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The role of the media in body image concerns among women: a meta- analysis of experimental and correlational studies

Solomon Kitaka

Psychological bulletin

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The Role of the Media in Body Image Concerns

Among Women: A Meta-Analysis of

Experimental and Correlational Studies

Article in Psychological Bulletin · June 2008 DOI: 10.1037/0033-2909.134.3.460 · Source: PubMed

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The Role of the Media in Body Image Concerns Among Women: A Meta-Analysis of Experimental and Correlational Studies

Shelly Grabe University of Wisconsin–Madison

L. Monique Ward University of Michigan

Janet Shibley Hyde University of Wisconsin–Madison

Research suggests that exposure to mass media depicting the thin-ideal body may be linked to body

image disturbance in women. This meta-analysis examined experimental and correlational studies testing

the links between media exposure to women’s body dissatisfaction, internalization of the thin ideal, and

eating behaviors and beliefs with a sample of 77 studies that yielded 141 effect sizes. The mean effect

sizes were small to moderate (ds � –.28, –.39, and –.30, respectively). Effects for some outcome

variables were moderated by publication year and study design. The findings support the notion that

exposure to media images depicting the thin-ideal body is related to body image concerns for women.

Keywords: body image, media, advertising, human females, meta-analysis

Body dissatisfaction has reached normative levels among Amer-

ican girls and young women. Approximately 50% of girls and

undergraduate women report being dissatisfied with their bodies

(e.g., Bearman, Presnell, & Martinez, 2006; Monteath & McCabe,

1997). These perceptions develop relatively early, emerging

among children as young as age 7 years, and appear to exist across

diverse levels of body size and race (Dohnt & Tiggemann, 2006a;

Grabe & Hyde, 2006). These feelings are not inconsequential; they

have been linked to critical physical and mental health problems.

Research from prospective and longitudinal designs has identified

body dissatisfaction as one of the most consistent and robust risk

factors for eating disorders such as bulimia and as a significant

predictor of low self-esteem, depression, and obesity (Grabe,

Hyde, & Lindberg, 2007; Johnson & Wardle, 2005; Neumark-

Sztianer, Paxton, Hannan, Haines, & Story, 2006; Paxton,

Neumark-Sztianer, & Hannan, 2006; Tiggemann, 2005). Thus, in

many ways, body dissatisfaction has emerged as a core aspect of

women’s physical and mental health.

Why is it that so many girls and young women are dissatisfied

with their bodies, regardless of the size? Among the many forces

believed to play a role (in addition to parental messages and

peer-related teasing) is the increasingly thin ideal dominating the

media. Across movies, magazines, and television programs, thin-

ness is consistently emphasized and rewarded for women (e.g.,

Fouts & Burggraf, 1999), and thin television characters are over-

represented while overweight characters are underrepresented

(e.g., Fouts & Burggraf, 1999, 2000; Greenberg, Eastin, Hofschire,

Lachlan, & Brownell, 2003). Indeed, the images of women pre-

sented in the media today are thinner than past media images of

women (Silverstein, Perdue, Peterson, & Kelly, 1986), thinner than

the actual female population (e.g. Fouts & Burggraf, 1999, 2000),

and often thinner than the criteria for anorexia (Wiseman, Gray,

Moismann, & Ahrens, 1992). This ideal is pervasive, with fashion

models, cartoon characters, movie and television actresses, Play-

boy centerfolds, and Miss America Pageant winners all having

become increasingly thinner over the past decades (Garner, Gar-

finkel, Schwartz, & Thompson, 1980; Klein & Shiffman, 2005;

Morris, Cooper, & Cooper, 1989; Silverstein et al., 1986; Spitzer,

Henderson, & Zivian, 1999). Thus, media aimed at girls, adoles-

cents, and young women are replete with extremely thin models

that portray an ideal that is unattainable to most.

