Body Image 1 (2004) 15–28
Body image in children and adolescents:
where do we go from here?
Linda Smolak∗
Department of Psychology, Kenyon College, Gambier, OH 43022, USA
Received 15 June 2003; received in revised form 17 July 2003; accepted 17 July 2003
Abstract
During the past two decades, there has been an explosion of research concerning body image in children and adolescence.
This research has been fueled both by concern about the effects of poor body image in children and adolescents themselves and
by the assumption that body dissatisfaction during childhood and adolescence creates risk for the development of body image
and eating disturbances as well as depression in adulthood. The extant research, however, has remained largely descriptive and is
marked by methodological problems. The purpose of the present paper is to identify substantial gaps in the literature concerning
body image in children and adolescents. The focus is on four major issues: (1) measurement, (2) epidemiological data, (3)
developmental trends, and (4) the meaning of gender. Addressing these and related questions will aid in the development of
treatment and prevention programs.
© 2003 Elsevier B.V. All rights reserved.
Keywords: Childhood; Measurement; Development; Gender
Introduction
It is invariably instructive to interview children
about their appearance. There are the children, most
typically average size girls, who lower their eyes,
heads, and voices as they answer the questions on the
Body Esteem Scale (BES; Mendelson & White, 1993)
and tell us that no, they do not like the way they look
in pictures, yes, they wish they were thinner, and no,
their classmates do not want to look like them—why
would anyone want to look like them? There are the
young children who are already modifying what they
eat or doing aerobics with their moms in order to
∗
Tel.: +1-740-427-5374; fax: +1-740-427-5237.
E-mail address: [email protected] (L. Smolak).
lose weight. They surprise us with their knowledge of
weight loss and body sculpting techniques, specifying commercial diet programs, such as Jenny Craig,
by name. Even more stunning was the first grader
who told us you would need to throw up after eating or the elementary schoolers who thought plastic
surgery would be necessary to achieve the body ideal
portrayed by Christina Aquilera or Britney Spears
(Murnen, Smolak, Mills, & Good, in press).
These experiences point to one of the reasons researchers, educators, and parents are concerned about
body image in children. It is clear that some children
are already worried about their ability to look “good
enough” to be accepted by others. They are saddened
and embarrassed by their looks. They are already trying food restriction and exercise techniques to change
1740-1445/$ – see front matter © 2003 Elsevier B.V. All rights reserved.
doi:10.1016/S1740-1445(03)00008-1
16
L. Smolak / Body Image 1 (2004) 15–28
their bodies. Some of these attempts may be health
endangering. Thus, there seem to be children whose
lives are already being negatively affected by poor
body image.
These anecdotes also raise the possibility that the
foundation of body dissatisfaction is laid in childhood.
There is prospective, longitudinal evidence that adolescent body dissatisfaction and especially concerns
about being or becoming fat is related to the development of eating problems, eating disorders, and depression (e.g., Leon, Fulkerson, Perry, & Early-Zald, 1995;
McKnight Investigators, 2003; Stice, 2002; Stice &
Bearman, 2001; Stice, Hayward, Cameron, Killen, &
Taylor, 2000; Wichstrom, 1999). Finding the roots of
this risk factor will be crucial in both the prevention
and treatment of eating disorders and depression.
But experiences and anecdotes are not data. There
is now a sizeable body of studies of body image in
children and adolescents (for reviews, see Ricciardelli
& McCabe, 2001a; Smolak & Levine, 2001), but there
are even more unanswered questions. The purpose of
this paper is to raise four broad questions, each with
several accompanying specific issues that need to be
addressed empirically. These issues focus on (1) measurement, (2) epidemiological data, (3) developmental
trends, and (4) the meaning of gender. Research on
these, and related, questions will expand our knowledge base about body image in children which will,
in turn, provide an empirical foundation for prevention and treatment programs for body image and eating problems.
How should we define and measure body image
in children?
Researchers have long argued that body image
is multidimensional with at least perceptual, affective, cognitive, evaluative, and investment/behavioral
components (e.g., Muth & Cash, 1997; Thompson,
Heinberg, Altabe, & Tantleff-Dunn, 1999). These distinctions have been supported empirically in adolescents and adults (e.g., Muth & Cash, 1997; Thompson,
Altabe, Johnson, & Stormer, 1994). These distinctions
have rarely been addressed in research with children,
though they occasionally surface in research with adolescents (e.g., Ricciardelli & McCabe, 2003). Indeed,
several of the measures of body esteem commonly
used with children, such as the BES, cover a broadly
defined construct and do not allow the researcher to
specify the body esteem problem.
