tag:theconversation.com,2011:/global/topics/body-dissatisfaction-5867/articlesBody dissatisfaction – The Conversation2023-12-15T05:45:15Ztag:theconversation.com,2011:article/2199012023-12-15T05:45:15Z2023-12-15T05:45:15ZThinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable<figure><img src="https://images.theconversation.com/files/565962/original/file-20231215-23-9ky8oh.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgeon-hand-drawing-marks-on-female-531165886">Africa Studio/Shutterstock</a></span></figcaption></figure><p>People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have <a href="https://www.abc.net.au/news/2023-12-14/new-cosmetic-surgery-standards-introduced/103218180">extra protection</a> following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.</p>
<p>The <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/national_safety_and_quality_cosmetic_surgery_standards.pdf">new standards</a> cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1735224191073575038"}"></div></p>
<p>The move is part of sweeping reforms of the cosmetic surgery industry and the <a href="https://www.medicalboard.gov.au/codes-guidelines-policies/cosmetic-medical-and-surgical-procedures-guidelines.aspx#:%7E:text=Cosmetic%20procedures%20must%20only%20be,care%20and%20any%20likely%20complications">regulation of medical practitioners</a>, including who is allowed to <a href="https://theconversation.com/doctors-may-soon-get-official-endorsements-to-practise-cosmetic-surgery-but-will-that-protect-patients-202136">call themselves a surgeon</a>.</p>
<p>It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a <a href="https://journals.sagepub.com/doi/10.1177/07488068221105360">highly unregulated</a> area of medicine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-cosmetic-surgery-at-last-some-clarity-on-who-can-call-themselves-a-surgeon-196947">Thinking about cosmetic surgery? At last, some clarity on who can call themselves a surgeon</a>
</strong>
</em>
</p>
<hr>
<h2>Why do people want cosmetic surgery?</h2>
<p>Australians spent an <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/media_infographic_cosmetic_surgery_standards.PDF">estimated A$473 million</a> on cosmetic surgery procedures in 2023.</p>
<p>The <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144518305552">major reason</a> people want cosmetic surgery relates to concerns about their body image. <a href="https://academic.oup.com/asj/article/43/9/994/7125043">Comments</a> from their partners, friends or family about their appearance is another reason. </p>
<p>The way cosmetic surgery is portrayed on <a href="https://www.sciencedirect.com/science/article/pii/S1740144522001784">social media</a> is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised. </p>
<p>The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is <a href="https://academic.oup.com/asj/article/36/8/920/2613944?login=false">even more necessary</a>.</p>
<figure class="align-center ">
<img alt="Young woman sits cross-legged on chair" src="https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Body image is a major concern. But other factors motivate people to choose cosmetic surgery.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-home-massaging-tired-painful-spider-2155356421">alinabuphoto/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-do-normal-labia-look-like-sometimes-doctors-are-the-wrong-people-to-ask-112513">What do normal labia look like? Sometimes doctors are the wrong people to ask</a>
</strong>
</em>
</p>
<hr>
<h2>People don’t always get the results they expect</h2>
<p><a href="https://journals.lww.com/annalsplasticsurgery/abstract/2009/02000/a_prospective,_multi_center_study_of_psychosocial.5.aspx">Most people</a> are <a href="https://academic.oup.com/asj/article/40/10/1143/5722403?login=false">satisfied</a> with their surgical outcomes and feel better about the body part that was previously concerning them.</p>
<p>However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a <a href="https://www.tandfonline.com/doi/full/10.1080/13548500903112374">positive evaluation</a> may be needed to justify these experiences. </p>
<p>People who are likely to be unhappy with their results are those with <a href="https://journals.lww.com/plasreconsurg/abstract/2014/10000/why_some_patients_are_unhappy__part_2_.46.aspx">unrealistic expectations</a> for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-getting-a-minor-cosmetic-procedure-like-botox-or-fillers-heres-what-to-consider-first-161271">Thinking of getting a minor cosmetic procedure like botox or fillers? Here's what to consider first</a>
</strong>
</em>
</p>
<hr>
<h2>What’s changing?</h2>
<p>According to the <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/national_safety_and_quality_cosmetic_surgery_standards.pdf">new standards</a>, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.</p>
<p>For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy. </p>
<p>It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards. </p>
<p>It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.</p>
<figure class="align-center ">
<img alt="Surgeons operate on a patient" src="https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The new standards will govern how cosmetic surgery is advertised and promoted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgical-team-performing-surgery-patient-operating-750079588">Tong Nawarit/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/googling-for-a-new-dentist-or-therapist-heres-how-to-look-past-the-glowing-testimonials-84584">Googling for a new dentist or therapist? Here's how to look past the glowing testimonials</a>
</strong>
</em>
</p>
<hr>
<h2>What about the mental health assessment?</h2>
<p>The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”. </p>
<p>According to the <a href="https://www.medicalboard.gov.au/codes-guidelines-policies/cosmetic-medical-and-surgical-procedures-guidelines.aspx#:%7E:text=Cosmetic%20procedures%20must%20only%20be,care%20and%20any%20likely%20complications">guidelines</a> from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.</p>
<p>While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions. </p>
<p>So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have. </p>
<figure class="align-center ">
<img alt="Surgeons discuss a patient's case" src="https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ideally, mental health assessments should be done by health professionals with experience and training in body image concerns.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/plastic-cosmetic-surgeon-consults-woman-about-2147151401">Roman Fenton/Shutterstock</a></span>
</figcaption>
</figure>
<p>Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.</p>
<p>Of course, there are <a href="https://theconversation.com/we-cant-solve-australias-mental-health-emergency-if-we-dont-train-enough-psychologists-here-are-5-fixes-190135">not enough</a> mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution. </p>
<p>Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns. </p>
<p>In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-connection-between-cosmetic-procedures-and-mental-health-190841">What's the connection between cosmetic procedures and mental health?</a>
</strong>
</em>
</p>
<hr>
<h2>If you’re considering cosmetic surgery</h2>
<p>The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/media_backgrounder_-_cosmetic_surgery_reforms_will_help_protect_patients_-_14_dec_2023.pdf">four steps</a> if you’re considering cosmetic surgery:</p>
<ol>
<li><p>have an independent physical and mental health assessment before you commit to cosmetic surgery</p></li>
<li><p>make an informed decision knowing the risks</p></li>
<li><p>choose your practitioner, knowing their training and qualifications</p></li>
<li><p>discuss your care after your operation and where you can go for support.</p></li>
</ol>
<p>My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.</p><img src="https://counter.theconversation.com/content/219901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Sharp receives funding from NHMRC Investigator Grant (Emerging Leadership 2).</span></em></p>If you’re thinking of a breast augmentation, liposuction, or a face lift, this latest move is designed to provide extra protection. Here’s what you need to know ahead of surgery.Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061702023-06-07T12:25:05Z2023-06-07T12:25:05ZMounting research documents the harmful effects of social media use on mental health, including body image and development of eating disorders<figure><img src="https://images.theconversation.com/files/529888/original/file-20230602-15-ynda6h.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5742%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The hours spent – and the content viewed – by teens on social media can lead to depression, anxiety and body image issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cell-phone-break-up-royalty-free-image/483933372?phrase=upset+teenager+on+phone&adppopup=true">Mixmike/E+via Getty Images</a></span></figcaption></figure><p>Media influences and conventional beauty standards have long plagued society. </p>
<p>This issue took on new urgency in May 2023 when the <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">U.S. surgeon general issued a major public advisory</a> over the <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">links between social media and youth mental health</a>. </p>
<p>Research shows that images of beauty as depicted in movies, television and magazines <a href="https://doi.org/10.1037/0021-843X.103.4.836">can lead to mental illness</a>, issues with disordered eating and <a href="https://doi.org/10.1093%2Fpch%2F8.5.287">body image dissatisfaction</a>. </p>
<p>These trends have been documented <a href="https://doi.org/10.1037/0033-2909.134.3.460">in women</a> <a href="https://doi.org/10.1521/jscp.2008.27.3.279">and men</a>, in the <a href="https://doi.org/10.1016/j.jadohealth.2018.10.096">LGBTQ+ community</a> and in <a href="https://www.hsph.harvard.edu/striped/wp-content/uploads/sites/1267/2022/10/Real-Cost-of-Beauty-Report-10-4-22.pdf">people of different racial</a> and ethnic backgrounds. </p>