According to communications theories, repeated exposure to

media content leads viewers to begin to accept media portrayals as

representations of reality (e.g., cultivation theory: Gerbner, Gross,

& Morgan, 2002; social learning theory: J. D. Brown, 2002). In

this case, it is believed that the media’s consistent depiction of a

thin ideal leads women to see this ideal as normative, expected,

and central to attractiveness. However, because media presenta-

tions of women’s bodies are so skewed, showcasing an ideal that

is out of reach to most, adopting this reality may lead to decreased

satisfaction with one’s own body (e.g., Levine & Harrison, 2004)

and to behaviors aimed at meeting this ideal, behaviors such as

dieting, bingeing and purging, and skipping meals. A growing

body of research has begun to investigate these claims, testing how

both laboratory and natural exposure to the thin ideal shapes young

women’s internalization of this ideal, body dissatisfaction, and

disordered eating. Research in this area has produced more than

100 studies whose findings not only demonstrate the proposed

links but also provide evidence that body image disturbance pro-

spectively predicts eating pathology (e.g., Stice & Shaw, 2002)

Shelly Grabe and Janet Shibley Hyde, Department of Psychology,

University of Wisconsin–Madison; L. Monique Ward, Department of

Psychology, University of Michigan.

This research was sponsored in part by National Institutes of Health

Grant F32MH7197102 to Shelly Grabe.

Correspondence concerning this article should be addressed to Shelly

Grabe, Department of Psychology, University of Wisconsin–Madison,

1202 West Johnson Street, Madison, WI 53706. E-mail: [email protected]

Psychological Bulletin Copyright 2008 by the American Psychological Association 2008, Vol. 134, No. 3, 460 – 476 0033-2909/08/$12.00 DOI: 10.1037/0033-2909.134.3.460

460

and that treatment interventions aimed at reducing body image

disturbance can produce reductions in bulimic pathology (e.g.,

Bearman, Stice, & Chase, 2003). Thus, in the following review we

focus on body image dissatisfaction and related concerns, among

which we include behaviors and beliefs about eating and dieting.

The majority of studies examining connections between media

use and women’s body image and related issues have been exper-

imental laboratory studies that examine whether exposure to thin-

ideal media increases body dissatisfaction or related concerns in

the short term (e.g., Tiggemann & Slater, 2003). These types of

designs, in which participants are randomly assigned to conditions,

are often believed to offer the most conclusive evidence regarding

media effects on psychological outcomes (C. A. Anderson et al.,

2003). However, although experiments of this type contribute

significantly to our understanding of media effects on body image

and related concerns, they also include a level of artificiality that

limits their external validity. As such, findings from laboratory

studies may be especially valuable when they are combined with

results obtained from naturalistic, correlational studies in which

participants report their actual media use. However, findings from

these correlational surveys are also limited in that they cannot

indicate whether thin-ideal media cause negative body image

outcomes, whether women with poor body image are drawn to

thin-ideal media, or whether some other factor creates both con-

ditions. Neither method, then, provides unequivocal findings re-

garding the role of the media in women’s body image concerns.

The combination of the two, however, can provide converging

evidence. Although longitudinal and prospective studies can en-

hance confidence in the conclusions drawn, this area of research is

relatively new, and therefore, the number of such studies is small.

As a result, what follows is a review of the experimental and

correlational research examining the link between media use and

women’s body image and related concerns.

Experimental Research

The majority of studies in this area have used experimental

methods to test whether women feel worse about their bodies after

exposure to thin media models than after exposure to other types

of images (e.g., Dittmar & Howard, 2004). In a typical experiment,

women are shown a series of magazine or television advertise-

ments that contain either images of the thin-ideal body (experi-

mental condition) or images that are considered neutral (e.g.,

furniture; control condition). Following the experimental manipu-

lation, respondents are asked to complete assessments of body-

image-related constructs. Although experiment-based media expo-

sure cannot approximate the massive bombardment that occurs

naturally, a particular strength of this method is the potential for

causal inferences regarding the nature of the relation between the

media manipulation and women’s body image.

