Digital Manipulation of Images of Models' Appearance in Advertising: Strategies for Action Through Law and Corporate Social Responsibility Incentives to Protect Public Health

A mixed-methods study among adolescents and teachers in Bogotá, Colombia: adapting the OurFutures Alcohol Program

Early onset of alcohol consumption among Colombian adolescents highlights the need for effective and accessible preventive interventions. This project aimed to conduct formative work to inform the adaptation of an effective eHealth alcohol use prevention program originally developed in Australia, the OurFutures Alcohol Module, to the Bogotá context. Twenty-six adolescents and 10 teachers in Bogotá participated in the study. We used a mixed-methods approach comprising interviews, surveys and semi-structured discussions to evaluate the acceptability of OurFutures. Study materials were translated into Spanish before conducting three 1.5-hour focus groups with adolescents (aged 11-15; n = 26), and 1-hour interviews or online surveys with teachers to assess attitudes towards alcohol use and the acceptability of one lesson from the OurFutures Alcohol Module in the Bogotá context. Qualitative data were analysed thematically, and descriptive analyses of quantitative data reported percentage agreement for survey questions. Overall, 96% of students and 89% of teachers expressed strong satisfaction with the OurFutures Alcohol Module lesson. Most students (96%) liked its storyline and character portrayal, and most teachers (80%) said they would use OurFutures with their students. Participants provided feedback for improving program relatability, including adapting scenarios, character names, clothing and language to align with the Bogotá context and resonate with Colombian adolescents. This study marks the first step in informing the adaptation of the OurFutures Alcohol Module to the Bogotá context and highlights key considerations for cultural adaptations of other substance use prevention interventions. This research underscores the importance of place-based end-user involvement in co-designing adolescent prevention interventions.

A Close Association between Body Weight, Health-Related Quality of Life, and Risk Behaviors in a Sample of Italian High School Students

INTRODUCTION

Adolescents experience rapid physical, cognitive, and psychosocial growth with different factors contributing to health and well-being. In this view, an important role is played by body weight and related perceptions. The purpose was to determine, in a sample of Italian high school students, whether health-related quality of life (HRQoL) is associated with the different weight status categories (underweight, normal weight, overweight, obese), even considering sex differences.

MATERIAL AND METHODS

Data were collected from 1826 adolescents (n = 735 males). HRQOL was analyzed using the Italian version of KIDSCREEN-52.

RESULTS

Overweight adolescents showed reductions in psychological well-being (p < 0.05) and self-perception (p < 0.05) compared with individuals in other BMI categories. Subjects with obesity reported increased bullying victimization (p < 0.05) and reductions in self-perception and eating disorders (p < 0.001), while underweight individuals were characterized by altered adherence to the Mediterranean diet (p < 0.001), eating disorders (p < 0.001), and problematic use of social media (p < 0.05). No sex differences were found, except for socio-economic status perceptions, where underweight girls reported higher economic well-being than boys (p < 0.05).

CONCLUSIONS

Our findings may suggest that there is an association between weight status categories and HRQoL that is more pronounced in underweight and overweight adolescents. The association between BMI categories and psychosocial dimensions opens the need to define specific domains on which such preventive interventions should focus, always through a personalized perspective.

Sunscreens - another endangered species?

Skin cancer continues to increase in incidence year-on-year and represents the most common form of cancer across the globe. Every human undergoes premature ageing, particularly on the face, neck and hands. Both phenomena are driven primarily by chronic, daily exposure to solar ultraviolet radiation (UVR). While sunscreen products play a primary role in the prevention of UVR skin damage, the active ingredients, i.e., UVR filters, are facing unprecedented challenges in the coming 10 years and their future is by no means certain. This article, therefore, reviews afresh the facts around photoprotection and the role of sunscreen products in the prevention of acute (sunburn) and chronic (cancer, photoageing) skin damage and compares/contrasts these with various emerging questions and opinions around UVR filter technology. We present a passionate defence of this remarkable technology, but also attempt to imagine a world without it.

