fit into the socially established canons of beauty. They feel the need to hide their body and adopt avoidant behaviours when they are exposed to the rest of their peers. These behaviours are determined by the opinion that they themselves have of BI and they differ between boys and girls:

It is very important, because girls sometimes more than boys tend to obsess more over the physique and follow certain ideals. The boys maybe don’t talk about it, but inside they feel it too. A4.

The teachers also observe differentiating details between the boys and girls regarding a body that is not within the pre-established social canons:

The boys that are a little beyond what is normal might be chubbier, you do see them as being very shy, very much so, maybe extremely shy more than a fat girl, alternatively, with the girls if they’re a little outside of the common pattern I see them as somewhat disinhibited. T22.

But on the other hand, being different to the rest of the group is challenging and a concern for many of them. Faced with this experience, the teachers describe the individual adaptive responses of these students when they feel exposed to their peers, for example when they have to speak to an audience:

You see that they are a little embarrassed going to speak to an audience because they don’t feel confident in their body. T24.

or how they hide the body to not show it to their peers:

They wear looser things, or sweatshirts when it’s hot and they don’t even want to take off their coat (…) because either they have boobs because they’re fat or they have a belly. T24.

The teachers mention how the process of adaptation by the group is for those who have a different physical image to the rest:

There are groups that wouldn’t accept them because they are dressed differently, because they are different and there are groups that would accept them because they’re bringing other things as well as the way they dress. T20.

Confronting messages that attack body image

Some adolescents consider receiving messages from peers as a positive reinforcement:

My friends always tell me that they think I have a very good body. It isn’t important but I like it. When you receive these positive comments from your friends it makes you feel better and makes you like yourself more. A3.

But the influence of friends is not always positive, they also explain about messages between friends that attack the body image of others, causing upset between them:

They go along with them because they are very thin or because they don’t have boobs, for example… there are kids that tell them this. A1.

The teachers also highlight situations that are threatening for body image between peers:

Some girls are having a bad time due to comments that the boys are making. That they’re fat, that they don’t have breasts, that they have a fat bum. That’s what the boys say. The boys say things to the girls and there are even girls that were considering not going to the swimming pool or not wearing a bikini because of what the boys might think about their body. T20.

In the face of these threatening messages, the parents and teachers assess high self-esteem and confidence in adolescents as key factors for not letting themselves be influenced:

If you have a good base and good self-esteem it doesn’t have to affect you so much either. But if you’re someone who has very fragile moments maybe what they say affects you more. P11.

At the same time, the adolescents identify different strategies for dealing with the negative messages they receive from their peers such as selective listening:

I’m a person who doesn’t listen to harmful criticism very much, because it isn’t useful. You have to listen to the good ones to have good self-esteem and self-image. A6.

defending the weaker peer:

There were some boys who were calling another person names. They were calling them fat and such. They were starting on their body weight. Us girls always told them to be quiet, it was all the girls against these boys. A4.

or even helping them with strategies that they have learned by experiencing similar situations:

I went to help this person, because when they did it to me, I didn’t know how to defend myself either so I think that what’s needed when they’re doing that to you is to stick out your chest and face them so they see you, so they can’t bring you down. A5.

The influence of social media

The influence of social media with regards to body image is another of the elements that they talk about. It is worth underlining that the adolescents are fully aware of the effect of the messages they receive about beauty ideals on social media:

There are lots of comments talking about the physique on social media and this very much affects us teenagers, who are the people who use it most. A2.

and their consequences when they don’t comply with the beauty canons broadcast by the mass media:

I think we’ve reached a point where everyone gives it too much importance, because everyone also focuses on it a lot and brings down other people due to the appearance that society has given us of how a person has to be or how they have to stop being, people on TV, influencers. They give us an appearance that everyone wants to achieve and if you don’t have a certain build you can’t manage to have it. People have become so used to the fact that if someone is different, the only thing they do is bring them down because they are different. A5.

Theme 2: promoting factors in the familial and educational environment

In terms of the manner in which parents and educators talk about issues related to the appearance, the following sub-themes were identified: Pubertal timing, Values and actions that promote self-esteem and positive body image, Educational actions that generate self-esteem and positive body image and Media literacy.

