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Influence of Mass Media on Body Image and Eating Disordered Attitudesand Behaviors in Females: A Review of Effects and ProcessesGemma López-Guimeràa; Michael P. Levineb; David Sánchez-carracedoa; Jordi Fauquetc

a Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain b

Department of Psychology, Kenyon College, Gambier, Ohio c Department of Psychobiology andMethodology of Health Sciences, Universitat Autònoma de Barcelona, Spain

Online publication date: 15 December 2010

To cite this Article López-Guimerà, Gemma , Levine, Michael P. , Sánchez-carracedo, David and Fauquet, Jordi(2010)'Influence of Mass Media on Body Image and Eating Disordered Attitudes and Behaviors in Females: A Review ofEffects and Processes', Media Psychology, 13: 4, 387 — 416To link to this Article: DOI: 10.1080/15213269.2010.525737URL: http://dx.doi.org/10.1080/15213269.2010.525737

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Media Psychology, 13:387–416, 2010

Copyright © Taylor & Francis Group, LLC

ISSN: 1521-3269 print/1532-785X online

DOI: 10.1080/15213269.2010.525737

Influence of Mass Media on Body Image andEating Disordered Attitudes and Behaviors inFemales: A Review of Effects and Processes

GEMMA LÓPEZ-GUIMERÀDepartment of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain

MICHAEL P. LEVINEDepartment of Psychology, Kenyon College, Gambier, Ohio

DAVID SÁNCHEZ-CARRACEDODepartment of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain

JORDI FAUQUETDepartment of Psychobiology and Methodology of Health Sciences,

Universitat Autònoma de Barcelona, Spain

This article reviews research on the effects of television and mag-

azines on body image and on disordered eating attitudes and

behaviors in females. Evidence from different types of studies in

the fields of eating disorders, media psychology, health psychol-

ogy, and mass communication indicates that mass media are an

extremely important source of information and reinforcement in

relation to the nature of the thin beauty ideal, its importance,

and how to attain it. Although considerable research remains

to be done, evidence is accumulating that repeated exposure to

media and to both direct and indirect (via media’s effects on

peers, parents, coaches, physicians, etc.) pressures from media

to be thin constitute risk factors for body dissatisfaction, con-

cerns over weight and disordered eating behaviors in adolescent

girls and young women. To guide further research, as well as

the prevention and treatment of disordered eating, we present

a figural summary of media effects that integrates moderating

and mediating factors such as internalization of the thin beauty

Address correspondence to Gemma López-Guimerà, Department of Clinical and HealthPsychology, Edifici B, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallés)08193, Spain. E-mail: [email protected]

387

Downloaded By: [Consorci de Biblioteques Universitaries de Catalunya] At: 11:37 2 February 2011

388 G. López-Guimerà et al.

ideal, social comparison, and activation of the thinness schema.

We argue that risk factor research, prevention, and treatment

will benefit from systematic research designed to clarify how the

impact of various mass media is shaped by source and receiver/

perceiver factors.

Media are among the principal social agents in many societies around theworld. Television, magazines, newspapers, radio, cinema, advertising, theInternet, and other so-called ‘‘new media’’ or ‘‘new technologies’’ occupy—if not invade—much of our leisure time, and indeed our working time.Mass media transmit the ideas, values, norms, attitudes, and behaviors thatsocialize and construct the social reality of those who use them for a widevariety of reasons (Bryant & Oliver, 2009). The processes of media selec-tion, media use, and media effects are particularly important for childrenand adolescents because the powerful, insistent, market-driven media havebecome serious rivals to the family and school with regard to education andsocialization (Bercedo Sanz et al., 2005). In developed countries, televisionhas become (after sleep) children’s primary activity (American Academy ofPediatrics, 2001). A recent study in Spain found that adolescents consumean average of 3 hours to 3.2 hours a day of television on weekdays andweekends, respectively (Bercedo Sanz et al., 2005). These figures approachthose currently available for the Spanish adult population, who, accordingto an official survey, spend on average 3.8 hours a day watching television(Estudio General de Medios, 2009). A recent report of the Kaiser FamilyFoundation, in United States, shows that the average amount of time spentwatching television content among all 8–18 year olds is 4.29 hours in atypical day (Rideout, Foehr, & Roberts, 2010). Magazines aimed at females,and especially adolescents, have increased in number and availability inrecent years. An estimated 33 million 12–19 year olds spend upward of $175billion annually on these magazines (Kaiser Family Foundation, 2004).

Television, magazines, films, billboards, and the like frequently offer adistorted vision of the world (Bercedo Sanz et al., 2005; Shrum, 2009), andit may be difficult for children and adolescents to distinguish whether whatthey see is real or not, so that they are more vulnerable to the messagestransmitted (American Academy of Pediatrics, 2001). In a classic contentanalysis of prime-time television, Kaufman (1980) concluded that televisionwas obsessed with thinness, and the most prevalent and salient content ofmagazines aimed at adolescent females was focused on appearance (KaiserFamily Foundation, 2004). Undeniably, a substantial portion of media contentconsumed by children and adolescents is replete with unhealthy messagesabout the beauty ideal, body size, food, weight control, and the gender rolesof women and girls, as well as use of alcohol, tobacco, and other substancesfor managing one’s emotions and self-presentation (see, e.g., Greenberg,


Influence of Mass Media on Body Image 389

Rosaen, Worrell, Salmon, & Volkman, 2009; see also reviews by Levine &Harrison, 2004, 2009). People are often unaware—and mass media work hardto keep it that way—of the extent to which, and just exactly how mass mediaplay an important role in promoting consumerism, body objectification, andinternalization of the current beauty ideal. Similarly, various components ofthe media, including critics and other commentators, tend to avoid discussionof how often the fashion industries use digital technology to manipulateimages (Engeln-Maddox, 2006). These are the images that set the currentstandards of beauty and sexuality that are seen (experienced) as ‘‘real’’ and‘‘normative’’ but are actually impossible to attain (Levine & Harrison, 2004,2009; Levine & Murnen, 2009; Thompson, Heinberg, Altabe, & Tantleff-Dunn,1999; Thompson & Stice, 2001; Toro, 2004; Utter, Neumark-Sztainer, Wall, &Story, 2003).

For these and other reasons, many researchers argue that mass mediaare one of the principal factors behind body dissatisfaction, concerns aboutweight, and disordered eating behavior (see, e.g., Levine & Murnen, 2009).The purpose of this article is to review, in a critical but necessarily selectivefashion, current research on the effects of the media on body image andon disordered eating attitudes and behaviors. This analysis helps to clarifythe empirical status of media effects, to identify the most vulnerable typesof individuals, and to raise specific questions and suggestions about theimplications of this work for causal models, for treatment, and for prevention.Although there is a growing literature examining the Internet (see, e.g.,Bardone-Cone & Kass, 2007) and the impact of media on adolescent boysand young adult men (see, e.g., Bartlett, Vowels, & Saucier, 2008), the mainfocus of studies to date has been centered on adolescent girls and femaleundergraduates and how they are influenced by television and magazines,which are in fact the media most widely consumed by adolescents (EstudioGeneral de Medios, 2006; Roberts, Foehr, & Rideout, 2005).1

There are many ways to segment and organize the data on mediaeffects (see, e.g., Levine & Harrison, 2009; Levine & Murnen, 2009). Wehave chosen to group the studies according to methodology because dif-ferent designs have been employed for analyzing how exposure to me-dia images and other messages influence females’ perceptions, attitudes,and behaviors. Furthermore, we review those moderators and mediatorsof media effects that to date have the strongest empirical support. Sev-eral recent reviews have addressed either the effects of media exposureon body image and disordered eating (see, e.g., Grabe, Ward, & Hyde,2008) or processes such as internalization of the slender beauty ideal thatmoderate and/or mediate those effects (see, e.g., Cafri, Yamamiya, Bran-nick, & Thompson, 2005). However, to the best of our knowledge, thisis the first critical review to consider the nature and implications of mediaeffects as a function of both research design and the psychological processesinvolved. Additionally, we present a figural summary that synthesizes the



relationships among constructs as discussed in our review and in recentmeta-analyses.

