1. Dr. Ana Stefanic
Global Issues in Social and Behavioral Health GPH-GU 2140
Sociocultural Perception of Attractiveness and
the Development of Eating Disorders among
Adolescent Girls
Sahimar Yammine
21/12/2015
3. Abstract
Eating disorders are biopsychological complex conditions in which individuals engage in
eating behaviors that could be fatal if left unattended. [13-15] These psychiatric disorders are
commonly characterized by having food as their trigger. Some behaviors associated with eating
disorders are refusing or restricting food, overeating to the point of death, purging after food
consumption, laxative intake, use of diet pills, etc. However, clinical factors cannot fully explain
the whole framework that goes behind the increase of eating disorders. [1,15] This literature review
proves the essential influence that “sociocultural perception of attractiveness” has a profound
influence on the progress of eating disorders. The strong prominence on appearance and slimness
in Western societies has lead individuals into an intense body preoccupation and desire to
achieve slimness and physical perfection. [13] Following societal beauty standards of “thinness as
social attractiveness” is linked to weight preoccupation, especially during the adolescence
period, [1] since there is a desire for adolescents of being accepted in the society by being
physically attractive. The “thin ideal body shape” messages are believed to be transmitted
through media, parents, peers and best friends. [1,10,12,17] In addition, studies suggest that physical
appearance has been associated with positive attributes such as being socially, professionally,
and maritally acceptable. [6,9] It is concluded that body image is a combined concept determined
by one’s distress of their body image and how unsatisfied they are with what they see. The
mixtures of those two standings result in the development of self-esteem, and adolescent self-
perception. [1] This component of self-perception of body image begins during adolescence, the
period in which girls are more concerned about their looks and body changes. [14] In addition,
excessive concern about body weight is associated with the development of eating disorders. [3]
Hence, eating disorders are an important health concern that should be tackled at an early stage
4. and, by understanding the sociocultural and psychological issues surrounding body weight
concern and body image dissatisfaction, research and health practitioners can develop future
recommendations for weight control, maintenance and management of eating disorders.
Introduction
Eating disorders are a biopsychological complex in which individuals engage in eating behaviors
that could be fatal if left unattended. Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge
Eating Disorders (BED), and Eating Disorders Not Otherwise Specified (EDNOS) are some of
this complex psychiatric disorders commonly characterized by having food as a trigger. [13-15]
Some behaviors associated with eating disorders are refusing or restricting food, overeating to
the point of death, purging after food consumption, laxative intake, use of diet pills, etc.
However, clinical factors cannot fully explain the whole framework that goes behind an increase
of incidence and prevalence in eating disorders. [15] Every period in history has had its own
standards of beauty. In addition, every culture develops its own idea of beauty in terms of
“proper” body size and shape. Nevertheless, in the last 20 years there has been a marked move
towards thinness in women’s beauty: “There has been documented a significant decrease in body
weight and in measurements during the 20 past year’s period.”[15] Therefore, one influence that
can have an impact on the advancement of eating disorders is the sociocultural pressure of
women to achieve societal beauty standards of “thinness as social attractiveness.” Moreover,
there is an increased pressure to be thin and to look good in the eyes of society: “looking healthy
now signifies being healthy and thinness has been associated with beauty and success.”[7] The
resilient and never-ending stress on appearance and slenderness in Western societies has led to
an intense body obsession and yearning to achieve thinness and physical perfection so to say. [16]
In addition, studies suggest that physical appearance has been associated with positive attributes
5. such as being socially, professionally and maritally acceptable. [1,10,12,17] Nevertheless, an
increased focus on body image is more predominant among women than men. [6,9] Women
perceive their body to be an aesthetic and evaluative attribute. This component of self-perception
begins during adolescence, the period in which girls are more concerned about their looks and
body changes. [2,3,12] In addition, excessive concern about body weight in associated with the
development of eating disorders. [3,6,8,9,12] Hence, eating disorders is an important health concern
that should be tackled at an early stage: Eating disorders are categorized as the third most
common ailment among young females. [3] Nevertheless, eating disorder behaviors can lead to
potential mental and health consequences. Therefore, I chose female adolescents to compromise
my study population. The purpose of my article is to study the sociocultural-induced aspects of
“social attractiveness” in society and its impact on the progress of eating disorders among female
adolescents in Western populations. It is hypothesized that sociocultural pressure to be thin,
driven by society, is a determinant for the development of eating disorders among adolescents.