Pubertal timing

In many cases, the parents and educators know what it means to go through these vital stages characterized by a process of physical, psychological and emotional change. They indicate that they know about aspects of the adolescent stage:

It changes a lot, there are animal changes on physiological levels, they’re animalistic the changes that happen. T23.

For the teachers and parents these physical changes have an emotional impact and cause a lack of emotional regulation:

it’s a stage with lots of changes, they aren’t balanced, as soon as they’re happy they’re angry, they can feel happy with themselves or not. It’s a stage of lots of imbalances and little acceptance and of rage and getting angry, being angry. Little acceptance of rules, or of themselves, it’s like they’re a little angry with the world… T22.

And it also affects self-esteem and self-knowledge:

They’re really in a process of change, so what happens? They don’t feel well with their mind or with their body because they’re in a process of change. Of course, they don’t yet really know where to go and then their self-esteem is affected. P10.

And they identify consequences related to social interaction,

It’s a topic that matters so much to them and they really look after their image, excessively so I think rather than too much, but of course it’s their whole world right now, the social relationships, fitting into the world, and they value it excessively. I find that there are lots of problems related to food that are unnecessary. T21.

They also have lots of problems, I think, psychological problems, problems like anorexia. It’s that now, social media and everything like that is making it very bad. P12.

They also indicate the influence of friends and the fact of following a uniform pattern of dressing and thus feeling integrated into the group:

Friendships do a lot! It’s that for them at this stage of life, friendships are more important than parents and being another one in the group is essential for them. T24.

I see that their external style is always a mono-topic. Nobody goes outside the norm, I don’t know any 1st year ESO student that has their own style, in other words, they all wear the same type of T-shirt. What I see is that there is one style and nobody departs from that. T18.

Family values and actions that promote self-esteem and positive body image

Another topic that was identified in the data was the transmission of values in the family environment. These values are defined as aspects that facilitate the children having positive body image and high self-esteem. The parents highlighted the affective link, help and accompaniment:

There is an esteem link, the family link, the link that has to transmit values, values for making your bed, values for cooking, values for beliefs I mean… that’s what a family is, not just transmitting certain values. I think that it has to transmit all of them, the more the better. P10.

They teach them to find solutions based on parental communication:

What I always repeat to them is that if they ever see a problem, they find themselves trapped, they find that they don’t know what to do, as much as it seems very complicated, very difficult and very hard to them, that they should talk to me about it because just the fact of explaining half of the problem works and then, maybe between the two of us we can find the solution that one person alone can’t find. P13.

Accompaniment that is guided, and they explain how they put limits on their children and the reason for doing so,

I put limits on them. Or rather you reach a point where it’s “Right, that’s it”. I’ve tried to reason everything… or I say something, I don’t agree, I don’t see it like that, whatever… but if I really think that it is better for them and the other thing isn’t good, if necessary, in the end I’m capable of saying “that’s it, because I said so” because I’m reasoning everything to you and I’m giving a basis for it and you’re not paying attention to me, you’re not listening, so that’s it. P13.

Teaching them to have their own style, their own opinion and not letting themselves be influenced by others:

At home certain values have been given, you’re clean, you’re polite, you dress in the style you like, but you dress well and from there everyone has their own style. P13.

This accompaniment and values are received and interpreted by the children as they explain:

They’ve never told me to stop eating, that you’re fat or to eat less. They’ve never started on me and my body. A4.

Physical appearance at my house is not very important, it’s more important to be a good person. A6.

The adolescents explain how their parents teach them skills and points of view in the face of negative comments that attack the physical appearance:

My Mum and Dad told me and everyone has told me you have to learn to defend yourself, you can’t lower your head and let them bring you down because none of us are better, nobody is better than anyone. Then at home they also helped me, they told me that I had to defend myself without lacking respect. A5.

They are families that generate healthy relationships with self-esteem and self-image. The parents express, among the strategies that they talk about, they believe that it is crucial to be present in the day-to-day and maintain good communication links:

I am always very much in contact with the children. We do lots of things together, we talk a lot, I go in their room, they come in mine, I mean that at my house there are no closed doors. I think that they tell me about lots of things, I’m sure they don’t tell me everything, or anywhere close, but they tell me lots. P10.