In addition, current research does not generally
have a way to identify problematic levels of body
dissatisfaction. As Cash (2002a) has argued with
respect to defining “negative body image,” dissatisfaction alone is an insufficient criterion; the emotional
and behavioral consequences of such dissatisfaction
must the considered. If body dissatisfaction is in
fact a “normative discontent” (Rodin, Silberstein, &
Striegel-Moore, 1985) among girls and women, it is
important to distinguish the girl who is engaging in
socially sanctioned “fat talk” for the sake of seeming
friendly from the child who is on a path to eating
disorders or depression. While a few studies have
identified “cut-offs” for weight concerns among adolescents for identifying girls at risk for developing eating problems (e.g., Killen et al., 1996), such research
is not available for children. Nor have similar cut-offs
been established for ethnic minority girls or for
boys.
Evaluative body image
Body image evaluation, which refers to how satisfied one is with one’s body (Muth & Cash, 1997),
is probably the most common aspect of body image
that is measured in children. This is also sometimes
referred to as attitudinal body image (Gardner, 2002).
Both figure drawings and questionnaires have been
used to assess body dissatisfaction in children and adolescents.
Being able to evaluate one’s body requires that the
child can assess her/his own body, has an ideal to
which to compare her/his body, and is capable of making such a comparison. It is possible that one must be
more than aware of the ideal; perhaps the ideal needs
to be internalized (Thompson & Stice, 2001) before
meaningful body dissatisfaction will develop. Clearly,
these components are in place by adolescence. But
when do they first appear?
In terms awareness of the culturally defined ideal
body, there are data indicating that 5 year olds
have absorbed the cultural bias against fat people (Cramer & Steinwert, 1998; Musher-Eizenman,
Holub, Edwards-Leeper, Persson, & Goldstein, 2003).
Three year olds may also be aware of the anti-fat
L. Smolak / Body Image 1 (2004) 15–28
prejudice but they are less committed to it. They
are less likely to ascribe negative characteristics to
fat children than 5 year olds are (Musher-Eizenman
et al., 2003). However, the 5 year olds have a wider
range of what constitutes an acceptable body type
than do adults (Musher-Eizenman et al., 2003).
Unfortunately, these studies are marked by methodological problems. The samples tend to be small
as well as white and middle-class, the designs are
cross-sectional, and there are questions about the
measures. For example, it is not clear that preschool
and even early elementary school children can use
checklists of fairly abstract personality characteristics (Musher-Eizenman et al., 2003). Indeed, they do
not use these types of terms to describe other people
(Ewell, Smith, Karmel, & Hart, 1996). Researchers
have not looked at whether measures such as the
Sociocultural Attitudes towards Appearance Questionnaire (SATAQ; Heinberg, Thompson, & Stormer,
1995) that measure awareness and internalization of
the thin-ideal are valid with preschool and early elementary school children, although revised forms do
appear to have validity with adolescents (Smolak,
Levine, & Thompson, 2001). Musher-Eizenman et al.
(2003) developed a story-based measure of fat prejudice. However, they do not provide psychometric
data, such as test–retest or internal consistency for
the measure. There are, then, questions as to how
to measure body ideal and fat prejudice in young
children.
There are also questions as to how children report
their “current” body types. Ideally, construct validity
of a measure would be assessed by correlating the
child’s actual BMI with the selected “current” figure
(in figural measures) or the chosen body shape category (in questionnaires). Unfortunately, BMI standards vary by age and gender. Therefore, it is not clear
that BMI in preschoolers carries the same meaning that
it does in adults. Researchers have used BMI, BMI percentile (based, for example, on the Centers for
Disease
Control data), and ponderal index (height/ 3 weight)
to assess levels of weight for height among children.
Without a valid criterion, it will be difficult to establish the construct validity of the child’s own body ratings. Research must examine the relationships of BMI,
BMI percentiles, and ponderal index in young children to future weight, body dissatisfaction, and eating
problems.
17
Figure drawings
Despite the problems with establishing the validity
of the current and ideal body shape components, there
are several versions of figure drawings that have been
used in research with children and adolescents. For
many of these, few or no psychometric data are available (see Gardner, 2001, 2002, for reviews). Probably the most commonly used of child figure drawings
measure was developed by Collins (1991). In her article, Collins (1991) reports an overall 3-day test–retest
coefficient for current self of first to third graders of
0.71. She does not report this correlation by grade
though she notes that figure selections “were stable in
many instances . . . but dropped sporadically in others”
(Collins, 1991, p. 203) when the analyses were performed by grade and gender. The test–retest correlations for other figure selections, including ideal self,
ideal other child, and ideal adult, did not reach the
acceptable level of 0.70 despite an interval of only
3 days. Furthermore, criterion validity correlations,
though statistically significant, were not impressive.
The correlation between pictorial self-selection and
weight was 0.36 while the correlation between BMI
and self rating was 0.37.
There are even fewer data available for preschool
age children. Not surprisingly, the news is worse.
