Exploring the Appearance Culture in Early Adolescence

Abstract

Despite the heightened awareness of body image concerns in early adolescence, there has been little research in Ireland regarding young people’s own perspectives on associated factors. Eight focus groups with young adolescents were conducted to explore common perceptions and influential processes occurring within the current Irish appearance culture. Three main themes emerged reflecting (a) appearance-related norms and processes operating in young adolescents’ immediate environment, (b) means by which more distal levels of sociocultural influences are transmitted, and (c) individual characteristics that shape the experience of the appearance culture. On the whole, the appearance-related values and behaviors of significant others were highly influential, especially those of peers. Cultural norms were evident in the young adolescents’ conceptions of the ideal body, and these appeared to be further negotiated and reinforced in proximal contexts. The collective interaction in the focus group discussions allowed alternative perspectives to be considered and generated new insights and perceptions. Outcomes indicate that the transmission of processes from distal and proximal environments are often interrelated and highlight the need to place greater emphasis on the interactive nature of sociocultural influences and the multiple processes by which appearance-related messages are transmitted.

Keywords

body image early adolescence gender qualitative methods

Negative evaluative body image, or body dissatisfaction, is a growing health problem for adolescents in Western societies, with prevalence studies indicating its existence in youth across gender, body mass index scores, socioeconomic status (SES), and ethnicity (e.g., Bucchianeri, Arikian, Hannan, Eisenberg, & Neumark-Sztainer, 2013; Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006). While body image concerns can relate to dissatisfaction with any aspect of an individual’s physical appearance, adolescents’ concerns most typically relate to their body shape and size and can be influenced by a variety of fluctuating state factors, such as body surveillance in a particular social setting, and more stable or fixed trait factors, such as internalization of the thin ideal (Cash, 2002; Cash, Fleming, Alindogan, Steadman, & Whitehead, 2002; Thompson, Coovert, & Stormer, 1999).

Although body dissatisfaction can materialize in childhood, it predominantly develops early in adolescence (Calzo et al., 2012) and can result in a range of long-lasting adverse health outcomes including disordered eating behavior (Espinoza, Penelo, & Raich, 2010) and impaired psychological functioning (Mäkinen, Puukko-Viertomies, Lindberg, Siimes, & Aalberg, 2012). A major intrapersonal change facing young adolescents is the realization of a new sense of self. In order to develop a personal identity and to be accepted socially, others’ approval of one’s appearance is of high importance, with peer acceptance, romantic relationships, and popularity all inextricably embedded (Price, 2009). As the integration of the physical self into one’s self-concept is an important aspect of identity formation during this developmental phase, the risk for the emergence of a negative body image is amplified (Jones, 2001; Smolak & Levine, 1994). As such, recent years have seen an increased focus on research addressing body image issues in early adolescence (Smolak & Thompson, 2009).

Cultural norms regarding the body are omnipresent within many cultures and widely dispersed in the distal environment through the media. Proximally, these values and expectancies can be reinforced through immediate socialization agents such as family members and peers, creating an appearance culture where individual-context interactions reciprocally influence each other (Jones, 2011). As individuals enter adolescence, biological changes such as puberty and socioenvironmental changes such as increased time spent with peers and the initiation of romantic relationships will alter the dynamic processes within the appearance culture. Depending on personal characteristics, this may lead to endorsement of the values, expressions, and activities of groups and symbols in the immediate and distal environment that promote the ideal body. Thus, the level of endorsement will produce different developmental consequences for an individual’s body image.

In current society, adolescents can interact with media in almost any environmental context at any time with the proliferation of personal and mobile devices, and can choose content from a range of print media, hundreds of television channels, interactive video games, and countless amounts of websites online (Currie et al., 2012; Ito et al., 2010). The media are overloaded with flawless images of models and celebrities, messages regarding body shape ideals, and appearance management products and behaviors, such as dieting and exercise (Murnen, 2011). The cumulative effects of these messages can lead to body dissatisfaction if these standards are accepted and deviation from these ideal portrayals is perceived (Tiggemann, 2011).

Overall, research supports the notion that exposure to appearance-focused media increases vulnerability to body image concerns in girls (e.g., Grabe, Ward, & Hyde, 2008). The impact appears less substantial for boys, but effects are noteworthy all the same (e.g., Blond, 2008). However, factors such as media multitasking and the proliferation of the Internet and its communication sites create great difficulty in attempting to measure media effects on body image. Moreover, when research has narrowed its focus to celebrity role models, negative effects on body image attitudes and behavior were found for both boys and girls (Field et al., 2001). Further consideration is also required in relation to the interconnections between media effects and parent and peer influences, such as means by which media messages may negatively affect body image through the reflected appraisals of significant others within the immediate appearance culture. Thus, difficulties in the empirical assessment of media effects and the ubiquitous nature of its influence suggest that its reported impact on young adolescents’ body image is likely to be underestimated.

Parents and peers are central transmitters of potentially negative forms of influence due to their continuous presence in the adolescent’s immediate environment. Influences can be transmitted in a variety of forms: directly communicated through discussion, encouragement, and teasing; or indirectly through the modeling of appearance-related concerns, attitudes, and behaviors (Helfert & Warschburger, 2011; Vincent & McCabe, 2000). In addition, the perceived quality of relationships with significant others is an important indirect influence to consider (Byely, Archibald, Graber, & Brooks-Gunn, 2000). In the developmental stage of early adolescence, peers become increasingly important socialization agents and their influence may take precedence over that of parents (Wertheim & Paxton, 2011). With this stronger reliance on, and investment in, peer interactions, and the pursuit of social rewards such as prestige and popularity from one’s social standing (Wang, Houshyar, & Prinstein, 2006), the peer context is of great importance in relation to body image development. In a focus group study with Irish girls, peer acceptance was cited as an important reason for pursuing the thin ideal (Mooney, Farley, & Strugnell, 2009). Furthermore, Jones, Vigfusdottir, and Lee’s (2004) notion of a peer appearance culture posits that norms, beliefs, and expectations related to appearance are transmitted to, or created within, a peer group, shaping attitudes and behaviors about one’s own and others’ appearance.