In addition, the families also talk about activities and actions that they do to educate and work on the self-esteem and positive self-image of their children. Such as working on self-acceptance and confidence in yourself:

We’ve prioritized feeling confident in yourself, or loving yourself as you are, accepting yourself and giving others the image of who you really are inside. I have always given them certain very clear parameters around what to do in lots of situations. For self-confidence and self-esteem, I think that all that makes self-esteem, feeling confident. P13.

Giving positive reinforcements:

Giving them positive reinforcements with the things that you see that they can highlight and those that they do not, so bringing out the good. Make them see what they’re worth, so they go looking for their path towards things that can be good. P11.

Looking after yourself:

You have to have a good concept of yourself, you have to look after yourself. Looking after yourself doesn’t mean you have to be thin, that you have to be all muscular. P13.

Knowing how to decide and being responsible for the consequences:

You have to make a decision, you have to evaluate it and once you’ve evaluated it, you have to accept that maybe it won’t please everyone and that you’ll have to be responsible for your actions. P13.

Educational actions that generate self-esteem and positive body image

The teachers explain in detail their educational aim and how this is determined by professional teaching values: respect, consideration, visibility and not judging. The importance of these aspects for the development of self-esteem:

Respect, consideration, giving each student the place that corresponds to them, meaning that they aren’t invisible in the classroom, even if they aren’t always visible. They’re all part of that group and this is very important for self-esteem. T17.

Evaluating them:

My job is also to evaluate them very positively. T18.

Establishing a good channel of communication:

I talk to the students a lot when I can. Whenever I can. T24.

It is important to highlight that the teachers identify certain characteristics in the adolescents with low self-esteem:

A person who is insecure, introverted, people who are negative and for whom it is difficult to get themselves up, when so many young people sometimes tell you “It’s hard for me to get up in the morning but I’ll make the effort. T19.

As a trait characteristic of the adolescent age in current society:

They have low self-esteem, because it’s protected them a lot and this has made it so that any form of effort grinds them down, makes them suffer, they get exhausted. From this culture of effort, trying, falling and getting back up again and all that I don’t think so: they don’t have too much of it. T20.

In addition, they highlight how self-esteem is a key element for functioning throughout life and carrying on despite having little integration of a culture of effort:

A person with self-esteem will carry on going. T17.

They describe teaching strategies when faced with adolescent students with low self-esteem,

With students with low self-esteem what I do, what I try to do is give them an important place in the class, but as important as that of any other student. T17.

giving elements because they believe in themselves and encouraging them to tackle challenges:

Reinforcing self-esteem, with the feeling of always giving them encouragement and forward movement and you’ll come out of it and not doing the opposite: “you’ll do nothing with your life”. T21.

giving confidence through communication:

Speaking with them: to give them confidence because they talk to me about what is happening, and then when they explain what is happening, trying to look for solutions within what I can do. T20.

These teaching actions have the reward of feeling like they help the adolescent:

There are lots of teachers who help with lots of students who don’t find themselves, who don’t see themselves or have a negative image of themselves, a physical as well as mental image, we go along with them and, at times, as well, if the thing isn’t very serious sometimes they come out of this type of dark hole. T23.

The teachers at the school carry out activities aimed at educating the adolescents on self-esteem and emotional regulation:

We did an activity that was called Great and it was about saying positive things, not about buttering them up or telling lies, but saying positive things about yourself, the teachers, your peers… well activities like that. T21.

These teachers find themselves in situations in the classroom in which they have to work on positive body image and thus avoid dissatisfaction or conflict and carry out activities aimed at this such as:

The other day I did an activity where I put images of the kinds of girls that the boys follow and that they like and such and afterwards I put the opposite, those images of the boys that the girls follow. Then I had them stand up in front of the class and I asked: boys are you the same as these boys that come up here on social media? No, so don’t ask the girls to be the same as these girls. It was an exercise in seeing that one thing is day-to-day reality, and the other is how they want to appear. T20.

By comparing images between one and the other they see it is a visual thing and this stays with them there. T20.

