Media influence on self-image:
The real fashion emergency

by Alison E. Field, ScD

   The role of sociocultural factors in the etiology of eating disorders has been widely accepted. How or by whom the pressure to be thin is transmitted to young girls is not well understood, but the media have been implicated in the formation of unrealistically thin body ideals.^1-6 Much of the research in this area has been ecologic, showing trends in the decreasing weight or increasingly androgenous shape of models in the media over time or documenting an increase in diet and weight articles over time. These changes are cited as evidence that the media creates overconcern with weight. However, ecologic studies can be difficult to interpret because the associations are not on the individual level.⁷ 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 paucity of research directly assessing the influence of the media on weight concerns among young women.
   To assess the associations between frequency of media exposure and weight concerns and weight control/loss behaviors, we conducted two studies: (1) a cross-sectional study among girls in a working-class suburb of a large city in the northeastern United States and (2) a prospective investigation among a large cohort of girls living throughout the United States. The cross-sectional study of 548 girls in grades 5 to 12 attending public schools in a working class suburb of Boston, Massachusetts⁸ was conducted in 1991. Sixty-nine percent of the girls reported that magazine pictures influence their idea of the perfect body shape, and 47 percent reported wanting to lose weight because of magazine pictures. The more frequently a girl read women's magazines, the more likely she was to have dieted to lose weight because of a magazine article (p = .02), have wanted to lose weight because of pictures in magazines (p = .004), and have felt that pictures in magazines influenced her idea of the perfect body shape (p = .001). After statistically controlling for weight status (comparing overweight with not overweight girls), school level, and race/ethnic group, we found that 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 and to feel that magazines influenced what they thought was the ideal body shape. In addition, moderate-frequency readers were significantly more likely than infrequent readers of fashion magazines to report feeling that magazines influenced what they thought was the ideal body shape.
   Although we observed a strong relationship between frequency of exposure to the fashion magazines and discontentment with body weight and shape, the cross-sectional study design did not allow us to determine whether exposure to the media predicted the development of weight concerns or whether girls who were very concerned with their weight reinforced those feelings by frequently reading fashion magazines. To understand the temporal order of the association, we conducted a second, prospective analysis using data from the Growing Up Today Study, a prospective cohort study established in 1996 and comprising 9,039 girls and 7,843 boys who were 9 to 14 years of age when the study began. The investigation was restricted to girls because the incidence of purging was too low among the boys to conduct meaningful analses.
   The participants have been followed since 1996 with annual questionnaires that include a variety of measures. Questions adapted from the junior high school version of the McKnight Risk Factor Survey⁹ are used to measure weight concerns, attitudes, and behaviors; weight control methods (dieting, exercise, self-induced vomiting, diet pills, and laxatives) are adapted from the Youth Risk Behavior Surveillance System questionnaire.¹⁰ The relationship of media influences to the risk of beginning to purge (using laxatives or vomiting at least monthly to control weight) was assessed prospectively among the 6,982 girls who (1) completed questionnaires in 1996 and 1997, (2) reported in 1996 not using vomiting or laxatives to control weight, and (3) were between 9 and 14 years of age in 1996.¹¹ In 1996, approximately 29 percent of the girls had been on a diet to lose weight during the preceding year, 14 percent reported that they were concerned with their weight "a lot" or "always," and 6 percent of girls reported making considerable effort to look like females on television or in movies or magazines. Between 1996 and 1997, 74 girls (1%) began using vomiting or laxatives at least monthly to control weight. Independent of age, maturational stage, dieting frequency, and weight concerns, the more effort a girl reported making to look like females on television or in movies or magazines, the more likely she was to start purging over a 1-year period. Regardless of the ovariates included in the logistic regression model, the risk of beginning to purge increased approximately 30 to 40 percent per one-category increase in frequency of trying to look like females on television or in magazines or movies.
   Our results support those from several cross-sectional studies, including our own, that have observed a positive association between weight concerns and frequency of reading fashion magazines^8,12 or trying to look like females in magazines or on television.⁷ It is unclear where the girls peers learned to place such emphasis on thinness, but our results suggest that the popular media are partially responsible for creating unrealistic body-image goals for young females. Thus, the media should be discouraged from using actresses and models who would be considered severely underweight by the medical community because they serve as unhealthy role models for young girls.

Alison Field would like to thank and acknowledge Graham A. Colditz, C. Barr Taylor, Anne M. Wolf, and Carlos A. Camargo, Jr, for their helpful comments and suggestions on the manuscripts on which this review is based.
   Alison E. Field, ScD ([email protected]), works in the Channing Laboratory in the Department of Medicine at Brigham & Women's Hospital and Harvard Medical School in Boston.
 

References

1. Tiggemann M, Pickering AS. Role of television in adolescent women's body dissatisfaction and drive for thinness. Int J Eating Disord 1996;20:199-203.
2. Wiseman CV, Gray JJ, Mosimann JE, Ahrens AH. Cultural expectations of thinness in women: an update. Int J Eat Disord 1992;11:85-89.