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PEDIATRICS Vol. 103 No. 3 March 1999, p. e36
,
From the * Channing Laboratory, Department of Medicine, Brigham
and Women's Hospital and Harvard Medical School, Boston,
Massachusetts; Departments of Nutrition, § Health and Social
Behavior, and Epidemiology, Harvard School of Public Health, Boston,
Massachusetts; ¶ Department of Health Evaluation Science, University of
Virginia Medical Center, Charlottesville, Virginia; and # Department of
Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
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ABSTRACT |
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Top
Abstract
Methods
Results
Discussion
References
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Objective. To assess the influence of the media on girls' weight concerns, weight control/loss behaviors, and perceptions of body weight and shape.
Design. Cross-sectional survey completed in school. The questionnaire assessed body weight, dissatisfaction with body weight and shape, exposure to fashion magazines, the impact of media on feelings about weight and shape, attributes of and preferences for body types, and whether subjects had gone on a diet to lose weight or initiated exercise because of an article in a magazine.
Setting. Mandatory physical education class in public elementary, junior high, and high schools.
Participants. Subjects included 548 5th- through 12th-grade girls in a working-class suburb in the northeastern United States.
Outcome Measures. Perceived influence of fashion magazines on body dissatisfaction, idea of the perfect body shape, dieting to lose weight, and initiating an exercise program.
Results. Pictures in magazines had a strong impact on girls' perceptions of their weight and shape. Of the girls, 69% reported that magazine pictures influence their idea of the perfect body shape, and 47% reported wanting to lose weight because of magazine pictures. There was a positive linear association between the frequency of reading women's magazines and the prevalence of having dieted to lose weight because of a magazine article, initiating an exercise program because of a magazine article, wanting to lose weight because of pictures in magazines, and feeling that pictures in magazines influence their idea of the perfect body shape. In multivariate logistic regression models controlling for weight status (overweight vs not overweight), school level (elementary vs junior high school, elementary vs high school), and race/ethnic group, girls who were frequent readers of fashion magazines were two to three times more likely than infrequent readers to diet to lose weight because of a magazine article (odds ratio [OR] = 2.11, 95% confidence interval [CI]: 1.19-3.75); to exercise to lose weight because of a magazine article (OR = 3.02, 95% CI: 1.77-5.17); and to feel that magazines influence what they believe is the ideal body shape (OR = 2.81; 95% CI: 1.72-4.58). In addition, moderate-frequency readers were more likely than infrequent readers of fashion magazines to report exercising because of a magazine article (OR = 1.94; 95% CI: 1.14-3.30) and feeling that magazines influence what they believe is the ideal body shape (OR = 2.03; 95% CI: 1.30-3.15).
Discussion. The majority of the preadolescent and adolescent girls in this school-based study were unhappy with their body weight and shape. This discontentment was strongly related to the frequency of reading fashion magazines. Although previous studies have concluded that the print media promotes an unrealistically thin body ideal, which in turn is at least partially responsible for promoting eating disorders, the present study is the first that we are aware of to assess directly the impact of the print media on the weight and body shape beliefs of young girls. We observed that the frequency of reading fashion magazines was positively associated with the prevalence of having dieted to lose weight, having gone on a diet because of a magazine article, exercising to lose weight or improve body shape, and deciding to exercise because of a magazine article. Given the substantial health risk associated with overweight and the fact that during the past 2 decades the prevalence of overweight has increased sharply among children and adolescents, it is not prudent to suggest that overweight girls should accept their body shape and not be encouraged to lose weight. However, aspiring to look like underweight models may have deleterious psychological consequences. The results suggest that the print media aimed at young girls could serve a public health role by refraining from relying on models who are severely underweight and printing more articles on the benefits of physical activity. Additional research is needed to assess whether articles on the health hazards of severe dieting, bulimic behaviors, and maintaining a very low body weight would be beneficial. female, preadolescent, adolescent, media, weight concerns.