Sitting in a circle and expressing how they feel or how they feel from what the others make them feel with them, of how they treat them, how they stop treating them and comparing themselves, from now on… speaking about it among them all in small groups to talk about it and how to be able to solve this and how you make the other, with your own reactions, can make the other feel better. T20.

Media literacy

Another emerging theme that the parents and teachers mention is the use that the adolescents make of social media and how they influence BI. For the educators and parents, media literacy and education is a challenge. For example, they realize the effects that it has for young people listening depending on which type of music that entails implicit patriarchal values:

It’s this patriarchal culture that we have in our society that, as much as we try to fight and fight, there is always this background of social media, music… everything that affects adolescents. This music leaves the girls on the ground. And the girls listen to this music and sing it and then you say it’s just lyrics, no no, but this gets into you and you end up feeling the same as the boys that follow it. And this very negatively affects them and they don’t realize it as much as we try to educate, educate, educate… we have all this background. T20.

Or of how they mirror the success of the youtubers:

If I have a youtuber as a model, and a youtuber making 4 videos earns a living and a very good one, why do I need to make an effort? If I’m an instagrammer what I’m doing is uploading photos of how I dress, what I visit, the places I go, etc., with this I’m earning a good living why do I need to make an effort, why do I have to do a degree, a training course, it’s not worth it, so this low-effort society, I think it also affects them. T19.

Even so, both the teachers and the parents look to teach the critical analysis of the information and what they receive on social media:

I’m sick of telling them not to look for information where we don’t know that the source is reliable or they might be tricked, or going to look for videos that don’t explain anything good to you, don’t look at this, do a search. Guiding them a bit. T23.

They’re becoming aware of the manipulation of the images they receive on social media :

They see it on a tablet, remind themselves with a TikTok: here there are lots of filters what an embarrassment, this girl with such a filter, look on Google and compare. I think that it’s going to make the kids open their eyes, that all that is a lie, it’s cinema, it’s a film: they’re wearing make up, it’s all… it’s all a lie. T22.

This study has explored positive body image in adolescents in Catalonia (Spain) as well as the perspective of parents and educators. In particular it contributes data from the adolescents considered by their peers as having high self-esteem, confidence and good body image, the teachers who are references for these same students and their parents, an aspect that contributes to the in-depth and detailed results on positive body image at this age. In this regard, the formation of positive body attitudes and perceptions is an important development task during adolescence. In particular, the influence of the education received from parents and friends has been studied (Frisén & Holmqvist, 2010 ), but there is a lack of studies on the influence of the school environment, an aspect that can be essential and which is covered in the current research.

Experiences regarding positive body image

With regards to the aspects that characterize positive body image, many adolescents describe doing self-care as a beneficial aspect that brings them physical and psychological wellbeing (Wood-Barcalow et al., 2010 ). In addition, it is worth pointing out that they are capable of detecting unhealthy habits such as unhealthy diets or excessive physical activity and giving healthy lifestyle advice to friends when they detect that they are doing these practices. This reinforces a protective role towards body dissatisfaction associated with the development of eating disorders or psychological stress (Añez et al., 2018 ; Dhillon & Dhawan, 2011 ).

This study also highlights the association between high self-esteem, confidence and self-image. In this regard, some participants prefer being good people even though their body is not perfect, and having confidence in yourself and being capable of not paying attention to negative comments on your appearance. These are aspects that are reinforced by the work of Holmqvist et al. (Holmqvist & Frisén, 2012 ) as protective attitudes.

In addition, another aspect to highlight is the acceptance and appreciation of their own body as inseparable aspects and ones that make up the identity (Holmqvist & Frisén, 2019 ). However, the study shows that there are also adolescents that hide their body and adopt avoidant behaviours when they perceive that they do not have the body that they would like, seen from the perspective of the educators. The study has not identified the consequences of the appreciation of the body of others. However, it is possible to confirm this through the follow-up of the qualitative study on these adolescents.