Some sociocultural factors underlying the extreme concerns with body image include social
standards of physical attractiveness. [1,6,8-12,17] In the literature, women’s body image is well-
defined in expressions of body displeasure. In addition, body image plays an important role in
self-perception which is an important term that not only influences the way we perceive
ourselves, but determines our social and personal relationships. [1,14] Therefore, more people will
focus on their bodies and its faults, leading them to further try to achieve an unrealistic beauty
stereotype. They will do anything from engaging in many weight loss strategies, to diet products,
and extreme restrictive diets. Thus, we come to a conclusion that harmful eating behaviors
happen in response to body discontent and weight unease. [4,5] Research suggests that eating
disorders serve as a strategy to regulate the threat they feel and result in a feeling of safety and
6. physically acceptable in social groups. [4] In other words, attractiveness relates to self-acceptance.
[14]
Methods
We searched on the Pub-Med database for literature that addresses the effect of sociocultural
factors on body dissatisfaction and body image concern. Using the query “Sociocultural
perception of attractiveness and eating disorders”, the literature search included 168 related
articles. However, we limited our scope to young adolescent girls. Therefore, by adding
“adolescent girls” to the database search tool we further limited our decision to 38 possible
scientific articles. After carefully reading those 38 abstracts, we chose 5 articles that clearly
addresses how thin internalization idea set by society leads to one’s physical appearance
dissatisfaction and plea to lose weight in many adolescent girls. [3,6,8,9,11] In addition, we had a
look at the list of “similar articles” offered by Pub-Med database. After reviewing abstracts from
the 9 items list, we chose 4 articles [1-3,10,17] that were commonly addressing how pressure from
parents, friends, peers and best friend lead to desire to change body weight and shape. Therefore,
our literature review considers media, peer, and parents as potential social factors that might
influence body satisfaction and hence, result in young female girls engaging in extreme and
unhealthy weight loss strategies to achieve that unrealistic ideal body shape. Nevertheless, to
further justify the hypothesis that not puberty, but rather society influence body image concerns
during adolescent we chose an additional article[12] that was addressed puberty as a possible risk
aspect for the advancement of eating illnesses. Additionally, to provide the literature review with
strong and reliable background information, from those 168 initially found articles we chose 7
that were commonly addressing culture as a strong determinant for weight concern and social
interaction. [4,5,7,13-16]
7. Results
Thin ideal body shape portrayed by society predicted changes in body satisfaction, dieting, and
compulsive exercise. [8] This result is also supported in the study “Prospective Study of Pressure
from Parents, Peers, and the Media on Extreme Weight Change Behaviors among Adolescent
Boys and Girls,” in which researchers state that “weight change behaviors are shaped by
biological, psychological, and social factors.”[12] These social aspects comprise of apparent
pressure from peers, parents, and television to alter their weight and shape.[12] In addition,
adolescents, both boys and girls, perceive that they should respond and conform to the
sociocultural pressure to have the ideal weight according to their gender. [17] There is an existing
significant association between social reputation and dietary intake: “Adolescent Girls’ and
Boys’ Weight Related Health Behaviors and Cognition: Association with Reputation and Peer
Status.” [17] A larger body shape was linked with small intensities of supposed social acceptance.
[4] Therefore, women show a strong association between thin body and being attractive to men. [2]
Female adolescents being perceived as attractive are more probable to involve themselves in
weight preoccupation behaviors in comparison to those female adolescent rated as “less
attractive.” [4]
In the article, adolescent girls showed to have higher intensities of body displeasure than
boys.[12] Hence, girls are more likely to participate and take part in extreme eating patterns to
decrease their heaviness.[1] Moms and best female friends’ feedback were the most important
forecasters of figure appearance importance and body change strategy in adolescent girls.” [11] In
addition, “A Prospective Study of Pressure from Parents, Peers, and the Media on Extreme
Weight Change Behaviors Among Adolescents”[3] also supports the fact that “female girls were
mostly influenced by their mothers and same sex peers, when it comes to body weight change
8. concerns. Perceived messages from these individuals play an important role in shaping strategies
to lose weight.” [10,3]
Moreover, the association between skinny ideal internalization and body discontent was detailed
in “The role of social comparison and body surveillance.” [6] Results of this study shows that
increased body monitoring/body observation leads to advanced levels of body dissatisfaction. [6]
In addition, “implicit internalization of the thin ideal as a predictor of increases in weight, body
dissatisfaction and eating disorder.” [9] Therefore, women who are constantly troubled about their
body figure and body appearance are more likely to develop eating illnesses. [6,9] This idea is
also supported in the study “Socio-cultural factors in the Development of Anorexia Nervosa:” in
this study researchers found that Anorexia Nervosa is more common in modelling and dance
students than in other similar age women. Therefore, individuals who increase their focus on
their body appearance are more expected to develop Anorexia Nervosa or other eating disorders.