Using an adaptation of Collins’s (1991) figures,
Musher-Eizenman et al. (2003) found no correlation
between preschool children’s height or weight and
their “current” body size rating. They did find a substantial correlation of 0.84 between the children’s
mothers’ ratings of maternal current body size and maternal BMI. Thus, while heavier adult women actually
select drawings depicting heavier people, children’s
selections are unrelated to their actual body size.
Quite simply, we do not have the validity data
to reliably use figure drawings with young children
(approximately ≤8 years old). In fact, the data have
not been collected to clearly indicate at what age the
current and ideal ratings, and hence the body dissatisfaction measures they constitute, become reliable,
although questionnaire data indicate that adolescents’
ratings should be reliable.
Questionnaires
Many researchers have simply asked adolescents a
single question such as “How satisfied are you with
18
L. Smolak / Body Image 1 (2004) 15–28
your appearance?” The only construct validity we have
for such questions is that they often show the expected
correlations with weight control strategies or eating
problems. Typically, test–retest is not reported.
One of the best available scales for assessing body
dissatisfaction among older children and adolescents
is the Eating Disorders Inventory Body Dissatisfaction
scale (EDI-BD; Garner, Olmstead, & Polivy, 1983).
Adequate internal consistency has been reported with
girls as young as 8 and for both boys and girls aged
11–18 years (Shore & Porter, 1990; Wood, Becker, &
Thompson, 1996). It also does seem to focus on the
evaluation component of body image. However, because this scale was developed to focus specifically
on body areas of greatest concern to females with eating disorders, its content narrowly emphasizes feelings
about one’s hips, thighs, buttocks, and stomach.
Several other measures, especially the BES
(Mendelson & White, 1993) and weight concerns
(Killen, 1996; Shisslak et al., 1999) have also shown
good internal consistency and reasonable test–retest
reliability. In the case of weight concerns, these forms
of validity have been demonstrated in children as
young as fourth grade (Shisslak et al., 1999). Furthermore, weight concerns has been shown to predict the
development of eating disorders, at least among adolescents (Killen et al., 1996; McKnight Investigators,
2003). Unfortunately, weight concerns mixes evaluative and investment aspects of body image and so can
be difficult to interpret. Furthermore, one attempt to
use it with 5–9 year olds indicated poor internal consistency (α < 0.70; Davison, Markey, & Birch, 2003).
1984), and the Harter Scales (Harter, 1985). Harter’s
Scales are applicable to both children and adolescents
and so may be particularly useful in longitudinal
research.
Affective body image
Body image schema
There are several self-esteem scales that tap feelings
about body or appearance in children and adolescents.
These are only occasionally used by body image researchers. However, some of them do demonstrate
at least internal consistency and test–retest reliability and so should be considered more thoroughly by
body image researchers. They might even serve as
criterion variables for researchers trying to develop
“purer” measures of body image focusing on muscles or weight. These scales include the Self-Image
Questionnaire for Young Adolescents (Petersen,
Schulenberg, Abramowitz, & Offer, 1984), the Offer
Self Image Questionnaire (Offer, Ostruv, & Howard,
Several authors have suggested that a body image
schema guides the interpretation of sociocultural influences, such as media images (Cash, 2002b; Markus,
Hamill, & Sentis, 1987; Smolak & Levine, 1994, 1996,
2001; Smolak, Levine, & Schermer, 1998; Vitousek &
Hollon, 1990). The schema serves as a mediator between the sociocultural influences and poor body image. The schema is thus crucial in understanding why
some people are so negatively affected by sociocultural influences while others are not.
Smolak and Levine (1994, 2001) have further argued that such a schema, which they term a “thinness
schema,” develops during childhood and is in place,
Body image investment
Body image investment involves both cognitive and behavioral indicators of the importance of
one’s appearance to one’s sense of self. Several researchers have offered lists of weight control techniques or muscle-building techniques to boys and
girls (e.g., Levine, Smolak, & Hayden, 1994; Shisslak
et al., 1999; Smolak et al., 2001). Perhaps one of
the better-developed measures is Ricciardelli and
McCabe’s (2002) Body Change Inventory. This scale
consists of three subscales: strategies to decrease body
size, strategies to increase body size, and strategies
to increase muscle size. As such, it is applicable to
both boys’ and girls’ body concerns since boys may
be as interested in gaining as in losing size (Smolak
& Levine, 2001). There is also some evidence that
African American girls may be interested in gaining
size (Thompson, Corwin, & Sargent, 1997), so this
scale may be of interest to researchers investigating
ethnic differences in body image. Ricciardelli and
McCabe (2002) report extensive exploratory and confirmatory factor analyses in the development of these
scales as well as concurrent and discriminant validity.
The scale was developed for use with adolescents,
with 11 year olds being the youngest children in their
samples.