CROSS-SECTIONAL STUDIES

Cross-sectional studies explore the concurrent association between exposureto television (certain programs in particular) or fashion magazines and vari-ables such as concerns about weight, body dissatisfaction, and disorderedeating behaviors. Magazines often show underweight models juxtaposedwith articles about how to lose weight and how to change body shape (Dohnt& Tiggeman, 2006a; Harrison, 2000). Field, Cheung, et al.’s (1999) survey of548 preadolescent and adolescent girls found that 69% acknowledged thatimages in magazines had influenced their conception of the ideal body, while47% reported that they wanted to lose weight after seeing such images. Inter-estingly, for regular readers of fashion magazines, the probability of going ona diet or doing physical exercise to lose weight in accordance with the rec-ommendations of a magazine article was two to three times greater than theprobability of similar weight management behaviors in non-regular readers.

The tendency of magazine articles and advertisements to activate weightconcerns and weight management behavior was also demonstrated in asurvey study of 4,746 adolescent boys and girls conducted by Utter et al.(2003). Compared to girls who did not usually read fashion and glamourmagazines, girls who frequently read articles about diets and issues relatedto weight loss were seven times more likely to practice a range of unhealthyweight control behaviors and six times more likely to engage in the mostextreme unhealthy weight control behaviors (e.g., taking diet pills, vomiting,using laxatives, and using diuretics). The data suggested that these articleshad a direct effect on unhealthy weight management behavior. Althoughgirls who read ‘‘diet articles’’ were indeed more likely to have low self-esteem, greater body dissatisfaction, and more depressive mood than the girlswho did not read them, none of these variables mediated the relationshipbetween reading diet-related material in magazines and unhealthy weight-control behaviors. It is important to stress, however, that the magazinesin question also appear to have a positive influence in promoting physicalactivity (Field, Cheung, et al., 1999) and a balanced diet (Utter et al., 2003).

In general, cross-sectional studies show that the average amount of timeadolescent girls spend viewing appearance-focused media such as fashionand glamour magazines, soap operas, and music videos is positively andmodestly correlated with body dissatisfaction, drive for thinness, internal-ization of the thin ideal, endorsement of surgery to attain a bust size thatis neither small nor too large, and bulimic symptomatology (Levine & Mur-nen, 2009). Yet, there is substantial variability in the survey-based empiricalfindings, and there is conflicting evidence as to whether these relationships



apply to non-White as well as White girls. The issue is difficult to resolvebecause most studies are conducted with samples in which the vast majorityof participants are White women and girls (DeBraganza & Hausenblas, 2010;Levine & Harrison, 2009; Levine & Murnen, 2009; Murnen, Levine, Smith, &Groesz, 2007).

Thus, it is important to acknowledge, for example, that some studies ofadolescent samples have found no relationship between weight and appear-ance concerns and the variables of exposure to television, in general, as wellas to other electronic media. However, these same studies have found ef-fects of exposure to certain genres of television programming. Borzekowski,Robinson, and Killen’s (2000) study of 837 adolescent girls explored therelationship between use of electronic media (watching television, watchingvideos, playing on the computer and watching music videos) and bothperceived importance of one’s appearance and preoccupation with one’sweight. The only statistically significant relationship was a weak association,mediated by level of body fat and ethnicity, between hours spent watchingmusic videos and concerns about appearance and weight; this associationwas strongest among the Black girls. In a study of nearly 100 Australianadolescents ages 15 and 16, Tiggemann and Pickering (1996) failed to finda significant association between amount of television watched and eitherbody dissatisfaction or drive for thinness. But amount of time spent watchingsoap operas and movies was correlated significantly with body dissatisfac-tion, while time spent watching music videos was associated with drive forthinness. These results are not surprising because music videos promotehigh levels of sex-role stereotyping and feature attractive women whilefocusing on physical appearances characterized by thin ideal and provocativeclothing.

In contrast to studies with adolescents, studies with children more con-sistently find a relationship between exposure to television and both disor-dered eating and preoccupation with physical appearance. For example, ina study of 303 boys and girls with an average age of 7.45 years, Harrison(2000) found that extent of television exposure was positively correlatedwith disordered eating in both sexes. In addition, the greater the exposureto television, the more likely that boys would negatively stereotype fat girls,but not fat boys. Harrison (2000) concluded that both girls and boys, butespecially boys, can learn to denigrate fatness before learning to idealizethinness.

It appears that television and magazines have different effects, perhapsas a function of age and outcome variable (Grabe et al., 2008; Levine &Harrison, 2009; Levine & Murnen, 2009). Tiggemann (2003) analyzed thecorrelates of television and magazine exposure separately in a sample of104 female Australian university students. As Tiggemann expected, extentof reading fashion and beauty magazines was related to internalization ofthe thin beauty ideal, which mediates the relationship between reading



magazines and body dissatisfaction; both Stice’s (1994) Dual Pathway modeland Thompson, van den Berg, Roehrig, Guarda, and Heinberg’s (2004) Tri-partite model of sociocultural influences also predicted such findings. Incontrast, the amount of television watched was directly related to bodydissatisfaction, with no evident relationship to internalization of the thinbeauty ideal; these results are consistent with those obtained in Harrison’s(2000) study of children.

It seems that the underlying processes linking magazine reading tobody image are different from those linking television watching to bodyimage (Harrison 2000; Tiggemann, 2003). The complexity of this matter isillustrated in a recent study by Dohnt and Tiggemann (2006a) that exploredpeer and media influences on body image concerns and dieting awarenessin 128 girls ages 5 to 8 years old. Awareness of the thin ideal and the waysof achieving this thin ideal occurs at early ages; 6 years of age was identifiedas the likely age of onset for the desire for thinness. Those young girlswho spent more time looking at magazines aimed at adult women reportedgreater dissatisfaction with their appearance. As important, the greater thelevel of engagement with music television shows and appearance-focusedmagazines, the stronger the level of dieting awareness.

More research is needed to verify and clarify the potentially importantdistinction between television and magazine effects. Grabe et al.’s (2008)meta-analysis did not find a difference in effect size for the relationshipbetween internalization of the thin ideal and magazine exposure (d D 0.37,k D 14; see the note for Table 1 to interpret the effect size) versus televisionexposure (d D 0.39, k D 7) or composite measures of media exposure (d D

0.33, k D 2), but this heterogeneity analysis did not distinguish betweensurvey-based (correlational) and experimental studies. Tiggemann’s (2003)data are, however, consistent with Murnen et al.’s (2007) meta-analytic find-ing that the strongest relationship across media and criterion variables wasthat between exposure to fashion magazines and internalization of the thinbeauty ideal, with moderate effect sizes (d D 0.42). Murnen et al. foundsmaller but still statistically significant correlations (d’s D 0.04 to 0.18) for therelationship between television exposure in general and criterion variablescategorized as thin-ideal internalization, body dissatisfaction, weight andshape control, and disordered eating.