The above socialization agents generally combine to contribute to the development of body dissatisfaction better than any one agent individually (e.g., Smolak, Murnen, & Thompson, 2005), and influences from these sources are also often associated with each other (Clark & Tiggemann, 2007). The contribution of the triad of sociocultural influences are commonly considered independently (e.g., Papp, Urbán, Czeglédi, Babusa, & Túry, 2013; Ricciardelli & McCabe, 2003), but in reality these relationships are often interrelated or convergent (Jones, 2011). As such, both distal and proximal influences need to be conceptualized as interactive in nature, transmitting appearance-related messages in multiple ways, as part of the everyday collective experience of the appearance culture.

Sociocultural perspectives have provided the dominant theoretical framework to explain how influences from the appearance culture form internalized expectations from which body image evaluations are based. Thompson and colleague’s (1999) integrative tripartite influence model proposes that the three core sources of sociocultural influence (i.e., parents, peers, and the media) affect body dissatisfaction indirectly through the extent to which appearance-related cognitive processing is utilized. Specifically, two processes have been postulated: appearance comparisons and internalization of the ideal body. Both of these processes have been posited to intensify the effects of the appearance culture on body dissatisfaction. Promising findings have arisen from previous research applying variations of the tripartite influence model to adolescents. For example, Keery, van den Berg, and Thompson (2004) proposed that sociocultural influences are best thought of as a multidimensional construct and used a composite measure in their model testing. Findings confirmed the mediating roles of social comparison and internalization, while showing how body dissatisfaction led to disordered eating and impaired psychological functioning.

Although similar processes are expected for males and females, the experience of the appearance culture is likely to be highly gendered. Societal ideals for males and females are, respectively, hyper-muscular and hyper-thin (Tiggemann, 2011), and cultural norms have created gendered roles, in particular focusing on what the female body should look like and what the male body can do (Murnen, 2011). In addition, boys may face the additional expectation that they should appear to put little thought or effort into their appearance, coined the “not being bothered” discourse (Grogan & Richards, 2002, p. 227).

Coinciding with differences in body ideals, body image concerns also display differences across sex. One widely reported difference in evaluative body image is how girls experience greater body dissatisfaction than boys (e.g., Jones, 2004; Westerberg-Jacobson, Edlund, & Ghaderi, 2010). However, research has shown that while girls can experience a “drive for thinness” and wish to decrease their body weight, boys can experience a “drive for muscularity” and often wish to increase their muscle size (Smolak & Stein, 2006). Accordingly, research with an exclusive focus on weight concerns overlooks many unique aspects of the male body image experience (Hargreaves & Tiggemann, 2006). When boys with muscularity concerns and the desire to gain bulk are combined with boys with weight concerns, both levels of body esteem (Smolak & Thompson, 2009) and body dissatisfaction (Ricciardelli & McCabe, 2007) are comparable with those of girls. Thus, patterns of beliefs, thoughts, and feelings associated with the body and appearance are likely to differ across gender.

The Present Study

Recently reported body dissatisfaction rates among young Irish adolescents appear similar to those in other Westernized regions (e.g., Currie et al., 2012; Lawler & Nixon, 2011) and highlight the importance of understanding more about related risk and protective factors. However, we cannot assume that the influencing processes operating within the Irish sociocultural environment are the same as those in the United States, Australia, and the United Kingdom, where the majority of research on body image issues among this sample has been conducted to date. Irish research with this sample on this matter is sparse and has predominantly focused on females (e.g., Mooney et al., 2009), and so comparisons across gender are scarce. Thus, qualitative studies on the perspectives, attitudes, and behaviors of young adolescents specific to the cultural domain can inform Irish-based etiological research and contribute toward a richer research base generally.

The present focus group study drew from Cash’s (2002) notion of the evaluative-affective dimension of the negative body image construct, referring to negative self-appraisals entailing dissatisfaction with one’s body characteristics and emotional distress associated with one’s appearance. Specifically, it was concerned with negative evaluative body image or body dissatisfaction experienced by young Irish adolescents and their perceptions of current ideals within the appearance culture. A particular focus was the investigation of the dynamic processes they perceive as influential in their immediate environment and how these influence their values and goals in relation to body image. It was also intended to explore the nature and power of more distal levels of sociocultural influences, such as the portrayal of cultural appearance norms through the media, and to investigate the means by which macro-level influences are transmitted. For example, does it predominantly occur indirectly through its impact on significant others or directly through accessing appearance-related media? Is appearance-related media accessed in family or peer contexts? A further goal of the study was to examine the differential experience of the appearance culture across gender. The extended conceptualization encompassing concerns related to weight and muscularity has led to an increased recognition of the extent of body image concerns in males and points to a pressing need to further explore their body image experiences.

The present study was conducted as part of a larger mixed methods investigation where the information from the first qualitative stage was used to inform the second quantitative stage from which an ecological survey instrument was developed. The survey was intended to reflect the endorsement of influential processes stemming from the current sociocultural environment. An essential first step was to gain an understanding of how the appearance culture is currently experienced by young Irish adolescents through qualitative means. Focus groups are intended to loosely emulate a naturalistic discussion among a group of people with an informal atmosphere, and therefore this method was adopted as insight into the adolescent experience that could be gained within an everyday peer context (Hollander, 2004; Liamputtong, 2011). Although the power differential between adult and adolescent is not eliminated, it is greatly reduced in the focus group situation as the importance is placed on participants’ own construction of meaning rather than the researcher’s speculations, shifting the power imbalance toward participants (Grogan & Richards, 2002; Mooney et al., 2009). Group members generally manage the dynamic of the group and this sense of empowerment encourages active participation, as the pressure experienced in individual interviews to respond to every question is not present. The creation of such a synergy was considered ideal for discussion of appearance and body-related issues as the groups were likely to vary in the extent to which the topic had previously been articulated (Krueger & Casey, 2000; Tiggemann, Gardiner, & Slater, 2000). In addition, considering the importance of the peer group in adolescence (e.g., Jones, 2011; Wertheim & Paxton, 2011), and the cultural values that are transmitted through the peer environment, a focus group approach was considered an appropriate means of gaining a collective notion of the proximal processes occurring within the appearance culture with the target population (Tiggemann et al., 2000).