[7] A population of 183 professional dancers and 56 modeling students were included in the study
Researchers chose to focus on this population since modeling and dancing are activities highly
associated with increased control and attention over weight and body shape. At the beginning of
the freshman year, females are more susceptible to adopt the thinness as the ultimate body shape,
which puts them at higher risks of eating disorders due to body image dissatisfaction. [9]
Therefore, the adolescence years is a critical period for girls, in which the primary source of
appraisal is peers. [1,2,9,10]
Wrapping up everything that we studied, all studies being chosen in this literature review were
addressing the role of sociocultural influences and the thin-internalization idea in women during
the adolescence years. Although the sample’s characteristics and data collection questionnaires
varied in each study, the general purpose of all articles was to study the association of social
9. comparison, stress to be skinny, body disappointment, thin internalization ideal and usage of
extreme weight loss strategies-method in young girls.
In addition, eight of these studies were cross-sectional design studies that were not able to draw
conclusions about causality. [1,3,6-8,11,12,17] However, even though the two articles left are
considered cohort studies, [9,10] inaccuracy of data collected due to the self-reported method
used,[10] presence of a homogeneous sample size of undergraduate women from one university
that are not representative of the general population,[10] and short time period to effectively
obtain realistic and accurate results[9] are some limitations of these cohort design studies.
Discussion
Social attractiveness or “sociocultural pressure to be thin” is believed to negatively affect
women’s body image. [1-5,12] Studies advise that self-comparison is related with an increase in
external shame in society and predicted the drive for thinness. [4] Moreover, body discontent has
a direct consequence on the effort for slimness. [4] Articles used in this review support the notion
that eating/exercise comparison is motivated by the thin ideal set by society. [5] In addition, there
is an inconsistency between what a lady presently appears like and what she would preferably
like to look. [5]A lack of self-compassion might explain the link that exits between body
dissatisfaction and tendency to control body weight by inadequate eating behaviors (via dieting).
[4] Nevertheless, excessive body surveillance/body concern also leads to body dissatisfaction:
[6,8,9] When women monitor their body size and shape, they might realize that there is an
inconsistency between how they look and their preferable ideal body weight, which in turn
indicates to an amplified risk for the expansion of eating sicknesses and increased body
unhappiness.[1-3,12] In other words, eating disorders serve as a tool to regulate sociocultural
threats, feeling safe in the society group, and avoid being judged by one’s body shape and
10. weight. [4] Society does not only influence the pathology of eating disorders by promoting thin-
ideal body weight, but also, social support has been found to have significant association with
the expansion of eating conditions: Individuals with eating sicknesses report lower levels of
perceived social support. [10] Moreover, maladaptive social relationships have also been
associated with increased bulimic symptoms. [1] In addition, messages from parents, best friends
and same sex peer influences person’s tactics and methods to try to lose weight or the
intensification of muscles during adolescence, [1,10,12,17] and sociocultural comments from peers,
friends and family are more likely to influence body dissatisfaction amongst girls with a high
Body Mass Index (BMI). Therefore, BMI is another significant predictor of body satisfaction
and positive body appearance development among adolescents. [2] It is concluded that girls that
feel a great pressure to please others in society are more expected to progress eating illnesses,
since they are more vulnerable to social clues such as: ideal weight, and shape (two components
related to body dissatisfaction). [2] In other words, restrictive diet and excessive exercise are
strategies used by females in an attempt to achieve the desired thin ideal body. [12] In addition,
educations have originated a noteworthy association between parents’ remarks about their
children’s weight and the children’s weight apprehensions. [4]
Moreover, only one study, from all selected research studies, found a weak relationship amongst
social media and both body discontent and body change strategies, but a resilient connotation
between social media and body image concern. [17] Hence, there is an existing gap between body
image concern and body dissatisfaction which leads to a desire to lose weight and achieve the
ideal body shape: “there are other factors contributing to eating and exercise behaviors (e.g self-
esteem, late maturation).” [12] On the other hand, other researches did support the fact that media
provides an appropriate foundation of evidence regarding specific attractiveness and societal
11. standards, and it has a significant impact in the developing of eating disorders. “Appearance
television” was exceedingly interconnected with the internalization of specify beauty
