Adolescents' body image and analysis of effectiveness of body image improvement program

Our children grow and mature in the times, where image and media attention to a beautiful body is overestimated, and the social pressure for meeting image expectations influences and affects the development of immature persons. The less physical characteristics of a person meet social expectations, the more dissatisfied the person is with his/her body, the lower is self-esteem, and the bigger is propensity for depression and manipulation with food (Cash, Pruzinsky, 2004; Tiggemann, 2011). Adolescent dissatisfaction with appearance is related to low self-esteem that leads to eating disorders or disordered eating. Such behaviour is harmful to health and causes obesity (Haines, Neumark-Sztainer, 2006). Poor self-esteem is associated with a higher likelihood of becoming a victim of bullying (Jankauskiene et al., 2008), increased risk of suicide and deliberate self-harm (Rodrigues-Cano, Beato-Fernandes, Llario, 2006; Laskytė, 2009). A large part of modern consumerist society is constantly concerned about weight loss/gain methods that promise rapid results (O’Dea, 2007; Bauman, 2011; Tereškinas, 2011). Seeking peer recognition and wanting to meet the society’s expectations young people often exhaust themselves with diets and/or excessive exercise (O’Dea, 2007; Ojala et al., 2007; Sabbah et al, 2009; Jankauskienė et al, 2010; Tereškinas, 2011). Obesity and eating disorders prevention programs are not standardized and are based on parental understanding of healthy nutrition, physical activity and body weight control. Unfortunately, this understanding is not always correct. Health educators along with physical education and other teachers must seek that obesity prevention programs would not induce negative body image, biased judgement of personal body weight, not provoke eating disorders, not uphold the understanding that dieting, intensive exercising and imbalanced nutrition is a norm (O’Dea, 2005). Until now research was mainly focused on disordered eating behaviour, whereas there are few studies into exercising behaviour to control the body weight. It is not clear how internalization of sociocultural ideals towards appearance is related to weight control behaviour and it is unknown how adolescents behave if they decide to lose weight by exercising. There is a lack of studies revealing the relationship between adolescent body image and health perception with the drive for thinness and muscularity in different physical activities and sports. The above statements prove the relevance of research into the relations between adolescent body image, physical activity and weight control behaviour as well as body dissatisfaction prevention. There are very few studies analysing the said issues from the gender perspective. Research aim is to determine the characteristics of body image among adolescents and to investigate the effect of educational program on its correction. To solve the problematic issues and verify the hypotheses the primary research objectives were to: 1. Determine the expression of body image and related factors in groups by of gender, body mass index and physical activity. 2. Find the relationship between body image and sociocultural, self-esteem, and unhealthy weight control behaviour factors. 3. Assess the factors that predict unhealthy weight control behaviour among teenagers. 4. Develop an educational program and evaluate its effectiveness for the improvement of body image and health literacy in body mass control. Methods of the first survey. The participants filled the questionnaires consisting of different scales (SATAQ, MBSRQ-AS, DMS, EAT-26, Rosenberg’s self-esteem scale, Unhealthy weight loss behaviour and unhealthy exercising behaviour scales, PA, etc.) and other demographic questions. Data of 805 adolescents (mean age – 17.23 (0.6) years, 476 (58.9%) of them were females) were used for the analysis. Methods of the second survey. We used an educational experiment (with the support of Research Council of Lithuania (No MIP-22/2010) and interviewing in writing. The students were asked to fill in a specially designed for this survey questionnaire consisting of different scales (EDI, EAT-26, DMS, Rosenberg’s Self-esteem scale, LTEQ, etc.). The sample for the analysis of health education program efficiency contained 448 subjects (191 boys and 237 girls). The subjects’ average age was 15 (0.42) years. Dissertation structure and scope. The thesis consists of introduction, theoretical backgrounds (literature review), description of research methodology, presentation and discussion of research results and conclusions with recommendations. The evidence is presented in 56 tables and illustrated in 21 figures. The reference list consists of 441 sources. 17 annexes include permits to conduct the survey, sample agreements, permits to use the scales and tables of research results. Conclusions: 1. Body image is a problematic issue among teenagers. Body image dissatisfaction is more common among adolescent girls and teenagers with higher body mass index and lower physical activity. Adolescent girls have a more negative body image; they are more likely to use unhealthy weight control behaviours (and risk of eating disorders) and are less physically active, whereas adolescent boys have a higher drive for muscularity and related behaviours. Underweight teenagers have the best body image. Overweight teenagers most often use unhealthy weight control behaviours, they smoke more often, however their physical activity does not differ from their peers with normal body mass index. Physically active teenagers have better body image, use unhealthy weight control behaviours less frequently but have a higher drive for muscularity. 2. Adolescent girls more than boys internalize sociocultural ideals towards appearance. Less physically active and overweight teenagers experience a higher pressure to meet appearance ideals. Internalization of sociocultural ideals towards appearance among teenagers is related to higher body dissatisfaction, more frequent unhealthy weight control behaviour, lower physical activity and more frequent alcohol abuse. The perceived pressure to meet appearance ideals is related to lower self-esteem, more frequent unhealthy weight control behaviour and smoking. Internalization of athletic ideal is related to a higher drive for muscularity. 3. Unhealthy weight control behaviour (risk of eating disorders) can be best predicted from the access to information about the ideal appearance, body dissatisfaction, low self-esteem and insufficient physical activity irrespective of body mass index. The drive for muscularity among teenagers is mostly predicted by male gender, athletic ideal internalization, body dissatisfaction and lack of physical activity. 4. The educational program developed on the basis of cognitive dissonance strategy and aimed for raising self-esteem and improving media literacy had a positive effect on adolescent self-esteem, but it did not have a significant effect on the changes in body image, drive for thinness, risk of eating disorders, body weight control and physical activity literacy. The program content and implementation measures should be corrected by conducting further research