Method

Recruitment and Sample

Eight focus groups, four groups of each sex,¹ were conducted involving a total of 39 young adolescents (19 boys) aged between 12 and 14 years recruited from pre-existing groups² in one co-educational post-primary school and two youth clubs. Participants were predominantly Caucasian (90%), but also represented Asian, South American, and African backgrounds. SES status was not noted but the school and youth club locations were predominantly low- to middle-class areas. Each group contained 4 to 6 participants, which is considered appropriate for focus groups with children and adolescents (Vaughn, Schumm, & Sinagub, 1996).

Procedure

Ethical approval to conduct the study was granted by the School of Psychology Research Ethics Committee, Trinity College Dublin. Students in Year 1 from the school and members of the youth clubs who were aged between 12 and 14 years were invited to participate in group discussions to “explore the many influences that young teenagers face in relation to their thoughts and feelings about their appearance and body image.” Written informed consent was obtained from all participants and their parents or guardians.

The focus groups took place during school and youth club hours. To provide maximum group interaction, large rooms were used that were free of distraction and seating was arranged in a circle to not only facilitate interaction but also avoid any intimidation within the group (Liamputtong, 2011). An audio recorder was placed in the center of the circle. The principal researcher moderated each group in the presence of school or youth club personnel who were seated at the back of the rooms away from the circle and did not actively participate in the discussions. An introduction was provided, which covered topics like the format of the discussion, what participation entailed, and the extent of confidentiality. Some terminology was then explained such as body image and the ideal body.³

A questioning route was followed for each group to guide the discussion and promote consistency (e.g., “What do you think might influence young people to think about the way they look or engage in behaviors to improve their appearance and body shape?” “What kind of message do you think these influences give to young people?”). However, participants generally directed the flow of conversation in accordance with the issues raised while the moderator probed for clarification or elaboration.

The recorded discussions lasted approximately 30 to 40 minutes and ended after all questions were addressed and participants had nothing further to say. A hand out was provided with information on referral services for emotional support in case participants had strong feelings upon completion of the study.

Analysis

Focus group discussions were transcribed verbatim from audiotape shortly after each group ended and before the next group was conducted. Thematic analysis was employed to obtain a rich account of the complexity of the focus group data (Braun & Clarke, 2006). The intention was to explore the social contexts in which young adolescents discussed issues presented to them in accordance with research aims that were driven by the literature base and theoretical assumptions of the sociocultural perspective. Specifically, the tripartite influence model with an integrated conception of sociocultural influences guided the analysis. Thus, data were coded based on the predetermined research objectives and, using a deductive approach, latent themes were defined and interpreted with this identified theoretical framework in mind (Braun & Clarke, 2006).

The initial coding phase involved all elements of interest in the text being organized within a master-coding template of broad themes based on the questioning route. Codes that represented similar meanings were grouped together resulting in the emergence of subcategories within particular themes. Following this, an expert reviewer who was not involved in the focus groups reviewed transcriptions to corroborate the master-coding template from an objective perspective. Revisions in the coding system were then carried out collaboratively until a satisfactorily high level of agreement was reached.

As all of the focus groups covered the topics in the same sequence, an overall grid was created allowing for the examination of the codes and themes across and within groups and comparisons across gender. A second round of coding was conducted to further refine the themes and a thematic map (Braun & Clarke, 2006) was created to increase the specificity of the data set. When the data within themes were coherent and themes were easily distinguishable from one another, the interpretive process ceased. In addition, in accordance with Creswell’s (2007) recommendation to employ “validation strategies” in attempting to assess the “accuracy” of the findings, a number of strategies were employed. These included (a) triangulation, (b) peer review, (c) reflexive practice, and (d) thickly contextualized descriptions.

Results

The three central themes that captured the essence of participants’ attitudes and experiences of sociocultural influences related to body image were the proximal appearance environment, the distal appearance environment, and personal attributes. The findings will be presented under these three theme headings, each of which is divided into subthemes. Participants are referenced by pseudonyms to maintain confidentiality.

The Proximal Appearance Environment

This theme encapsulated the influence of significant others in the proximal environment and perceptions of the appearance culture clearly suggested the importance of appearance and body image for social success. The values and behaviors of significant others were highly influential, especially those of peers.

Peer acceptance

The groups collectively interpreted peer acceptance as the dominant motivation driving young people to look a certain way. They spoke of persistent pressure to keep up with fashion trends set by the peer group and how changing the appearance of their bodies through dieting, fasting, and exercising might be necessary to “fit in,” for example, “They like could be fat and everybody’s mocking them so they like exercise because exercise makes you thin” (Jack, Boy Group 2).

The modeling of a desired image or body shape by peers with popularity or prestige emerged as a strong indirect form of influence. Social acceptance was perceived to be achievable through conforming to trends modeled by popular peers, or through engagement in body-change behaviors in order to achieve a similar appearance: “ . . . she could hang around with people that are really anorexic and that aren’t really healthy and she might think that she wants to be anorexic now as well because everyone else is” (Enda, Boy Group 2).

The participants’ negotiation of the persistent societal endorsement of appearance ideals often included contradictory views as many claimed that despite the importance of establishing one’s own identity, all young adolescents aspired to attain the ideal in the hope of positive social consequences.

Louise:

’Cos they want them to change themselves.

Hayley:

And everybody would be like the same.

Danielle:

And it’s very like, everybody saying you have to look this way and stuff.

Alannah:

And you be copying everyone else. (Girls Group 8)

Examples were provided of people engaging in behaviors against their judgment to conform to the peer group (e.g., “They might want to dress the way they want to dress but they dress like the way the popular people dress”—James, Boy Group 4), while some participants felt that the influence of peers was, at times, so ingrained that young people were unaware that they were changing in order to conform:

Katie:

And sometimes people, they might not see themselves changing.

Maria:

But they actually are.

Katie:

They are changing yeah.

Emily:

Yeah, someone said that before, you don’t realize that people are changing just to look like—to get on with the crowd—with them like.