In summary, the weight of evidence from individual cross-sectionalstudies and from meta-analyses (see Table 1) indicates that greater use ofthe mass media—specifically fashion magazines and television music videoshows—is significantly correlated (with small to moderate effect sizes), withhigher levels of body dissatisfaction and with higher scores on eating disordercomponents in females. Of course, such correlations do not legitimize anyconclusions about causality, although it is worth remembering that lack ofcorrelation means lack of a causal relationship. Consequently, we turn ourattention to experimental and longitudinal, prospective studies.


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393



EXPERIMENTAL STUDIES

Reviews of Laboratory Research

Groesz, Levine, and Murnen (2002) carried out a meta-analysis of 25 exper-imental studies that assessed the effects on ‘‘state’’ body satisfaction in girlsand women of controlled exposure to portrayals of the thin beauty idealin media photographs or video (e.g., television commercials). In general,immediate ratings of body satisfaction become significantly lower after afemale sees images of the thin beauty ideal than after she sees images ofwomen with average weight, women with fat bodies, or inanimate objects.The effect sizes found were low to moderate (d D 0.31), becoming moderateto high (d D 0.50) in the samples of adolescent girls and women with aprevious history of body dissatisfaction or eating disorders. The effect wasalso slightly more pronounced in girls under age 19 (d D 0.36).

A recent meta-analysis by Grabe et al. (2008) located an additional 19experimental studies of magazine-based images, as well as 8 more experi-mental studies of the immediate effects of controlled presentations of imagesfrom television shows and commercials. The extent of the effect size for thenow larger sample of experimental studies has to be inferred, however, forthe following reason: Grabe et al. reviewed a total of 77 studies and in theiranalysis considered the type of design (experimental vs. correlational) asa moderator variable. The effect size for the relationship between mediaand body dissatisfaction for all studies (correlational and experimental) wasd D 0.28 (k D 90). However, because significant heterogeneity was notpresent, moderator analyses, including study design, were not warranted.Grabe et al. also reported that, although there was substantial heterogeneity,the ds for experimental effects (across magazines, television, and media ingeneral) on internalization and on eating behaviors and beliefs were 0.21and 0.36, respectively. With respect to heterogeneity of media effects, it isworth noting also that, in several experimental studies with samples of highschool girls and college women, a significant minority of females who wereexposed to images of attractive models from magazines exhibited an increase

in state body satisfaction. In this regard, one meta-analysis of a mixture ofexperimental and cross-sectional studies failed to find a relationship betweenmedia exposure to thin images and body image (Holmstrom, 2004).

External Validity

Experimental designs implemented in laboratory contexts are open to thecriticism of having low external validity in part because the typical ex-periment arranges for only brief exposures to the target stimuli, followedby assessment of short-term (‘‘state’’) effects. Thus, researchers conductingexperiments are, typically, only able to speculate about the cumulative,



‘‘dispositional’’ effects of media influence over the long term. To addressthis concern, Hargreaves and Tiggemann (2003) examined the long-termeffects of exposing a group of 17-year-old Australian girls to 20 televisioncommercials (30 seconds each) that showed actresses representative of cur-rent thinness and beauty ideals. Those girls who had the highest levels of‘‘state’’ body dissatisfaction immediately after seeing the ads tended to havethe highest levels of ‘‘trait’’ body dissatisfaction and of desire for thinness2 years later. Hargreaves and Tiggemann argued that the negative short-term effects observed in laboratory contexts may represent a marker forsubsequent vulnerability to sociocultural pressure to be thin. These findingsare indeed consistent with sociocultural models of disordered eating, butthey need to be replicated with larger and varied samples and so should beinterpreted with caution, as the sample size was small.

The important issue of external validity was also addressed by Stice,Spangler, and Agras (2001). These researchers constructed an unusual nat-uralistic experiment for assessing long-term effects of exposure to mediaimages of the thin beauty ideals on body dissatisfaction, negative affect,internalization of the thin beauty ideal, restrictive dieting, and bulimic symp-toms. Capitalizing on the design of a separate risk factor study, Stice et al.randomly assigned 219 adolescent girls to a condition in which each receiveda prize of a subscription to a fashion magazine for 15 months, or to anonsubscription condition. At 20-month follow up, there were no signifi-cant differences between the experimental and control conditions in anyof the dependent variables. However, those girls who received the fashionmagazine and who initially reported lower levels of social support showeda significant increase in body dissatisfaction, dieting, and bulimic symptoms.These findings may reflect the interaction, or transaction, between the imme-diate social environment—family and peers—and the impact of mass mediaon internalization of the thin beauty ideal and, in turn, on body dissatisfaction(see Levine, Smolak, & Hayden, 1994; Smolak & Levine, 1996). As Stice et al.(2001) suggest, ‘‘perhaps exposure to thin ideal images does not producenegative effects for adolescents who feel accepted in their immediate socialenvironment’’ (p. 285).

Another naturalistic study relevant to external validity was conductedby Becker, Burwell, Gilman, Herzog, and Hamburg (2002), who examinedthe impact of television on disordered eating attitudes and behaviors in asample of adolescent girls from the Pacific islands of Fiji.2 These researchersobserved that 3 years after television reception became widespread, 11.3%of girls reported having vomited with the aim of controlling their weight,compared to 0% before the advent of television on the islands. Likewise,the percentage of girls with high levels of disordered eating attitudes morethan doubled during this period, rising from 13% to 29%. Further, oncetelevision had been introduced, 74% of girls reported ‘‘feeling fat,’’ and thosewith television at home were three times more likely to present disordered



eating attitudes. It is interesting to note that the traditional Fijian culturalaesthetic reflects a preference for robust bodies, and certainly does notendorse individual efforts to shape the body through diet or exercise. Beckeret al.’s study strongly suggests that mass media, and especially television,not only have a substantial impact on adolescents, but exert their influencewithin a short space of time, despite the traditional values of a given culture(see also Bilunka & Utermohlen, 2002, for an example in the Ukraine).

In brief, findings from experimental studies indicate that exposure toimages of the thin beauty ideal featured in the media—and particularlyin magazines, television shows and commercials—increases body dissatis-faction, internalization of thin ideal, and disordered eating behaviors andbeliefs. Effect sizes are small to moderate. However, there are some factorsthat seem to moderate this effect. These include prior body dissatisfactionand internalization of the slender beauty ideal, as well as low social supportfrom peers and family, and age. To further summarize and organize theprincipal findings from both cross-sectional and experimental studies, Table 1presents the findings of the four published meta-analysis to date that havereviewed the effects of media exposure on body image and disordered eatingin females (see Barlett et al., 2008, for a parallel review of media effects inmales). Three publications examined the specific effects of media exposureon body image (Grabe et al., 2008; Groesz et al., 2002; Holmstrom, 2004),whereas the other (Cafri et al., 2005) examined the impact of individualvariables that mediate the effects of media, most notably internalization of athin ideal. In general, the effect sizes reported by Cafri et al. are larger thanthe others, highlighting the great importance of moderating variables and ofindividual variables and mediator processes in how body image is influencedby media (see also Dittmar, Halliwell, & Stirling, 2009). We will return to theissue of mediators and moderators of media effects in the sections addressing‘‘processes’’ and moderators, including ethnicity.