Population-level policy recommendations for the prevention of disordered weight control behaviors: A scoping review

OBJECTIVE

The aim of this scoping review was to identify recommendations and gaps in knowledge surrounding the prevention of disordered weight control behaviors (DWCBs) through policy.

METHOD

A search was conducted in several databases to identify English language articles that described an active policy, recommendation, guideline, or educational curriculum that could be implemented by governments or regulatory bodies to prevent DWCBs or related constructs (e.g., weight stigma, body dissatisfaction). Two researchers independently screened articles with oversight from a third researcher. Data were extracted from the final sample (n = 65) and analyzed qualitatively across all articles and within the domains of education, public policy, public health, industry regulation, and media.

RESULTS

Only a single empirical evaluation of an implemented policy to reduce DWCBs was identified. Over one-third of articles proposed recommendations relating to industry regulation and media (n = 24, 36.9%), followed by education (n = 21, 32.3%), public policy (n = 19, 29.2%), and public health (n = 10, 15.4%). Recommendations included school-based changes to curricula, staff training, and anti-bullying policies; legislation to ban weight discrimination; policies informed by strategic science; collaboration with researchers from other fields; de-emphasizing weight in health communications; diversifying body sizes and limiting modified images in media; and restricting the sale of weight-loss supplements.

DISCUSSION

The findings of this review highlight gaps in empirically evaluated policies to reduce DWCBs but also promising policy recommendations across several domains. Although some policy recommendations were supported by empirical evidence, others were primarily based on experts' knowledge, highlighting the need for greater research on population-level DWCBs prevention through policy.

PUBLIC SIGNIFICANCE

Our scoping review of the evidence on policies for the prevention of disordered weight control behaviors identified several recommendations across the domains of education, public policy, public health, and industry regulation and media. Although few empirical investigations of implemented policies have been conducted, expert recommendations for policies to prevent disordered weight control behaviors among populations are plentiful and warrant future consideration by researchers and policymakers alike.

Addressing eating disorders through legislation: The Israeli 'Models' Law'-process, enactment, and dilemmas

Preventing the onset of eating disorders and disordered eating pathology is crucial. While these conditions have a multi-factorial etiology, socio-cultural norms, particularly the media, contribute greatly. Policy and legislative action are warranted to change harmful media images. To the best of our knowledge, Israel was the first country to tackle the problem of unrealistic and unhealthy images in the media through legislation by initiating and passing an innovative law. The "Knesset," the Israeli Parliament, voted in December 2012 to pass new legislation that forbids the appearance of underweight models (BMI of 18.5 or less) in commercial advertising. The law further requires that if a graphic editing program has been used to reduce the dimensions of a model in advertising photographs, this fact must be clearly indicated. The purpose of this article is to describe the law; the process and obstacles to creating and passing the law in the Knesset; national and international reactions to this Israeli law; and the challenges of implementing (enacting and enforcing) this law in Israel. Given that other countries are implementing similar policies, additional legal approaches are described, including ideas for further research on how to enact, enforce, and evaluate the impact of such laws.

Social media use and body image issues among adolescents in a vulnerable Louisiana community

Widespread concern has been expressed regarding unrealistic body image and adolescent eating disorder promoting content on social media (SM) platforms. Numerous research studies have examined the impact of SM on body image as well as social vulnerability on negative mental health outcomes. Despite this, few previous studies have examined the impact of SM on body image specifically in vulnerable, underserved, or predominantly minority communities. This study examines the impact of SM on body image issues (BII) in adolescents in a public school system where greater than 50% of the students live in impoverished households. In late 2019, high school student leaders in Northwest Louisiana developed a survey alongside Step Forward, a collective impact initiative. Questions investigated adolescent SM use and mental health in Caddo Parish, namely BII. Teachers within Caddo Parish Public School System administered the survey. Out of the 11,248 total high school students in the school system, nearly 50% were sampled for a sample size of 5,070. Hypotheses included: (1) females were more likely to use SM than males, (2) increasing time spent on SM would correlate with females reporting BII, with males remaining largely unaffected, and (3) highly visual social media (HVSM) platforms would be associated with greater reports of BII than non-HVSM platforms. Results showed females were more likely to use SM (p < 0.001) and report BII (p < 0.001) compared to males, while both sexes reported BII with increasing time spent on SM (p < 0.001). A diversity of platforms were associated with increased BII among SM users compared to non-users (p < 0.001): Pinterest, Reddit, Snapchat, TikTok, Twitter, and YouTube. This conclusion is tempered by the omission of race as a variable in the study design, the use of self-report, and the use of an unvalidated instrument. These findings suggest that the harmful association between SM use and BII may transcend culture and socioeconomic status for a broadly deleterious effect on adolescent mental wellbeing.