Katie:

It’s not good to change your person and to copy people and stuff. (Girl Group 7)

Concern with appearing attractive to opposite sex peers was evident throughout the groups. Participants often stated that the time they became interested in romantic partners was also the time they began to consider how they looked.

Chelsea:

Eh, I’d say when you are about like 8 or something.

Vera:

No, when you’re older.

Debbie:

When you start to think about boys. (All giggle)

Chelsea:

When you start hanging around with boys and people like that . . .

Debbie:

That judge you.

Chelsea:

And then you see people that are quite pretty and you want to be them . . . So you start putting on makeup and all. (Girl Group 2)

It was felt that the pursuit of romantic partners was primarily based on physical attractiveness. The girls explicitly stated that boys are more interested in their looks than their personality, placing increased pressure on them. However, the boys also appear to experience this source of pressure, as they claimed that they rarely considered their own appearance except when in the company of girls.

Leo:

Well I don’t really give a shit about my appearance so like . . . Actually no. I start to think about my appearance when I’m eh . . .

Dave:

When you’re around 12.

Leo:

Yeah, oh and you especially think about your appearance when you’re around girls y’know.

Dave:

Yeah. (Boy Group 1)

The girls reported that the boys they knew readily discussed female attributes and celebrities they found attractive and overhearing these discussions could trigger appearance concerns. Here is an example of how the distal appearance environment can play an indirect role as the celebrities discussed by opposite sex peers provide standards to aspire to:

Katie:

. . . a lot of the boys talk about what celebrities they like and then the girls would look up that celebrity and how they look, what they wear and everything and might copy them.

Maria:

Yeah, they talk about the girls.

Katie:

And, just to get the boys’ attention and stuff. (Girl Group 3)

Peer rejection

Coinciding with the significance of peer acceptance in motivating the pursuit of appearance ideals, both direct and indirect forms of appearance-related peer rejection were considered to detrimentally impact appearance and body image evaluations across the groups. As Charlene stated simply, “Look good or get bullied” (Girl Group 6). Both boys and girls discussed teasing and bullying over appearance extensively and it was generally felt that hurtful comments about one’s appearance triggered related concerns and behaviors. Examples of appearance teasing could readily be provided. Individuals who deviated from the societal ideal were most vulnerable:

People actually like, well they like starve themselves. Say if there was a girl . . . and she was very, and she was kind of big and people started calling her “fatty” or something, she’d like starve herself. Some people do that like. (Lee, Boy Group 3)

Participants reported adverse consequences of appearance teasing that they observed through reality television shows and social media, further indicating the indirect transmission of influences from the distal appearance environment.

Lee:

. . . even some boys like if they get bullied too much (about their appearance), it causes death like I’ve seen it on TV, like sometimes it causes death, people bullying them about it (how they look) all their lives . . .

Colm:

And they can’t take it anymore. (Boy Group 3)

Facebook was discussed as a platform for peer rejection. Its popularity was highlighted and those who did not have parental permission to become a member voiced their desire to join. Although participants generally spoke about social media positively, when discussing appearance-related teasing they noted how some peer comments on photos that are posted are derisive (“Facebook. There are pictures on that and it [appearance teasing] can be quite bad like”—Melanie, Girl Group 7). This indicates that combined influences from the peer group and the media are explicably apparent in young adolescents’ lives through this virtual realm involving significant others.

Family and friend modeling

Both girls and boys cited influential processes within the proximal appearance environment, including the modeling and discussion of body-change behaviors by family and friends. The girls did not discuss family modeling extensively but there was some evidence of influential processes within the home environment, such as when mothers share their magazines with their daughters and discuss how celebrities’ look, sometimes with a view toward copying their style (e.g., “My mom gets magazines and we would look through them . . . if we like it [celebrity look] I’d do something like and copy [them]”—Katie, Girl Group 7).

Knowledge of dieting and exercise habits of family and friends was apparent among the boys and was discussed positively and at length when the motivation was for sporting success, for example,

One of my friends, em do you know Shane? Yeah he does kickboxing and yeah did you see him jogging yesterday? He says that because he does kickboxing he has to lose some weight and now he’s going off jogging all around (the town). (Luke, Boy Group 4)

The Distal Appearance Environment

The influence from the distal appearance environment was clear, as was the interactive nature of its transmission. Through discussing the messages transmitted by role models in the media, it was apparent that an aspirational appearance standard had been set, and that the social consequences of emulating celebrity looks and deviating from the ideal was further substantiated from this macro-level influence. The validation of the ideal body resonated with wider sociocultural prototypes, while degrees of muscularity and thinness, for males and females, respectively, were negotiated within the group context.

Role models in the media

Much of the norms that were communicated at a proximal level stemmed from the mass media, most notably the ideal promoted by celebrities. Girls cited celebrities that they believed the boys they knew thought were attractive, and boys cited the top rugby and football players as most influential.

In this example, one group of girls discussed a U.S. actress who they thought was too thin but who they believed all the boys they knew found attractive. They co-constructed the narrative indicating that they had overheard such discussions among boys.

Emily:

Yeah she’s pretty skinny.

Katie:

Oh my God she’s after starving herself. She’s down to children’s sizes.

Emily:

Oh my God.

Maria:

But she’s very tall like.

Zara:

Baby sizes!

Girls laugh

Katie:

Seriously, 7- and 8-year-olds, that’s how skinny she is.

Emily:

She looks really ugly now. Because she got all like her nose sorted and things like that.

Maria:

Yeah but everyone likes her so.

Melanie:

Her and (another U.S. actress).

Zara:

Yeah John, John . . .

Emily:

All the lads do. (Girl Group 3)

Some of the girls spoke of an ambition to follow celebrity looks predominantly to attain a strong social standing and appear attractive to potential romantic partners. Again, the interconnectedness of sociocultural influences is evidenced, where the distal influences of celebrities in the media are transmitted through family and peer environments, and whereby the dominant motivation for emulating these ideal figures is social approval.

Debbie:

It’s like when you see all the pictures of famous people like and they’re all skinny and size zero and all. You’re like and you’re like “aw everybody wants to be like that.” So I don’t want to be left out.