Media Literacy

If media exposure and its potential effects are a causal risk factor, thenexperimental use of ‘‘media literacy’’ techniques and programs to reduceor eliminate negative media influences should eventually reduce or preventnegative body image and other processes that eventually result in eatingdisorders. Literature on the nature of media literacy and on its effects hasrecently been reviewed in detail elsewhere (see, e.g., Levine, 2009; Levine& Murnen, 2009; Levine & Smolak, 2006, ch. 13). Briefly, the findings of lab-oratory studies, both brief, in vivo interventions and longer, more intensiveprograms, are promising but inconclusive. To date, there have been no direct,well-controlled, long-term studies of whether media literacy in particular canprevent development of negative body image and the spectrum of disorderedeating. We can with confidence state that (a) brief training in media literacy as



a critical social perspective can mitigate the immediate (or ‘‘state’’) negativeeffects of exposure to the thin ideal; and (b) more systematic, intensiveinterventions over days or weeks can significantly reduce one importantdispositional risk factor: internalization of the thin beauty ideal.

LONGITUDINAL PROSPECTIVE STUDIES

If X (e.g., media exposure) is a variable and causal risk factor for criterionvariable Y (e.g., negative body image), then two criteria should be met:X should precede Y, and X (at Time 1) should predict subsequent changesin level of Y (i.e., the level of Y at Time 2, controlling for level of Y at Time 1;Kraemer et al., 1997; Stice, 2002). In other words, longitudinal prospectivestudies are a very important aspect of exploring the causal status of a possiblerisk factor, especially given the necessity (for the required statistical power)of a large sample and a long follow up (Field, 2004). However, very fewstudies in this field have approached fulfillment of such conditions. Giventhe relevance of this type of design, Table 2 presents the main characteristicsand findings of the most important longitudinal studies.

Over a period of 3 years, The McKnight Investigators (2003) assessedpotential risk factors for eating disorders in a sample of 1,103 girls whowere initially ages 10–15. The self-reported influence of mass media, whichformed part of a multidimensional factor called ‘‘thin body preoccupationand social pressure,’’ predicted the onset of eating disorders in young girls3 years later, when all were in high school (note that ethnicity moderatedthis relationship, depending on the study site; see Table 2). This finding issupported by a more recent longitudinal study. In a sample of over 1,300 girlsin middle school and high school, those who ‘‘sometimes’’ or ‘‘often’’ read‘‘magazine articles in which dieting or weight loss are discussed’’ (p. 32)were twice as likely to be engaged in unhealthy weight-control behaviorsand three times as likely to be engaged in extreme weight-control behaviors5 years later, even when initial weight-control behaviors, weight importance,demographic features, and body mass index were statistically controlled (vanden Berg, Neumark-Sztainer, Hannan, & Haines, 2007).

A research team that included one of the principal McKnight investi-gators (C. B. Taylor) conducted three longitudinal studies with a sample ofnearly 7,000 girls aged 9 to 14 (Field, Camargo, Taylor, Berkey, & Colditz,1999; Field, Camargo, Taylor, Berkey, Roberts, et al., 2001; Field, Javaras,et al., 2008). Regardless of initial age and BMI level, at one-year follow-up girls who consciously tried to look like the female ideal presented ontelevision, in films, or in magazines were 1.6 to 1.9 times more likely to haveconcerns about their weight, to be continually dieting, and/or to be ‘‘hooked’’on purging behaviors. At 7-year-follow-up females of all ages who weretrying to look like females in the media were 1.5 times more likely to start


TA

BLE

2Repre

senta

tive

Pro

spect

ive

Studie

sofM

edia

Effect

son

Body

Imag

ean

dD

isord

ere

dEat

ing

a

Study

NA

ge

range

(mean

atbas

eline)

Follow

up

Media

type

Mai

nre

sults

Stic

e(1

998)

-Stu

dy

2-

USA

218

girls

16–18

9m

onth

sTele

vis

ion

and

mag

azin

es

Media

soci

alre

info

rcem

entpro

spect

ively

did

notpre

dic

tth

eonse

tofbin

ge

eat

ing

and

purg

ing.M

edia

modeling

of

abnorm

aleat

ing

behav

ior

was

notas

soci

ated

with

concu

rrentbulim

icsy

mpto

ms

and

did

notpre

dic

tth

eonse

tof

bin

ge

eat

ing

and

purg

ing.

Fie

ld,

Cam

argo,

etal

.(1

999)

USA

6982

girls

9–14

1year

Tele

vis

ion,m

ovie

san

dm

agaz

ines

Independentofag

edevelo

pm

ent,

tryin

gto

look

like

fem

ales

on

tele

vis

ion,in

movie

s,or

inm

agaz

ines

was

pre

dic

tive

of

begin

nin

gto

purg

eat

leas

tm

onth

ly.

Fie

ldetal

.(2

001)

USA

6770

girls

5287

boys

9–14

1year

Tele

vis

ion,m

ovie

san

dm

agaz

ines

Independentofag

ean

dbody

mas

sin

dex,both

girls

and

boys

who

were

mak

ing

alo

tof

effort

tolo

ok

like

sam

e-s

ex

figure

sin

the

media

were

more

likely

than

their

peers

tobeco

me

very

conce

rned

with

their

weig

ht.

Girls

who

were

mak

ing

gre

aterefforts

tolo

ok

like

fem

ales

inth

em

edia

were

more

likely

than

their

peers

tobeco

me

const

antdie

ters

.

Mar

tínez-

Gonzá

lez

(2003)

Spa

in

2862

girls

12–21

18

month

sTele

vis

ion,girls

’m

agaz

ines,

radio

Fre

quently

read

ing

girls

’m

agaz

ines

or

list

enin

gto

radio

pro

gra

ms

was

rela

ted

toa

hig

her

risk

ofeat

ing

dis

ord

er

onse

tat

the

begin

nin

goffo

llow

up.N

oas

soci

atio

nw

asfo

und

for

tele

vis

ion

vie

win

g.

The

McK

nig

ht

Invest

igat

ors

(2003)

USA

1103

girls

6th

–9th

gra

de

(11–15)

3year

s‘‘M

edia

modeling’’

ingenera

lH

ighersc

ore

son

the

multid

imensi

onal

fact

or

thin

bod

ypre

occ

upa

tion

an

dso

cia

lpre

ssu

rem

eas

uring

conce

rns

with

weig

ht,

shap

e,an

deat

ing

(incl

udin

gm

edia

modeling,so

cial

eat

ing,die

ting,an

dw

eig

htte

asin

g)

signific

antly

pre

dic

ted

onse

tof

eat

ing

dis

ord

ers

inyoung

wom

en.

Bein

gH

ispan

icm

odera

ted

the

onse

tof

eat

ing

dis

ord

ers

atth

eA

rizo

na

butnotth

eCal

iforn

iasi

te.

Inth

eH

ispan

icsa

mple

,a

risk

fact

or

for

new

-onse

teat

ing

dis

ord

ers

case

sw

asth

inbod

y

pre

occ

upa

tion

an

dso

cia

lpre

ssu

re.

Inth

enon-H

ispan

icsa

mple

,only

thin

bod

ypre

occ

upa

tion

an

dso

cia

lpre

ssu

rew

assi

gnific

antly

rela

ted

with

new

-onse

teat

ing

dis

ord

ers

case

s.