L. Smolak / Body Image 1 (2004) 15–28
at least in an immature form, by early adolescence.
They suggest, then, that young children will be relatively less resistant to the messages in universal
prevention programs. These children will not yet have
integrated beliefs about appearance—including cultural ideals, the importance of meeting such ideals,
and the means to attain such an appearance—with
each other into a cognitive schema. Furthermore, the
children will not have fully integrated such ideas into
their self-systems. It is for this reason that Smolak and
Levine have argued strongly for universal prevention
programs aimed at elementary school age children.
The ability to measure the development of body image schemas has theoretical and applied importance.
Cash, Melnyk, and Hrabosky (in press) have developed a measure to assess body image schemas among
adults. The Appearance Schemas Inventory-Revised
(ASI) has two factors. One factor measures the
self-evaluative salience of one’s appearance (e.g.,
“What I look like is an important part of who I am.”
“When I meet people for the first time, I wonder
what they think about how I look.”), while the other
factor assesses the simpler motivational salience of
appearance (e.g., “Before going out, I make sure
that I look as good as I possibly can”) (Cash et al.,
in press). Cash and his colleagues have presented
substantial psychometric information concerning this
scale using a college-age sample.
No comparable measure is available for children
or even young adolescents. Given the argument that
the thinness schema is gradually constructed during
childhood (Smolak & Levine, 1994, 1996, 2001), it
will be crucial to develop and validate a measure that
might tap into the developmental process.
Summary
There are tools for measuring body image in children. As one might expect, they are not as extensively
developed as those available for adults and even for
adolescents. What is surprising is how very limited our assessment arsenal is. We are especially ill
equipped to measure body image in children who
are under 10 (third grade or younger in the United
States). It is absolutely imperative that new measures
be developed and that both new and existing measures
be more rigorously subjected to psychometric evaluation. Such work is time consuming and can even seem
19
tedious at times. It is often difficult to get schools to
agree to participate in research whose primary aim is
assessment development. Yet, the questions raised in
the remainder of this chapter—and indeed all questions concerning body image in children—cannot be
answered without such research.
How are body image problems distributed?
In reading the popular press, it is not unusual to
see figures suggesting that as many as 60% of elementary school girls are dissatisfied with their bodies.
Such numbers are usually based on a single study. In
reviewing several studies, Smolak et al. (1998) concluded that it was fairly common to find that about
40% of late elementary school (typically fourth and
fifth grade) girls reported body dissatisfaction.
Even this is a misleading number, however. First,
the studies have fairly small samples, at least in terms
of epidemiology. Second, the samples are overwhelmingly white. It is not clear that girls from ethnic minority groups, particularly black girls, share the same
body image concerns as white girls do. Third, there are
several different measures used in the studies, some of
which focused on body in general, others on weight
and shape per se.
These concerns do not even address several important limitations. First, boys are not well represented. While research is now appearing that looks at
boys’ body image (e.g., Corson & Andersen, 2002;
Ricciardelli & McCabe, 2003; Smolak et al., 2001),
there are no epidemiological data available. Second,
ethnic groups’ differences are poorly understood.
Third, we have few data on children under 10.
Such limitations make it difficult to establish when
body dissatisfaction becomes a problem. For example, when are ideal-current figure rating differences
large enough to indicate a body image problem may
exist? Without large-scale standardization studies and
epidemiological data, it is difficult to know what is an
unusual or pathological level of body dissatisfaction.
What are the developmental trends in
body image development?
Similarly, we know little about the development
of body image, particularly during the preschool and
20
L. Smolak / Body Image 1 (2004) 15–28
early elementary school years. Davison et al. (2003)
reported an improvement in body esteem during
the early elementary school years (ages 5–9 years).
During middle school, both boys and girls seem to
experience a decrease in body esteem although boys’
decrease may be less dramatic and may show a faster
recovery than girls’ decrease does (e.g. Abramowitz,
Peterson, & Schulenberg, 1984; Rosenblum & Lewis,
1999; Wichstrom, 1999).
It is not yet clear at what point body image becomes
reasonably stable. Davison et al. (2003) reported
significant, but small to moderate (r = 0.23–0.37)
correlations between body esteem at ages 5, 7, and 9,
Smolak and Levine (2001) reported no significant relationships between body esteem measured in grades
1–3 and again 2 years later. Smolak and Levine
(2001) also reported that body esteem measured in
fourth or fifth grade was related to body esteem measured 2 years later. Cattarin and Thompson (1994)
similarly found that body dissatisfaction was quite
stable in a group of 10–15-year-old girls followed
over a 3-year period. Both the Davison et al. (2003)
and the Smolak and Levine (2001) studies had relatively small samples of white girls, leaving us a long
way from establishing when stability of body image
occurs.
