Body Image Curriculum

Adolescence is a period of social, cognitive, emotional, and physical change. This transition can be challenging. During this period, there is rapid change that can be disruptive to an individual's sense of self and body self-image. This article provides a brief discussion about the issue of body dissatisfaction and how our socio-cultural ideals have promoted this through messages transmitted by the media. This discussion of the problem is followed by an overview of suggestions made by researchers, clinicians, and health educators. These concern the incorporation of prevention programs and what information and skills students should be acquiring through the programs. The World Health Organization's Health-Promoting Schools framework is discussed in detail and is followed by examples of body image programs created for both genders and specifically for female students.

Keywords Adolescence; Body Dissatisfaction; Body Image; Diet Mentality; Eating Disorders; Health Literacy; Health Promoting Schools Framework; Psychosocial Development; Self-Esteem; World Health Organization (WHO)

Overview

The period of adolescence involves rapid change and many transitions that are social, cognitive, physical, or emotional and relate to identity formation, sexuality, and social and familial relationships (LeCroy, 2004). The primary task of the early and middle adolescence periods is to attain a positive sense of self in response to the changes that are occurring (Blythe, 1987, as cited by LeCroy, 2004). The attainment of a positive sense of self is challenging, as it requires the individual to call upon coping mechanisms (that he or she may not possess) to navigate through the changes and transitions. Unfortunately, girls have a particularly challenging time gaining a positive sense of self, as research has indicated that adolescent girls have lower self-esteem and self-confidence than adolescent boys (Blythe, 1987 as cited by LeCroy, 2004). In the early twenty-first century, policymakers, researchers, and clinicians have grown more concerned about the overall health status of adolescents, adolescent girls in particular (LeCroy, 2004). Adolescent girls are feeling increasing pressure to be physically beautiful and sophisticated, which often results in the use of chemicals and becoming sexually active at an early age (LeCroy, 2004). These pressures are also leading adolescents to feel a general dissatisfaction with their body shape and size, which has become the norm for young American women and is increasing with young men and pre-teens (Kater, Rohwer, & Londre, 2002).

The Body Image Issue in America

The emphasis on physical beauty and perfection is underlined by socio-cultural forces in America (Kater, Rohwer, & Londre, 2002). American culture equates feminine desirability with physical appearance, and that desired appearance with an unnaturally and unhealthily lean look (Kater, Rohwer, & Londre, 2002). This socio-cultural value is promoted incessantly in the media, where Americans are inundated with images of the desired appearance, and advertisements for diet miracles, exercise equipment, and beauty products. These media campaigns reinforce the message that being thin is beautiful and desirable, leading to body dissatisfaction for many who do not fit this ideal. Body dissatisfaction is the general dissatisfaction that one has with body size and shape. This is manifested in the preoccupation with the subjective experience of "feeling fat," or a fear of becoming fat regardless of actual size (Kater, Rohwer, & Londre, 2002). These deep-seated cultural values have also contributed to the "diet mentality," which is the belief that restricting calories and nutrients is the method by which one can attain the desired body, and that anyone with willpower can obtain a fat-free appearance. Those who do not meet the ideal are considered as not doing what it takes and subsequently receive negative judgment and discrimination (Kater, Rohwer, & Londre, 2002).

These cultural norms and diet mentality have been the cause for the aggressive dieting trends in America. As a result, socially vulnerable adolescent girls are increasingly anxious and dissatisfied with their developing, fuller bodies, causing them to compromise their nutritional intake during their formative years (Kater, Rohwer, & Londre, 2002). This disproportionate emphasis on controlling external appearance during the formative years of adolescence creates a disconnection with the "deeper sense of identity and integrity in which healthy ego strength is built" (Kater, Rohwer, & Londre, 2002, p. 199). This disconnection and inability to develop and confirm personal identity and ego strength contributes to higher rates of depression in adolescent girls (more so than boys), which causes them to focus on obtaining the right look, make-up and beauty products, fashion, and denying their hunger (Kater, Rohwer, & Londre, 2002). There becomes a preoccupation with eliminating fatness and attaining the "right" appearance that is not grounded in the desire to achieve a healthy weight. This preoccupation leads to a "willingness to compromise physical, psychological, and ethical integrity to achieve that look" (Kater, Rohwer, & Londre, 2002, p. 199). Research has indicated that 6 percent of adolescent girls will experience body dissatisfaction that eventually manifests itself as a diagnosable eating disorder (Kater, Rohwer, & Londre, 2002). Eating disorders are serious illnesses that can be life threatening.