Using this paradigm, body-image researchers have repeatedly

shown that women who view thin-ideal images in the lab experi-

ence lower body satisfaction than do women who view neutral

images (e.g., Birkeland, Thompson, & Herbozo, 2005). For exam-

ple, findings among both adolescent and adult women indicate that

participants who viewed magazine ads featuring the thin-ideal

body type reported significantly greater body dissatisfaction than

did those who viewed neutral ads (e.g., Halliwell & Dittmar,

2004). Similar findings have been demonstrated with televised

media. For example, exposure to television commercials that fea-

ture the thin-ideal image (as opposed to average-weight women or

nonappearance-related content) increases women’s body dissatis-

faction (e.g., Hargreaves & Tiggemann, 2004) and eating disorder

symptomatology (e.g., Strahan, 2003). Similar results have been

obtained after the viewing of music videos (Tiggemann & Slater,

2003). Thus, a growing body of experimental research indicates

that exposure to thin-ideal models leads to increased body dissat-

isfaction and eating disorder symptomatology.

Other research, however, suggests that this is not invariably the

case and that experimental effects of exposure to the thin ideal are

not universal. First, certain factors make some women more vul-

nerable than others to the effects of media exposure (e.g., accep-

tance of societal attitudes toward female attractiveness; Heinberg

& Thompson, 1995). For example, it has been demonstrated that

prior levels of body dissatisfaction moderate women’s responses to

media images such that women who are initially dissatisfied with

their bodies are most sensitive to the adverse effects of media

exposure (Posavac, Posavac, & Posavac, 1998). Second, other

studies have found little to no immediate effect of thin-ideal media

portrayals on women’s body image or related concerns (e.g.,

Halliwell, Dittmar, & Howe, 2005). Similarly, null effects have

been reported for exposure to thin-ideal ads and adolescent girls’

self-reported physical attractiveness (Martin & Kennedy, 1993),

adult women’s body satisfaction (Irving, 1990), and endorsement

of dieting attitudes and behaviors (Thornton & Maurice, 1997).

Third, a few studies have reported that media exposure is nega-

tively related to dissatisfaction—in other words, after viewing

appearance-focused stimuli, women’s dissatisfaction decreased

(e.g., Coolican, 1999; Cusumano & Thompson, 1997). Overall,

however, many well-controlled, randomized experiments have

demonstrated an effect of the thin-ideal media on women’s body

image and related concerns in samples of varying ages with a

number of different outcome measures. Although some null or

conditional outcomes emerge, the majority of evidence from these

experiments indicates that brief exposure to media images depict-

ing the thin-ideal body often leads to short-term adverse outcomes

in women’s body image and related concerns.

Correlational Research

The second set of studies in this research area uses naturalistic,

correlational data to investigate the relationship between women’s

media consumption and their body dissatisfaction and related

issues (e.g., Bissell & Zhou, 2004; Jones, Vigfusdottir, & Lee,

2004). Here, findings indicate that more frequent exposure to

fashion magazines or to television programming featuring the

thin-ideal body type is associated with higher levels of body

dissatisfaction and eating disorder symptomatology among girls

and women (e.g., D. R. Anderson, Huston, Schmitt, Linebarger, &

Wright, 2001; Bissell & Zhou, 2004; Jones et al., 2004; Morry &

Staska, 2001; Sands & Wardle, 2003; Stice, Schupak-Neuberg,

Shaw, & Stein, 1994; Thomsen, 2002). Similar relations have been

demonstrated between generalized media use (Abramson &

Valene, 1991) or music television viewing (e.g., Hofschire &

Greenberg, 2001) and body image dissatisfaction.

With few exceptions, then, correlational research appears to

demonstrate a positive relation between media consumption and

body dissatisfaction among women (see Cusumano & Thompson,

461MEDIA AND BODY IMAGE

1997, for an exception). These correlational studies illustrate that

regular exposure to thin-ideal media is frequently associated with

comparatively higher levels of negative body image outcomes.

Although causal inferences cannot be drawn, these findings com-

plement the conclusions of the experimental studies and suggest

that the short-term effects found in controlled settings may be

generalizable outside of the laboratory.