Developmental trends must be mapped for the various components of body image. It is not necessarily
the case that evaluation, affect, and investment develop
in tandem. Indeed, it seems likely that evaluation predates investment. Some studies have found, for example, substantially fewer elementary school aged girls
engaging in dieting than reporting body dissatisfaction
(e.g. Smolak et al., 1998). This finding is underscored
by the considerably lower correlations between body
dissatisfaction and measures of dieting in elementary
school girls when compared to those of adults (Smolak
& Levine, 2001). The value of either the individual
components or their interrelationships to predict depression or eating problems or even later body image
problems is also an important developmental issue.
Risk factors and protective factors for the development of body image problems may also change.
Several risk factors (see Stice, 2001, 2002, for reviews) that appear to foster body image problems in
adolescence and adulthood also may be operative in
childhood. For example, media influences and parental
comments appear to affect body image by late ele-
mentary school (e.g., Field et al., 1999; Smolak et al.,
1998; Taylor et al., 1998). Sexual harassment is related to poorer body esteem, at least among girls, in
elementary school (Murnen & Smolak, 2000). Many
of these studies are cross-sectional and most involve
only white girls. There is much work to be done on
risk factors for body image problems, particularly during the preschool and early elementary school years.
BMI may be a particularly interesting example
of a risk factor whose meaning may change across
childhood. BMI is correlated with body dissatisfaction in both adolescent and adult men and women.
Body dissatisfaction may show a curvilinear relationship for men and a linear relationship for women and
concerns about being fat may be more clearly tied
to being overweight for men than for women (e.g.,
Dornbusch et al., 1984; McCreary, 2002; Muth &
Cash, 1997). In the preschool years, children’s body
size is not related to their appraisal of their current
body type (Musher-Eizenman et al., 2003). Davison
et al. (2003) reported small but significant correlations between BMI and body dissatisfaction in 5–9
year olds. The size of the correlations increased with
age (r = 0.13–0.27). Davison, Markey, and Birch
(2000) reported a correlation of 0.17 between BMI
and body dissatisfaction for 5-year-old girls while
the comparable correlation for the girls’ mothers was
0.77 and for their fathers was 0.61. Weight concerns
were not associated with weight status among the
5 year olds.
The lesser strength of the relationships between
BMI and body esteem in younger children is consistent with the argument that fat prejudice increases
with age (Cramer & Steinwert, 1998; Wardle, Volz, &
Golding, 1995). It is also consistent with Levine and
Smolak’s argument (Levine et al., 1994; Smolak &
Levine, 2001) that the “thinness schema,” a cognitive
structure integrating thin-ideal, body dissatisfaction,
and weight control techniques, may be less consolidated in younger children than in adolescents. If this
is so, then elementary school may be a particularly
appropriate time for universal programs aimed at preventing body image and eating problems. Thus, the
BMI-body dissatisfaction relationship demonstrates
the importance of charting changing patterns in the
development of body image.
Even among adults, there is little research concerning factors that might protect against the development
L. Smolak / Body Image 1 (2004) 15–28
of body image and eating problems (Crago, Shisslak,
& Ruble, 2001). Murnen et al. (in press) reported that
elementary school girls who actively reject the sexualized thin-ideal media image of women have higher
body esteem. Smolak, Murnen, and Ruble (2000)
found that high school girls participating in non-elite
sports had better body esteem while Geller, Zaitsoff,
and Srikameswaran (2002) reported that basing competence on academic and other activities (including
sports), rather than on appearance, was associated with
more positive body esteem in high school girls. In 5and 7-year-old girls, participation in aesthetic sports
(e.g., dance or gymnastics) has been correlated with
higher weight concerns, a relationship that echoes that
found with adults (Davison, Earnest, & Birch, 2002).
However, participation in non-aesthetic sports (e.g.,
basketball or soccer) did not emerge as a protective
factor. This may be another example of a changing relationship between a risk or protective factor and body
image. It is possible that non-aesthetic sports participation means something different to younger girls
than to adolescents. Currently, we do not have enough
data to definitively document developmental changes
in this relationship much less the basis for those
changes.
While first graders are capable of social comparison, older children engage in the process much
more frequently (Smolak, 1999). Social comparison
may well be an important mediator in the development of body esteem (e.g. Stormer & Thompson,
1996). Similarly, self-esteem becomes more differentiated with age (Harter, 1986). Self-esteem is also
more likely to suffer as social comparison becomes
a more powerful source. Thus, the mediating roles
of social comparison and self-esteem, as well as the
relationship between them, may change as children
develop.
Developmental considerations have not yet been
adequately addressed in the body image literature.
Indeed, in some areas we have virtually no data
concerning the developmental changes in risk or protective factors. There are even relatively few data
available on the nature of changes in body image itself, particularly if one wishes to examine either the
components of body image or the differences in body
image development by ethnicity, gender, or culture.