stereotypes. [6,8,9] In addition, media has caused an increased desire to lose weight and body
image concern, coupled with eating behavior.”[10,12] In study “Weight preoccupation as a
function of observed physical attractiveness”, girls aged 9-14 years old who reported an effort to
like an X-same sex media figure were more expected to advance in their weight anxieties and
become future weightwatchers. [3] Perceived messages of ideal body shape transmitted by the
media, has its highest impact on girls during their adolescent period.[10] The internalization of the
skinny perfect body weight produces disappointment in women since these standards are almost
unrealistic to achieve in a healthy way. Nevertheless, this is why is it important health concern
for adolescents since body image concerns during childhood have important implications not
only in a the possible development of eating disorders but for the formation of unfortunate body
image, self-esteem and psychological functioning.
However, “Excessive concern about weight is more prevalent among young adolescent. These
young women are more likely to engage in detrimental food and exercise behaviors to achieve
the ideal thin body weight.”[1] Therefore, as mentioned before, peer influence on thin-idealization
ideas and its impact of the development of eating disorders varies through age, and has its
highest impact when girls are 13-14 years, then it gets reduced. There is an existing relationship
between body mass and peer status: larger bodies are associated with lower levels of peer
reported popularity, and popularity is associated with dieting after accounting for body
dissatisfaction and body image concern. [17] Nevertheless, it is argued that it is not puberty what’s
really causing body image concerns and desire to lose weight: “puberty during adolescence
showed to have no significant influence on body image concern, eating, and weight loss.”
12. To sum up that point, our culture has recently shifted to an aesthetic ideal promoting thinner
body shapes in woman. In addition, thinness is nowadays being endorsed as a representation of
attractiveness and success. There has also been an substantial intensification in diet articles in
women’s magazines.[6] Eating disorders may be viewed as multifactorial disorders with family,
individual and cultural predisposition factors. (Refer to figure 1 and figure 2).
Even though all articles listed before, support the notion that culture and society plays an
essential role in the developing of eating disorders by the promotion of thinness as an ideal body
weight, no study has shown the effect of social economic status, income, education, etc. as
possible mediators of this association. These relationships need to be determined in order to find
if they also mediate the association between culture/thinness and eating disorders.
Conclusion
Eating disorders cause severe psychological, medical and social consequences that could be
lethal if not adequately treated. [13,14] Real suffering exists not only on those who suffer from the
disease, but also on those who care for them. Additional research is needed to continue studying
this multifactorial disease so that we can better understand and respond to this serious condition.
By understanding the sociocultural and psychological issue surrounding body weight concern
and body image dissatisfaction, research and healthcare practitioners can develop future
recommendations for weight control, maintenance, and the treatment of eating disorders.[6] This
literature review proves that the essential influence that sociocultural perception of attractiveness
plays on the development of eating disorders is immense. The research suggests that there is a
desire for adolescents to fit in society by being physically attractive. Following society beauty
standards of “social attractiveness” is linked to weight preoccupation, especially during the
adolescent period. [6,9,12] In addition, reading magazines at a younger age is associated with
13. engaging in more frequent dieting and excessive exercising behaviors, as well as the use of diet
pills, laxatives or other restrictive dieting methods.[3] It is concluded that body image is a
combined concept determined by body image concerns and body dissatisfaction; those two terms
combined lead to the development of decreased self-esteem and a negative perception of their
bodies. Dieting behaviors and body size are associated with peer popularity, in a style that could
lead to challenging exercise and eating manners. [17] Moreover, the adolescent years is a critical
period for girls in which the primary source of their appraisal is coming from their peers. In
addition, media and family promoting thin ideal body shape might be also reinforced by the
group of friends and hence, be associated with peer popularity.[17] The thin internalization idea
plays an imperative part in the etiology of eating disorders.[6,8,9] Girls presented to be internalized
at an early stage; and preoccupied with the sociocultural messages of what the ideal body weight
for a woman was. [3] Therefore, we suggest and recommend that there be intervention strategies
to modify cognition about ideal body weight and they be implemented at an early stage in order
to avert the expansion of eating disorders amongst young women.