Beauty and the big business: A qualitative investigation of the development and implementation of the CVS Beauty Mark

Detrimental effects of retouched media imagery on body image among women have led to calls to increase transparency regarding the use of digital modification. CVS Health, a large US-based beauty retailer, announced in 2018 its intention to implement across its beauty department imagery two labels: a "Beauty Mark" label to indicate a retouch-free image, and a second label disclosing digital modification. The aim of the present study was to explore the motivations, facilitators, and barriers to its implementation. In-depth individual interviews (n = 11) were conducted with professionals involved in the conceptualization, development, artistic vision, and implementation of the initiative. Thematic analysis revealed three themes: (1) CVS's perception that the campaign as a good fit; (2) the marketing of "empowerment" to generate profit as well as a desired outcome; and (3) desire to exemplify a value-driven company model and contribute sustainably to broader values such as diversity and body positivity. These findings may help to identify ways in which to create larger scale change within media imagery.

Examination of Self-Esteem, Body Image, Eating Attitudes and Cardiorespiratory Performance in Adolescents

Self-esteem, body image and eating attitudes are important characteristics regarding adolescent mental health. In our present work, we aimed to investigate these psychological items in adolescent boys and girls examining gender differences and correlations with the BMI-for-age and cardiorespiratory performance. 374 students (209 girls with an average age of 16.4 ± 1.08 years, and 165 boys with an average age of 16.5 ± 1.03 years) underwent investigation using the Rosenberg self-esteem scale, EAT-26 and BAT questionnaires. The BMI-for-age was calculated with BMI growth charts and the cardiorespiratory performance was measured with the 20 m shuttle run test. Our results showed that adolescent girls scored lower self-esteem and higher values for BAT and each scale of eating behaviors, such as uncontrolled eating, cognitive restraints and emotional eating compared to boys despite the fact, that obesity and overweight were more common among boys. No significant correlation was found between BMI and psychological test results in either boys or girls, however, subjective body shape and gender predicted self-esteem and BAT scores and the cognitive restraints in the eating attitudes. Uncontrolled and emotional eating were primarily influenced by gender, in which BMI played only a weaker role. Cardiorespiratory performance was positively associated with self-esteem and body image among boys, and it had a negative correlation regarding BMI in both genders.

The effects of self-disclaimer Instagram captions on young women's mood and body image: The moderating effect of participants' own photo manipulation practices

The current experiment investigated the impact of attaching self-disclaimer captions (i.e., captions about whether photos had been edited) to thin-ideal Instagram photos on young women's body image and mood. Participants were 311 undergraduate students aged 18-25 years. Participants were randomly assigned to view images of a thin woman on Instagram with no captions, or with a generic, specific, or warning self-disclaimer caption, and completed pre and post measures of body image and mood and a questionnaire about their own photo-editing practices. Across all conditions, exposure to the images resulted in decreased body satisfaction, likelihood to compare one's body to another's, happiness, confidence, and anxiety. There was no significant effect of disclaimer type on body image or mood, and therefore no type of self-disclaimer had an ameliorating effect. However, specific disclaimers were superior to the other disclaimers at reducing likelihood to compare one's body to another's, for women high on photo manipulation. Future research should be conducted in adolescent girls and men.