Such information will be critical to the development
of effective prevention and treatment programs.
21
What is the role of gender in body image
development?
Body image is a strongly gendered phenomenon.
In the past, a statement like this has often been interpreted as meaning that boys and men do not have body
image problems. This is clearly not true. Nonetheless,
it is evident that the nature, risk factors, outcomes, and
probably the developmental course of body dissatisfaction differ by gender. While it is important to identify gender differences in patterns in the development
of body image, it is probably more crucial to work
toward understanding why gender differences exist at
all.
Patterns
Until recently, virtually all research on body dissatisfaction in children and adolescents focused on concerns about being too fat and methods to prevent or
reduce body fat. The findings concerning dissatisfaction about being fat are quite clear. Girls are more
worried about fat than boys are (see Smolak & Levine,
2001 for a review). This gender difference is evident
in elementary school and in every American ethnic
group that has been studied. It is related to the onset of
gender differences in depression in early adolescence
(Wichstrom, 1999). It is likely that it is one of the contributing factors to the gender differences in the eating
disorders, anorexia nervosa (AN) and bulimia nervosa
(BN). This is a critically important gender difference,
then, since it is related to the development of a variety of pathological, and, in the case of AN, potentially
fatal, outcomes.
One of the reasons girls are more dissatisfied in
terms of body fat is they are more likely to judge
themselves as fat when they are average-weight, and
even under-weight (e.g., Dornbusch et al., 1984;
McCreary, 2002). Boys and men are most likely to
be concerned about being fat when they actually
have high BMIs. This may reflect the greater societal
emphasis on the appearance of women’s rather than
men’s bodies (Fredrickson & Roberts, 1997).
On the other hand, boys are more likely than girls to
want to increase the size of their muscles (see Corson
& Andersen, 2002; McCabe & Ricciardelli, in press,
for reviews). By sometime in adolescence, the desire for larger muscles becomes about equivalent to
22
L. Smolak / Body Image 1 (2004) 15–28
or greater than the interest in losing weight among
boys (e.g., Furnham & Calman, 1998; Ricciardelli &
McCabe, 2001b,c). If the boys who are dissatisfied
with their bodies because they are too fat are combined
with those who are unhappy because their muscles
are too small, then the frequency of body dissatisfaction is similar among adolescent boys and girls
(McCabe & Ricciardelli, in press). It is important to
note, however, that this is not true of children younger
than about age 11 years. Young boys are apparently
not very concerned about building muscles, although
the research is very sparse (e.g., Polce-Lynch, Myers,
Kilmartin, Forssmann-Falck, & Kliewer, 1998). This
may reflect an important gender difference in the sociocultural demands concerning bodies. While prepubertal boys are not expected to meet the adult male
muscular body ideal, young girls are expected to try
to achieve the adult female thin body ideal. Hence, the
pressure on girls to achieve a certain body type may begin earlier than the comparable pressure on boys. This,
in turn, might mean that issues of body image are more
fully incorporated in the self-systems of girls than of
boys. This is an important issue for future research.
Boys’ concerns about muscularity also carry
risk. By middle school, there is an association between concerns about muscularity and the use of
muscle-building techniques (Ricciardelli & McCabe,
2003; Smolak et al., 2001). Anabolic steroid and food
supplement abuse are among the techniques that boys
use to gain muscle. Boys are more likely to use these
techniques than girls are. Furthermore, steroid abuse
may be at least as common among adolescent boys as
AN is among adolescent girls (McCabe & Ricciardelli,
in press). The effects of steroid use in older boys and
men are well established (National Institutes of Drug
Abuse, 2000); indeed, anabolic steroid abuse may
even be fatal. These effects may be exacerbated during the developmental period. This may also be true
of food supplements, such as ephedra, whose effects
are generally poorly understood. There is a desperate need for research that more intensely examines
the link between body image and steroid and food
supplement abuse in boys.
At the extreme end, behavioral outcomes of body
dissatisfaction may be comparably dangerous for boys
and for girls. At more moderate levels, however, body
image may be more problematic for girls. Some evidence suggests that girls are more likely to act on their
body dissatisfaction (e.g., Hill, Draper, & Stack, 1994;
Kelly, Ricciardelli, & Clarke, 1999; Smolak & Levine,
1994; Smolak et al., 2001). This might be interpreted
as indicating that boys have lower body image investment, a finding consistent with the adult literature
(Cash et al., in press; Muth & Cash, 1997). It is especially the case that girls are more likely to engage
in calorie restrictive dieting than boys are (Smolak
& Levine, 2001). Dieting has short-term effects, including fatigue, headaches, and irritability. It also has
long-term health-endangering effects, including eating
problems, obesity, growth stunting, and bone density
loss (e.g., Davis, Apley, Fill, & Grimaldi, 1978; Stice,
Cameron, Killen, Hayward, & Taylor, 1999). These
important problems may well be intensified when dieting occurs during childhood and adolescence.