Prevention of the Poor Body Image Problem

The severity of poor body image issues and the medical and psychological problems that result have led health professionals to develop programs, literature, and other resources to focus on the prevention of body dissatisfaction. The period of adolescence, particularly early adolescence, is an ideal time for educators, agencies, and other health-focused organizations to conduct preventative interventions as they can have a positive impact on the mental health of girls and help in the prevention of decreased self-esteem and self-confidence (LeCroy, 2004). School-based prevention programs should be introduced into the upper level elementary school curriculum as a means to create a foundation to stop unhealthy behaviors and attitudes from developing (Kater, Rohwer, & Londre, 2002). Prevention models have been created by researchers, treatment providers, government health providers, and non-profit organizations and focus on the cultural factors that contribute to concerns about body image and eating problems (Kater, Rohwer, & Londre, 2002).

Prevention models typically vary in approach; however, they typically focus on fostering resistance to culturally transmitted risk factors and messages (i.e., media messages about feminine "ideal," dieting) (Kater, Rohwer, & Londre, 2002). Most prevention models focus on:

• “Genetic influence and acceptance of diversity in height, weight, and body fat,

• Developmental changes in appearance expected with puberty,

• Counterproductive and dangerous effects of weight loss dieting, and the importance of choosing sufficient, varied, wholesome food,

• Value of physical activity,

• Skepticism and critical thinking regarding mass media messages that contribute to body dissatisfaction, and

• Protective factors such as self-acceptance, life skills, and healthy coping mechanisms” (Kater, Rohwer, & Londre, 2002, p. 200).

Specifically, the body image curriculum should incorporate activities that include peer involvement, parental involvement, and sports/physical activities (O'Dea & Maloney, 2000). Intervention programs should also address feminist issues (i.e., stereotypes and empowerment of women) and teach students how to deconstruct the social body image ideals and related messages from the media (O'Dea & Maloney, 2000). Programs provide adolescents with information that helps them to know who to ask/where to go for help and how to use the help/information that they are provided (LeCroy, 2004). This power of knowledge is critical, as many adolescents are faced with problems that are not visible to their families, teachers, or friends, such as depression, eating disorders, and poor body image (LeCroy, 2004). Programs should also implement a process or actively identify students who are at-risk for developing eating disorders (e.g., ballet students, athletes, and overweight students and/or those with high trait anxiety and low self-esteem) (O'Dea & Maloney, 2000).

Choosing the Right Program

It is also critical that educators identify and avoid ineffective strategies for prevention and those strategies that have been found even to be harmful (O'Dea & Maloney, 2000). For example, educational programs that are facilitated by recovered eating disorder patients have the potential to inadvertently “increase students' knowledge about the symptoms of eating disorders (e.g., dieting, vomiting, laxative use)” (O'Dea & Maloney, 2000, p. 4). Sometimes, the attitudes and beliefs that are related to eating problems, may potentially be glamorized and serve to normalize the behaviors associated with these illnesses (O'Dea & Maloney, 2000). School-based prevention and education curricula should also avoid treating food and nutrition issues negatively by labeling foods as "good" and "bad" or "junk food;" when this overall negative message becomes part of the school environment or curriculum, it may contribute negatively to the underlying fear students have of food, dietary fat, and gaining weight (O'Dea & Maloney, 2000). School staff members should be encouraged to reflect on what messages they are personally sending to their students as their “negative beliefs and attitudes (i.e., personal poor body image, prejudices about body weight, and bias toward overweight students)” may be unintentionally conveyed to students (O'Dea & Maloney, 2000, p. 4). With these curricular and co-curricular recommendations in mind, the educators who are responsible for the implementation of a body image program must critically examine and explore all potentially harmful outcomes of methods and content before incorporating into the school-based program (O'Dea & Maloney, 2000).