(con

tin

ued

)

398


TA

BLE

2(C

on

tin

ued

)

Study

NA

ge

range

(mean

atbas

eline)

Follow

up

Media

type

Mai

nre

sults

Pre

snell

etal

.(2

004)

USA

293

girls

238

boys

16–19

(17)

9m

onth

sM

edia

ingenera

lEle

vat

ions

inperc

eiv

ed

pre

ssure

tobe

thin

from

media

did

not

pre

dic

tin

creas

es

inbody

dis

satisf

action.

McC

abe

&Ric

ciar

delli

(2005)

Au

stra

lia

236

girls

207

boys

8–12

(9.2

4girls

/9.2

6boys)

16

month

sTele

vis

ion

Perc

eiv

ed

pre

ssure

sfr

om

the

media

tolo

sew

eig

htpre

dic

ted

body

dis

satisf

action

only

among

boys.

Perc

eiv

ed

media

mess

ages

tolo

sew

eig

htpre

dic

ted

stra

tegie

sto

decr

eas

ew

eig

htonly

for

boys.

The

media

pla

yed

the

stro

ngest

role

insh

apin

gst

rate

gie

sto

incr

eas

em

usc

leam

ong

girls

,w

ith

perc

eiv

ed

media

mess

ages

tolo

sew

eig

htin

the

long

term

pre

dic

ting

stra

tegie

sto

incr

eas

em

usc

le.

Dohnt&

Tig

gem

ann

(2006b)

Au

stra

lia

97

girls

5–8

(6.9

1)

1year

Appear

ance

-focu

sed

tele

vis

ion

show

s(o

rm

agaz

ines)

Wat

chin

gap

pear

ance

-focu

sed

tele

vis

ion

pro

gra

ms

(but

notre

adin

gap

pear

ance

-focu

sed

mag

azin

es)

pro

spect

ively

pre

dic

ted

appear

ance

satisf

action.

Har

riso

n&

Hefn

er

(2006)

USA

257

girls

2nd–4th

gra

de

(8.7

2)

1year

Tele

vis

ion

and

mag

azin

es

Controllin

gfo

rag

e,ra

ce,perc

eiv

ed

body

size

,an

dbody

ideal

san

ddis

ord

ere

deat

ing

meas

ure

dat

Tim

e1,te

levis

ion

vie

win

gat

Tim

e1

(butnot

read

ing

heal

than

dfitn

ess

mag

azin

es,

fash

ion

mag

azin

es,

or

sports

mag

azin

es)

pre

dic

ted

incr

eas

ed

dis

ord

ere

deat

ing

and

ath

inner

futu

rebody

ideal

atTim

e2.

None

ofth

em

edia

var

iable

spre

dic

ted

ath

inner

curr

entbody

ideal

atTim

e2.

van

den

Berg

etal

.(2

007)

USA

1386

girls

1130

boys

7th

–12th

gra

de

(12–18)

5year

sM

agaz

ines

For

fem

ales

adole

scents

,in

dependentof

weig

ht-co

ntrolbehav

iors

,w

eig

htim

portan

ce,

body

mas

sin

dex,an

ddem

ogra

phic

covar

iate

s,th

em

ost

frequentre

aders

(com

par

ed

with

those

who

did

notre

ad)

of

mag

azin

ear

ticl

es

about

die

ting

and

weig

htlo

ssw

ere

atsi

gnific

antly

hig

her

risk

for

engag

ing

inunheal

thy

and

extrem

ew

eig

ht-co

ntrol

behav

iors

.B

ein

ga

frequentre

ader

of

these

mag

azin

es

was

not

asso

ciat

ed

pro

spect

ively

with

bin

ge

eat

ing

ineither

girls

or

boys.

Those

fem

ales

who

‘‘som

etim

es’’or

‘‘often’’

read

‘‘mag

azin

ear

ticl

es

inw

hic

hdie

ting

or

weig

htlo

ssar

edis

cuss

ed’’

were

twic

eas

likely

tobe

engag

ed

inunheal

thy

weig

ht-co

ntrolbehav

iors

five

year

sla

ter,

even

when

initia

lbehav

iors

,dem

ogra

phic

feat

ure

s,an

dbody

mas

sin

dex

were

stat

istica

lly

controlled.

There

were

no

signific

antas

soci

atio

ns

for

either

weig

ht-co

ntrolbehav

iors

or

psy

cholo

gic

aloutc

om

es

for

mal

ead

ole

scents

.

Fie

ldetal

.(2

008)

USA

6916

girls

5618

boys

9–15

7year

sTele

vis

ion,m

ovie

san

dm

agaz

ines

Try

ing

tolo

ok

like

pers

ons

inth

em

edia

was

apre

dic

tor

ofst

arting

topurg

ean

dbin

ge

eat

ing

among

fem

ales

of

allag

es,

but

notam

ong

boys.

aThis

table

pre

sents

only

resu

lts

pertai

nin

gto

media

effect

son

body

imag

ean

ddis

ord

ere

deat

ing.For

more

deta

iled

resu

lts

rela

ted

with

oth

er

var

iable

sst

udie

d,se

eth

eorigin

alst

udie

s.

399



purging and 2.2 times more likely to binge eat (Field, Javaras, et al., 2008).This is one of the few studies published in the field of eating disorders thatcollected data over a very long period of time and in a very large sample.Similarly, a study of almost 3,000 Spanish girls and young women ages 12to 21 assessed over a period of 18 months found that frequent readers offashion magazines for adolescents were 2.1 times more likely to developan eating disorder (Martínez-González et al., 2003). Interestingly, althoughno significant relationship was found between the number of hours theywatched television and risk of an eating disorder, a significant relationshipwas indeed observed between listening to the radio for more than an houra day and the risk of developing such disorders. Martínez-González et al.noted, as a possible explanation of these results, that radio programs transmitmany messages, primarily through advertising, in relation to ‘‘the perfectfigure’’ and how to achieve it.

In contrast to the findings in Martínez-González et al.’s (2003) survey ofadolescents and young adults, early exposure to thin-ideal television appearsto predict subsequent increases in body image problems. In a study ofAustralian girls ages 5–8, Dohnt and Tiggemann (2006b) found that thenumber of appearance-focused television programs (but not appearance-focused magazines) viewed predicted a decrease in appearance satisfactionone year later. A one-year longitudinal study with 257 preadolescent girls(Mage D 9 years) found that exposure to television, but not to magazines,predicted a significant increase in disordered eating (Harrison & Hefner,2006). According to the researchers, the fact that children watch far moreadult-oriented television than they read adult-oriented magazines helps ex-plain why studies carried out in preadolescent populations (although theseare extremely scarce) yield a different pattern of results than do studiesof adolescent and young adult populations, for whom magazines are themedia format that most influences the internalization of the thin beautyideal. It is also very likely that adolescents and young adult females, forvarious developmental reasons, are more inclined to engage in the importantmediating process of social comparison (Levine & Smolak, 1996; Thompson,Heinberg, et al., 1999; Tiggemann, Polivy, & Hargreaves, 2009; Trampe,Stapel, & Siero, 2007).