Girls’ greater investment in body image may be
rooted in different cultural definitions of the female
versus the male body (Bordo, 1993; Fredrickson &
Roberts, 1997). While the male body is viewed as
agentic and active, the female body is an object to
be looked at, particularly by men. The function of
women’s bodies, then, is to be attractive, to be sexually
pleasing to men. Girls learn this lesson early with messages coming from media, peers, and parents (Smolak
& Murnen, 2001, in press). Messages to girls may be
more consistent, both in terms of number of sources
and the clarity of the message, than those directed at
boys. This may suggest etiological differences in body
image problems for girls and for boys.
Etiology
It is important that researchers increasingly focus
on the process of the gendered development of body
image. There are at least two broad questions concerning gender differences in the etiology of body image.
First, there is the issue of whether boys and girls have
different experiences in terms of their bodies. Second,
we must address whether these experiences have the
same meaning for boys and girls.
Experiences
body image researchers have emphasized sociocultural factors, particularly peer, parent, and media
influences, as possible contributors to the development of body dissatisfaction. While there are some
L. Smolak / Body Image 1 (2004) 15–28
similarities in boys’ and girls’ exposure to negative
influences, there are also some potentially important
differences. Not surprisingly, there is more evidence
available for girls than for boys, and there is more
research concerning wanting to be thinner than wanting to be more muscular. Therefore, even at the basic
level of describing gender differences in exposure to
body-related influences, substantially more research is
needed.
Parents generally like the way their young children
look, though they become more dissatisfied as the
children get older (Striegel-Moore & Kearney-Cooke,
1994). Parents also do not appear to direct more comments about the child’s body to their daughters than
to their sons (Smolak, Levine, & Schermer, 1999;
Striegel-Moore & Kearney-Cooke, 1994). By adolescence, girls may be more likely to actually discuss
weight loss with their mothers than boys are although
there is still no gender difference in direct parental
encouragement for the child to lose weight (Vincent
& McCabe, 2000). High school girls also report more
maternal modeling of weight loss behavior than boys
do (Vincent & McCabe, 2000).
Peer influences also vary by gender. Appearancerelated teasing is the most common form of teasing
among children. Boys are more likely to engage in
teasing than girls are. Accordingly, adolescent boys report more negative comments about their bodies from
their peers than girls do (Vincent & McCabe, 2000).
However, girls are more likely than boys to discuss
weight and weight loss than boys are (Oliver & Thelen,
1996; Vincent & McCabe, 2000). Indeed, girls may
routinely engage in “fat talk,” disparaging their normal weight bodies for the purpose of fitting in socially
(Nichter, 2000).
Media is a multi-faceted influence on body image
(see Levine and Harrison, in press, for a review). Different television shows portray body image differently
with soap operas showing a more rigidly thin-ideal
for girls than, for example, dramas do. Girls are more
likely to watch soap operas than boys are. Furthermore, the acceptable body type portrayed for women
is narrower than that for men on television and fat
women are the single group most likely to be the target of jokes. In addition, many more girls’ magazines
focus on appearance than do boys’ magazines (Levine
& Smolak, 1996). Girls begin reading these magazines
on a fairly regular basis in late elementary school.
23
For example, Field et al. (1999) found that roughly
25% of late elementary school girls read “fashion”
magazines at least twice a week, a number that rises
at least through middle school (Levine et al., 1994).
Little is known about boys’ use of magazines, other
than that Sports Illustrated, a magazine that portrays
active, although sometimes unrealistically muscular,
male bodies, is the one most commonly read. Thus,
this may be another indicator of the greater sociocultural pressure on young girls to achieve a particular
body type.
There are data suggesting that some girls are more
susceptible than others to at least peer and media
influences (e.g., Levine et al., 1994; Taylor et al.,
1998). Such research is not available yet for boys. Researchers looking at self-esteem and body comparison
as mediators, for example, have generally treated eating disorders or weight loss or muscle-building techniques as the dependent variable with body dissatisfaction serving as a predictor variable. Much more research is needed on how children of both genders assimilate media, peer, and parental messages into their
own body images.
Meaning
There is evidence that the interpretation of cultural
messages varies by gender. Given the extent of behavioral and attitudinal gender differences and gender
roles, this does not seem surprising. Yet, few studies
have examined such differences and their implications
for body image development.