<p>Experts have long suspected that social media may be playing a role in the growing <a href="https://www.nytimes.com/2022/04/23/health/mental-health-crisis-teens.html">mental health crisis in young people</a>. However, the surgeon general’s warning is one of the first <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">public warnings supported by robust research</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yj60GRxHRa8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The U.S. surgeon general says the youth mental health crisis is the ‘defining public health challenge of our time.’</span></figcaption>
</figure>
<h2>Social media can be toxic</h2>
<p>Body dissatisfaction among children and adolescents is commonplace and <a href="https://doi.org/10.3389%2Ffpsyg.2023.1037932">has been linked to</a> decreased quality of life, worsened mood and unhealthy eating habits. </p>
<p>As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29092">eating disorder and anxiety specialist</a>, I regularly work with clients who experience eating disorder symptoms, self-esteem issues and anxiety <a href="https://news.cuanschutz.edu/news-stories/how-does-social-media-affect-our-mental-health">related to social media</a>. </p>
<p>I also <a href="https://doi.org/10.1016/S2215-0366(23)00116-5">have firsthand experience with this topic</a>: I am 15 years post-recovery from an eating disorder, and I grew up when people were beginning to widely use social media. In my view, the impact of social media on diet and exercise patterns needs to be further researched to inform future policy directions, school programming and therapeutic treatment. </p>
<p>The mental health of adolescents and teens has been <a href="https://www.cdc.gov/nchhstp/dear_colleague/2020/dcl-102320-YRBS-2009-2019-report.html">declining for the past decade</a>, and the <a href="https://doi.org/10.1016%2Fj.psychres.2023.115082">COVID-19 pandemic contributed to worsening youth mental health</a> and brought it into the spotlight. As the mental health crisis surges, researchers have been taking a <a href="https://cuanschutz360.buzzsprout.com/1991131/10641970-how-does-social-media-affect-our-mental-health">close look at the role of social media</a> in these increasing mental health concerns.</p>
<h2>The pros and cons of social media</h2>
<p>About 95% of children and adolescents in the U.S. between the ages of 10 and 17 are <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">using social media almost constantly</a>.</p>
<p>Research has shown that <a href="https://www.commonsensemedia.org/sites/default/files/research/report/2021-coping-with-covid19-full-report.pdf">social media can be beneficial</a> for finding <a href="https://doi.org/10.2196/26011">community support</a>. However, studies have also shown that the use of social media contributes to social comparisons, unrealistic expectations and <a href="https://doi.org/10.1001/jamapsychiatry.2019.2325">negative mental health effects</a>. </p>
<p>In addition, those who have <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use.pdf">preexisting mental health conditions</a> tend to spend more time on social media. People in that category are more likely to <a href="https://doi.org/10.1177/1461444817694499">self-objectify</a> and <a href="https://doi.org/10.1016/j.eatbeh.2012.06.003">internalize the thin body ideal</a>. Women and <a href="https://doi.org/10.1371/journal.pgph.0001091">people with preexisting body image concerns</a> are more likely to feel worse about their bodies and themselves after they spend time on social media.</p>
<h2>A breeding ground for eating disorders</h2>
<p>A recent review found that, as with mass media, the use of social media is a risk factor for <a href="https://doi.org/10.1371/journal.pgph.0001091">the development of an eating disorder</a>, body image dissatisfaction and disordered eating. In this review, social media use was shown to contribute to negative self-esteem, social comparisons, decreased emotional regulation and idealized self-presentation that negatively influenced body image.</p>
<p>Another study, called the <a href="https://www.dove.com/us/en/stories/campaigns/social-media-and-body-image.html">Dove Self-Esteem Project</a>, published in April 2023, found that 9 in 10 children and adolescents ages 10 to 17 are exposed to toxic beauty content on social media and 1 in 2 say that this has an impact on their mental health. </p>
<p>Eating disorders are <a href="https://theconversation.com/eating-disorders-among-teens-have-more-than-doubled-during-the-covid-19-pandemic-heres-what-to-watch-for-201067">complex mental illnesses</a> that develop because of biological, social and psychological factors. Eating disorder hospitalizations and the need for treatment have dramatically <a href="https://doi.org/10.1001/jamapediatrics.2022.4346">increased during the pandemic</a>.</p>
<p><a href="https://doi.org/10.1001/jamanetworkopen.2021.34913">Some reasons for this</a> include isolation, food scarcity, boredom and <a href="https://doi.org/10.3389/fpsyg.2023.1139261">social media content</a> related to weight gain, such as the “<a href="https://doi.org/10.1016/j.bodyim.2021.04.002">quarantine15</a>.” That was a reference to the weight gain some people were experiencing at the beginning of the pandemic, similar to the “freshman 15” belief that one will gain 15 pounds in the first year of college. Many teens whose routines were disrupted by the pandemic turned to eating disorder behaviors for <a href="https://doi.org/10.2196/26011">an often-false sense of control</a> or were influenced by family members who held unhealthy beliefs around food and exercise. </p>
<p>Researchers have also found that increased time at home during the pandemic <a href="https://www.luriechildrens.org/en/blog/social-media-parenting-statistics/">led to more social media use by young people</a> and therefore more exposure to toxic body image and dieting social media content. </p>
<p>While social media alone will not cause eating disorders, <a href="https://www.hsph.harvard.edu/striped/wp-content/uploads/sites/1267/2022/10/Real-Cost-of-Beauty-Report-10-4-22.pdf">societal beliefs about beauty</a>, which are amplified by social media, can contribute to the development of eating disorders. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/VN6st_4_FDg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">According to a report from the Centers for Disease Control and Prevention, 42% of high school students say they feel ‘persistently sad’ and ‘hopeless.’</span></figcaption>
</figure>
<h2>‘Thinspo’ and ‘fitspo’</h2>
<p>Toxic beauty standards online include the normalization of cosmetic and surgical procedures and pro-eating-disorder content, which promotes and romanticizes eating disorders. For instance, social media sites have promoted trends such as “thinspo,” which is focused on the thin ideal, and “fitspo,” which perpetuates the belief of there being a perfect body that can be achieved with dieting, supplements and excessive exercise.</p>
<p>Research has shown that <a href="https://doi.org/10.1186/s40337-019-0246-2">social media content encouraging “clean eating</a>” or dieting through pseudoscientific claims can lead to obsessive behavior around dietary patterns. These unfounded “wellness” posts <a href="https://doi.org/10.1016/j.childyouth.2020.105659">can lead to weight cycling, yo-yo dieting</a>, chronic stress, body dissatisfaction and higher likelihood of <a href="https://doi.org/10.1177/1461444818821064">muscular and thin-ideal internalization</a>.</p>
<p>Some social media posts feature <a href="https://doi.org/10.3390/ijerph18042186">pro-eating-disorder content</a>, which directly or indirectly encourages disordered eating. Other posts promote deliberate manipulation of one’s body, using harmful quotes such as “nothing tastes as good as thin feels.” These posts provide a false sense of connection, allowing users to bond over a shared goal of losing weight, altering one’s appearance and continuing patterns of disordered eating. </p>
<p>While young people <a href="https://www.dove.com/us/en/stories/campaigns/real-cost-of-beauty/thestats.html">can often recognize and understand</a> toxic beauty advice’s effects on their self-esteem, they may still continue to engage with this content. This is in part because friends, influencers and <a href="https://doi.org/10.1016/j.bodyim.2022.03.007">social media algorithms</a> <a href="https://doi.org/10.1007/s10964-012-9898-9">encourage people</a> to follow certain accounts. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XvM8hqoHXkI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Not all teens are on social media.</span></figcaption>
</figure>
<h2>How policy changes could help</h2>
<p><a href="https://scrippsnews.com/stories/legislators-target-social-media-to-combat-eating-disorders/">Legislators across the U.S.</a> are proposing different <a href="https://www.pbs.org/newshour/health/new-state-laws-aim-to-tackle-surge-in-eating-disorders">regulations for social media sites</a>. </p>
<p>Policy recommendations include increased transparency from social media companies, creation of higher standards of <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use?">privacy for children’s data</a> and <a href="https://doi.org/10.1177/0098858819849990">possible tax incentives and social responsibility initiatives</a> that would discourage companies and marketers from using altered photos.</p>
<h2>Phone-free zones</h2>
<p>Small steps at home to cut down on social media consumption can also make a difference. Parents and caregivers can <a href="https://www.luriechildrens.org/en/blog/social-media-parenting-statistics/">create phone-free periods</a> for the family. Examples of this include putting phones away while the family watches a movie together or during mealtimes. </p>
<p>Adults can also help by modeling healthy social media behaviors and encouraging children and adolescents to focus <a href="https://www.dove.com/us/en/dove-self-esteem-project/help-for-parents/social-media/social-media-filters.html">on building connections and engaging in valued activities</a>. </p>