Chelsea:

They’re the pretty people and loads of people don’t want to be different.

Debbie:

Yeah. (Girl Group 1)

Despite the persistent pressures faced by the girls and the common desire among peers to look like celebrities, they also showed a degree of resistance as they cited some of the popular celebrities as too thin and unrealistic (as in the first example above). In the example below, the girls did not accept the societal ideal passively, yet their defense of a celebrity on an extreme diet because the celebrity did not appear “really skinny” highlights how unhealthy notions may be promoted through negotiation within the peer context.

Katie:

Yeah she’s comfortable with what she does and she’s not going on any crazy diets like do you (know) the vinegar diet that (U.S. female singer) goes on and stuff like that.

Melanie:

What vinegar diet?

Katie:

You know the vinegar, she drinks that and it kind of stops her from eating and it actually just makes her stomach feel full.

Maria:

Yeah but she looks . . .

Emily:

She’s not going on any diets.

Maria:

She looks OK, like she’s not really skinny.

Emily:

Well any crazy diets.

Katie:

That is a crazy diet like drinking vinegar.

Melanie:

She’s not too skinny though.

Maria:

It’s just like she’s not too skinny.

Caroline:

She’s normal size.

Maria:

She’s just the way she wants to be comfortable with. (Girl Group 3)

When discussing celebrities pictured in magazines, the boys also mentioned how female models have become increasingly thin.

Enda:

Yeah and they be getting skinnier than that (Enda makes a circle with the thumb and forefinger of each hand to demonstrate the size). Seriously, you can put—you can like just put a circle around their arms like that and shwoop . . .

Ronan:

That’s how thin it is. (Boy Group 2)

The boys did not initially cite celebrities as an influence but discussed the fashion and sports products promoted by the most talented sports stars and the body shape required for sporting success.

Karl:

Yeah, like Messi is the best soccer player in the world like he does it for Adidas.

James:

Advertises them and then everybody buys them then. (Boy Group 4)

The collective view brought this source of influence into their awareness as the discussions progressed and allowed the boys to reflect on the emerging discourse. They spoke about the need for sports stars to attain the aesthetic-athletic body shape to be successful. These sports stars were also considered to influence healthy eating behaviors, whereas they thought models would influence unhealthy eating among girls:

Andy:

. . . say if one model has like a great figure and then when say some girl like 12 years old wants that figure, they might like, eat like one thing for breakfast every morning and . . .

James:

That’s all like.

Andy:

Yeah and starve . . . (Boy Group 4)

Information on how to accomplish celebrity looks was sourced from television, mothers’ magazines, and also from peer appearance discussions. The girls discussed how television programs and magazines mainly contained young people with ideal bodies and how this triggered a drive for thinness. For example, “ . . . the girls our age are real pretty and everything and all and, and I’m always like ‘Aw I want to be able to look like them’” (Debbie, Girl Group 1). The information received appears to interact with personal attitudes and proximal influences affecting their body-related concerns, further highlighting the multidimensionality of media influences.

Distal appearance norms validating the ideal

Cultural norms were evident in the validation of the ideal body, with a dominant focus on aesthetics for girls and on both aesthetics and athleticism for boys. In addition to peer acceptance, a further motivation for thinking about and engaging in body-change behaviors was to succeed in sport or for a specific career, such as modeling. Participants provided examples by referring to both professional sporting figures and similar others in the proximal environment, thus assigning these bodily requirements to all.

James:

In rugby like you have to be big, you couldn’t be, well unless you were out of the scrum.

Luke:

Yeah but that’s muscle, that’s not fat.

Karl:

You have to be, you have to be built.

Andy:

You have to be built and you can’t be slow.

Luke:

Like my brother.

Andy:

Even Peter Stringer (Irish rugby player), even Peter Stringer, like he’s tiny but well—he’s still built.

Luke:

My brother, he’s only 15, his team the under 17s, they are, they have to start working in the gym now and they have to be on this diet, and my brother’s friend plays for Munster and they have to be on this proper diet like they can’t eat chocolate bars . . . (Boy Group 4)

Personal Attributes

The experience of the appearance culture was dependent on a number of personal attributes. In particular, the young adolescents discussed how preoccupation with appearance and body shape depended upon one’s degree of resilience to external pressures, largely determined by weight status, confidence, self-esteem, and age. In addition, gender-typed traits were evident, particularly among the boys’ discourses, despite the general notion that the gender gap in preoccupation was narrowing.

Resilience

The importance of attaining the ideal body varied among participants; some felt it was not very important to them but acknowledged that it was for other young adolescents, while others disclosed that they regularly considered their appearance. Although many voiced that it should not matter, there was an equally strong feeling that it did matter, as those that deviated from the ideal would be subjected to criticism from peers, providing further indications of the centrality of pervasive peer influences for participants. Despite knowing that striving for the societal ideal is unrealistic for many, the female groups predominantly felt that it was widespread among girls these days. When asked about typical experiences that influence one to think about their appearance, such as people they meet and things that they see, they described daily encounters and triggering events.

Chelsea:

It’s the pretty people that do it to you.

Researcher:

. . . How often does that happen do you think?

Pause—5 seconds

Debbie:

Every day you have to think about yourself when you walk past people like and that.

Chelsea:

And when you look in the mirror.

Debbie:

Yeah. (Girl Group 1)

Personality traits and age were thought to moderate the effects of inescapable sociocultural influences and were considered partly responsible for the variability in preoccupation. Confidence and self-esteem were discussed, providing a glimpse into the reasons why it was felt that some, but not all, young adolescents were highly preoccupied with their bodies.

Hayley:

Some people it could happen to and others it would never.

Roisin:

Like if the person is confident.

Researcher:

OK, so you think that helps them not be affected by it?

Roisin:

Yeah ’cos if they are really shy and all they would probably be but if they were confident they wouldn’t. (Girl Group 4)

Generally, both boys and girls felt that they were too young to be concerned with their weight although they did feel that being overweight would lead to social exclusion. Concerns about clothing and grooming were more common across the groups but it is noteworthy that they expected these behaviors to progress to more drastic body-change behaviors in later years.