The influence of friends is not always positive and at times they find themselves in situations where their self-image or that of their peers feels threatened. In these cases it must be emphasized that the adolescents with good confidence defend the weak ones, or rather they acquire an attitude of selective listening and do not let themselves be influenced by these comments. These abilities to face negative comments may suggest aspects for development in programmes that promote health and the prevention of body dissatisfaction.

The adolescents are fully aware of the influence of social media and of how it can condition their self-image and self-esteem (Burnette et al., 2017 ) and body dissatisfaction (Calado et al., 2011 ; Mooney et al., 2009 ). The results indicate that those adolescents with good self-esteem and confidence in themselves are also more critical when faced with the messages received from the mass media. Therefore, helping the adolescents to understand this influence in the school and family environment can be highlighted as a recommendation for the development of healthy body image and self-esteem.

Promoting factors in the familial and educational environment

The parents and educators selected by the students themselves have a direct influence on the way in which the adolescents perceive their self-image. One of the important things that they do to help them to perceive a healthy self-image and self-esteem, among others, is talking about these topics with them, therefore building support bridges. In this manner, the accompaniment of the parents and educators, when they know the characteristics of the adolescent stage and are capable of understanding it, are preventive measures that must be considered in programmes that educate about health.

In relation to family values, we have shown how the vast majority of parents have a good communication link with their children, a link of esteem and a safe environment. In addition, they impose limits when it is necessary and put in place guidelines to be followed. At the same time, the children evaluate the messages received from their parents as help to make them grow up. These families have healthy interpersonal relationships, many parents take actions aimed at working on positive self-image and self-esteem, they can affirm with these results that they may be crucial elements for the development of healthy body image. Alternatively, they are educationally complex aspects that may be included in interventions such as “parent school” (Sharpe et al., 2013 ).

Another aspect that is worth highlighting from the study and which has been scarcely studied is the role of educators (Ciao et al., 2018 ; Sundgot-Borgen et al., 2018 ). The data from the study provide new information specifically with regards to the context of the promotion of healthy body image. For example, these schoolteachers take actions aimed at working on self-esteem and confidence, resolving situations of conflict between peers. The educational aim is based on educating the adolescents. In addition, the influence of social media can increasingly lead to body dissatisfaction (Burnette et al., 2017 ), the study underlines that the teachers need to place emphasis on media education to help the adolescents to have a critical attitude towards the negative messages from social media.

To finish, the adolescents’ successful experiences related to body image cannot be understood without considering the influence of their families and teachers. These results suggest inclusive interventions, not only from the school environment, but also in the community sphere that may have a positive impact (better acceptance, fostering of self-esteem, expansion of perspectives on beauty ideals, normalization of concerns between parents and educators) despite the direct influence exercised by friends and social media during adolescence.

Limitations

This study has various limitations. The first is that it can only be transferable to similar social and cultural contexts and adolescents or young people of the same age band. The sample is small and, therefore, it is not representative of all adolescents with a similar profile. The context in which the study was carried out was limited to schools in a specific area in Catalonia (Spain) with specific sociodemographic characteristics. A wider sample of participants from different educational, family and social backgrounds may reinforce this study. It is also important to highlight that in a qualitative descriptive study it is impossible to quantify the experiences of the participants. Finally, our study only includes the perspective of adolescents, families and teachers, and it is possible that a qualitative discussion methodology such as a focus group may provide new information on the topic. Likewise, a more complete image may arise if the perspective of school nurses and healthcare workers were included.

Conclusions

The study provides a perspective on positive body image in adolescents, families and teachers in an area in Catalonia (Spain). The adolescents communicated their experiences and perspectives related to positive body image such as the actions aimed at the care of the body, the acceptance of the body and the normalization of differences and security with oneself. Their parents also expressed aspects such as those that contribute to the development of healthy self-esteem, confidence and positive body image in this crucial stage of development and maturation, placing emphasis on family activities and values. Alternatively, the teachers indicated educational activities to work on self-image and self-esteem when faced with situations of concern in the classroom, the fostering of a critical attitude and media literacy on the messages received on social media.

This research provides a complete description of aspects relevant to positive body image addressed in the current social and cultural context in which the adolescents are immersed.