Applications

The Health-Promoting Schools Framework

Empirical research and exploration into the effectiveness of programs that are focused on preventing body dissatisfaction and unhealthful eating patterns has suggested that prevention programs, as previously discussed, should be aimed at educating adolescents about healthy eating attitudes and behaviors, as well as the enhancement of self-esteem and how to deconstruct media messages related to body image (O'Dea & Maloney, 2000). One particular curriculum that aims to promote student health is the Health-Promoting Schools framework that has been proposed by the World Health Organization (WHO). The WHO is the branch of the United Nations that focuses on providing leadership in global health. The Health- Promoting Schools framework is a holistic approach to fostering health within the school and its surrounding community and is based on the premise that education and health are not mutually exclusive, because successful learning is supported by health and well-being (O'Dea & Maloney, 2000). This approach aims to engage the health and education officials in a community/school to create a school that promotes health (O'Dea & Maloney, 2000).

Health-promoting schools actively utilize an “organized set of policies, procedures, activities, and structures that are designed to protect and promote health and well-being amongst the school staff, students and school community members” (O'Dea & Maloney, 2000, p. 7). The ideological foci of the program are grounded in the promotion of and the respect for “individual self-esteem, providing multiple opportunities for success, and purposeful acknowledgement of good efforts and intentions as well as personal achievements” (O'Dea & Maloney, 2000, p. 7). This holistic program also focuses on implementing curricula that seek to increase students', staff's, and the community's health literacy (O'Dea & Maloney, 2000). Health literacy is the acquisition of "the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain health" (O'Dea & Maloney, 2000, p. 19). Health literacy and the Health-Promoting Schools framework promote the empowerment of students, teachers, parents, school staff, and community members (O'Dea & Maloney, 2000).

The Health-Promoting Schools framework focuses on three areas of intervention, including

• School curriculum, teaching, and learning,

• School ethos, environment, and organization, and

• School-community partnerships and services (O'Dea & Maloney, 2000).

School curriculum, teaching, and learning address the implementation of a planned sequential health education curriculum for all age groups that it crosses and intersects through the school curriculum (O'Dea & Maloney, 2000). For example, issues related to holistic health and prevention of body dissatisfaction may be incorporated into health education, English, and science courses. This multidisciplinary approach helps to strengthen the educational message through consistency and empowerment. It offers opportunities for educators to reflect on their own values, beliefs, and life experiences as they strive toward becoming effective role models. However, teachers may need special training in order to effectively address eating and body issues with their students within the context/course in which they are seeking to cover the material (O'Dea & Maloney, 2000).

The second area of intervention, “school ethos, environment, and organization, involves addressing the beliefs, attitudes, and norms that exist within the school and local community,” as these all factor into and form the overall "ethos" of the school environment (i.e., school structures, policies, and practices) (O'Dea & Maloney, 2000, p. 8). Also, the policies that the school has in place that are directly and indirectly related to health promotion must be critically examined, including the school meal policy, bullying, dress codes, prejudices, and the need for special programs to address specific issues (e.g., overweight and obesity issues) (O'Dea & Maloney, 2000).

The final area of intervention, school-community partnerships, addresses the deliberate development of collaborative partnerships “with students' families, the school, community health workers, youth and educational services, and other non-government agencies in the community” at large (O'Dea & Maloney, 2000, p. 8). With these collaborative relationships developed and acknowledged, resources can be exchanged between the school and community in an effort to prevent eating and body image problems from a more holistic approach (O'Dea & Maloney, 2000). These partnerships may include the provision of health services and sponsorship of training programs that aim to prevent body dissatisfaction and eating problems (O'Dea & Maloney, 2000).