Enda:

I’d say as you get older . . . I’d say, yeah as you get older it becomes more and more important . . .

Jack:

Yeah, you get more self-conscious about yourself, like . . . (Boy Group 2)

Roisin:

Yeah well I don’t think people would go on diets yet really ’cos we’re a bit young, maybe later . . .

Researcher:

Yeah, so you don’t think that is really an issue at this stage?

Hayley:

Unless like . . . you felt that you wouldn’t be able to fit into a dress or something, then yeah.

Girls:

Yeah. (Girl Group 4)

Gender-typed traits

Appearance was viewed as a means of affirming a masculine or feminine identity for these young adolescents, particularly in the pursuit of romantic partners. For boys, looking tough was thought to impress girls, while for girls, looking slim and attractive was thought to impress boys.

The boys’ discourses were infused with many gendered references. They often discussed weight-related issues from a female perspective while physical activity and fitness issues were generally referred to males. Dieting was typically perceived as a feminine behavior except when the boys readily discussed the importance of dieting for sporting success. Physical mastery and sporting achievements were highly desirable aspects of identity for these boys, possibly due to popularity and prestige often concurring. According to the boys, girls were more susceptible to external influences, and some male group members expressed a desire to maintain their autonomy and resist sociocultural standards. Gendered discourses emerged in how levels of preoccupation were described.

The boys presented a much more relaxed attitude toward pressures for a particular body shape, claiming that it was predominantly clothing trends that guided their consumer behavior. They also engaged in a stereotypical “not bothered” discourse at times when expressing their personal views on how they look, likely to be influenced by perceived gendered norms.

Andy:

I never burn I just tan really, really dark.

Researcher:

So do you think it is good to have a tan then?

Andy:

To be darker, yeah.

Karl:

Yeah, but I’m not really bothered. (Boy Group 4)

The girls, however, felt that concerns were increasing for boys in recent years. After one female participant proposed this premise, the other girls began to expand on the original idea to socially produce a shared meaning. The girls felt that boys’ concerns were moving further from athletic function and more toward aesthetics, attributing this to a changing culture and increased influence from the media.

Roisin:

Yeah like, when like, about 50 years ago or something eh, boys you’d never see them with highlights or gel or anything like that. And they wouldn’t be going around in tracksuits either.

Hayley:

Yeah, ’cos now it’s like you hang out in like a big group of boys and girls and it used to be just like eh . . .

Roisin:

They’d be playing sports or something.

Alannah:

Things have changed.

Girls:

Yeah.

Roisin:

It used to just be all like play sports and stuff but now it’s all about looks . . .

Alannah:

Probably ’cos there’s more celebrities . . .

Roisin:

Like eh people started dyeing their hair, and . . .

Alannah:

Because there used to be like, em none of that before TV. (Girl Group 4)

Although none of the boys who participated expressed any personal appearance concerns, some reported that their peers had such concerns. Boundaries were set within the context of one boy group between behaviors considered acceptable and behaviors deemed inappropriate for boys to engage in. One participant, referred to as “soft” because of his supposed appearance-related behaviors, had to insist that he does not put effort into his appearance, perhaps in order to protect his social positioning within the group:

Conor:

Yeah, they (girls) worry about it (their appearance) too much and they’re like “Wow look at me I’m so cute woooo.”

Leo:

Ah, you worry about it too now you big soft boy.

Dave:

And you see boys just work out and sometimes they spike their hair and sometimes they just put water on it. But Conor . . .

Conor:

I don’t, just water on it—I wash my hair. Some guys like back comb it and . . .

Alex:

Yeah all the faggots.

Conor:

And straighten their hair and all, I don’t. (Boy Group 1)

Discussion

One of the aims of this study was to explore young adolescents’ perceptions and experiences of the appearance culture, and the processes that commonly occur in young adolescents’ immediate sociocultural environment. This was largely reflected in the first theme, the proximal appearance environment. The young adolescents perceived the main driving force behind the pursuit of appearance ideals to be the ensuing social rewards. Thus, motivations for attaining the ideal were predominantly for social reasons, supporting previous work that has highlighted the importance of perceived peer relations for body image outcomes (Byely et al., 2000; Westerberg-Jacobson et al., 2010). Popular peers were cited as trendsetters and targets for upward comparisons, motivating engagement in behaviors to attain similar standards and, in effect, improve one’s social standing. The male groups in particular appeared to perceive a link between visual displays of consumption and social status, showing the interacting effects of distal (consumerism) and proximal (social position) appearance contexts. The importance of appearance and body shape for increasing heterosexual popularity was also highlighted. Indeed, attracting attention from potential romantic partners has been cited as a strong influence in other qualitative research for both males (Hargreaves & Tiggemann, 2006) and females (Mooney et al., 2009), despite quantitative research suggesting that these influences may not yet have materialized in early adolescence (McCabe & Ricciardelli, 2005).

The majority of participants, regardless of gender or location, produced discourses indicative of a strong fear of peer rejection regarding their appearance. Teasing and other forms of peer rejection appeared to be prevalent processes within these young people’s proximal environment, highlighting vicarious appearance teasing as an important process to consider. Indeed, the negative experiences of others observed in the peer context can serve to transmit appearance norms and expectations by identifying physical attributes that are stigmatized within the peer appearance culture (Jones & Crawford, 2006). Another less explored process, perceived judgments, was also noted, and in accordance with the literature, was predominantly associated with females (e.g., Jones & Crawford, 2006). Although references were brief, social networking sites emerged as an additional context where visual displays of the self can increase vulnerability to forms of appearance-related peer criticism. This small study did not provide sufficient data on the role of social networking sites, but its unprompted acknowledgment by the participants indicates the importance of including this new appearance context in research assessing the modern-day appearance culture. Participants also mentioned the transmission of appearance-related information and the discussion and modeling of body-change behaviors by family members and peers within the proximal environment. This further indicates the need to address the wide spectrum of influences from these significant others as many are likely to be present in contexts supporting particular body shapes. On the whole, the appearance-related values and behaviors of significant others were highly influential, especially those of peers.