In the United States, many young females are extremely
concerned with their body weight and shape and may engage in unhealthy weight-control practices as a result.1 A small proportion suffer from full-criteria eating disorders (0.1% have anorexia nervosa
and 1% to 3% have bulimia nervosa) that can have serious mental and
physical health outcomes such as depression, acute gastric dilation and
rupture, metabolic alkalosis, cardiac arrhythmias, and
death.2
Weight concerns, which are predictive of developing eating disorders of
at least subsyndromal severity,3 are being seen at younger
and younger ages. For example, Gustafson-Larson and Terry4
observed that more than half of the 4th-grade girls in their sample
reported a desire to be thinner. During preadolescence and adolescence,
concerns with weight and shape are so common among
girls5-13 that they are considered normative.
Weight concerns and bulimic behaviors are assumed to primarily affect
white females. However, several recent studies have documented that
compared with white females, black and Hispanic females have equal or
higher levels of weight concerns and weight control
efforts.4,5,14,15 Whether the correlates of weight
concerns vary by race/ethnic group is not known.
The role of sociocultural factors in the etiology of eating disorders
has been widely accepted. Nevertheless, how or by whom the pressure to
be thin is transmitted to young girls remains unclear. The mass media
have been implicated in the formation of unrealistically thin body
ideals.16-21 Most research in this area has consisted of
studies showing trends in the decreasing weight or increasingly
androgenous shape of models in the media over time. Other studies have
documented an increase in diet- and weight-related articles over time
and have cited this increase as evidence that the media creates
overconcern with weight. These ecologic studies have been used to
support the position that the increase in weight concerns and eating
disorders over time is caused at least partially by the unrealistic
body weight and shapes portrayed by the mass media. However, ecologic studies can be difficult to interpret because the associations are not
on the individual level.22 In other words, two trends may
occur over time in a population, but have no causal relation to each
other. To date, there is a lack of research assessing directly the
influence of the media on weight concerns among young women. To assess
the associations between frequency of exposure to the media, weight,
weight concerns, and weight control/loss behaviors, we conducted a
cross-sectional study among girls in a working-class suburb of a large
city in the northeastern United States.
Between February and May 1991, a questionnaire was administered
to girls in grades 5 to 12 attending public schools in a working class
suburb of Boston, MA. The study population was sampled so that its
ethnic composition was representative of the entire school district.
Thirteen elementary schools (grades 5 and 6), one junior high school
(grades 7 and 8), and one high school (grades 9 through 12) were
sampled. The composition of the total sample of 548 girls was 29.5%
elementary school, 34.1% junior high school, and 33.3% high school
students.
Before administration of the survey, the study was approved by the
Human Subjects Committee at Massachusetts General Hospital, both the
study design and the questionnaire were approved by the School Board,
and parental consent was obtained. To ensure uniformity, all written
and oral instructions were standardized and given by trained research
assistants. The questionnaire was completed during physical education
class time. Physical education is a mandatory class for all students in
the school district. The response rate, adjusted for absenteeism,
drop-outs, and moving out of the school district was 78%.
Height and weight were self-reported. A scale was available to anyone
who was unsure of her weight. In a pilot study in the same sample, we
found strong correlations between self-reported and measured height
(r = 0.73; P < .0001) and weight
(r = 0.98; P < .0001), leading us to
conclude that self-reported measures were valid. Overweight was defined
as equal to or above the 85th percentile of body mass index
(weight/height2), according to age- and sex-specific
reference data from the First National Health and Nutrition Examination
Survey, which was collected between 1971 and 1974.23
Exposure to fashion magazines was assessed with a question asking,
"How often do you read magazines (for example, Seventeen, Jet, Sassy, Glamour... )?" The
response categories ranged from never to daily. Students reporting
"never" or "once a month" were classified as infrequent
readers, those reporting "2-5 times a month" as moderate-frequency
readers, and those reporting "twice per week" or "daily" as
high-frequency readers. Two questions were used to assess the impact of
media on feelings about weight and shape: "Do you think that pictures
of women in magazines influence what you think is the perfect body
shape?" and "Do pictures of women in magazines make you want to
lose weight?". In addition, girls were asked whether they agreed with
the following two statements: "I have gone on a diet to lose weight
because of an article in a magazine" and "I have initiated exercise
because of an article in a magazine."
Attributes of and preferences for body types were assessed by showing
the girls four pictures of models representing different body types
(very thin, overweight, athletic, and "normal" weight). Participants were asked to indicate which model they wanted to look
like, did not want to look like, thought would be most popular with the
boys, was the most healthy, was the least healthy, was most likely to
be a success in life, and was most likely to be a failure in life.