Implications for clinical practice

The diversity of experiences and points of view given in this study reflects the complexity of the construct of body image that still has aspects that can be explored further. The results cast light on certain multifactorial components of body image in adolescence to be taken into account when designing and implementing educational programmes for the promotion of healthy self-esteem, confidence and body image in adolescence in order to prevent eating disorders. The role of nurse as well as teacher in the community context plays an important role in the promotion of health on this topic. Inclusive programmes that are carried out by various health professionals may help these adolescents to prevent eating disorders. In addition, it is also important to highlight that the active participation of adolescents in programmes on body image in the school setting is necessary. Also, it is necessary to carry out interventions directly in families or with teachers in order to make them aware of the importance of creating a favourable environment for positive body image.

Acknowledgements

The research team wish to thank all the participants and schools that facilitated the project for their collaboration: IES Lo Pla d’Urgell (Bellpuig, Catalonia, Spain)

Biographies

Gloria Tort-Nasarre Nurse, anthropologist and doctor in pedagogy. Primary care nurse in the public health network of Catalonia. She works in a rural primary care center and teaches the nursing degree and the master’s degree in health education at the University of Lleida. Degree in Social and Cultural Anthropology from the Autonomous University of Barcelona (1995) and doctorate in pedagogy from the University of Barcelona in 2015. I have extensive experience in the world of university nursing teaching for more than 20 years, vice-dean of the Faculty of Nursing and Physiotherapy at the University of Lleida-Igualada Campus.

Mercè Pollina-Pocallet I do my daily work as a Pediatric Nurse in Primary Care Centre. I have a Postgraduate in Nutrition, Health Promotion and another one in Education and Public Health Nursing. I was a Member of the Scientific Committee at the XIII Family and Community Congress (2016). I received a Grant for the Promotion of Health Research from the Biomedical Research Institute of Lleida (2018). I am Internship tutor at the University of Nursing of Lleida and also at the Ramon Llull University.

Yvonne Ferrer-Suquet Graduated in Labor Relations and Technical Administration. I have professional experience in labor relations and in the Social and Health fields. I have worked in Mental Health area, in particular, in eating behavior disorders and addictions. I am currently working in the Lleida-Pyrenees Research Support Unit from the Catalonia’s Health Department and the Institute for Primary Health Care Research Foundation (IDIAP JGol) and at the Multiprofessional Teaching of Family and Community Care- Lleida-ICS Unit. I collaborate on projects associated to COVID-19, ethics, or body image and self-esteem. I am a teacher in regulated training courses about bibliographic resources.

Marta Ortega Bravo I am a Family and Community Doctor. I have worked at the Cappont Primary Care Center, Lleida since 2007. Currentlly Coordinator of the Research Support Unit in Lleida of the Institute for Primary Healthcare Research IDIAP Jordi Gol. Member of the Research Ethics Committee of the Arnau de Vilanova University Hospital in Lleida. I am an Associate professor of the subject of University of Lleida, as well as a tutor of pre-doctoral training programs at the Doctorate School from the University of Lleida and Thesis director of the Health Doctorate at the University of Lleida.

Mireia Vilafranca Cartagena Graduated in nursing in 2013 from the University of Barcelona. Master of “nursing care: methodology and applications” by the University of Barcelona. Currently pursuing a doctorate in health sciences at the University of Lleida. Hospital nurse in Sant Joan de Déu in Manresa, Althaia, located in the center of Catalonia. Specialized in the field of internal medicine. She works at the university of UCC-UManresa, teaching in the nursing degree. The line of research is focused on his doctorate, healthy habits, Diabetes Mellitus Type 2, physical activity. He is being trained in qualitative methodology, already having contributions.

Eva Artigues-Barberà I am a Health PhD and Primary Care nurse. I collaborate with research groups and also in projects, development and dissemination of different investigations. I am an associate professor in the Master’s Degree in Health Education at the Faculty of Nursing and Physiotherapy of the UdL and have also taught at the Nursing Diploma and Degree. With a long career in Primary Care and Community intervention Programs, I have experience regarding school groups and universities. I have been trained in research methodology, gender perspective, citizen participation, Health Education and group interventions.

Funding Statement

The authors declare no support from any organization for the submitted work; no financial relationships with organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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