Meta-Analysis

Although findings from experimental and correlational studies

suggest important connections between women’s media use and

their body image and related concerns, significant questions re-

main. How strong and consistent are these links, especially given

the presence of some null results? In what contexts are they most

relevant? Because a close inspection of individual articles reveals

use of varying stimuli, outcome measures, and methodology, a

firm understanding of the association between thin-ideal media

exposure and body image concerns among women is lacking.

Methodological differences in measurement and design type, the

presence of moderating factors, or simple random error that leads

to effect sizes of varying magnitude make it difficult to draw

generalizable conclusions. Meta-analytic work that allows for the

quantitative combination of all relevant data can estimate the

magnitude of the effects, analyze variations in study outcomes, and

investigate potential moderators of the relation between media

effects and body image.

Researchers have attempted to analyze this body of research

with just that aim, but the conclusions are somewhat inconsistent.

In one meta-analysis of 25 experimental studies investigating the

effects of media exposure on female body image (including only

generalized dissatisfaction measures), the authors reported an ef-

fect size of d � –.31 across all studies, indicating that women feel

worse after exposure to thin images versus neutral images (Groesz,

Levine, & Murnen, 2002). However, in a second meta-analysis

examining a similar question, Holmstrom (2004) analyzed findings

from 34 studies (mixed experimental and correlational) and re-

ported a notably smaller effect (r � –.08), suggesting that there is

little influence of media exposure on women’s body image. Be-

cause these reviews did not converge on similar findings, there

remains a need to examine the issue more closely. Furthermore,

neither meta-analysis reflects a comprehensive review of current

research. For example, Groesz et al. (2002) included only exper-

imental research, and of the 34 studies included in the Holmstrom

review, only 9 overlapped with those in the Groesz et al. review.

In addition, neither review included unpublished research, leading

to concerns about the file drawer problem (i.e., studies that were

conducted but never published; Rosenthal, 1979). Moreover, de-

spite the relative recency of these meta-analyses, an updated re-

view is warranted to reflect the rapidly growing number of articles

accumulating in this area of study. Finally, although the Holm-

strom review investigated four body image constructs (importance

of appearance, eating pathology and restrained eating, body dis-

satisfaction, and endorsement of the thin ideal), the author reported

an overall effect size collapsed across measures, thereby limiting

our understanding of how media use may contribute differently to

different outcomes.

Therefore, the current meta-analysis sought to improve upon the

two previous reviews in several important ways: (a) we included a

much larger sample of studies despite more stringent inclusion

criteria (N � 77); (b) we obtained and included unpublished

studies; (c) we reviewed both controlled experiments and correla-

tional studies; and (d) we viewed body image and related concerns

as multidimensional and therefore grouped our analyses on the

basis of four outcomes.

Measurement of Body Image and Eating Behaviors and

Beliefs

What is perhaps the greatest challenge to drawing sound con-

clusions from this large and growing literature is that results may

vary depending on the particular dimension of body image or

related eating behavior that is being measured. Researchers have

come to realize that body image concerns are multidimensional

and include thoughts, feelings, and behavioral responses related to

one’s body (Thompson & van den Berg, 2002). Thus, in the

burgeoning study of the media’s thin ideal, different components

of body image and related consequences such as disordered eating

behaviors have gained increasing attention since the 1990s. Given

this complexity, it is common for researchers to include in one

study several measures of body image or related constructs. For

example, researchers routinely use a body dissatisfaction measure,

a disordered eating measure, and a thin-ideal internalization mea-

sure in one study (e.g., Stice, Spangler, & Agras, 2001). Some

studies report consistent results across constructs (e.g., Bissell &

Zhou, 2004; Dunkley, Wertheim, & Paxton, 2001; Morry &

Staska, 2001), whereas others do not (e.g., Cusumano & Thomp-

son, 1997). For example, in some experimental studies researchers

report stronger media effects on internalization of the thin ideal

(Jones, Vigfusdottir, & Lee, 2004) and eating disorder symptom-

atology (e.g., Tiggemann, 2003) than on body dissatisfaction. To

complicate matters further, opposite results have been demon-

strated within the same study. Hawkins, Richards, Granley, and

Stein (2004) reported that exposure to thin-ideal magazine images

increased body dissatisfaction and negative mood among college

women but decreased internalization of the thin ideal. Thus, the

combination of null results and mixed results across constructs

makes it difficult to determine what construct related to body

image is most strongly linked to media exposure and points to the

importance of meta-analysis to sort out these findings.