Consumer warning versus systemic change: The effects of including disclaimer labels on images that have or have not been digitally modified on body image

Two strategies for protecting body image against the negative effects of exposure to idealized media images have been proposed: (1) using labels to alert viewers to digital retouching, (2) limiting digital retouching. This study investigated the effects digitally modified vs.unmodified images and the use of labels on those images (disclaimer/retouch-free] vs. unlabeled) on appearance satisfaction and mood. Trait upwards appearance comparison, media ideal internalization, media similarity, and body appreciation were explored as moderators. Participants (n = 614, women, 18-30 years) viewed the same ten images of female figures (both thin ideal and size/shape diverse images) across four conditions: (1) unmodified, unlabelled, (2) unmodified, labelled, (3) modified, labelled, and (4) modified, unlabelled images. Exposure to unmodified images was shown to be less harmful than exposure to modified images. Neither label type was associated with more positive outcomes compared to their counterpart unlabelled conditions. State appearance comparison was highest in the two labelled conditions. Trait upwards appearance comparison and media ideal internalization to some extent moderated effects on negative mood. Findings provide additional evidence that disclaimer labels on digitally modified images are not helpful for body image, while images that depart from the thin-ideal can contribute to promoting positive body image.

Adolescent body image: influencing factors and the clinician's role

PURPOSE OF REVIEW

Body image is a crucial part of adolescent development for teens all over the world. Studies show that negative body image impacts many aspects of adolescent health and that anticipatory guidance about body image is important at the annual health maintenance exam visit. Weight bias is closely tied to body image and is associated with negative health effects as well; research shows weight bias is a problem throughout healthcare. The purpose of this review is to discuss influencing factors on adolescent body image and to explore interventions to promote positive body image.

RECENT FINDINGS

Research shows that adolescent body image is shaped by media influence, athletics and personal relationships. Studies have also begun to show that negative and positive body image are separate entities, and that overall health outcomes seem to be better in adolescents with positive body image. In thinking about intervention, there are ways to promote positive body image in the provider--patient interaction, within the school and community, in healthcare education, and at the societal level.

SUMMARY

Body image is an incredibly important aspect of adolescent health, and clinicians should be aware of ways to help promote positive body image in adolescents.

Assessing the Cost-Effectiveness of Interventions That Simultaneously Prevent High Body Mass Index and Eating Disorders

Eating disorders (ED) are among the top three most common debilitating illnesses in adolescent females, while high Body Mass Index (BMI) is one of the five leading modifiable risk factors for preventable disease burden. The high prevalence of eating and weight-related problems in adolescence is of great concern, particularly since this is a period of rapid growth and development. Here, we comment on the current evidence for the prevention of EDs and high BMI and the importance of assessing the cost-effectiveness of interventions that integrate the prevention of EDs and high BMI in this population. There is evidence that there are effective interventions targeted at children, adolescents and young adults that can reduce the prevalence of risk factors associated with the development of EDs and high BMI concurrently. However, optimal decision-making for the health of younger generations involves considering the value for money of these effective interventions. Further research investigating the cost-effectiveness of potent and sustainable integrated preventive interventions for EDs and high BMI will provide decision makers with the necessary information to inform investment choices.

Labels to prevent the detrimental effects of media on body image: A systematic review and meta-analysis

OBJECTIVE

Most advertisements contain thin-ideal imagery enhanced by digital modification. The deleterious effects on body image and eating disorder risk of exposure to such images have been well documented. One of the proposed macro-level solutions to mitigate these effects has been the use of labels on images, primarily disclaimer labels. A growing number of studies have explored the usefulness of such labels in protecting body image against the detrimental effects of media exposure; however, findings have been divergent.

METHODS

The current study aimed to conduct a systematic review and meta-analysis of the existing literature investigating the effects of including labels on media images on body image.

RESULTS

The systematic review identified n = 22 studies that were included in a narrative review, n = 18 were included in the meta-analysis. Overall, findings provided little support for the use of disclaimer or warning labels as a means of protecting against the detrimental effects of media exposure on body image. Furthermore, findings suggested that such labels might increase state appearance comparison when exposed to media images.

DISCUSSION

These findings are especially concerning in light of recent legislative efforts to mitigate media effects through the use of labels on imagery, as well as industry initiatives based on image labeling. Additional research examining alternative strategies for universal prevention of body image and eating concerns is warranted.