<p>Mindful social media consumption is another helpful approach. This requires recognizing what one is feeling during social media scrolling. If spending time on social media makes you feel worse about yourself or seems to be causing mood changes in your child, it may be time to change how you or your child interact with social media.</p><img src="https://counter.theconversation.com/content/206170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Hemendinger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that social media, with it endless promotion of unrealistic standards of beauty, has had a negative impact on millions of young people.Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2010672023-03-31T12:23:17Z2023-03-31T12:23:17ZEating disorders among teens have more than doubled during the COVID-19 pandemic – here’s what to watch for<figure><img src="https://images.theconversation.com/files/517032/original/file-20230322-419-qse5vl.jpg?ixlib=rb-1.1.0&rect=30%2C46%2C5129%2C3380&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The traditional assumption that eating disorders primarily affect affluent white women has led to stigma, stereotyping and misunderstanding. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asia-woman-feeling-sad-in-the-bedroom-royalty-free-image/1324460530?phrase=eating%20disorders%20in%20teens&adppopup=true">toondelamour/E+ via Getty Images</a></span></figcaption></figure><p>The COVID-19 pandemic has been <a href="https://doi.org/10.1016/j.jaac.2022.12.026">associated with worsening mental health</a> among teens, including increasing numbers of patients with eating disorders. In fact, research indicates that the number of teens with eating disorders <a href="https://doi.org/10.1001/jamapediatrics.2022.4346">at least doubled during the pandemic</a>. </p>
<p>This is particularly concerning given that eating disorders <a href="https://doi.org/10.1001/archgenpsychiatry.2011.74">are among the most deadly</a> of all mental health diagnoses, and teens with eating disorders are at <a href="https://doi.org/10.1016/j.copsyc.2017.08.023">higher risk for suicide</a> than the general population.</p>
<p>While experts don’t know exactly why eating disorders develop, studies show that <a href="https://doi.org/10.23750/abm.v93i3.13140">body dissatisfaction and desire for weight loss</a> are key contributors. This can make conversations around weight and healthy behaviors particularly tricky with teens and young adults.</p>
<p>As an <a href="https://profiles.umassmed.edu/display/30628475">adolescent medicine doctor</a> <a href="https://www.researchgate.net/scientific-contributions/Sydney-M-Hartman-Munick-2175760133">specializing in eating disorders</a>, I have seen firsthand the increases in patients with eating disorders as well as the detrimental effects of eating disorder stereotypes. I regularly work with families to help teens develop positive relationships with body image, eating and exercise.</p>
<p>Understanding the signs of a possible eating disorder is important, as studies suggest that timely diagnosis and treatment leads to <a href="https://doi.org/10.1002/eat.22840">better long-term outcomes</a> and to better chances of full recovery. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yZpMT8dvqE0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Excessive dieting and withdrawal from friends are two signs of disordered eating.</span></figcaption>
</figure>
<h2>Eating disorders defined</h2>
<p>Eating disorders, which <a href="https://doi.org/10.1038/s41380-021-01161-7">often start in adolescence</a>, include <a href="https://www.allianceforeatingdisorders.com/anorexia-nervosa/">anorexia nervosa</a>, <a href="https://www.allianceforeatingdisorders.com/bulimia-nervosa/">bulimia nervosa</a>, <a href="https://www.allianceforeatingdisorders.com/binge-eating-disorder/">binge eating disorder</a>, <a href="https://www.allianceforeatingdisorders.com/other-specified-feeding-or-eating-disorders/">other specified feeding and eating disorders</a> and <a href="https://www.allianceforeatingdisorders.com/avoidant-restrictive-food-intake-disorder-arfid/">avoidant restrictive food intake disorder</a>. Each eating disorder has specific criteria that must be met in order to receive a diagnosis, which is made by a professional with eating disorder expertise.</p>
<p>Research suggests that up to 10% of people will develop <a href="https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/">an eating disorder in their lifetime</a>. Medical complications from eating disorders, such as low heart rate and electrolyte abnormalities, <a href="https://doi.org/10.1186/s40337-023-00759-2">can be dangerous and result in hospitalization</a>, and malnutrition can affect growth and development. Many of the patients I see in clinic show signs of paused puberty and stalled growth, which can influence bone health, adult height and other aspects of health if not addressed quickly.</p>
<p>Teens are also at risk for disordered eating behaviors such as intentional vomiting, caloric restriction, binge eating, overexercise, the use of weight loss supplements and misuse of laxatives. </p>
<p>A recent study estimated that 1 in 5 teens may <a href="https://doi.org/10.1001/jamapediatrics.2022.5848">struggle with disordered eating behaviors</a>. While these behaviors alone may not qualify as an eating disorder, they may predict the <a href="https://doi.org/10.1016/j.jada.2006.01.003">development of eating disorders later on</a>.</p>
<p>Treatment methods for eating disorders are <a href="https://www.aedweb.org/resources/about-eating-disorders/treatment-options">varied and depend on multiple factors</a>, including a patient’s medical stability, family preference and needs, local resources and insurance coverage. </p>
<p>Treatment can include a team consisting of a medical provider, nutritionist and therapist, or might involve the use of a specialized eating disorder program. Referral to one of these treatment methods may come from a pediatrician or a specialized eating disorder provider.</p>
<h2>Unpacking misconceptions and stereotypes</h2>
<p>Traditional ideas and stereotypes about eating disorders have left many people with the impression that it is mainly thin, white, affluent females who develop eating disorders. However, research demonstrates that anyone can develop these conditions, regardless of age, <a href="https://doi.org/10.1016/j.eatbeh.2018.11.004">race</a>, <a href="https://doi.org/10.1186/s40337-022-00720-9">body size</a>, <a href="https://doi.org/10.1016/j.jadohealth.2015.03.003">gender identity</a>, <a href="https://doi.org/10.1007/s11920-017-0801-y">sexual orientation</a> or <a href="https://doi.org/10.1002/eat.22846">socioeconomic status</a>. </p>
<p>Unfortunately, stereotypes and assumptions about eating disorders have <a href="https://doi.org/10.1186/s40337-022-00730-7">contributed to health disparities</a> in screening, diagnosis and treatment. Studies have documented negative eating disorder treatment experiences among <a href="https://doi.org/10.1016/j.eatbeh.2021.101517">transgender and gender-diverse</a> individuals, <a href="https://doi.org/10.1002/eat.23402">Black and Indigenous</a> people and those <a href="https://www.nytimes.com/2022/10/18/magazine/anorexia-obesity-eating-disorder.html">with larger body size</a>. Some contributors to these negative experiences include lack of diversity and training among treatment providers, treatment plans without cultural or economic nutritional considerations and differential treatment when a patient is not visibly underweight, among others. </p>
<p>Contrary to popular assumptions, studies show teen boys are <a href="https://doi.org/10.1097%2FMOP.0000000000000911">at risk for eating disorders as well</a>. These often go undetected and can be disguised as a desire to become more muscular. However, eating disorders are just as dangerous for boys as they are for girls.</p>
<p>Parents and loved ones can play a role in helping to dispel these stereotypes by advocating for their child at the pediatrician’s office if concern arises and by recognizing red flags for eating disorders and disordered eating behaviors.</p>
<h2>Warning signs</h2>
<p>Given how common disordered eating and eating disorders are among teens, it is important to understand <a href="https://www.medainc.org/resources-2/about-eating-disorders/">some possible signs</a> of these worrisome behaviors and what to do about them.</p>
<p>Problematic behaviors can include eating alone or in secret and a hyperfocus on “healthy” foods and distress when those foods aren’t readily available. Other warning signs include significantly decreased portion sizes, skipped meals, fights at mealtime, using the bathroom immediately after eating and weight loss. </p>
<p>Because these behaviors often feel secretive and shameful, it may feel difficult to bring them up with teens. Taking a warm but direct approach when the teen is calm can be helpful, while letting them know you have noticed the behavior and are there to support them without judgment or blame. I always make sure to let my patients know that my job is to be on their team, rather than to just tell them what to do.</p>
<p>Teens may not immediately open up about their own concerns, but if behaviors like this are present, don’t hesitate to have them seen at their pediatrician’s office. Following up with patients who have shown signs of having an eating disorder and promptly <a href="https://www.nationaleatingdisorders.org/where-do-i-start-0">referring them to a specialist</a> who can further evaluate the patient are crucial for getting teens the help they may need. Resources for families <a href="https://www.feast-ed.org/">can be helpful</a> to navigate the fear and uncertainty that can come along with the diagnosis of an eating disorder.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7VZNGgDjsMo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Many misconceptions exist about eating disorders, including that they are about vanity or that people should just be able to stop.</span></figcaption>
</figure>
<h2>Focus on health, not size</h2>
