Body Image in Children and Adolescents:

Why the unhealthy cognitions and behaviors? Why the dissatisfaction? What can be done to stop this?

Kelly Grimes


Introduction: An Overview

What is body image? A two-dimensional model of body image incorporates both perceptual and emotional components. It focuses on both how we feel about the size and shape of our bodies and how accurately we perceive our body size as well. A more recent cognitive approach suggests that body image is a complex set of cognitive schema. A schema is a grouped body of knowledge. Groups of schema are readily available for important tasks such as guiding behavior, circumstantial scripts (or dialogue), and evoking the appropriate emotional, somatic, visual, and auditory responses in certain situations. The cognitive schema for body image is an organized domain of knowledge about oneself and others. Different situations evoke different schema. For example, watching a runway show or looking at a women’s magazine filled with page after page of waifs may evoke the "I’m fat" schema, while being complimented for how good your body looks in a certain dress may evoke the "I’m sexy" schema. We begin constructing schema from a young age; thus, by the time we are adults we have been through many experiences and established very elaborate schema. Such elaborate constructs are resistant to change. These schema influence our perception of the world and ourselves, our feelings, and our behaviors.

Every culture around the globe stresses specific ideals for body image. In the United States and many other countries, the media plays a big role in how we view ourselves- it shows us what is "good" and what is "bad." In many ways our society infiltrates our concept of ideal body image by setting unrealistic expectations for both genders. At an early age we are instructed to pay special attention to our appearance. At an early age body image schema develop through the training given to us by our families, peers, and the mass media. Unfortunately, studies show that many young children have already internalized negative body images of themselves. Body image is studied widely in the fields of psychology and psychiatry because of the correlation between body image distortions and eating disorders or self-esteem issues.

My literature review paper includes several very recent studies that address the cognitive and behavioral components of body image and dieting in young children and adolescents. I discuss what is known and what is still not understood about body image in children around the world today. I give examples of holistic programs developed for school and community involvement in body image awareness. I attempt to show the complexities of the issues about body image and conclude with (what I feel might be) the most effective method (to date) for incorporating healthy body image awareness into the community and instilling realistic goals within each individual child.

The Research

Research with preadolescent children reports mixed findings about at what age body image becomes a real issue for them. Body-image dissatisfaction was believed to be associated with the onset of puberty. Current literature suggests that the development of body image dissatisfaction occurs as much as 3 to 4 years prior to the onset of puberty. A study by Rolland, Farnhill, and Griffiths (1997) showed that children as young as 8 years of age report high levels of body dissatisfaction and negative thoughts about being overweight (Kostanski & Gullone, 1999). For over a decade research has indicated the prevalence of this early development. Thelen et al. (1992) published findings indicating that girls between second and fourth grade were already concerned about their weight. Girls between fourth and sixth-grade expressed even greater anxiety about gaining weight and a desire to be thinner than they were (Kostanski & Gullone, 1999).

The desire to be thin contributes to unhealthy eating behaviors (including unnecessary restriction of food intake) which are particularly dangerous for children because they need proper nutrition to continue normal physical development.

Body image dissatisfaction and dieting in children

Kostanski and Gullone (1999) investigated the relationship between perceived body-image dissatisfaction, concepts of dieting, and reported restrictive eating behaviors in primary school students (Kostanski & Gullone, 1999). This recent study incorporates three related issues in a comparative study, incorporating an additional measure examining the cognitive aspects of children’s diet related-beliefs.

The study invited children to participate in a self-report survey of body-image dissatisfaction, and dietary behaviors and attitudes. The study took a sample of 431 Australian children in Grades 2, 3, and 4. The sample consisted of 199 boys and 232 girls with an age range from 7 years to 10 years and 9 months. BMI was calculated to be 16.7 for boys and 16.5 for girls.