The second theme, the distal appearance environment, highlighted the pervasive impact of the media and cultural appearance norms, such as the appearance-related messages transmitted by role models in the media, and also how these distal influences are inextricably linked with more proximal social issues. Sought-after celebrity looks encompassed both styles and body shapes for the girls and mainly sports products for the boys. The girls perceived that the emulation of celebrity bodies would improve their social standing and contribute toward the pursuit of romantic relationships. This was highlighted when one group of females discussed celebrities they felt were too thin but highly desired by the boys. The degree of resistance displayed by the girls to ultra-thin celebrities was also challenged in the focus group context when they collectively defended an unhealthy celebrity diet. If these discourses loosely reflect everyday peer appearance norms and discussions, it suggests that proximal processes such as appearance-related discussions may challenge personal views regarding media influences, contesting findings of such resistance that have been noted elsewhere (e.g., Dixey, Sahota, Atwal, & Turner, 2001). These examples are indicative of the distal appearance environment filtering through proximal processes and appearance norms, reinforcing the ideal body that role models in the media promote.

Although the boys did not perceive themselves to be influenced by the media when asked directly, their extensive knowledge of the behaviors and products associated with their respective favored sports stars that later emerged indicated that certain media influences might be operating at a subconscious level. This is consistent with previous research where boys have not directly discussed the link between the media and bodily issues (Hargreaves & Tiggemann, 2006), possibly reflecting a lack of awareness of the media as a potential source of influence. This is especially likely in today’s society where intimate details of the lifestyles of public figures are readily available and widely circulated through the media, of which many adolescents in Western cultures have extensive access (Ito et al., 2010).

References made regarding the media in the focus groups were often indirect, as a means of gaining information about celebrities or when illustrating the effects of peer influences. Consequently, young adolescents may be largely unaware of its influencing role in transmitting messages regarding appearance. However, with the media conceptualized as part of the everyday experience of the appearance culture, a greater reflection of its impact can be obtained. The discussion of the use of mediums transmitting appearance-related messages such as television, magazines, and the Internet, suggests that processes are occurring within home and peer contexts. Distal appearance norms are pervasive and can be intensified when reinforced within the proximal appearance culture, and with such indirect forms of transmission, one can be largely unaware of its impression. Consequently, the extent of its influence may not be uncovered by the direct questioning that is typical in many self-report measures of sociocultural influences.

The meaning of the ideal body for these young adolescents largely reflected cultural norms. The greatest similarity across gender was with the key function of attaining the ideal body—to improve one’s social standing and avoid peer rejection. This is consistent with previous claims of comparable environmental influences despite highly gendered body image ideals (Helfert & Warschburger, 2011; Smolak & Stein, 2006). However, the degree of thinness and muscularity considered ideal was negotiated within the focus group context, highlighting how distal appearance norms may be transmitted and shaped through proximal processes such as peer appearance discussions (Jones & Crawford, 2005).

The final theme that emerged, personal attributes, attended to the ways in which person characteristics shape participants’ experiences of the appearance culture. These young adolescents appeared to readily encounter messages from both the proximal and distal appearance environments and actively negotiated their way around them. This may account for levels of resilience appearing to be quite subjective and varied. Resilience to sociocultural influences was discussed in terms of protective personality traits and attributes such as weight and age. The expectation across groups that bodily concerns would progress as they got older was also seen throughout the groups in Dixey and colleagues’ (2001) research and resonates with the literature evidencing the progression of bodily pressures in middle adolescence (Helfert & Warschburger, 2011).

Gender-typed traits were apparent among the discourses and physical appearance seemed to play a strong role in supporting an identity reflecting socially constructed gender roles. Typical gendered discourses emerged throughout the groups where girls were displayed as more vulnerable to sociocultural messages (e.g., Hargreaves & Tiggemann, 2006) and the boys frequently constructed body image issues with feminine connotations. Their discourses produced an implicit classification of male- and female-appropriate body-change behaviors through the pronouns used, indicative of cultural norms and the intensification of gender roles in early adolescence where masculinity and femininity become increasingly polarized (Calzo et al., 2012). However, the gender gap in preoccupation was perceived to be decreasing, indicating that young adolescents are also aware of the recent cultural shift toward the male aesthetic body (Leit, Pope, & Gray, 2001).

Within the male groups, boundaries were set reflecting appearance- and body-related concerns and behaviors that were considered acceptable, while attempting to portray low investment in their looks. The male participants did not appear to have issues with their own appearance and topics were largely discussed within a sports context. This reframing is noteworthy as it increased the boys’ comfort in discussing these topics and further supports the focus on sport and physical competence as important factors in considering male appearance and body image issues (Grogan & Richards, 2002; Lyu & Gill, 2012). Overall, the findings further highlight the importance of acknowledging the highly gendered appearance ideals and bodily matters that are displayed in early adolescence (Calzo et al., 2012), in addition to similarities and differences in the perception of processes occurring within the appearance culture across gender (Helfert & Warschburger, 2011).

One of the key characteristics of focus groups is the group interaction, permitting access to the processes by which meaning is constructed and how participants share and negotiate their viewpoints and experiences within a particular social context (Liamputtong, 2011). The group interaction was particularly useful for exploring perceptions of body image as the influencing factors appear to center around, or are transmitted through, the peer group. By attempting to create a context that loosely reflected a normative conversation addressing the appearance culture in depth, an indication of the dynamic processes that may occur within the group context was obtained (Vaughn et al., 1996). There were indications of sharing information, and when participants differed in their opinions they often negotiated a common ground, possibly signifying the strong role of the peer group in the development of attitudes and norms in everyday life. Although the groups did not fully emulate natural processes that occur within the peer appearance culture, access to these forms of interaction and the insight gained could not have been captured through quantitative methods or individual interviews.

In summary, new insights were gained on the multidimensionality of sociocultural influences and the various patterns by which they are transmitted. These findings are somewhat inconsistent with the original tripartite influence framework, where the triad of parents, peers, and the media has been postulated to exert their influence independently, but support Keery and colleagues’ (2004) multidimensional conceptualization of sociocultural influences for adolescent girls. Hence, in order to progress integrative sociocultural theories of body image, more research is needed on the intricate ways individual-environment interactions affect body image appraisals across gender. Further insight is required into the influential processes that occur between individuals and the sociocultural environment for a thorough account of the appearance culture and the resulting impact on body image in early adolescence.