In thinking about media influences, it is important to note that longitu-dinal, prospective studies with much smaller samples (typically around 300preadolescent and adolescent girls) suggest that the messages transmittedby parents (especially mothers) and by friends (primarily same-sex friends)have more influence on awareness and internalization of the thin beautyideal and on body dissatisfaction and unhealthy weight-control behaviorsthan do mass media (McCabe & Ricciardelli, 2005; Presnell, Bearman, &Stice, 2004; Stice, 1998). In terms of social cognitive theory, this may bedue to the fact that proximal messages transmitted directly and indirectlyby people who are important to these girls (e.g., mothers and friends)



are given priority over more distal images and messages; that is, womenin mass media are seen as more symbolic and may not be as personallysignificant for these girls. These ‘‘models’’ are not as ‘‘immediate a presence’’or are dissimilar in ways that lower their value for observational learning andas ‘‘standards’’ for social comparison (Levine & Smolak, 1996, 2006; Sands& Wardle, 2003; but see Jones, Vigfusdottir, & Lee, 2004). However, thisexplanation does not exclude the influence, albeit indirect, of the media,since messages conveyed and reinforced by communications from peersand family probably reflect messages they have assimilated from the media(Levine & Harrison, 2009).

In summary, longitudinal studies indicate that the greater exposure tothe messages conveyed by media, particularly those that transmit messagesin relation to thin ideal and how to achieve it from magazines, television, andradio, the more likely females are to develop disordered eating behaviorsand concerns about weight (see Table 2). As is the case for cross-sectional(correlation-based) and experimental studies, effects appear to depend tosome extent on the type of media in interaction with age. Specifically,television has a stronger effect on children, whereas magazines are moreinfluential for adolescent and adult females. Peers and family also appear toact as moderating variables of this effect.

PROCESSES

Research on the effects of the media on body satisfaction and on eatingattitudes and behaviors has increased substantially in recent years, yet muchwork remains to be done in order to clarify the processes through whichmedia exercise their influence (see Dittmar, 2009; Harrison & Hefner, 2008;Levine & Harrison, 2009; Levine & Murnen, 2009; Tiggemann & McGill, 2004).We do know that the process as a whole is not subliminal, although certainaspects (e.g., activation of social comparison and of self-target discrepancies)may be automatic (Levine & Harrison, 2009). Tiggemann and colleagues inAustralia (e.g., Tiggemann & Slater, 2004) have shown that music videos,which are saturated with salient (supraliminal ) visual images and auditorycues pertaining to appearance, gender, sexuality, and objectification, areparticularly potent activators of body dissatisfaction. A considerable amountof data indicates that the negative impact of media images depends on theconscious and, in many instances, cumulative processing of unambiguous,direct, and ‘‘attractive’’ social messages (Harrison & Hefner, 2008; Levine &Harrison, 2009).

In the fields of body image and eating disorders, it is postulated thatthere are at least three processes that mediate the relationship between themedia, body dissatisfaction, and disordered eating behaviors and moderatemedia effects on these variables. These processes are: internalization of the



thin beauty ideal; social comparison; and activation of the thin-ideal schema(Dittmar et al., 2009; Halliwell & Dittmar, 2005; Levine & Harrison, 2009;Tiggemann et al., 2009; Trampe et al., 2007). Even so, and despite thefact that progress is being made (see, e.g., Dittmar et al., 2009; Vartanian,2009), knowledge is still lacking on the number and the time sequence ofmajor processes, their order of importance, and how they mediate as well asmoderate the impact of various sociocultural factors, including mass media.Two new processes, the ‘‘activation of weight-shape-related self-ideal dis-crepancy’’ (Dittmar et al., 2009; Harrison & Hefner, 2008) and ‘‘self-conceptclarity’’ (Vartanian, 2009), are being considered as possible mediating andmoderating processes, and preliminary evidence indicates that these aredeserving of further research attention.

Internalization of the Thin Beauty Ideal

Stice’s (1994; Stice, Nemeroff, & Shaw, 1996) Dual-Pathway Model of bu-limia nervosa and Thompson et al.’s (2004) Tripartite Model of disorderedeating both propose that internalization of the thin beauty ideal mediatesthe relationship between exposure to the media (and other sociocultural in-fluences) and resultant body dissatisfaction and disordered eating symptoms(see also Thompson & Stice, 2001). In this regard, it is noteworthy that severalexperimental studies in Great Britain and the United States have found thatonly ‘‘high internalizers’’ experience heightened body dissatisfaction (Dittmaret al., 2009; see Levine & Murnen, 2009, for a review).

Consistent with these sociocultural models, a study of 14- to 16-year-old Swiss girls by Knauss, Paxton, and Alsaker (2007) found that perceivedpressure from the media, internalization of the thin beauty ideal, and bodydissatisfaction were highly inter-correlated (all rs > .60). Jones et al.’s (2004)cross-sectional study of adolescents ages 11–14 revealed that girls, as com-pared with the boys, were more invested in appearance-oriented maga-zines, were more likely to internalize the beauty ideals in them, and hadgreater body dissatisfaction. In fact, for girls, exposure to appearance-relatedmagazines and to appearance conversations by peers each predicted bodydissatisfaction through the mediator of internalization of the thin beauty ideal.The path analytic model for girls explained 48% of the variance in bodydissatisfaction.

These studies reflect a robust finding. Cafri et al.’s (2005) meta-analysis(see Table 1) of 31 effect sizes from 18 studies found an r of .50 (d D 1.15) forthe correlation between thin-ideal internalization and negative body image(see also Stice, 2002). This is considered a large effect according to Cohen’s(1988) criteria, and it is significantly greater than the r of .29 (d D 0.61, basedon 25 effect sizes) for awareness of the thin ideal. Engeln-Maddox (2006)found that young women who have a clear and strong expectation thatlooking like a media ideal would transform their lives in multiple, positive



ways, and who have internalized the media ideal of thin beauty tended tohave greater levels of body dissatisfaction.

Krones, Stice, Batres, and Orjada (2005) have argued that internalizationof the thin beauty ideal promotes body dissatisfaction specifically throughthe process of social comparison. Along similar lines, research assessingThompson et al.’s (1999, 2004) tripartite influence model has found that bothinternalization of the thin beauty ideal and social comparison mediate the re-lationship between sociocultural influences (parents, peers, and media) andbody dissatisfaction and disordered eating behaviors (Shroff & Thompson,2006; van den Berg, Thompson, Obremski-Brandon, & Coovert, 2002). How-ever, it remains unclear whether the two processes operate simultaneouslyor whether one precedes the other.

Two provocative studies in this regard were recently conducted byVartanian (2009). American college females who reported an unstable, poorlydefined sense of self were more likely to report internalization of the thinbeauty ideal and, in turn, greater levels of negative body image and dietingconcerns. Moreover, as predicted, it appears that such low ‘‘self-conceptclarity’’ makes young women more prone to public self-consciousness andconformity to social norms. Although it remains to be tested, it follows fromVartanian’s (2009) work that low self-concept clarity would predispose oneto both heightened social comparison processes and internalization of thethin beauty ideal, acting, possibly, as a moderator of the effect of mediaexposure.

In two recent, well-controlled studies, Dittmar et al. (2009) demonstratedthat young women who had already internalized the thin beauty ideal werethe only participants to exhibit increased negative affect concerning theirbodies following exposure to the thin beauty ideal. Not only was internal-ization of this ideal a potent moderator of the classic contrast effect, this effectwas fully mediated by activation of weight-related self-ideal discrepancy andwas not dependent on whether the context of exposure emphasized thethinness of the models. The latter finding was consistent with previous re-search by Dittmar and colleagues (reviewed in Dittmar et al., 2009) indicatingthat internalizers will activate concerns about the self-ideal discrepancy evenwhen they are not paying a great deal of attention to slender models.