In the current review we treated body image and related con-

cerns as multidimensional and examined the effects separately for

four outcomes related to body image. The first is body satisfaction/

dissatisfaction, which represents a global and subjective evaluation

of one’s body. Based on a review of published measures of body

image satisfaction and related constructs, Thompson and van den

Berg (2002) defined two additional dimensions of body image:

cognitive and behavioral. The authors argued that the cognitive

component of body image attempts to capture beliefs, thoughts,

and attributions of body image by measuring constructs such as

self-attentional focus, investment in one’s appearance, and inter-

nalization of social stereotypes regarding appearance. In our re-

view, we broke this category down further by distinguishing be-

tween (a) self-attentional focus or preoccupation with the body and

self-objectification (i.e., adopting a view of oneself as an object

whose value is based on appearance), which we believe to reflect

more clearly a degree of dysfunctional cognitive schema, and (b)

internalization of thin ideals, which we view as the adoption of

462 GRABE, WARD, AND HYDE

sociocultural appearance ideals as a personal goal and standard.

Finally, Thompson and van den Berg defined behavioral measures

as those that assess participants’ behaviors related to body image.

Given the large literature on eating disorders, we focus specifically

on behaviors related to eating but also broaden this category to

include beliefs related to eating because many measures assess

participants’ beliefs and attitudes as well as behaviors (e.g., “Feel

extremely guilty after eating”).

Method

Measures

We grouped our review of the relevant studies into the following

four categories of outcome variables: (a) body dissatisfaction, (b)

body self-consciousness/objectification, (c) internalization of the

thin ideal and drive for thinness, and (d) eating behaviors and

beliefs. When a study included more than one measure within a

category, effect sizes were calculated separately and then averaged

in order to produce one effect size per outcome variable of interest.

In the category of body dissatisfaction we focused on measures

that assess the evaluative component of body image, that is,

satisfaction/dissatisfaction with the body. The following scales

were classified as measures that assessed dissatisfaction with the

body and were included in the current review: (a) the Visual

Analogue Scales (Heinberg & Thompson, 1995), (b) the Body

Dissatisfaction Subscale from the Eating Disorders Inventory

(Garner, Olmsted, & Polivy, 1983); (c) the Body Satisfaction

Questionnaire (Berscheid, Walster, & Bohrnstedt, 1973), (d) the

Body Esteem subscale of the Body Image Scale (Conner, Martin,

Silverdale, & Grogan, 1996), (e) the Physical Appearance State

and Trait Anxiety Scale (Reed, Thompson, Brannick, & Sacco,

1991), (f) the Body Esteem Scale (Franzoi & Shields, 1984); (g)

the Appearance Self-Esteem subscale of the Current Thoughts

Scale (Heatherton & Polivy, 1991); (h) the Multidimensional

Body–Self Relations Questionnaire (T. A. Brown, Cash, &

Mikulka, 1990); (i) the Body Shape Questionnaire (Cooper, Tay-

lor, Cooper, & Fairburn, 1987); (j) the Figure Rating Scales

(Stunkard, Sorenson, & Schlusinger, 1983); (k) the Body Image

States Scale (Cash, Fleming, Alindogan, Steadman, & Whitehead,

2002); (l) the Body Satisfaction Scale (Slade, Dewey, Newton,

Brodie, & Kiemle, 1990); (m) the Body Attitudes Questionnaire

(Ben-Tovim & Walker, 1991); and (n) the Body Esteem Scale

(Mendelson & White, 1985). In addition to these scales, a variety

of scales that were not standardized but were specifically described

as measuring global body dissatisfaction were …