The Health-Promoting School Framework in Action

O'Dea and Maloney (2000) discuss an example of the implementation and application of the Health-Promoting School framework in a school that had a problem with students abusing laxatives. The school personnel sought to use community resources by contacting a local physician. Their intention was to have the physician speak to students about the hazards of laxative use. The doctor sought help from community-based health educators for direction on how to appropriately and effectively address this problem with the student body. Instead of directly preaching about the hazards of laxative use, a holistic health promotion approach was applied. With help from school personnel and parents, the group was able to determine three questions that they felt needed to be addressed. These questions were: What is being taught in the overall school curriculum? Does the school curriculum promote a slim ideal body image? What do they know about the issues and where can they find help for problems with eating? (O'Dea & Maloney, 2000).

As a result of the careful consideration and critical assessment of the existing school curriculum, a new program was created that focused on addressing the societal expectation “of females, the media and the influence it has on students' perceptions of the ideal body image, individuals' internal messages about their personal body image, coping mechanisms for handling problems, and the responsibility of individuals as advocates of change toward a more realistic and positive body image” (O'Dea & Maloney, 2000, p. 9). This curriculum was implemented in health, English, and media studies classes (O'Dea & Maloney, 2000). This process forced all community members to critically look at the values of the school and the teachers and their practices allowing them to move toward a program where school staff and teachers participate in training about eating and body images, referral systems and treatment (O'Dea & Maloney, 2000).

Healthy Body Image: Teaching Kids to Eat & Love Their Bodies, Too!

Another body image curriculum that has been developed, called "Healthy Body Image: Teaching kids to eat and love their bodies too!," includes eleven lessons for students in grades 4–6 (Kater, Rohwer, & Londre, 2002). This curriculum uses age-appropriate activities that incorporate prevention principles into games, experiential activities, stories, and discussions (Kater, Rohwer, & Londre, 2002). Four of the eleven lessons teach the intrinsic nature of body size, composition, and shape, which also addresses the changes in appearance that adolescents experience during puberty, genetic diversity, internal weight regulation, and the hazards of extreme dieting (Kater, Rohwer, & Londre, 2002). These four lessons aim to teach the students to understand the limits of healthy weight and shape control and to accept size diversity as natural (Kater, Rohwer, & Londre, 2002).

The next four lessons focus on the factors that positively influence weight, body image, and well-being and includes the concepts related to the consumption of wholesome food to satisfy hunger, increasing physical activity, balanced attention to diverse aspects of identity, and choosing realistic role models (Kater, Rohwer, & Londre, 2002). The final three lessons focus on educating students so that they learn and acquire socio-cultural life skills that aim to help them cope with changing appearance, cultural perspectives on changes in body image, and critical assessment of media images that influence body image attitudes (Kater, Rohwer, & Londre, 2002). The goals of this particular program are geared toward the prevention and susceptibility of developing body dissatisfaction and other body image related issues as children are moving into the period of early adolescence.

Examples of Gender-Specific Health Body Image Curriculum

LeCroy (2004) proposed a gender-specific curriculum for girls that incorporate six tasks over a period of twelve sessions. These tasks are incorporated as they are considered critical for the healthy psychosocial development of early adolescent girls (LeCroy, 2004). The critical tasks that are incorporated include:

• Being a girl in contemporary society,

• Establishing a positive self-image,

• Establishment of independence,

• Making and keeping friends,

• Coping mechanisms and using resources, and

• Planning for the future (LeCroy, 2004).

More specifically, task one involves the achievement of competent gender role identification (LeCroy, 2004). Task two involves the development of a positive self-image and the acceptance of one's self as a person of worth along with a positive body image (LeCroy, 2004). Task three addresses how girls can establish independence, have an independent voice, be assertive, and acquire problem-solving skills (LeCroy, 2004). Task four focuses on the skill of making and keeping friends, developing and maintaining positive peer relations, and the achievement of successful membership in the peer group (LeCroy, 2004). Task five aims to assist the female students in learning how to find and use resources when they are having difficulty coping and are overwhelmed with pressure (LeCroy, 2004). The final task focuses on helping the students to plan for the future while building their confidence in their ability for future, educational and career success (LeCroy, 2004).