14. Appendix
PUB-MED research
38 articles
5 articles that clearly addresses how thin
internalization idea set by society leads
to body image dissatisfaction and desire
to lose weight in adolescent girls
4 articles that were commonly
addressing how pressure from parents,
friends, peers and best friend lead to
desire to change body weight and shape
17 total selected
articles
1 additional article that
addresses puberty vs
sociocultural factors as possible
developers of eating disorders
7 articles chosen as background
information that were commonly
addressing culture as a strong
determinant for weight concern and
social interaction.
Figure 1. Process of identifying scientific articles for the literature review “Sociocultural
perception of attractiveness and development of eating disorders among female adolescent”
15. Figure 2: explaining how sociocultural factors influence the development of Eating Disorders by promoting
dieting, weight loss and “thin-ideal body weight”. [7]
Figure 3: Summary of relationship investigated between biological variables, sociocultural influences,
individual psychological variables, and body image. [2]
16. Figure 4: An elaborated sociocultural model of disordered eating. Social comparison and body surveillance are
conceived as mediators of the thin-ideal internalization-body dissatisfaction link. [3]
Clark L, Tiggemann M. Sociocultural and individual psychological predictors of body image in young girls: A
prospective study. Dev Psychol 2008;44(4):1124.
17. Table summarizing main articles
Author Year Characteristic of the
sample
Methods Results
Type
Of
Study
Bell C, Cooper
MJ
2006
18 girls between 14-15 years out
of 83 sample size successfully
participated in the study. The
mean age was 15. Sample size
was recruited from 2 mainstream
schools in the UK; girls were
chose to volunteer in this study
once their mothers signed a
confirming form.
Questionnaire packs were sent
home and the researchers were the
ones responsible for collecting
them after a week. *“Eating
Attitude Test”
* “Eating Disorder Belief
Questionnaire”
* “Sociocultural Attitude Towards
Appearance Questionnaire”
*self-reported weight and height
Peer and media influence the
development of eating
disorder’s symptoms in young
girls. However, individual
cognitions about body image
add to this relationship.
Cross-sectional
McCabe MP,
Ricciardelli LA,
Finemore J.
2001
1185 adolescents: 527 boys and
598 girls enrolled in grades 7
and 8 in six schools located in
Melbourne, Australia
5 scales of
-“Body Image and Body change
inventory”,to determine:
*body dissatisfaction, *body image
importance,
*strategies being implemented to
reduce weight.
-“media scale”.
-Pubertal Development scale
-the“Self-descriptive questionnaire
II”
Adolescents both boys and
girls perceived that they
should respond and conform
to the sociocultural pressure
to have the ideal weight
according to their gender.
However, consistent with
others research, adolescent
girls showed to have a higher
level of dissatisfaction that
boys. Girls are more likely to
adopt extreme eating patterns
to decrease weight.
Cross-sectional
McCabe MP,
Ricciardelli LA.
2004
compromises 246 girls who
completed the questionnaire in
all 3 times. All participants
where chose from 6 public and
private schools in Australia
Scales from the Body Image and
Body Change Questionnaire. These
scales assessed levels of body
dissatisfaction, image importance,
strategies used to lose weight. In
addition, 5 subscales from the
“sociocultural influences on body
change questionnaire” were also
implemented in order to measure
social pressure from parents, peers,
media and best friend.
Nevertheless, weight and height
were self-reported by the
participants
Weight change behaviors are
shaped by biological,
psychological and social
factors.
Social factors include
perceived pressure from
peers, parents and media to
change weight and shape.
Perceived messages from
these individuals (peers and
parents) play an important
role in shaping strategies to
lose weight
Female girls were mostly
influenced by their mothers
and same sex peers, when it
comes to body weight change
concerns.