The study used three forms of measurement. The first was a sentence-completion task with questions related to knowledge about dieting and dieting behaviors. A Likert-type scale ("I diet…" always, sometimes, or never) scored dieting behavior and there were two additional sentence completions that allowed for qualitative response. Previous studies have shown that young children may offer a perceived desired response. Because this bias accounts for higher scores, this study offered an I don’t know response. Using a Figure Rating Scale (developed by Collins, 1991) participants were asked to choose the figure that looked most like them out of seven drawings of preadolescent figures ranging from thin to obese. There were actual cognitive, actual ideal, actual affective, and ideal components to this test. Discrepancies between the components showed the level of perceived body image dissatisfaction. The third instrument used was the Children’s version of the Eating Attitudes Test (ChEAT), a measure established by Maloney et al.(1989) of dieting behaviors, food preoccupations, weight concerns, and bulimia. This is a 26-item self report test with a Likert scale. The ChEAT has high internal reliability and test-retest reliability.

The children were divided into four age groups and three BMI groups. Statistical methods including Pearson’s chi square, MACOVAs and ANCOVAs were used to interpret relationships. Results showed that children were aware of their body image but few had actually dieted. The Figure Rating Scale findings indicated that 33% of the children felt larger than their ideal body size as well as a significant main effect in level of cognitive dissatisfaction, with girls reporting higher levels than boys. The sentence completion tasks showed that the majority of subjects had clear social attitudes and beliefs toward dieting. 28% indicated that they were not sure what dieting meant, while most understood how to control their weight with dieting. Many of the children reported using dieting behaviors, but over 76% indicated that they had never dieted. The ChEAT score analysis showed that there was a strong correlation between cognitive and affective body dissatisfaction. The children who perceived themselves to be very large also indicated the highest levels of restrictive eating behaviors.

This study was important because it investigated not the understanding of what dieting means, but the underlying knowledge of the concept as it relates to the concept of body image. The study added validity to previous research of ChEAT measurements of restrictive eating behaviors. It provided further evidence that children report preference for mesomorph ("normal") figures. It also showed that children as young as 7 years old are capable of perceived body dissatisfaction- these thought patterns are instilled at a much younger age than the onset of puberty.

The research further proved that the relationship between body-image dissatisfaction and dieting is significant. However, the low correlation between them suggests that they are for the most part individual concepts, with body-image dissatisfaction representing negative cognitions about the self, and restrictive eating behaviors associated with socially learned lifestyle behaviors.

The research was thorough in its use of measurements and added beneficial information to an existing base of knowledge. The researchers commented on the limitations of a cross-sectional study and hoped that in the future researchers might use a prospective study. A longitudinal study might give more insight into how these feelings and behaviors progress throughout adolescence.

Body image dissatisfaction and ideal size preferences in children

A recent report by Gardner, Friedman, and Jackson (1999) discusses the results of the second year of a 3-year long longitudinal study on children’s body size estimations. The study took a sample of 216 children ages 6 to 13. It focused on improving the assessment of body image distortions related to perceptual aspects of body size (the degree to which a person accurately perceives her body size).

Gardner et al. (1999) used a tv-video system to measure the children’s body size estimations. Three psychophysical procedures were also used to assess body size estimates. Method of adjustment presented a distorted image that the subject had to manipulate to look like a personal representation. The Staircase Method presented the children with an image that became larger or smaller in 2-second intervals. The subject had to estimate when the body size was the same as their perceived actual size. The third procedure was called the Adaptive Probit Estimation and measured the subject’s ability to judge body image distortion compared to their actual size.

The best example of body dissatisfaction was the discrepancy between children’s perception of their body size and the judgement of how they would ideally like to look. For the most part, their ideal image was thinner than their perceived actual size. The method of adjustment test showed that females wanted a greater change in body size than males. Gender differences seemed to manifest at around age 9. As both genders got older, the discrepancy between females and males increases; females develop increased dissatisfaction with their bodies as they reach puberty while satisfaction level remains constant for males.

Overall the children estimated their body size accurately. The total sample averaged estimations of body size remained constant, but there was significant individual variability between the first and second year (11.5%). The adaptive probit estimation methodology measured any response bias.

A variety of factors- including self-esteem, body esteem, birth order, number of siblings, and parents’ SES- were assessed using a variety of tests. A series of multiple regression analyses examined the effects of these factors. Higher fathers’ SES associated with a thinner ideal body size; taller children had less body dissatisfaction and heavier children had more; first born children in a family with many children were more dissatisfied with their body size.