<p>Research shows that <a href="https://doi.org/10.1097/MOP.0000000000000910">poor body image</a> and <a href="https://doi.org/10.23750/abm.v93i3.13140">body dissatisfaction</a> can put teens at risk for disordered eating behaviors and eating disorders. </p>
<p>Parents play an important role in the development of teens’ self-esteem, and research demonstrates that <a href="https://doi.org/10.1186/s40337-022-00561-6">negative comments from parents</a> about weight, body size and eating are associated with eating disorder-type thoughts in teens. Therefore, when talking to teens, it <a href="https://doi.org/10.1001/jamapediatrics.2013.78">can be beneficial</a> to take a weight-neutral approach, which <a href="https://doi.org/10.1002/ncp.10885">focuses more on overall health</a> rather than weight or size. I unfortunately have had many patients with eating disorders who were scolded or teased about their weight by family members; this can be really harmful in the long run.</p>
<p>One helpful strategy is to incorporate lots of variety into a teen’s diet. If doable, trying new foods as a family can encourage your teen to try something they haven’t before. Try to avoid terms such as “junk” or “guilt” when discussing foods. Teaching teens to appreciate lots of different kinds of foods in their diet allows them to develop a healthy, knowledgeable relationship with food. If you’re feeling stuck, you may want to ask your pediatrician about seeing a dietitian.</p>
<p>It’s important to remember that teens need <a href="https://doi.org/10.1111/nyas.13330">a lot of nutrition</a> to support growth and development, often more than adults do, and regular eating helps avoid extreme hunger that can lead to overeating. Letting teens listen to their bodies and learn their own hunger and fullness cues will help them <a href="https://doi.org/10.1007/s40519-020-00852-4">eat in a healthy way</a> and create healthy long-term habits.</p>
<p>In my experience, teens are more likely to exercise consistently when <a href="https://health.gov/our-work/nutrition-physical-activity/move-your-way-community-resources/campaign-materials/materials-kids-and-teens#videos">they find an activity</a> that they enjoy. Exercise doesn’t need to mean lifting weights at the gym; teens can move their bodies by taking a walk in nature, moving to music in their rooms or playing a pickup game of basketball or soccer with a friend or sibling. </p>
<p><a href="https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm">Focusing on the positive things</a> exercise can do for the body such as improvements in mood and energy can help avoid making movement feel compulsive or forced. When teens are able to find movement that they enjoy, it can help them to appreciate their body for all it is able to do.</p><img src="https://counter.theconversation.com/content/201067/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sydney Hartman-Munick does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Eating disorders in teens are common and dangerous, and parents and loved ones play a crucial role in helping to both identify concerning behaviors and promote healthy ones.Sydney Hartman-Munick, Assistant Professor of Pediatrics, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1287172019-12-19T14:00:03Z2019-12-19T14:00:03ZSlim and skinny: how access to TV is changing beauty ideals in rural Nicaragua<figure><img src="https://images.theconversation.com/files/307665/original/file-20191218-11900-182hqnl.jpg?ixlib=rb-1.1.0&rect=22%2C45%2C5015%2C3301&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The more television people watch the more they prefer a thinner female body type.</span> <span class="attribution"><span class="source">Jean-Luc Jucker</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Think about the last time you watched a film or picked up a magazine. Chances are the majority of models and actresses were young, beautiful and slim – or even underweight. </p>
<p>Research shows that in films and TV programmes heavier characters are more likely to be lower status, the target of jokes and are less likely to be <a href="https://www.karger.com/Article/Abstract/276547">lead or romantic characters</a>. This sends a very clear message: that thinness is normal and desirable.</p>
<p>For many young people, this emphasis on extreme thinness in women seems normal. But it’s actually relatively new and seems to have arisen in parallel with the growing cultural dominance of mass media – films, television and magazines. Models, for instance, became <a href="https://journals.sagepub.com/doi/abs/10.2466/pr0.1980.47.2.483">thinner across the latter half of the 20th century</a>, and are now <a href="https://onlinedoctor.superdrug.com/evolution-miss-universe/">considerably slimmer</a> than depictions of female beauty in preceding eras. Just as in the past when the development of shape-altering garments <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123284">changed ideas about body shape</a>, the mass media now seems to have changed ideas about body size. </p>
<p>Current body ideals in Western Europe and North America are also significantly slimmer than in other cultural groups, such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S1090513899000070">Tanzanian hunter-gatherers</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1090513806000584">black South Africans</a> or <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144507000769">rural Malaysians</a>. And it’s been argued this large gap between the ideal female figure and most women’s own bodies is a key factor in the endemic levels of body dissatisfaction and eating disorders in countries such as <a href="https://guilfordjournals.com/doi/abs/10.1521/jscp.2009.28.1.9">the UK</a>.</p>
<p>Body dissatisfaction and <a href="https://www.ingentaconnect.com/content/wk/yco/2016/00000029/00000006/art00006">rates of disordered eating are increasing globally</a>, and the <a href="https://link.springer.com/article/10.1007/s11013-004-1067-5">spread of mass media may be one reason why</a>. But it’s a challenge to link increasing media access with changing body ideals – because as populations gain more access to media, they also change in other ways. They may become more urbanised, wealthier and have better access to nutrition – all of which can lead to <a href="http://www.mysmu.edu/faculty/normanli/Swamietal2010.pdf">differences in body ideals</a>.</p>
<h2>The Nicaragua project</h2>
<p>This is why we have spent three years running a <a href="http://www.dur.ac.uk/l.g.boothroyd/NEBP/">research project</a> in an area of rural Nicaragua – where access to mass media is often unrelated to urbanisation or nutrition. </p>
<p>The government in Nicaragua has been increasing electrification of the rural Caribbean coast. This has led to a region where very similar neighbouring villages differ in whether or not the residents have access to mains electricity – and whether they can run televisions. There are no magazines in this region. And at the time of our research, very few residents had access to smart phones, making television viewing a good measure of total media access.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=330&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=330&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=330&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=415&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=415&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307670/original/file-20191218-11896-foh37u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=415&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The study shows television is having a significant impact on what people think is the ideal woman’s body.</span>
<span class="attribution"><span class="source">Jean-Luc Jucker.</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We recruited 300 participants from seven villages around the region. Some villages had regular electricity supplies, others did not. Because the region is very ethnically diverse, we also balanced our sample across four main ethnic groups. Generally among our participants, those of Mestizo ethnicity – who have the highest levels of European heritage – tend to prefer slimmer figures than those of more indigenous or Afro-Caribbean heritage, such as the Miskitu, Garifuna and Creoles. </p>
<p><a href="https://doi.org/10.1037/pspi0000224">Our research found</a> that above and beyond ethnicity, those who watched more television preferred slimmer bodies. Specifically, our analysis suggested that people who watched approximately three hours of TV a week preferred a body one full point slimmer on the <a href="https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/">Body Mass Index</a> than someone who didn’t watch TV. On a woman of average height, that’s about a difference of three kilos. We also found the more people watched TV, the slimmer their preferred female body size became. This was true for both men and women.</p>
<h2>Changing ideals</h2>
<p>Over the three years, we also collected data from a small village without electricity. For a short period of time, one house in this village had a small TV powered by a solar panel. Residents were also able to watch TV for short periods of time if they travelled to other communities. We found that over the three years, villagers tended to favour thinner figures when they had been able to watch more TV, suggesting that real-time change may be happening in these communities.</p>
<p>When we showed residents of two villages without TV images of typical or plus size media models, their preferences shifted in the immediate aftermath of viewing these images towards thinner figures. Again this was true for both men and women.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307671/original/file-20191218-11951-wq495t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Utility cables crisscross the streets in the city of Bluefields, Nicaragua.</span>
<span class="attribution"><span class="source">Jean-Luc Jucker</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>By studying one population in depth, and by also having previously ruled out evidence for <a href="https://www.nature.com/articles/s41598-017-08653-z">impacts of nutrition in this population</a>, we have been able to give the strongest evidence to date that visual media really does change people’s perception of the ideal female body.</p>