Despite the progress made in recent decades, in the 2020s the problem of body image continues to persist. One issue are those who, perhaps, inadvertently contribute to the problem. One such example are school routines designed to assist with the crisis of childhood obesity. Schools often implement practices such as weigh-ins, food diaries, and measuring body fat with calipers. These practices often do not lead to healthy forms of moderation but instead to a sense of shame. They can lead to self-image problems for children and lead them to unhealthy weight loss efforts. Educators should, therefore, be provided with better information, including solutions that do not spur these behaviors.

Conclusion

The inclusion of a properly planned and evaluated school-based body image education program that focuses on improving body image, self-esteem, physical self-concept, body satisfaction, a reduced importance of peer group acceptance, and skills related to deconstructing media messages can help adolescent students acquire the skills that they need to successfully move through adolescence and beyond with a more healthy body image and body satisfaction. School personnel should be encouraged to critically examine their school's curricula, ethos, and environment to determine whether or not a holistic health message is being conveyed to students in all facets of the school's programs, policies, and curricula.

Also prevalent in the 2020s are social media sites, which are prime contributors to inducing negative body image behaviors. In marketing products and services, many sites promise amazing image results but promote very dubious methods to achieve them. These can include supplements, injections, and foot intake regimens. Not only can these be questionable, but such practices can lead to long-term damage as well. Some suggest other promotions, such as “self-love” or the self-acceptance of one’s physical makeup, can have their downsides as well. These mindsets still place an emphasis on physical appearance. They continue to feed an obsession with beauty. Instead, advocates are now suggesting more of a neutral approach where a person focuses on an appreciation of what their body provides to them.

Terms & Concepts

Adolescence: The period of human development that begins when normal puberty starts and ends when the person develops an adult identity—typically between the ages of 10 and 19 years.

Body Dissatisfaction: Dissatisfaction with body size and shape as manifested in the self-absorbed preoccupation and subjective experience of "feeling fat" or fear of becoming fat regardless of the individual's actual size.

Diet Mentality: The belief that restricting calories and nutrients is the method by which one can attain the desired body, and that anyone with willpower can obtain this fat-free appearance.

Eating Disorders: A psychological condition characterized by excessive and harmful overeating or especially undereating (e.g., anorexia nervosa, binge eating disorder, bulimia nervosa).

Health Literacy: "The cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain health" (O'Dea & Maloney, 2000, p. 19).

Health-Promoting Schools Framework: A program developed by the World Health Organization (WHO) that focuses on the development of school communities that encourage, promote, and foster a holistic approach to health.

Psychosocial Development: Conceptualized as "a process whereby young people must learn to adapt to the necessary tasks placed on them by the social environment" (LeCroy, 2004, p. 430).

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Suggested Reading

Brindis, C. D., Irwin, C. E. Jr., Ozer, E. M., Handley, M., Knopf, D. K., & Millstein, S. G. (1997). Improving adolescent health: An analysis and synthesis of health policy recommendations. San Francisco: University of California.

Carter, J. C., Stewart, D. A., Dunn, V. J., & Fairburn, C. G. (1997). Primary prevention of eating disorders: Might it do more harm than good? International Journal of Eating Disorders, 22, 167-172.

Cauce, A. M. (1986). Social networks and social competence: Exploring the effects of early adolescent friendships. American Journal of Community Psychology, 14, 607-628.

Florin, T. A., Shults, J., & Stettler, N. (2011). Perception of overweight is associated with poor academic performance in US adolescents. Journal of School Health, 81, 663-670. Retrieved December 5, 2013, from EBSCO online database, Education Research Complete http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=66283002

LeCroy, C. W., & Daley, J. (2001). Empowering adolescent girls: Examining the present and building skills for the future with the Go Grrrls Program. New York: W. W. Norton.

Lindeman, A. K. (1994). Self-esteem: Its application to eating disorders and athletes. International Journal of Sport Nutrition, 4, 237-252.

Moreno, A. B., & Thelen, M. H. (1993). A preliminary prevention program for eating disorders in junior high school population. Journal of Youth and Adolescence, 22, 109-124.

Simmons, R. G., & Blythe, D. A. (1987). Moving into adolescence: The impact of pubertal change and school context. New York: Aldine De Gruyter.