Cohort
Garner DM,
Garfinkel PE
1980 441 adolescent is grade 11 and
12
Data was collected by self-reported
weight, height, dietary behavior,
peer perceived popularity and peer
likeability.
Eating Attitudes Test: in order to
measure symptoms of Anorexia
Nervosa
There is a significant association
between social reputation and
dietary intake. Thinness is
associatedwith peer popularity. A
larger body shape was associated
with small levels of perceived
social popularity. In addition,
girls show a stronger level of
body dissatisfaction than boys.
Individuals with increased focus
on slim body shape are at risk for
anorexia nervosa.
Cross-sectional
18. Fitzsimmons-
Craft EE, Harney
MB, Koehler LG,
Danzi LE,
Riddell MK,
Bardone-Cone
AM.
2012
which 265 women with a mean
age of 19, who were attending
Southwestern University, were
recruited through “Introduction
to Psychology course” offered at
the university
These results were calculated using
correlation measurements between
scale results of computer based
questionnaires with a timeframe of
45 min. Body Surveillance
subscale, Iowa-Netherlands
comparison orientation measure
and the internalization appearance
questionnaire-3 were the scales
used for data collection
Increase body monitoring/
body observation leads to
higher levels of body
dissatisfaction.
Cross-Sectional
Juarascio AS,
Forman EM,
Timko CA,
Herbert JD,
Butryn M, Lowe
M
2011
By 80 freshman women within a
18-25 age range. Recruitment
and baseline data collection took
place at the first month of
college; the study lapse time was
7.8 months.
Body shape questionnaire to assess
body image satisfaction, Eating
Attitude Test to measure disordered
eating behavior, and Sociocultural
Attitude Towards appearance scale
to test for the level of
internalization of the thin ideal
At the beginning of the
freshman year, women are
more susceptible to
internalize the thinness as the
ideal body shape, which puts
them at higher risks of eating
disorders due to body image
dissatisfaction.
In addition, body image
surveillance is highly
influenced by the
internalization of the ideal
thin body weight-
sociocultural standard.
Cohort
Homan K. 2010
231 women students who were
attending art classes at a private
liberal art college. Data was
collected in 2 times. Time 1 took
place during the first month of
the academic year; after 7
months’ time 2 data collection
took place
“Athletic subscale of the
sociocultural attitudes towards
appearance questionnaire 3”, “the
internalization subscale of the
sociocultural attitude towards
appearance questionnaire”,
“Multidimensional body-self
relations questionnaire”,
“Obligatory Exercise
Questionnaire” and “Dutch
Restrained Eating Scale”
Thin internalization idea
predicted changes in body
dissatisfaction, dieting and
compulsive exercise
Cohort
McCabe MP,
Ricciardelli LA
2003
800 adolescent (423 boys and
377 girls) students from 6 high
schools in Melbourne, Australia
the “Body Image and Body Change
Inventory” during a single class
period. This scale measured body
image dissatisfaction, importance,
strategies to decrease weight,
strategies to increase weight,
strategies to increase muscle, binge
eating and supplement intake
Mother and best female
friend’s feedback were more
important predictors of body
image importance and body
change strategies.
Cross-sectional
19. Colabianchi N,
Ievers-Landis CE,
Borawski EA
2006
4324 females adolescents in
grades 8-12 with normal BMI
were
Data source from this report comes
from the National Longitudinal
Study of Adolescent Health.
Researches used questionnaires to
test for these variables: weight
preoccupation, dieting and exercise
to lose weight, thinking they were
overweight and engaging in
inappropriate dieting behavior.
Physical beauty function as a
risk factor for weight
preoccupation and therefore,
for the development of eating
disorders among adolescent
girls.
Thinness and attractiveness
are a great concern for self-
identity among adolescent
girls.
Cross-sectional
Wang SS,
Houshyar S,
Prinstein MJ
2006 183 professional dancers and 56
modeling students
Perceived Body Size: using the
Ideal Body Subscale-Female.
Body Related Cognition: To test for
frequency of adolescent’s cognition
about their body appearance and
size.
Dieting: To test for food behaviors
Peer-rated social preference and
social reputation.
Girls reported higher levels of
body image concern and
obesity cognition than boys.
Ideal body shape and dieting
are associated with higher
levels of peer popularity.
Cross-sectional
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