<p>Our findings also support the argument that increasing global rates of body dissatisfaction and eating disorders are driven at least in part <a href="https://link.springer.com/article/10.1007/s11013-004-1067-5">by the expansion of globalised mass media</a>. </p>
<p>Of course, television is in many respects a valuable and important source of information. Our participants considered that besides entertainment, television gave them a vital link to the rest of Nicaragua, to political news, and lifesaving services such as storm warnings. But while it’s important that such benefits be maximised, threats to women’s body image must be minimised. </p>
<p>Body positive education can help here, and this is something <a href="http://community.dur.ac.uk/l.g.boothroyd/NEBP/wellcome_body.html">we are working on with local groups</a>. But ultimately, media producers and commissioners must do a better job of diversifying their content to reflect a range of sizes and body types.</p><img src="https://counter.theconversation.com/content/128717/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lynda Boothroyd receives funding for her research on this topic from the Leverhulme Foundation and the Wellcome Trust.</span></em></p>The more people watch TV the more likely it is that they prefer a slimmer female body size.Lynda Boothroyd, Professor in Psychology, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1201152019-07-10T11:04:32Z2019-07-10T11:04:32ZSix-packs and bulging biceps – how appearance pressures take their toll on men’s mental health<figure><img src="https://images.theconversation.com/files/283331/original/file-20190709-44466-w11z09.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Over recent years, “<a href="https://us.macmillan.com/books/9780374527327">body dissatisfaction</a>” – or shame about one’s appearance – has been on the rise in men. This isn’t something just affecting young men either, it’s extensively reported across a range of age groups. And it’s harmful – <a href="https://us.macmillan.com/books/9780374527327">research</a> shows it can lead to depression, steroid abuse and even suicide. </p>
<p>More commonly, though, it coincides with punishing gym routines, overly strict dieting, and repetitive anxious thoughts – all of which can add up to have a severe impact on daily functioning. Indeed, this pressure for men to look “perfect” is one of the reasons why there’s been a rise in the number of <a href="https://theconversation.com/why-more-men-are-wearing-makeup-than-ever-before-88347">men using makeup</a>. </p>
<p>I have spent eight years researching male body dissatisfaction. For my PhD, I carried out focus groups with male university students, to explore the relationship between their appearance and their well-being. </p>
<p>Men in the groups told me that, for them, body dissatisfaction meant spending money on clothes they would never wear – as they felt too conscious of their bodies and that certain clothing exacerbated “problem areas”. They also spoke about not wanting to have sex with their partners as they felt ashamed about how they looked naked. For some men, their body dissatisfaction had also led to them avoiding activities they used to enjoy. One participant explained: “I used to be on a swimming team and now I don’t dare go into the pool.”</p>
<h2>Tackling the problem</h2>
<p>For these men, effective support is needed to combat male body dissatisfaction, but it’s seriously hard to find. For example, just 3% of <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-854">studies</a> published in a leading international eating disorders journal actually attempted to prevent eating disorders. </p>
<p>Similarly, there aren’t <a href="https://www.annualreviews.org/doi/10.1146/annurev.clinpsy.3.022806.091447">many</a> existing programmes to reduce male body dissatisfaction. And the <a href="https://www.annualreviews.org/doi/10.1146/annurev.clinpsy.3.022806.091447">ones that do exist</a> tend to have limited benefits. This is in part because such programmes tend to either <a href="https://www.tandfonline.com/doi/full/10.1080/10640266.2015.1034056#">blame the individual</a> or <a href="https://glenjankowski.wordpress.com/2016/03/31/my-thesis-mens-body-dissatisfaction-a-critical-analysis-of-neoliberal-and-representational-approaches/">blame other people</a>.</p>
<p>These programmes make an assumption that if a man can change his behaviour or his thinking and stop “internalising” appearance pressures – and consuming appearance focused media, such as magazines and <a href="https://www.instagram.com/explore/tags/fitspiration/?hl=en">#fitspiration</a> social media posts – then his body dissatisfaction should reduce. But as Harvard professor, Bryn Austin, <a href="https://www.tandfonline.com/doi/full/10.1080/10640266.2015.1034056#">writes</a>, this “limited” and even “unethical” assumption places “the burden solely on individuals while leaving toxic environments and societal bad actors unchallenged”.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lc-PEOva0y0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>There is also a tendency to <a href="https://glenjankowski.files.wordpress.com/2019/06/jankowski2019.pdf">blame women</a> for male body dissatisfaction. Mothers are chastised for callously modelling unhealthy food behaviours onto their children. Feminists are depicted as promoting female body positivity on the one hand and cruelly body shaming men on the other. And women generally are blamed for holding men to appearance standards they themselves could not meet.</p>
<p>But not only is this unfair to women –- who have to deal with their own severe body dissatisfaction and bear stricter, more frequent appearance pressures than men –- but it’s also unfair to men, as it ignores the real cause.</p>
<h2>Appearance insecurity</h2>
<p>It’s unsurprising men are feeling this way, given that my research has shown how <a href="http://eprints.leedsbeckett.ac.uk/3002/">most images</a> in popular magazines, dating and porn websites are of muscular lean, young men –- who pretty much always have a full head of hair. So anyone that doesn’t fit this notion of “attractiveness” is going to feel like they’re not good enough.</p>
<p>Men are now feeling dissatisfied not only with their muscles, but also their hairline, wrinkles and body fat – and a heavy cultural and commercial promotion of unrealistic appearance standards is to blame. One of the most compelling examples of this, is the way toy manufacturers have <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1098-108X(199907)26:1%3C65::AID-EAT8%3E3.0.CO;2-D">added muscle and reduced the body fat</a> of successive editions of action dolls over the years. Similar changes have <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/1098-108X(200101)29:1%3C90::AID-EAT15%3E3.0.CO;2-F">also been seen</a> with centrefolds models. </p>
<p>There has also been a rise in brands marketing protein shakes, cosmetic surgery, waxing products, makeup and cellulite creams directly at men. And as the participants I spoke with noted, you see protein shakes at supermarkets and local shops, which makes these products hard to avoid.</p>
<p>Psychotherapist and writer Susie Orbach has written extensively about why people feel dissatisfied with their physical appearance. She has described how “<a href="http://www.any-body.org/anybody_vent/2012/3/6/susie-orbach-speaks-at-the-un-commission-on-the-status-of-wo.html">businesses mine our bodies for profits</a>”. Or, in other words, they promote appearance insecurity to sell products. It is this that must be tackled if both men’s and women’s body dissatisfaction is to be reduced.</p><img src="https://counter.theconversation.com/content/120115/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Jankowski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Men are feeling more and more pressure to get rid of their love handles and beer bellies – and heavy promotion of unrealistic appearance standards are to blame.Glen Jankowski, Senior Lecturer in the School of Social Sciences, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1077032018-12-26T19:28:40Z2018-12-26T19:28:40Z‘Strong is the new skinny’ isn’t as empowering as it sounds<figure><img src="https://images.theconversation.com/files/251131/original/file-20181218-27761-rgx6hk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An athletic ideal still demands stringent diets and exercise regimes.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Women have long been subject to <a href="https://link.springer.com/article/10.1176/appi.ap.30.3.257">powerful social pressures</a> to look a certain way. The “<a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.20039">feminine ideal</a>” – a svelte female figure – has dominated film, television and magazine culture.</p>
<p>The result is a narrow idea of what feminine beauty should look like and an associated crisis in <a href="https://journals.sagepub.com/doi/abs/10.1111/j.1471-6402.2006.00292.x?casa_token=xI9aCl5G8K0AAAAA%3A-DFk1ElCpn9HEMrrkmsfRO2f5t_EZLfixIS5DOvv4YLu0IKd90pWiQU4tlcY8vVjvPVJ8Njwb7Mxcg">body satisfaction</a>. </p>
<p>In recent years an “<a href="https://www.sciencedirect.com/science/article/pii/S1740144510000070">athletic ideal</a>” – characterised by muscle tone and power – has emerged as an alternative conception of beauty. Female bodies on the track are as appealing as those on the catwalk. </p>
<p>This might be considered a good thing – a broader definition of beauty is more inclusive. More accepted body types, more body satisfaction, right? </p>
<p>From the perspective of former athletes, it’s a little more complicated than that.</p>
<p>Athletes are a useful population to explore in terms of the relationship between “athletic” and “feminine” ideals – they are exposed to both more than most women. </p>
<p>A <a href="http://psycnet.apa.org/doiLanding?doi=10.1037%2Fspy0000111">recent study</a> of 218 former athletes showed they found body image a difficult terrain to navigate. Gymnasts and swimmers, retired for between two and six years, were asked to identify what body changes they noticed, how they felt about them and how they coped. </p>