The benefits of a longitudinal study allowed researchers to better understand the effects of weight and height gain on their ideal and perceived body size estimations. The most evident findings suggest that females show much higher levels of body dissatisfaction beginning at age 7 and increasing through age 13, which provides evidence that females may be more likely to develop eating disorders. The factors associated with body image are all predictors of dissatisfaction level but the strengths of the relationships are low. Thus, further study needs to work on understanding these different factors that predict body size estimations and body dissatisfaction.

Little is known about body image perception in fast growing populations in America such as Hispanics. 189 white and Hispanic children took part in a study where they looked at figure drawings to determine their perceived and ideal body sizes as well as same sex and other sex body size. 7, 10, and 13 year olds participated (Gardner & Friedman, 1999).

A high level of body dissatisfaction was shown for girls but not for boys. This was because the discrepancies between perceived and ideal body weight (a measure of body dissatisfaction) were greater for girls. As a whole, no differences were found between white and hispanic children on judgements of perceived body size, ideal body size, or body dissatisfaction. But there were significant differences between the genders in the white population of the study. Gender differences seem to be much larger and more consistent overall than ethnic differences.

In the future, studies might possibly focus on longitudinal methods of assessing ethnic differences. The researchers note that it is possible that differences might develop as the children mature into adolescence.

Children’s concern for thinness around the world

Eastern countries are beginning to eating disorders in their cultures that were once reserved for Western countries. In a recent study in Taiwan a sample of 890 10 to 14- year old girls was selected. This study was established for the collection of data in questionnaire format concerning satisfaction with body weight, perceived weight categories, and weight-loss practices. A third of the group in normal weight range perceived themselves as overweight; 71% of these subjects said they would like to be thinner (Wong, Bennink, Wang, & Yamamato, 2000).

The results suggest that dissatisfaction characterizes women of all weight categories. Possible longitudinal follow-up might help researchers understand the consequences of preadolescent feelings on maladaptive postadolescent behavior.

Adolescent Perceptions of Weight Gain

Excessive concern over weight gain is common in adolescents. Literature indicates that adolescents are extremely concerned with body image, yet poorly predict their actual body weight. Females tend to perceive themselves as overweight. They use a variety of harmful methods to control their weight. A recent study by Kilpatrick, Ohannessian, and Bartholomew (1999) investigated weight perceptions of adolescents in the United States and the prevalence of weight-loss and gaining activities.

This study was part of a larger study of adolescent health behavior known as the National Longitudinal Study of Adolescent Health (Add Health). This particular study surveyed 6,504 adolescents stratified by factors such as ethnicity and urbanicity, producing a national sample of 7th through 12th graders.

Measurements included ten questions from in-home and in-school interviews chosen from AddHealth, among which asked questions related to perceived weight, weight change activities, BMI, and school health education. Chi square analysis was used for data analysis.

The results showed that as a group, 19.5% of adolescents were attempting to gain weight, while 33.6% were attempting to lose weight. Females were more likely to be attempting to lose weight while males were more likely to be attempting to gain weight. Younger students were less concerned with efforts to control weight gain. Native Americans were the largest ethnic group most likely to attempt weight loss. Almost a third of the student population considered themselves to be overweight; females more so than males. About half of the student sample accurately classified their weight. About one-fifth of the students were attempting inappropriate weight loss techniques.

Using a Chi-square test with such a large sample group is more likely to produce significant results, so this study selected the more stringent p-value of .001 rather than the usual .05. Comparing BMI with perceptions of weight effectively indicated adolescent’s inability to accurately classify their weight. Limitations of this study are that is was cross-sectional as well as relied on adolescent self-report.

The effects and interactions of gender, pubertal status, and weight gain on the self-concept and body image of adolescents are discussed in the research of O’Dea & Abraham (1999). The variables were known to have an effect on self-concept; However, interactions among the variables were not well understood.

7th and 8th graders were given questionnaires to obtain demographic data and the Self-Perception Profile for Adolescents to determine self-concept. Results showed that males and females tended to score higher in certain categories. Females had a more positive self-concept of close friendships, while males had more positive academic, physical, and athletic competence than females. In terms of all scores, postmenarcheal females had the lowest mean self-concept scores. The research results show, in accordance with other studies related to this subject, that male students in general have a higher self-esteem regarding their body image than female students.