Mantel-Haenszel Among 548 5th- through 12th-grade girls, the prevalences of
dissatisfaction with body shape (59%) and wanting to lose weight (66%) were higher than the prevalence of overweight (29%). These discrepancies indicated that some girls of healthy weights were not
satisfied with their body weight and shape. Pictures in magazines had a
strong impact on girls' perceptions of their weight and shape.
Sixty-nine percent of the girls reported that magazine pictures
influence their idea of the perfect body shape, and 47% reported
wanting to lose weight because of magazine pictures.
Approximately 85% of girls had some exposure to fashion magazines;
however, only 26% of girls read fashion magazines at least twice a
week. The prevalence of high frequency of reading women's fashion
magazines was similar among the girls in elementary (25%), junior high
(32%), and high school (21%) (Table 1).
However, the proportion of girls who were infrequent readers went down with age (ie, a higher percentage of high school than elementary school
girls were moderate-frequency readers).
TABLE 1
METHODS
Top
Abstract
Methods
Results
Discussion
References
2 tests, with 1 degree of freedom, were
used to test the significance (at the 
= 0.05 level) of the trends across level of frequency of reading women's fashion magazines. Multivariate logistic regression models were used to test the associations between levels of frequency of reading women's fashion magazines and dieting to lose weight because of a magazine article, initiating an exercise program because of a magazine article, and
feeling that magazines influence their idea of a perfect body. In the
logistic regression models, moderate and high frequency of reading
fashion magazines were entered as separate dichotomous variables, thus
a linear relation with frequency of reading fashion magazines was not
assumed. School level (ie, elementary, junior high, and high school)
and weight status (overweight vs not overweight) were adjusted for in
the logistic regression models predicting dieting to lose weight
because of a magazine article, initiating an exercise program because
of a magazine article, and feeling that magazines influence their idea
of a perfect body. The analyses also were conducted including three
dichotomous variables for race/ethnic group (with whites as the
referent). In the logistic regression models predicting whether girls
aspired to look like the thinnest of the four models shown and whether
they thought that boys would prefer the thinnest of the four models,
only race/ethnic group (entered as three dichotomous variables) and
frequency of reading fashion magazines (entered as two dichotomous
variables) were included in the final models. All analyses were
performed using SAS software.
RESULTS
Top
Abstract
Methods
Results
Discussion
References
Prevalence (%) of School Level, Overweight, Desire to Lose Weight, and
Contentment with Body Shape by Frequency of Exposure to Women's
Fashion Magazines Among 548 Preadolescent and Adolescent Girls
The perceived influence of the media was related to the frequency of reading women's fashion magazines. There was a positive linear association between the frequency of reading women's magazines and the prevalence of having dieted to lose weight because of a magazine article (P = .02), initiating an exercise program because of a magazine article (P = .001), wanting to lose weight because of pictures in magazines (P = .004), and feeling that pictures in magazines influence their idea of the perfect body shape (P = .001) (Table 2).
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In multivariate logistic regression models controlling for weight status (overweight vs not overweight), school level (elementary vs junior high school, elementary vs high school), and race/ethnic group, girls who were frequent readers of fashion magazines were two to three times more likely than infrequent readers to diet to lose weight because of a magazine article (odds ratio [OR] = 2.11; 95% confidence interval [CI]: 1.19-3.75), to exercise to lose weight because of a magazine article (OR = 3.02; 95% CI: 1.77-5.17), and to feel that magazines influence what they believe is the ideal body shape (OR = 2.81; 95% CI: 1.72-4.58) (Table 3). In addition, moderate-frequency readers were more likely than infrequent readers of fashion magazines to report exercising because of a magazine article (OR = 1.94; 95% CI: 1.14-3.30) and feeling that magazines influence what they believe is the ideal body shape (OR = 2.03; 95% CI: 1.30-3.15).
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We observed several racial/ethnic group differences in the perceived influence of the media on girls' weight concerns and beliefs. Independent of school level, weight status, and frequency of reading fashion magazines, Hispanics were more likely than whites to diet because of an article they read in a fashion magazine, whereas, independent of frequency of reading fashion magazines, blacks were more likely than whites to want to look like the thinnest model (OR = 4.91; 95% CI: 1.58-15.23) and to believe that boys would prefer the thinnest model (OR = 3.25; 95% CI: 1.32-8.04) (Table 4).