<p>Some former athletes embraced a new, less muscular body that emerged due to the retirement-induced reduction in training load. </p>
<p>Chelsea, a 26-year-old retired swimmer, commented:</p>
<blockquote>
<p>Lost most of the heavier muscle I gained while training in college about six months after I stopped swimming. Due to the loss, I dropped about 15–20 pounds… I was surprised at how baggy my clothes felt and was pleasantly surprised that I could fit in smaller sizes. I didn’t feel as bulky or broad-shouldered.</p>
</blockquote>
<p>With bulk and brawn confined to her former life, Chelsea rejoices in her increased sense of femininity. This suggests traditional conventions of feminine beauty remain the preference even for former athletes who often take pride in their physical strength and muscularity.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/size-is-largely-in-the-mind-how-your-body-image-can-change-in-two-minutes-62428">Size is largely in the mind: how your body image can change in two minutes</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251146/original/file-20181218-27752-ht74ao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A stronger ideal doesn’t necessarily lead to a healthier body image.</span>
<span class="attribution"><span class="source">from shutterstuck.com</span></span>
</figcaption>
</figure>
<p>So, perhaps statements such as “<a href="http://www.womensfitness.com.au/editorial/strong-new-skinny/">strong is the new skinny</a>” are overplayed and the feminine ideal remains powerful and difficult to resist.</p>
<p>Another finding was that the athletic ideal may be the alternative ideal, but it’s not necessarily a healthier ideal or one that will lead to a more positive body image. </p>
<p>Retired swimmer Abbey, 26, illustrated this point when she stated:</p>
<blockquote>
<p>It took me a long time to realise that my body would never be what it was when I was an athlete… I still think back and use that image as a gauge to how I could look, but also know that my life does not revolve around working out 20-plus hours a week or needing to be in top shape to be successful. I still want to be as lean and as strong as I used to be.</p>
</blockquote>
<p>Although Abbey remains committed to an athletic ideal, she is unable to fulfil it now she is no longer an athlete. Accepting this is a difficult process and she still pines for her former body. </p>
<p>An athletic ideal may not exclusively focus on thinness but it still demands stringent diets and training regimes and it has been linked to <a href="https://www.sciencedirect.com/science/article/pii/S1471015315300386">disordered eating and exercise behaviours</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-can-damage-body-image-heres-how-to-counteract-it-65717">Social media can damage body image – here's how to counteract it</a>
</strong>
</em>
</p>
<hr>
<p>Ideals, by definition, aren’t healthy because they demand the unachievable: perfection.</p>
<p>Some athletes were torn between the athletic ideal and the feminine ideal, identifying with both and attempting to walk a tightrope between a sporty look and a feminine one.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251142/original/file-20181218-27764-1vcadpv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many former athletics walk a tightrope between a feminine and sporty body.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>For example, former swimmer Simone, 26, reflected:</p>
<blockquote>
<p>My weight is pretty much the same as when I was swimming, but I am significantly less muscular. I’m glad I am not as muscular as I was when I was swimming and that my shoulders shrunk to a size that would fit into clothes, but I would like to be a little more muscular/toned than I am now.</p>
</blockquote>
<p>And 25-year-old Carrie, a retired gymnast, echoed the “toned but not too toned” mantra:</p>
<blockquote>
<p>I am less muscular and my butt has gotten a little saggy. I feel OK because I am still thin and feel energetic, but I would like to be more toned but not as bulky (muscular) as I was when I was competing in my sport.</p>
</blockquote>
<p>Carrie and Simone desired athletic tone but not at the expense of conventional femininity. At the same time, they sought the thin ideal but not at the expense of an athletic look. </p>
<p>The athletic and feminine ideal represent two contradictory masters; to serve one is to reject the other. Finding the middle ground necessary to appease both is an almost impossible task.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-with-facial-difference-have-a-lot-to-teach-us-about-body-image-90693">Children with facial difference have a lot to teach us about body image</a>
</strong>
</em>
</p>
<hr>
<p>It is naïve to view the athletic ideal as simply providing women with a different or new way to love their bodies; it might also provide a new way to hate them. The more ideals there are, the more ways there are to fall short.</p>
<p>Strong isn’t the new skinny quite yet. And, if it were, it would be nothing to brag about.</p><img src="https://counter.theconversation.com/content/107703/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Papathomas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Retired female athletes struggle with body image. Some miss their athletic figure, others want a more feminine ideal, while others walk a tightrope between the two.Anthony Papathomas, Senior Lecturer Sport and Exercise Psychology, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/742342017-04-18T19:47:18Z2017-04-18T19:47:18ZBody dysmorphic disorder and cosmetic surgery: are surgeons too quick to nip and tuck?<figure><img src="https://images.theconversation.com/files/163017/original/image-20170328-3819-1g49c50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The highest rates of body dysmorphic disorder are found among people seeking help from cosmetic surgeons, cosmetic dermatologists and other such specialists.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock </a></span></figcaption></figure><p>Most of us have some insecurities about how we look, and some aspects of our appearance that we might secretly wish were different. But for people with body dysmorphic disorder, these issues become an obsession and constant focus of concern.</p>
<p>Body dysmorphic disorder is a psychiatric condition that leads people to adopt<br>
extremely distorted negative beliefs about their appearances: seeing themselves to be ugly, malformed, misshapen or hideous. Such beliefs do not reflect the reality of how they appear to others. The degree of concern and distress they may feel about their appearance is vastly out of proportion to any actual physical “defect”. </p>
<p>A small minority of the population is believed to experience the condition. One study found about <a href="http://onlinelibrary.wiley.com/doi/10.1080/13284200601178532/full">2.3%</a> of participants had the condition.</p>
<p>The mirror is a major problem for people with body dysmorphic disorder. Some sufferers become fixated with mirror checking, with hours of their day absorbed in inspecting their appearance. Mostly this checking is counter-productive, making them feel worse and increasing their distress. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=371&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=371&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=371&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Body dysmorphic disorder should not be dismissed as extreme vanity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/fixersuk/15425017231/in/photolist-pCoZcF-j38YYW-j2SP4L-j2Rc8r-j2PQXF-j2Mbey-j2JGne-j376dw-j2LkJB-gbBes-G66z2-j38YJY-hn4kkB-pv4fdX-vuZD7E-uQBbNq-vMZ6TP-uQA5oo-vv8tji-pda5TU-puDRng-pdax8A-punywa-puDRpk-pdax8W-vKhudC">fixersuk/flickr</a></span>
</figcaption>
</figure>
<p>Other people with the condition may avoid mirrors altogether. Some can even have catastrophic reactions should they happen to glance at themselves in a reflective surface such as a shop window. Lots of sufferers conceal themselves under hats, scarves, wigs, dark glasses or excessive layers of makeup or concealing clothing in an attempt to hide their supposed defects.</p>
<p>Body dysmorphic disorder should not simply be dismissed as an expression of extreme vanity or insecurity about looks. This condition often leads to substantial distress and social and occupational impairment. Rates of depression are high, while suicide is not an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16816236">uncommon outcome</a> for those who do not receive appropriate treatment. Many avoid social situations for fear of others judging them negatively because of how they look. </p>
<h2>Cosmetic solutions?</h2>
<p>Because people with body dysmorphic disorder “see” themselves as having a cosmetic problem, it’s not surprising they often seek a cosmetic “solution”. </p>
<p>The highest rates of body dysmorphic disorder are found among people using cosmetic services like plastic surgeons, cosmetic dermatologists and cosmetic dentists. One study found up to <a href="https://www.ncbi.nlm.nih.gov/pubmed/19332010">70%</a> of people with body dysmorphic disorder had sought cosmetic procedures, and half had received such interventions.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cosmetic procedures of all types are becoming increasingly available and accessible to a wider public.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com">From www.shutterstock.com'</a></span>
</figcaption>
</figure>
<p>The tragedy is that cosmetic procedures – by definition – do not solve the underlying psychological problem. They leave a majority of sufferers worse off: they pay for the procedure and suffer the pain and inconvenience of it, yet “see” the resulting cosmetic outcome as unsatisfactory, even if objectively the result is excellent. </p>
<p>This often leads to requests for more treatments, with ensuing worsening of the mental state of the patient and increasing frustration on behalf of the cosmetic specialist. The situation can become so heated that <a href="https://www.ncbi.nlm.nih.gov/pubmed/19332010">legal action</a>, physical threats and even homicide have been known to be perpetrated by body dysmorphic disorder patients. </p>
