What works in secondary schools? A systematic review of classroom-based body image programs

Governments, schools, and curriculum authorities are increasingly recognizing that body image during adolescence is a public health issue that warrants attention in the school setting. After 30 years of eating disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post test, though effect sizes were small (d=0.22-0.48). These effective programs were conducted among younger adolescents 12.33-13.62 years, and included activities focusing on media literacy, self esteem, and the influence of peers. Implications for school personnel and curriculum authorities are discussed, and we provide recommendations for a strategic approach to future research in this area.

Training and experience of nurses in responding to alcohol misuse in rural communities

OBJECTIVE

Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

DESIGN AND SAMPLE

Qualitative interviews of 15 rural and remote nurses.

MEASURES

Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP-an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

RESULTS

Nurses found the training provided new-or built on existing-knowledge of alcohol misuse and offered practical hands-on "real life" skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

CONCLUSIONS

The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Physical activity guidelines for preschoolers: a call for research to inform public health policy

There are many challenges in developing evidence-based physical activity guidelines for preschoolers that can ensure health benefits for children. Guidelines for the preschool years have recently been developed in several countries, but there are notable inconsistencies in the amount of physical activity regarded as sufficient for this age group. Given the currently high prevalence of childhood obesity, there is an urgent need for evidence-based studies to inform the development of community-targeted programs to ensure healthy levels of physical activity in young children. Our article outlines the global recommendations for physical activity for children ≤ 5 years of age. We identify gaps in the literature and suggest recommendations for future research and public health policy.

Promoting fit bodies, healthy eating and physical activity among Indigenous Australian men: a study protocol

BACKGROUND

Overall the physical health of Indigenous men is among the worst in Australia. Research has indicated that modifiable lifestyle factors, such as poor nutrition and physical inactivity, appear to contribute strongly to these poor health conditions. To effectively develop and implement strategies to improve the health of Australia's Indigenous peoples, a greater understanding is needed of how Indigenous men perceive health, and how they view and care for their bodies. Further, a more systematic understanding of how sociocultural factors affect their health attitudes and behaviours is needed. This article presents the study protocol of a community-based investigation into the factors surrounding the health and body image of Indigenous Australian men.

METHODS AND DESIGN

The study will be conducted in a collaborative manner with Indigenous Australian men using a participatory action research framework. Men will be recruited from three locations around Australia (metropolitan, regional, and rural) and interviewed to understand their experiences and perspectives on a number of issues related to health and health behaviour. The information that is collected will be analysed using modified grounded theory and thematic analysis. The results will then be used to develop and implement community events in each location to provide feedback on the findings to the community, promote health enhancing strategies, and determine future action and collaboration.

DISCUSSION

This study will explore both risk and protective factors that affect the health of Indigenous Australian men. This knowledge will be disseminated to the wider Indigenous community and can be used to inform future health promotion strategies. The expected outcome of this study is therefore an increased understanding of health and health change in Indigenous Australian men, the development of strategies that promote healthy eating and positive patterns of physical activity and, in the longer term, more effective and culturally-appropriate interventions to improve health.

Socio-cultural agents and their impact on body image and body change strategies among adolescents in Fiji, Tonga, Tongans in New Zealand and Australia

This paper reports on the findings of studies that were conducted as part of the Pacific Obesity Prevention in Communities project. The studies evaluated the types of messages that adolescents received in relation to body image, physical activity and eating. The participants were male and female adolescents from Fiji (two cultural groups), Tonga, New Zealand (Tongans) and Australia (European Australians). Three studies were conducted: interviews with 48 adolescents (24 male, 24 female) from each cultural group, questionnaires with 600 adolescents (300 male, 300 female) from each cultural group and the perceptual distortion study with 100 adolescents (50 male, 50 female) from the two cultural groups in Fiji and European Australians. The results demonstrate that parents, peers, the media, as well as religious influences impact on the type of body valued by adolescents in each of the cultural groups, as well as their levels of body satisfaction. These influences also shape the type and volume of food consumed, and the type and frequency of physical activity. The results of these studies highlight the major role played by the broader societal values in shaping the nature of the messages that adolescents receive in relation to their body size, eating and physical activity.