Social Comparison Processes

Social comparison theory, originally formulated by Festinger (1954), refers topeople’s tendency to compare themselves to others with respect to certainattributes, especially when the characteristics (e.g., beauty or sexiness) areimportant and the relevant standards or criteria for evaluation are ambiguous(Trampe et al., 2007). Applied to the context of media, self-perception ofattractiveness, and body image, social comparison denotes the process inwhich women compare themselves with the idealized, symbolic images, and,



on finding that they ‘‘fail’’ to meet the social and cultural standards, show in-creased body dissatisfaction. For example, Hargreaves and Tiggemann (2004)exposed Australian girls ages 13–15 to a long series of television commercialsdepicting either idealized images or performers of ‘‘normal’’ appearance. Aspredicted, girls who viewed images of the thin ideal were significantly morelikely than girls in the control condition to compare their own appearanceto that of the women in the commercials and to react to the images withnegative feelings. Experiments conducted in Great Britain by Dittmar andHoward (2004) and by Halliwell and Dittmar (2004) demonstrated that itis the thinness of fashion models, not their attractiveness, that accounts forthin-ideal media’s immediate negative effects on body image in girls.

There is apparently a very complex interplay between the potential stan-dard for comparison (i.e., the social stimulus), the perceiver’s self-concept,the inclination toward and process of social comparison, and the impact ofmass media, as well as other sociocultural factors (see Levine & Smolak,1996; Tiggemann et al., 2009; Vartanian, 2009). For example, a marketingresearch study by Richins (1991) found that if consumers, specifically women,consider professional models as a separate category, there were no changesin their conception of beauty after seeing the ads. On the other hand, iffemale consumers considered the professional models to represent in someway the possibilities for a majority of women (Thompson & Heinberg, 1999),then they showed the standard post-exposure contrast effect (see Grabeet al., 2008; Groesz et al., 2002), at least temporarily, in the way they morenegatively judged themselves and the rest of the population (Richins, 1991).

Women and adolescent girls who tend to compare themselves withthe beauty ideals represented in the media—and in peers, family, and evenstrangers—are more likely to show greater body dissatisfaction and disor-dered eating behaviors than those who tend not to involve themselves inthe process of social comparison, especially if the tendency is to compareoneself ‘‘upward’’ against people whom society would tend to consider moreattractive (O’Brien et al., 2009; Thompson, Heinberg, et al., 1999). A recentseries of studies by Trampe et al. (2007) focused on undergraduate womenwho were already dissatisfied with, and presumably self-conscious about,their own bodies. As predicted, these women tended to compare their ap-pearance to a wide range of body-shape standards, including other students,fashion models, and celebrities. Further, relative to women who tended to bemore satisfied with their own bodies, the women with high levels of bodydissatisfaction were, as predicted, negatively affected by exposure to andcomparison with thin, physically attractive people, whether that person wasportrayed as a model or not. In fact, the women with negative body imagereported increased (‘‘state’’) body dissatisfaction after seeing a drawing of athin vase versus a fatter, rounded vase. It is possible that these women havea poorer self-concept—and lower self-concept clarity (Vartanian, 2009)—underlying their negative body image.



Trampe et al.’s (2007) findings suggest that the tendency of womenwith higher levels of body dissatisfaction to make broad and unhealthy socialcomparisons reflects the fact that their body-relevant self-schema (Hargreaves& Tiggemann, 2002), or their self-schema (self-consciousness) in general(Vartanian, 2009), is activated more readily. However, ‘‘the process throughwhich girls and boys determine the need to make social comparisons, selectthe targets, make the comparisons and assess the information available, isan area of great importance for future research on the effects of the media’’(Levine & Harrison, 2004, p. 700; see also Trampe et al., 2007).

Schema Activation

Social cognitive and cognitive behavioral theorists have cataloged the variousdirect and indirect ways that people receive information—from the media,parents, peers, coaches, to name but a few—about beauty, food, eating,weight control, and other aspects related to physical appearance. In theprocess of making meaning and of learning predictive relationships, suchinformation is distilled and arranged into a schema, that is, a mental structurethat helps people to organize their interactions with the world in a stableand consistent fashion (see Levine & Smolak, 2006, ch. 6). Based on mediamessages, gender socialization research, and studies of the psychopathologyof eating disorders, Smolak and Levine (1994, 1996; Levine & Smolak, 1996,2006) have proposed that, beginning as early as middle childhood, girls forma ‘‘thinness schema.’’ This cognitive structure, which is certainly connectedto and affected (cathected) by emotion-inducing memories and conclusions,is a combination of information and beliefs referring to the self and one’sself-worth, and to information extracted from sociocultural influences.

According to this schema theory, to a greater or lesser degree, femalesare likely to embrace beliefs, memories, assumptions, and feelings revolvingaround ‘‘ideas’’ such as (a) beauty constitutes the primary goal in a woman’slife; (b) a slim body is a fundamental component of beauty, physical health,success, and happiness; (c) by nature, women feel anxiety, shyness andshame in relation to their bodies; (d) women can transform and renewthemselves thanks to the technology of fashion, dieting, and exercise; and(e) fatness reveals a loss of personal control and is a sign of failure (seeLevine & Smolak, 2006). Mass media are presumed to play a role in both theconstitution of the schema and its activation once it is formed. As Dittmaret al. (2009) indicate, the results of their study of ‘‘internalizers’’ and weight-related self-discrepancies can be interpreted in terms of schema activation.Images of slender models activated self-focused, negative thoughts aboutthe gap between one’s self-perceived body image and the cultural ideals(see also Harrison & Hefner, 2008). In a self-perpetuating but ultimately self-defeating process, internalizers of the thin beauty ideal are cognitively andemotionally predisposed to ‘‘think ideal, feel bad,’’ and yet still ‘‘think ideal.’’



One aspect of the ‘‘thinness schema’’ that is recognized by the Amer-ican Psychiatric Association’s (2000) criteria for an eating disorder is the‘‘undue influence of weight and shape on self-evaluation’’ (see Criterion C,p. 589; and Criterion D, p. 594). In a study of Australian girls, ages 15through 18, Hargreaves and Tiggemann (2002) found that, compared tocontrol conditions, appearance-focused commercials did indeed producegreater activation of appearance-related self-schema. With regard to schemaas a moderator, these commercials also generated more overall appearancedissatisfaction for those girls who began the study with a more extensive,emotionally charged, appearance-related self-schema. With respect to medi-

ation, the negative (contrast) effect of the thin beauty ideal on girls’ appear-ance satisfaction was partially mediated by schema activation.

CONCLUSIONS

Based on this review and other, related analyses (see, e.g., Harrison &Hefner, 2008; Hogan & Strasburger, 2008; Levine & Harrison, 2004, 2009;Levine & Murnen, 2009; Thompson & Heinberg, 1999; Thompson et al.,1999) we can state the following with a fair degree of confidence: Massmedia are an extremely important source, if not the principal source, ofinformation and reinforcement in relation to the nature of the thin beautyideal, its importance, and how to attain it. Figure 1 provides a visual synthesisof the relationships between the constructs discussed in this review. Ourintent is to stimulate further modeling of media effects and to summarizepotential causal pathways that have a theoretical basis, that are supportedby empirical findings, and that have meaningful implications for preventionand perhaps treatment.

There is still a good amount of research remaining, but evidence isaccumulating that repeated exposure to media and to both the direct andindirect (via media’s effects on peers, parents, physicians, etc.) pressure frommedia to be thin constitute a risk factor for body dissatisfaction, concernsover weight, and disordered eating behaviors in adolescent girls and youngwomen. Relatively little research has addressed the intersection of sociocul-tural factors, but it appears that a confluence of media, family, and peerfactors increases the substantial risk posed by media alone (Levine et al.,1994; Jones et al., 2004).