<h2>How can these outcomes be avoided?</h2>
<p>Cosmetic interventions of all types are becoming increasingly accessible to a wider public. Therefore, it would be ideal for cosmetic specialists routinely to screen for body dysmorphic disorder.</p>
<p>Australian cosmetic specialists are not mandated to screen for body dysmorphic disorder and there’s no available information on the proportion of cosmetic clinics that screen for the condition. From my experience of speaking to patients who have sought cosmetic intervention, screening is variable at best.</p>
<p>There are certainly some practitioners who are very aware of the risks associated with body dysmorphic disorder and ensure their clients are screened and offered referral for further help if required. Unfortunately, too often screening is not performed and patients suffer as a consequence.</p>
<p>Screening should be mandated for people seeking any cosmetic procedure that might be seen as “enduring”: this includes surgical procedures. My colleagues and I have developed a questionnaire for practitioners, which through a series of simple questions can help diagnose body dysmorphic disorder. </p>
<p>For those who may body dysmorphic disorder, careful further questioning and referral to a body dysmorphic disorder specialist is required. A range of psychological therapies (such as cognitive behaviour therapy) and medications (mostly antidepressants) can be very effective at treating the condition’s underlying problems.</p>
<p>Simply providing cosmetic clinics with screening tools won’t guarantee all doctors accurately assess for body dysmorphic disorder. This is because we cannot expect all clients to answer questionnaires truthfully. However, in my experience, having seen hundreds of people with body dysmorphic disorder, they usually do. </p>
<p>At the end of the day, it would be ideal if cosmetic specialists did everything in their power to fulfil their ethical obligations. To not screen and then deliver cosmetic procedures to people who may have body dysmorphic disorder goes against the medical dictum “first do no harm”.</p><img src="https://counter.theconversation.com/content/74234/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Jonathan Castle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To not screen, and then deliver cosmetic procedures to people who may have body dysmorphic disorder, goes against the medical dictum “first do no harm”.David Jonathan Castle, Chair of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/310622014-09-02T04:39:59Z2014-09-02T04:39:59ZScapegoating steroids won’t make for a safer night out<figure><img src="https://images.theconversation.com/files/57971/original/hnmrxb24-1409621895.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Steroid use is growing in Australia but not among the usual suspects.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/japokskee/4391428993">Jhong Dizon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them. </p>
<p>Ostensibly, it is this perception of steroid users that has led the Queensland government to enact <a href="http://www.premiers.qld.gov.au/publications/categories/plans/assets/safe-night-out-strategy.pdf">tougher penalties</a> for steroids. The Safe Night out legislation increases the maximum penalty for possession or supply of steroids to 25 years in jail. </p>
<p>But tougher steroid laws are unlikely to have an impact on violence in the community because a) most steroid users are not violent, and b) other substances, including alcohol, are stronger risk factors for violent behaviour.</p>
<h2>Who uses steroids?</h2>
<p>The public perception of steroid users doesn’t match the reality. </p>
<p>The first red flag comes from demographic data. It turns out that in the United States, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/21923602">typical steroid user</a> is male, around 30 years old, has a bachelor’s degree, is employed full-time in a white-collar occupation, earns an above-average income, and does not play any form of competitive sport. Local data is lacking, but smaller studies of Australian steroid users <a href="http://www.sciencedirect.com/science/article/pii/S0376871600800113">corroborate this profile</a>.</p>
<p>In a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2131752/">large US study</a> of nearly 2,000 steroid users, the most-commonly reported occupations were in sales and marketing, information technology, banking and finance, health care, management and executives, and skilled labour. The least-commonly held occupations? Athletes, coaches, personal trainers and the military. </p>
<p>So these men don’t sound like a particularly violent bunch, but aren’t steroids still linked with increased aggression and violent behaviour?</p>
<h2>How steroids affect behaviour</h2>
<p>Some <a href="http://www.sciencedirect.com/science/article/pii/S0018506X96900215">studies suggest</a> that steroid users are more aggressive and irritable than non-users. Further, some <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636528/">population-based studies</a> have <a href="http://www.ncbi.nlm.nih.gov/pubmed/8355384">found links</a> between self-reported anabolic steroid use and self-reported involvement in aggressive and violent behaviour. </p>
<p>Arguably, however, the best data comes from studies where anabolic steroid use is objectively tested and violent behaviour is confirmed through legal records rather than self-report. </p>
<p>To this end, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17088508">Swedish retrospective cohort study</a> that compared registered criminal activity among individuals who had tested positive for anabolic steroids to those who had tested negative for steroids found that those who tested positive were no more likely to have committed violent crimes. </p>
<p>In fact, after controlling for substance abuse, the researchers found a lower risk for crimes against property among those individuals who tested positive for anabolic steroids. </p>
<p>A general limitation of studies on steroid use and violent behaviour is that few have controlled for other forms of substance use, including alcohol. </p>
<p>A <a href="http://uu.diva-portal.org/smash/record.jsf?pid=diva2:601819">recent Swedish study</a> examined the link between anabolic steroid use and violent crime in a sample of 3,594 remanded prisoners and found that 28% reported using steroids at least once in their lifetime. Prisoners who reported any lifetime use of steroids were 1.7 times more likely to be suspected of a violent crime. However, there was no temporal relation between the use of anabolic steroids and the suspected violent crime. </p>
<p>In contrast, there was a four-fold increase in the risk of violent crime if alcohol had been consumed 24 hours earlier. The average amount of alcohol consumed in the 24 hours prior to a violent offence was 107 grams, equivalent to 10.7 Australian standard drinks.</p>
<p>A <a href="http://uu.diva-portal.org/smash/record.jsf?pid=diva2:601819">second Swedish population study</a> of 10,365 men found that 4.9% had been convicted for a violent crime and 0.7% reported anabolic steroid use. Further examination showed that violent offenders were five times more likely to report anabolic steroid use than non-offenders. </p>
<p>But after controlling for other forms of lifetime substance abuse, including alcohol, this association lost statistical significance. In other words, once the researchers looked at alcohol and other drugs, it appeared that anabolic steroids were not at all associated with violent crime. </p>
<p>Steroid use is probably not a proximal risk factor for violent behaviour. Rather, co-occurrence of abuse of other substances, including alcohol, are probably more to blame. Another possibility is that using anabolic steroids <a href="http://www.ncbi.nlm.nih.gov/pubmed/12048171">makes people more susceptible</a> to the violence-inducing effects of other substances such as alcohol or <a href="http://www.ncbi.nlm.nih.gov/pubmed/15763599">amphetamines</a>, an idea which has some support in animal research.</p>
<h2>Cost of penalising steroid users</h2>
<p>The potential benefit of tougher laws on steroid use to curb violence and antisocial behaviour must be weighed against the potential costs. The proportion of steroid users who disclose their use to health professionals, which is already low, will likely fall. </p>
<p>Community health-promotion services, such as needle exchanges, may see a drop in visits from steroid users concerned about the potential for discovery and prosecution.</p>
<p>Steroid use is undoubtedly growing in Australia. In New South Wales in 2007, <a href="https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ANSPS_2008_2012%20KI.pdf">the proportion</a> of needle exchange service-users who reported that their last injection was steroids was just 2%. But by 2012 this had increased sixfold to 12%. Queensland <a href="https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ANSPS_2008_2012%20KI.pdf">fared no better</a>: rising from 2% in 2007 to 11% in 2012. By 2012, almost two-thirds of all new service-users, or “new initiates,” reported that their last injection was anabolic steroids. </p>
<p>These men are not competitive athletes or criminals. Overwhelmingly, they are men who are unhappy with their appearance and want to look better. </p>
<p>For some, large parts of their self-worth or self-esteem are tied to their bodies and their appearance. If building muscle becomes a preoccupation, a mental condition called <a href="http://www.ncbi.nlm.nih.gov/pubmed/9427852">muscle dysmorphia</a>, formerly named <a href="http://www.ncbi.nlm.nih.gov/pubmed/8131385">“reverse anorexia”</a>, may develop. Little wonder that <a href="http://ajp.psychiatryonline.org/article.aspx?articleID=174271">up to 50%</a> of men with muscle dysmorphia also use steroids. </p>