These studies suggests that to improve overall body image awareness and well-being, children must be taught from the inside out; that is, they must develop positive cognitions about their bodies and learn how to effectively deal with societal pressures to conform to an ideal body image. Research indicates that there is a lack of awareness in children and adolescent populations regarding their weight and body.

A study by Kilpatrick et al. (1999) shows the importance of health education. 92.2% of the students reported learning about the importance of exercise and proper nutrition in health class. Rather than unhealthy weight management strategies, exercise was the most popular method of weight control in the large sample. Those health classes with emphasis on problems related to being an inappropriate weight had a greater impact on weight change efforts than health education that only provided information about exercise and diet. This study suggests that students may make healthier life choices regarding their weight management strategies if educated about the health risks involved in not following such beneficial strategies. However, adolescent self-report does not indicate how adequate the health education was. Also, behavior change does not occur automatically with the exposure to health education.

Health education is most beneficial for students when it focuses on strategies of prevention rather than on the problem. In program planning educators must remember to take into account the range if effects puberty has on male and female students (O’Dea & Abraham, 1999).

O’Dea and Maloney (2000) outline the Health Promoting Schools Framework and how it might be implemented into school systems for preventing body image and eating problems. This emphasizes a holistic approach to health in which everyone in the children’s lives gets involved. The approach teaches that education and health are inseparable. It includes classroom Health Education such as a focus on dieting prevention as well as the restructuring of school environment around policies and practices that contribute to a healthful environment. Finally, it involves developing relationships within the community outside the school. Comprehensive coverage of diverse aspects of health from trained professionals promotes a healthy body image and eating behaviors. The researchers used this framework in a case study showing the effectiveness of a multifaceted revival of health education (O’Dea & Maloney, 2000).

Another approach consisted of after-school health education incorporated into the Girl Scout program. The goals of this prevention program called Taste of Food, Fun, and Fitness, targeting girls age 10-12, was to develop healthy attitudes toward body image, weight control and prevention, and eating. It hoped to instill messages of affirmation within the girls to countereffect the dieting pressures constructed by social norms and the media.

Most of the program was well-received by parents and the girls liked the program as a whole. They enjoyed creating their own "pro-girl" commercials and having snack time, but the physical component was not as satisfactory for them. However, in a postintervention survey, the results showed that there were minimal changes in eating attitudes and behaviors. Thus, these types of programs might need more focus, particularly on the role the media plays in the development of body image.

Our society cannot expect them to incorporate the facts they learn in a health class into their cognitive schema of body image. To reach a goal of health for children and adolescents, I believe that professionals and lay people from many different disciplines must work with one another to create unique health promotion efforts that sustain long-term changes in body image.







Kostanski, M. & Gullone, E. (1999). Dieting and body image in the child’s world:

Conceptualization and behavior. The Journal of Genetic Psychology, 160(4),



Gardner,R.M., Friedman, B.N., & Jackson, N.A. (1999) Body size estimation, body

Dissatisfaction, and ideal size preference in children six through thirteen.

Journal of Youth and Adolescence, 28(5), 603-618.


Kilpatrick, M., Ohannessian, C., & Bartholomew, J.B. (1999) Adolescent weight

Management and perceptions: An analysis of the National Longitudinal study of

Adolescent Health. The Journal of School Health, 69(4), 148-152.


O’Dea, J.A. & Abraham, S. (1999) Association between self-concept and body weight,

Gender, and pubertal development among male and female adolescents.

Adolescence, 34(133), 69-79.


Gardner, R.M., Friedman, B.N., & Jackson. (1999) Hispanic and White children’s

Judgements of perceived and ideal body size in self and others.

The Psychological Record, 49(4), 555-564.


Wong, Y., Bennink, M.R., Wang, M., & Yamamato, S. (2000) Overconcern about

thinness in 10- to 14-year old schoolgirls in Taiwan. American Dietetic Association, 100(2), 234-237.


O’Dea, J. & Maloney, D. (2000) Preventing eating and body image problems in

Children and adolescents using the health promoting schools framework.

The Journal of School Health, 70(1), 18-21.


Coller, T.G. & Neumark-Sztainer, D. (1999) Taste of food, fun, and fitness:

A community-based program to teach young girls to feel better about their bodies.

Journal of Nutrition and Education, 31(5), 292-293.


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