Maternal correlates of preschool child eating behaviours and body mass index: a cross-sectional study

To the authors' knowledge, this is the first study to evaluate maternal child feeding practices, maternal parenting characteristics and mother-child interactions as cross-sectional predictors of child eating and/or weight within the one sample. Maternal pressure for her child to eat was a significant positive correlate of fussiness and a negative correlate of enjoyment. Maternal parenting warmth was associated negatively with child BMIz, while mother-child dysfunctional interaction was associated positively with child BMIz. Our findings suggest that childhood obesity research may be better informed by evaluating not just what mothers do (feeding practices) but also how they parent (parenting behaviours and interactions with their child). Longitudinal studies are needed to identify causal influences of parenting on preschool child eating and weight.

The Alcohol Intervention Training Program (AITP): a response to alcohol misuse in the farming community

BACKGROUND

Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.

METHODS/DESIGN

A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.

DISCUSSION

The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

Are there different sociocultural influences on body image and body change strategies for overweight adolescent boys and girls?

This study examined how sociocultural messages differ for overweight and normal weight adolescents and how these messages predict body image and body change strategies. In total, 590 adolescents participated in the study. Overweight adolescents experienced greater body dissatisfaction, engaged in more strategies to lose weight, and experienced greater sociocultural messages to lose weight. Body dissatisfaction and sociocultural pressures predicted weight loss among overweight boys. Body image importance, and sociocultural pressures predicted increasing muscle bulk for normal and overweight boys. Weight loss for overweight girls was predicted by sociocultural pressures. Sociocultural pressures also predicted muscle increase for overweight and normal weight girls. Implications for intervention and prevention programs for overweight adolescent boys and girls are discussed.

The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: results of the international body project I

This study reports results from the first International Body Project (IBP-I), which surveyed 7,434 individuals in 10 major world regions about body weight ideals and body dissatisfaction. Participants completed the female Contour Drawing Figure Rating Scale (CDFRS) and self-reported their exposure to Western and local media. Results indicated there were significant cross-regional differences in the ideal female figure and body dissatisfaction, but effect sizes were small across high-socioeconomic-status (SES) sites. Within cultures, heavier bodies were preferred in low-SES sites compared to high-SES sites in Malaysia and South Africa (ds = 1.94-2.49) but not in Austria. Participant age, body mass index (BMI), and Western media exposure predicted body weight ideals. BMI and Western media exposure predicted body dissatisfaction among women. Our results show that body dissatisfaction and desire for thinness is commonplace in high-SES settings across world regions, highlighting the need for international attention to this problem.

Impact of a healthy body image program among adolescent boys on body image, negative affect, and body change strategies

This study evaluated the effectiveness of a healthy body image program. In total, 421 adolescent boys completed a five-session intervention program or a wait list control group. There were no differences between the intervention and the control group at post-intervention or any of the follow-up times. Boys in the intervention group who were one standard deviation above the mean on body dissatisfaction at baseline, demonstrated a reduction in negative affect in the intervention group at post-test and 6 months follow-up. Prevention programs need to target boys who are at risk of adopting health risk behaviors, rather than being universally applied.

Body dissatisfaction, engagement in body change behaviors and sociocultural influences on body image among Chinese adolescents

Body dissatisfaction and body image disorders are becoming increasingly prevalent in developing non-Western countries such as China, but there is a lack of research examining the sociocultural factors that in other contexts have been associated with these problems. The current study investigated body dissatisfaction, engagement in body change behaviors, and sociocultural pressures on body image, and the relationships between these variables among 517 adolescent males (N=219) and females (N=298) in China. Females reported greater body dissatisfaction than males, and males reported using strategies to increase their muscle bulk more often than females. Males reported pressure from a variety of sociocultural sources to increase their muscles or weight, while females reported pressure from the media to lose weight. For males body dissatisfaction was predicted by pressure from peers to increase their muscle bulk, while for females pressure to lose weight from peers, adult relatives, and the media was likely to increase body dissatisfaction. Pressure from the media and adult relatives was also predictive of body change behaviors in both males and females. The findings are discussed in relation to previous research in both Western and non-Western contexts.

Appearance-based comments, body dissatisfaction and drive for muscularity in males

This study examined the role of positive and negative appearance-based comments on body dissatisfaction and drive for muscularity among young adult males. The direct and moderating effect of self-esteem were also investigated; and BMI, age, and social desirability were included as covariates. The participants were 214 males aged between 18 and 30 years. More frequent negative comments were associated with higher body dissatisfaction whilst more frequent positive comments were associated with lower body dissatisfaction. However, both frequent negative and positive commentary were associated with higher drive for muscularity. Self-esteem was also associated with both body dissatisfaction and the drive for muscularity, but it did not moderate that influence of either positive or negative messages. Longitudinal research is now needed to determine the directionality of these relationships. Further research is required to establish the contexts in which positive and negative messages are associated with body dissatisfaction and the drive for muscularity.