The impact of media depends on a number of source and receiver/perceiver factors, including, most prominently, ethnicity and as yet poorlyunderstood developmental factors. Research to date indicates fairly consis-tently that, relative to watching television in general (except music videoshows), reading fashion and ‘‘glamour’’ magazines seems to have a greaterinfluence, for adolescent girls and young women, on internalization of thethin beauty ideal, on body dissatisfaction, and on disordered eating behav-



FIGURE 1 Model of the mass media as a risk factor for body dissatisfaction, weightconcerns and disordered eating behaviors. Variables that appear to moderate are age (and/ordevelopmental status), self-esteem, ethnicity, parents, peers, and media type. Variables thatappear to mediate are contained under ‘‘Processes.’’ The processes in bold have considerableempirical support, whereas the process in italics and in smaller text has some support but isin need of further investigation.

iors. Conversely, in children, television in general appears to have moreinfluence than magazines, probably because children watch more adult-oriented television (and movies) than they read adult-orientedmagazines andare more able and motivated to process (and internalize) the salient messagesabout gender, weight, shape, and such, that television so readily provides(Harrison & Hefner, 2008; Levine & Murnen, 2009). Internalization of thethin beauty ideal, social comparison, and activation of the thinness schemaare clearly among the processes which mediate the effects of the media onbody dissatisfaction, weight concerns and disordered eating behaviors.

Furthermore, there are some variables that seem to moderate mediaeffects. Girls and women who already show greater internalization of the thinbeauty ideal, who already tend to compare themselves with ideal figures,who have formed the thinness schema and, therefore, show greater bodydissatisfaction or disordered eating, are more likely to respond negativelyto the media content we have been discussing. Sadly, they also appear tobe more motivated to seek out mass media for guidance and inspiration



and self-evaluation. This paradox is particularly important when thinkingabout the resources of the World Wide Web, including pro-anorexia Websites and the efforts of the diet industry (Bardone-Cone & Cass, 2006, 2007;Harshbarger, Ahlers-Schmidt, Mayans, Mayans, & Hawkins, 2009). Otherpotentially important moderating variables that warrant further research areage (girls under 19 appear to be more vulnerable to the influence of themedia than older girls and women) and low self-esteem and low self-conceptclarity (girls with low self-esteem appear to be more vulnerable to the adverseeffects of the media). Moreover, parents and peers play an important rolein the transmission, reinforcement, and modeling of the thin beauty idealand disordered eating behaviors and beliefs or—in an opposite sense, theirsocial support could be a protective factor from the adverse effects of themedia.

Ethnicity as a Moderator

A meta-analytic review by Roberts, Cash, Feingold, and Johnson (2006) foundthat, in general, Black women have higher levels of body satisfaction andweight satisfaction than White women. Moreover, although actual evidencefrom content analyses is lacking, it appears that the vast majority of femaleswho constitute the cultural ideals of beauty, sexiness, and desirability in themass media and other avenues of social influences are White, or at leastnot dark Black. This suggests that Black women are affected differently bythe pervasive, (pre)dominant images of female physical attractiveness in themass media.

The research evidence pertaining to this matter is both woefully sparseand, perhaps not surprisingly, equivocal (see Harrison & Hefner, 2008, andLevine & Smolak, 2010, for reviews). On the one hand, a set of studiesprovides evidence that Black girls and women are just as vulnerable toeffects of images represented in the media too (see, e.g., Borzekowski et al.,2000; Botta, 2000; Gordon, 2008). On the other hand, another set of studiesindicates that Black girls are not negatively affected (or not as negativelyaffected) by the ideal most often represented in the media because they donot compare themselves (as often) with these ‘‘White image’’ (DeBraganza& Hausenblas, 2010; Frisby, 2004; Jefferson & Stake, 2009; Milkie, 1999;Schooler, Ward, Merriwether, & Caruthers, 2004). For example, Frisby foundthat, regardless of their initial levels of body esteem, young Black collegestudents did not report a decline in state body satisfaction following experi-mental exposure to White models in advertisements. However, those Blackstudents who had low initials levels of self-esteem and who saw Black mod-els from ads did show a significant decline in state body satisfaction. Recently,an experiment conducted by DeBraganza and Hausenblas found evidencethat mirrors, to some extent, that reported by Frisby. These researchersshowed that ethnicity moderates the expected effects of viewing model ideals



on body dissatisfaction. Young Black college students showed no significantchanges in body dissatisfaction after exposure to the White ideals, whereasWhite women reported significantly lower body dissatisfaction scores.

The findings of Frisby (2004), DeBraganza and Hausenblas (2010), andothers (e.g., Jefferson & Stake, 2009; Wood & Petrie, 2010) are consistent withthe tenets of social comparison theory (Festinger, 1954), which argues thatpeople tend to make social comparisons with those who are similar to them-selves (e.g., similar skin color and similar attitudes, values, or personality). AsMilke (1999) and others have argued, perhaps Black girls and young womenare insulated from the cumulative impact of exposure to the dominant Whiteideals because of their dissimilarity and, thus, their disinclination to makedestructive upward social comparisons. Moreover, despite the fact that Blackyouth report that they consume more hours of media in comparison to Whiteyouth (Roberts et al., 2005), it also appears to be the case that the beautyideal presented in programs targeted at Black audiences and promoted inthe Black community include a broader range of body sizes than thosetargeted at the general population (Schooler et al., 2004; Tirodkar & Jain,2003). Although social comparison theory is clearly an important contributorto our understanding of media effects (see, e.g., Trampe et al., 2007), muchmore research is needed to clarify the role of the Black–White distinction,various ethnicities, and ethnic identity (Wood & Petrie, 2010) in moderatingmedia effects (Levine & Smolak, 2010).

A Final Reflection

Despite nearly 35 years of concern about the relationship between massmedia and eating disorders, there remains a strong need for both basic andapplied research on the processes and mechanisms that constitute risk andprotective factors in regard to the effects of the media on attitudes andbehaviors related to body image and eating behavior in females (Dittmar,2009; Harrison & Hefner, 2008; Levine & Harrison, 2004; 2009; Levine &Murnen, 2009). Developmental factors, ethnicity (including level of ethnicidentity and acculturation), cross-cultural differences and similarities (Levine& Smolak, 2010), and the impact of new(er) media are all areas in needof substantial clarification. There is also a need for refinements and greaterconsensus in research methodology. Lack of agreement in the assessment ofkey variables is particularly troublesome; Grabe et al.’s (2008) meta-analysisreveals 14 different scales used by various studies to assess body dissatis-faction. We applaud initiatives such as those adopted by Cafri et al. (2005)to review only studies that used measures with demonstrated reliability andvalidity. Finally, there is a clear need for models (see, e.g., Figure 1) thatprovide a foundation for studies to determine whether the processes studiedare definitely mediating and/or moderating variables in the contexts andpathways that constitute media effects.



NOTES

1. Unless otherwise noted, all research samples are from the United States of America, andall measures are self-reports.

2. Technically, this well-known study by Becker et al. (2002) is not an experiment or quasi-experiment, but rather a statement of correlation between the variables being assessed andthe coming of television to Fiji, especially since other social and economic changes relatedto the institution of mass media may be contributing to the phenomena of interest.

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