<p>Derisively labelling steroid users as vain or narcissistic “gym bros” and disparaging their culture as “<a href="http://www.abc.net.au/news/2014-08-27/qld-beefs-up-steroid-laws-after-drastic-rise-in-seizures/5698532">bruss</a>” betrays a deep lack of compassion. There is a reason why extreme dieting and self-induced vomiting <a href="http://www.jeatdisord.com/content/1/S1/O23">grew faster</a> among Australian males than Australian females between 1998 and 2008 and a reason why teenage boys <a href="https://www.missionaustralia.com.au/2020-strategy-page/doc_download/198-mission-australia-youth-survey-2013">consistently rank</a> body image among their top three major life concerns. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Male action figures are becoming bulkier.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ntxpeach68/6785168533">SandyJo Kelly./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Our culture celebrates physically attractive and “masculine” men: tall, muscular, stiff upper-lipped. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18089212">Research shows</a> that media portrayals of men have become <a href="http://www.sscnet.ucla.edu/comm/haselton/papers/downloads/frederickbodyimage.pdf">more and more muscular</a> during the past few decades and the rise in steroid use in contemporary Australia is a symptom of men succumbing to body image pressures. </p>
<p>Solving this problem demands a compassionate understanding of the psychology behind why men start to use steroids. Too often we turn to outright denigration. We do not publicly berate girls for their attempts to look more attractive, so why do we berate men?</p>
<p>Tougher steroid laws are unlikely to have an impact on violence in the community. Rather, the steroid-using community will be driven further underground, making it more difficult to deliver health services to this misunderstood and under-served group of people, allowing the problem of steroids in Australia to grow even larger.</p><img src="https://counter.theconversation.com/content/31062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am currently affiliated with the Butterfly Foundation, the Redleaf Practice, the Australian and New Zealand Academy of Eating Disorders, and the National Association for Males with Eating Disorders.</span></em></p>Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them. Ostensibly, it is this perception…Scott Griffiths, PhD candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/123602013-06-11T20:32:45Z2013-06-11T20:32:45ZWho really pays for designer vaginas?<figure><img src="https://images.theconversation.com/files/25308/original/39rc9c32-1370914949.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More and more women are going under the knife in search of the 'perfect' vagina.</span> <span class="attribution"><span class="source">Flickr/Hey Paul Studios</span></span></figcaption></figure><p>Increasing numbers of Australian women are asking their doctors for a designer vagina. So many, in fact, that the government is reviewing whether such surgery should be publicly-funded via Medicare.</p>
<p>Over the last ten years, claims through the medical benefit scheme (MBS) for labioplasty have increased from 200 to over 1,500 per year. The resulting cost, rising from $40,000 to $740,000 annually, has led to a government <a href="http://www.msac.gov.au/internet/msac/publishing.nsf/Content/reviews-lp">review</a> questioning the procedure. </p>
<p>The Royal Australian and New Zealand <a href="http://www.ranzcog.edu.au/component/docman/doc_view/932-c-gyn-24-vaginal-rejuvenation-and-cosmetic-vaginal-procedures.html?Itemid=341%20">College</a> of Obstetricians and Gynaecologists strongly discourage labioplasty, unless there are compelling medical reasons. They cite a range of potential complications, including scarring, permanent disfigurement, infection, pain, and altered sexual sensations. </p>
<p>So why are so many Australian women demanding labioplasty, a surgical operation that involves reduction of protruding labial tissue surrounding the vagina? The main <a href="http://www.ioe.ac.uk/Study_Departments/SIG_Gender_SexCulture_Lei-Mei_Liao.pdf">reason</a> given is dissatisfaction with the appearance of the genitals. </p>
<p>This dissatisfaction is not unusual in the general population. One study found over 50% of women felt <a href="http://www.tandfonline.com/doi/abs/10.1080/02646830701759793">unhappy</a> with the size or appearance of their labia. In another, over <a href="http://www.radicalpsychology.org/vol8-1/brauntiefer.html">40%</a> of women had considered genital surgery. </p>
<p>The dramatic increase in genital dissatisfaction over the last decade is not due to changes in women’s anatomy. It’s due to changing social views on what is a “normal” vulva and vagina. A prepubescent, hairless, <a href="http://ztolk.interestingnonetheless.net/evulvalution.pdf">Barbie doll</a> appearance now stands as the ideal. </p>
<p>Pornography is partly to blame, depicting women’s genitals as a slit, with no visible labia at all. But the Australian censorship board enshrines such practices in law by allowing only “discrete genital detail” to be shown. </p>
<p>The <a href="http://vimeo.com/9924049">airbrushing</a> of photographs of women’s genitals is the inevitable consequence. The fact that women requesting labioplasty bring such images to their doctors as a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1877941/">model</a> for surgery shows the insidious nature of pornography’s influence. </p>
<p>But how else can heterosexual women find out what “normal” female genitals look like? Outside of pornography, women’s genitals are culturally invisible. The days of self-examination in feminist consciousness-raising groups, when women used a mirror and speculum to explore their <a href="http://womenshealthinwomenshands.org/PDFs/Immodest%20Witnessing%5B1%5D.pdf">vaginas</a>, are long gone. </p>
<p>This is a shame. If we dared to look, we would find that the majority of adult women look very different from the photographs depicted in pornographic magazines. A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/15842291">study</a> of genital size in 50 women found huge variation, with most women having protruding labia, not a simple slit. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=346&fit=crop&dpr=1 600w, https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=346&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=346&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=435&fit=crop&dpr=1 754w, https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=435&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/25310/original/fmzp3hbk-1370915194.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=435&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The reality of the female body has been airbrushed for centuries, the vagina is no exception.</span>
<span class="attribution"><span class="source">Shutterstock/Jochen Schoenfeld</span></span>
</figcaption>
</figure>
<p>Medical <a href="http://www.ncbi.nlm.nih.gov/pubmed/21393286">textbooks</a> ignore this fact, depicting women’s genitalia with smaller proportions than even those shown in pornography. Labia that protrude in a normal way are described as “<a href="http://www.radicalpsychology.org/vol8-1/brauntiefer.html">hypertropic</a>” (abnormal enlargement), but there’s no clear guidance on what level of protrusion merits such diagnosis.</p>
<p>With all this in mind, it’s not surprising that many women are referred for labioplasty without a physical <a href="http://www.ioe.ac.uk/Study_Departments/SIG_Gender_SexCulture_Lei-Mei_Liao.pdf">examination</a>, as the woman’s complaint of “abnormal” labial shape or size is simply accepted. When an examination is conducted, women are still referred for treatment, even if their labia are in the <a href="http://www.ioe.ac.uk/Study_Departments/SIG_Gender_SexCulture_Lei-Mei_Liao.pdf">normal</a> range. </p>
<p>The medical profession may simply be guilty of believing that they can make women <a href="http://mh.bmj.com/content/36/2/68.extract">happy</a> by acquiescing to their requests for genital surgery. Yet many women are sexually dissatisfied or anxious about their genitals after surgery and, for some women, labioplasty is just one of many cosmetic surgery procedures undertaken.</p>
<p>This is not to criticise women who seek such surgery. It’s difficult to resist the idealised images of female sexuality that surround us. The reality of the female body has been airbrushed for centuries, with artists depicting the nude with a vaginal slit and no hair. All notions of seepage – flesh or fluid – are completely removed from the frame. </p>
<p>The current popularity of Brazilian waxing (removing all pubic hair) has made prepubescent genital the new norm. It also draws attention to labial skin that would otherwise be concealed, a further <a href="http://www.radicalpsychology.org/vol8-1/brauntiefer.html">explanation</a> for the increased numbers of women seeking labioplasty.</p>
<p>Rather than subjecting women who are dissatisfied with their genitals to the surgeon’s knife, we need to inform them, and their partners, about what is normal. Some surgeons show women images of the wide range of female genitals to try to dissuade them from labioplasty. </p>
<p><a href="http://www.greatwallofvagina.co.uk/home">Artists</a>, <a href="http://www.vaginaverite.com/">photographers</a>, women’s <a href="http://largelabiaproject.tumblr.com/">blogs</a>, and feminist action <a href="http://courageouscunts.wordpress.com/">groups</a> have also joined the quest to normalise and celebrate the diversity of women’s genitals.</p>
<p>The real issue here is women’s dissatisfaction with their bodies. We should be challenging the unrealistic images and expectations that perpetuate this unhappiness, not cutting into women’s flesh.</p><img src="https://counter.theconversation.com/content/12360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Ussher does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Increasing numbers of Australian women are asking their doctors for a designer vagina. So many, in fact, that the government is reviewing whether such surgery should be publicly-funded via Medicare. Over…Jane Ussher, Professor of Women's Health Psychology, Centre for Health Research, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.