Weight concerns among elementary school children: a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8-12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.

University students' perceptions of the alcohol campaign: "Is Getting Pissed Getting Pathetic? (Just Ask Your Friends)"

The present study examined students' understanding and perceived effectiveness of a recent Australian alcohol campaign designed to increase students' awareness of excessive and harmful drinking. Six hundred and seventy one university students (51% females), who had seen the campaign posters, with the tagline "Is Getting Pissed Getting Pathetic? (Just Ask You Friends)", were asked to comment on the messages that the campaign was communicating and how informative, relevant, and effective they perceived the campaign. Many students were positive in their evaluations and described the messages as "truth and realistic", "clear and to the point", and that the campaign made them think about their own drinking. However, other views were more negative and indicative of psychological reactance. These included concerns that students "won't listen" or "don't care" about media campaigns, and that "they don't what to be told what to do". The findings highlight how media campaigns can help an audience contemplate behavioral change, however, they can also alienate students and promote counterproductive attitudes.

A longitudinal study of body change strategies of fitness center attendees

This study evaluated predictors of strategies to change weight and muscles among men and women who attend fitness centers. A questionnaire was completed by 107 men (mean age=39.17, SD=13.14), and 151 women (mean age=35.31, SD=11.38) who regularly attended fitness centers at two points in time, one year apart. The only unique predictor of body change strategies over time for men was body dissatisfaction predicting drive for thinness; for women, body dissatisfaction predicted strategies to lose weight, drive for thinness, use of food supplements to lose weight and levels of bulimia. Media messages also predicted drive for thinness and bulimia among women. These findings would suggest that attendance body dissatisfaction is an important factor predicting other normative and health risk behaviors among fitness center attendees, particularly women at a fitness center over a 12 month period was not generally associated with adverse health risk behaviors.

The role of ethnicity and culture in body image and disordered eating among males

An increasing number of researchers have examined body image concerns, disordered eating, and other behaviors associated with increasing muscle size among men from different cultural groups. However, to date there has been no synthesis or evaluation of these studies. In this paper we specifically review studies which have included a comparison between males from different cultural groups with White males on body image concerns or other related behaviors. The groups include Blacks, Hispanic Americans, Asians, Native Americans, Pacific Islanders, and men from Middle Eastern countries. Overall, evidence suggests that males from a range of cultural groups engage in more extreme body change strategies and binge eating than Whites. On the other hand, there is no consistent pattern which summarizes the nature of body image concerns across the different cultures. Mediating and/or moderating variables are proposed to account for the inconsistent findings. These include body build, levels of acculturation, socio-economic status, media exposure, and internalization of the muscular and lean body ideal.

Where is all the pressure coming from? Messages from mothers and teachers about preschool children's appearance, diet and exercise

This study used interviews and qualitative analyses to investigate the nature of the messages that preschool children receive from mothers and teachers about their bodies, general appearance, exercise and eating practices. Participants were 10 female teachers and 53 mothers. The behaviours of the 53 children (24 boys, 29 girls) were also observed to determine the nature of their eating and exercise behaviours. The results demonstrated that both mothers and teachers expressed concerns about their own bodies. Mothers also communicated messages to their daughters about losing weight and messages to their sons about increasing their muscles. Both girls and boys were concerned about their appearance, particularly their clothes and hair. Girls also demonstrated some concerns about losing weight, and boys with increasing muscles. Implications of these results are discussed in terms of designing education programs for mothers, teachers and children to prevent the development of body image concerns and disordered eating among children.

Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls

Research on body image has primarily been conducted among Western women who highly value the thin ideal body size. There has been limited research that has examined body image attitudes among Fijian adolescent girls who are exposed to both traditional sociocultural pressures that promote a larger body size and Western pressures that promote slimness. Using in-depth semi-structured interviews, we examined the factors associated with body image attitudes and concerns among a sample of 16 indigenous Fijian and 16 European Australian adolescent girls aged between 13-18 years. An inductive analysis of girls' responses indicated that both groups of girls experienced body image concerns including body dissatisfaction, a preference for thinness and concerns associated with weight gain. These findings have implications for our understanding of the role of culture in shaping body image among girls and may prove useful in the development of future survey research that can be implemented among both Fijian and Western adolescents.