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DISCUSSION |
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Top
Abstract
Methods
Results
Discussion
References
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We observed that the majority of the preadolescent and adolescent girls in this school-based study were unhappy with their body weight and shape. This discontentment was related strongly to the frequency of reading fashion magazines, which was reported to influence their idea of the perfect body shape by 69% of girls. The effect of the media was so strong that even among girls who only infrequently read fashion magazines, almost 60% felt that the media influenced their idea of the perfect body shape. The frequency of reading fashion magazines was positively associated with the prevalence of having dieted to lose weight, having gone on a diet because of a magazine article, exercising to lose weight or improve body shape, and deciding to exercise because of a magazine article.
Although previous studies have concluded that the print media promotes an unrealistically thin body ideal that, in turn, is at least partially responsible for promoting eating disorders, the present study is the first that we are aware of to assess directly the impact of the print media on the weight and body shape beliefs of young girls. This study offers support for the strong impact of the print media on young girls' perception of their weight and body shape as well as on dictating the perfect body shape.18,21 However, on the positive side, the print media was effective at promoting physical activity as a healthy means of weight control. In fact, more girls reported exercising than dieting to lose weight.
There are several limitations to this study. First, the study is cross-sectional, thus causality cannot be inferred. Girls who feel dissatisfied with their body weight and shape may be more likely to read magazines that enforce their negative and perhaps distorted beliefs about weight and shape. Ideally, children would be followed over time to assess whether girls who read fashion magazines are more likely than their peers with low exposure to the media to become preoccupied with their weight and develop maladaptive behaviors (eg, use of diet pills, laxatives, self-induced vomiting, etc, to control weight). Another limitation is that the questionnaire did not contain detailed questions about the influence of television on desires to lose weight and change body shape.
In conclusion, we observed that dissatisfaction with weight and shape were very common among preadolescent and adolescent girls. The frequency of reading fashion magazines was positively and independently associated with dieting and exercising to lose weight. Moreover, the more frequently girls read fashion magazines, the more likely they were to report that they had dieted or initiated an exercise program to lose weight because of a magazine article. Furthermore, the frequency of reading fashion magazines was positively associated with feeling that magazines influenced their idea of the perfect body. Given the substantial health risk associated with overweight24-27 and the fact that during the past 2 decades the prevalence of overweight has increased sharply among children and adolescents,28 it is not prudent to suggest that overweight girls should accept their body shape and not be encouraged to lose weight. However, aspiring to look like underweight models may have deleterious psychological consequences. The results suggest that the print media aimed at young girls could serve a public health role by refraining from relying on models who are severely underweight and printing more articles on the benefits of physical activity. Additional research is needed to assess whether articles on the health hazards of severe dieting, bulimic behaviors, and maintaining a very low body weight would be beneficial.
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ACKNOWLEDGMENTS |
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Drs Field and Colditz were supported in part by the Boston Obesity Nutrition Research Center (DK 46200).
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FOOTNOTES |
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Received for publication Jun 17, 1998; accepted Oct 12, 1998.
Reprint requests to (A.E.F.) Channing Laboratory, 181 Longwood Ave, Boston, MA 02115.
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ABBREVIATIONS |
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OR, odds ratio; CI, confidence interval.
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REFERENCES |
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Methods
Results
Discussion
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This article has been cited by other articles:
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  S. Whitehead and S. Biddle Adolescent girls' perceptions of physical activity: A focus group study European Physical Education Review, June 1, 2008; 14(2): 243 - 262. [Abstract] [PDF]
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 D. A. Hargreaves and M. Tiggemann 'Body Image is for Girls': A Qualitative Study of Boys' Body Image. J Health Psychol, July 1, 2006; 11(4): 567 - 576. [Abstract] [PDF]
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 A. E. BECKER, R. A. BURWELL, D. B. HERZOG, P. HAMBURG, and S. E. GILMAN Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls The British Journal of Psychiatry, June 1, 2002; 180(6): 509 - 514. [Abstract] [Full Text] [PDF]
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