Murnen and Smolak (2000) interviewed third
through fifth grade boys and girls about gendered
harassment, behaviors that might be considered early
forms of sexual harassment. Boys and girls reported
equal frequencies of being harassed. However, girls
were more likely than boys to report that victims
would be frightened by the harassment. This is consistent with findings with adolescents suggesting that
girls are more likely than boys to change their behavior to avoid harassment (American Association
of University Women, 2001). Murnen and Smolak
(2000) found that girls who were thought victims
would be afraid had lower body esteem than other
girls. Girls who said they did not know how the victims would react were more likely than other girls to
report lower body esteem. This was not true for boys.
24
L. Smolak / Body Image 1 (2004) 15–28
In fact, overall, frequency of sexual harassment was
negatively correlated with body esteem for girls but
not for boys.
Girls seem to be more directly and extensively affected by media images than boys are (Ricciardelli &
McCabe, 2003; Smolak et al., 2001). Is this because
of characteristics of the media, such as the greater
consistency of the thin-ideal for women than for the
muscular ideal for men? Or is it because the message to girls is more salient because it is reinforced
by various forms of media as well as by peers and
parents? Is it because girls are often socialized to be
more “cooperative” and to try to do more to maintain
relationships? These and other hypotheses, which are
applicable to a variety of potential risk factors, deserve
much more research attention.
Ethnicity and culture
There is considerable consensus that sociocultural
factors are keys in understanding the development of
body image. If this is so, then one important technique for uncovering contributing variables would be
to compare development across ethnic and cultural
groups. Not only might researchers compare factors
between groups, they might also investigate the nature
of intra-group processes.
Despite the likely fruitfulness of a multiethnic,
multicultural approach, the overwhelming research
base for studies of body image in children has been
white and American, British, or Australian. Many
of the issues concerning gender also apply to ethnic
and cultural groups. Indeed, examining cultural differences in gender differences and gender differences
within cultures will help us to tease apart influential variables. Such information will be crucial to
the development of “ethnically sensitive” prevention
programs (Smolak, 1999).
Conclusions
There are a number of findings about body image
in children and adolescents that have been replicated
sufficiently to think of them as facts. Some children
are quite concerned about their body shape, concerned
enough to do something such as diet or exercise in
order to change it. In elementary school, these children
are more likely to be girls than boys. This is true in
every American ethnic group studied to date as well
as in Australian and English children. Black girls may
be somewhat less dissatisfied with their bodies than
other girls are. By adolescence, boys are increasingly
concerned with becoming more muscular.
These trends are problematic for a variety of reasons. Girls who are concerned about being thin are
at risk for dieting which in turn puts them at risk
for eating disorders and obesity. Body dissatisfied
girls are also at risk for depression. Boys who are
invested in becoming more muscular may resort
to health-endangering techniques such as anabolic
steroid use. Dieting and excessive exercise may also
be used to alter one’s body shape. These techniques
have potential short and long-term effects ranging
from fatigue to gastrointestinal distress to joint or
bone injuries.
There is also some evidence as to what factors might
influence the development of poor body image. Sociocultural factors such as media, peers, and parents
seem to be instrumental. Anti-fat biases, which first
appear in the preschool years, are also important. In
general, we have more information on these factors,
as well as the outcomes and the developmental trends
of body image, for girls than for boys and for white
children than ethnic minority children.
There are many unanswered questions. Before these
can be thoroughly addressed, we need to develop
better measures of body image, especially in young
children. At the moment, it is difficult to argue that
researchers have even measured body dissatisfaction
in preschoolers. There are also severe limitations on
what type of body image we know how to measure.
Again, this is particularly true of young children.
While researchers have begun to develop more gender sensitive measures of body image, there is still
little research demonstrating the appropriateness of
measures for use with various ethnic groups.
There is also little epidemiological data available.
It is not yet clear how common body dissatisfaction
is at various ages for different genders and ethnic
groups. Given this, it is difficult to assess what levels
of body dissatisfaction are unusual. Such research will
need to be combined with prospective data looking
at pathological outcomes in order to establish what
levels of body dissatisfaction are problematic. These
levels are likely to vary by age, gender, and ethnicity.
L. Smolak / Body Image 1 (2004) 15–28
This is also true of developmental trends in body
image. For example, how do the relationships between risk factors and poor (or excellent) body image
change across development? When does poor body
image become predictive of eating disorders or steroid
abuse? Are the relationships among BMI, dieting,
muscle-building techniques, and body image constant
across development?
Then there is the issue of gender. Body image, as
well as its risk factors and outcomes, is a gendered
phenomenon. Researchers need to investigate the nature, causes, and outcomes of these gender differences.
Understanding why boys and girls differ may help us
to identify risk and protective factors at various stages
of development. This is probably also true of ethnic
group differences. If black girls are indeed more satisfied with their bodies than white girls are, for example, then explicating the roots of black girls’ body
satisfaction may help in the more effective design of
prevention programs.
Prevention and treatment programs will benefit from
our increased knowledge of body image development.
The challenges of such research are great, but the benefits are greater.
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