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School body image lessons improve teen body esteem (2013-11-20)

Training teachers to deliver body image lessons to teenagers in schools could help improve body esteem and reduce the risk of eating disorders, according to new research by King’s College London’s Institute of Psychiatry.

Body dissatisfaction in adolescence is common – 17-33% of teenagers report body dissatisfaction, with the figure higher for girls than boys. It is associated with a range of problems, from depression and eating disorders, to cosmetic surgery use, over- and under-exercising, obesity and unhealthy weight loss behaviours such as smoking.

School-based interventions for body dissatisfaction have been recommended by the UK All Party Parliamentary Group on Body Image. Having interventions delivered by teachers allows programmes to have wide reach, to have minimal costs and therefore to be sustainable in the long term. Some schools have been relying on programmes that are not evidence based. As well as potentially being a waste of resources, there is concern that these could cause harm.

Researchers set out to test the effectiveness of an intervention called Me, You & Us. 16 classes of adolescent girls from three different schools were recruited to participate in the study. 261 of the pupils were in the intervention group and received six, 50-minute body image lessons delivered by their school teachers.

Lessons focused on media literacy (where ideals of beauty come from and critically analysing media images), peer interactions (concerning ‘fat talking’ – discussions about weight and shape, and activities on giving and receiving compliments) and positive psychology principles (including boosting mood and self-esteem).
The other 187 pupils received their lessons as normal, and acted as the control group.

A week before the trial began, all pupils completed questionnaires to gather information about their age and ethnicity, and to screen for the presence of eating disorders including anorexia nervosa, bulimia nervosa and binge eating disorder. Their body esteem was assessed before the intervention began, after the intervention had finished and at a three-month follow-up.

The researchers found that receiving the lessons had a significant positive effect on the girls’ body esteem, and this effect was maintained over the three months of follow-up. At the start of the study, 17% of pupils in the intervention group and 19% of pupils in the control group were in the clinical range for body esteem.

After the intervention, 32% of the pupils who were in the clinical range for body esteem showed reliable improvements after receiving the intervention, compared to 8% in the control group. In the intervention group, small but significant improvements were found in the pupil’s thin-ideal internalisation – the extent to which they endorsed social ideals associated with thinness – and in their self-esteem.

Importantly, there was no evidence of harm (i.e. decreases in body esteem) from receiving the programme. Three-quarters of pupils were either neutral or positive about how enjoyable the lessons were, and approximately two-thirds were neutral or positive about the usefulness of the lessons.

Lead researcher Dr Helen Sharpe, from the Eating Disorders Section at the Institute of Psychiatry at King’s said: “There is a need for safe and effective, evidence-based body image interventions that teachers can deliver in school. Our study suggests that a teacher-delivered programme for body image dissatisfaction is feasible, acceptable and effective. However, substantial further work is needed in refining the content of the lessons, increasing the effectiveness, improving the flexibility with which they may be used in different schools, and exploring the best ways of providing training for teachers so they are adequately prepared for this role.”

The study is published today in the British Journal of Psychiatry.

The research was supported by the National Institute of Health (NIHR) Programme Grants for Applied Research and the NIHR Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

For more information
Sharpe H, Schober I, Treasure J and Schmidt U.
Feasibility, acceptability and efficacy of a school-based prevention programme for eating disorders: cluster randomised controlled trial
British Journal of Psychiatry