The strengths of this study include (a) gaining an insight into young adolescents’ shared understandings of the appearance culture and appearance-related issues, (b) acknowledgment of the ways in which the social context influenced the construction of meaning, and (c) the systematic analysis procedures employed. The sample size for the qualitative analysis ensured multiple viewpoints were gained. The multiple contexts and processes occurring within the appearance culture have not been widely accounted for in previous focus group studies on body image issues. In addition, this method of data collection appeared to be an impartial and appealing means of exploring a potentially sensitive issue with young adolescents. Furthermore, the data collection and analysis process was carefully planned and executed to ensure high-quality research was undertaken.

However, there are also limitations to be noted. First, in applying focus group methodology, data can only be interpreted from a group level. Second, some issues may have been too personal or sensitive to discuss in such a group setting, and others were not probed at length. Upon reflection, the questioning route may have contained too many general questions and personal bodily issues were not probed sufficiently. In addition, the exploration of how newer forms of media such as reality television and social networking sites affect young people’s views on ideal body types was limited in this study, and, in retrospect, delving deeper into these forms of influence could have provided fruitful information. Given the already vast and ever-expanding numbers of adolescent Internet users, future research that examines these processes is clearly warranted. It must be acknowledged that the sample may have been biased in that participants were more likely to represent young adolescents who were more comfortable discussing these issues and had low levels of concerns. In addition, although the pre-existing groups may have loosely emulated everyday interactions among peers, honest disclosure could not be guaranteed, as underlying thoughts and feelings may have been shaped by the power of peer pressure or the presence of the researcher and staff member. Thus, disclosures must be considered from the context in which they were discussed. If feasible, individual interviews would have provided a useful supplement to the focus group data as disclosures would not have been influenced by the group dynamic. Furthermore, the sample was made up of young adolescents, predominantly Caucasian, middle or lower middle class, and from two locations in Ireland, and therefore findings cannot generalize to the wider population. There is a need to focus on how the perceptions and experiences of the Irish appearance culture may vary across boys and girls from various ethnic backgrounds, and for replication in other geographical areas of Ireland, as corroboration is needed for these qualitative outcomes to effectively contribute to the development of important health initiatives.

The exploration of the appearance culture in the present study and previous findings (e.g., Mooney et al., 2009) highlight the need for proactive programs in educational settings for young adolescents in Ireland, which promote an environment that embraces diversity regarding appearance, body shape, and weight. Qualitative research as part of a larger study adopting a mixed methods approach can have similar implications to a needs assessment. These adolescents predominantly discussed issues and engaged in behaviors to uphold current appearance trends but had apprehensions regarding sociocultural pressures and increased preoccupation with bodily issues as they progress through adolescence. This further highlights the importance of prevention programs, promoting peer-supportive appearance contexts and resilience to the messages transmitted by the media, before middle adolescence where such concerns may become a more stable aspect of the self (Calzo et al., 2012), possibly leading to more serious body-change behaviors. In addition, because young adolescents’ appearance-related concerns and issues are influenced by the interactive effects of personal characteristics and sociocultural influences from both the immediate and distal environments, it is important that programs consider the dynamic processes that occur within this complex and multilayered appearance culture.

Findings indicate that school-based programs promoting peer-supportive appearance contexts would be highly beneficial considering the important role the peer group plays within the appearance culture. The current Irish Social, Personal, and Health Education (SPHE) syllabus touches on body image issues but many educators have claimed they feel ill equipped to delve too far into serious discussion on the topic (McSharry, 2009). Prevention programs could help increase awareness and understanding of the ways in which influences from the wider sociocultural environment serve to create appearance standards and how these may be further reinforced through proximal means. A group context in school can provide the opportunity to collectively deconstruct societal messages and the groups could also be empowered to develop individual- and school-based solutions that they are more likely to adopt. Such programs would be suitable for the SPHE syllabus as they would coincide with the equal-participation and shared learning principles of the curriculum, and contribute toward the ongoing efforts required to continually progress health promoting frameworks across post-primary schools in Ireland.

Conclusion

This research addressed the need to gain insight into the lived experiences of young adolescents within the current appearance culture. The interconnecting themes that emerged further support the need to acknowledge the interactive nature of sociocultural influences rather than assessing the triad of sources in isolation. The wide-ranging perceptions and processes from the multidimensional contexts highlighted within the group discussions have not been encompassed within a single study previously. However, similar influences and motivations for pursuing the ideal body have also been noted in other qualitative work on adolescents, both in Ireland and internationally (e.g., Grogan & Richards, 2002; Mooney et al., 2009), further highlighting the need for these issues to be addressed. The present study was successful in supporting the proposition that processes occurring within, and perceptions of, the appearance culture differ across gender and the interactive contexts in which they occur, contributing to existing literature from the sociocultural perspective. However, further theoretical work in understanding the appearance culture, incorporating both qualitative and quantitative approaches, is required to advance our knowledge of the interactive nature of sociocultural influences.

Footnotes

Acknowledgements

The researchers would like to acknowledge the assistance of the Trinity College Postgraduate Research Studentship Award. A special thanks to Karen Fitzgerald, Lauren Dooley, and Mark Brady for reviewing the questioning route, and Dr. Elizabeth Nixon for providing an expert review of the transcriptions.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

Author Biographies

Joanne Kierans, PhD, is a graduate from the School of Psychology at Trinity College Dublin. She is currently working as a consultant psychologist specializing in psychometrics. Her research interests include factors influencing children’s and adolescents’ body image, and other areas of child and adolescent health, including nutrition and physical activity.

Lorraine Swords, PhD, is an assistant professor with the School of Psychology and a research associate with the Children’s Research Centre, Trinity College Dublin. She teaches, researches, and publishes on topics relating to children’s health and well-being, with particular interest in peer interactions in the context of physical or mental health conditions in childhood and adolescence, focusing on help-seeking, help-giving, and stigmatizing responses.

References

Blond

(2008). Impacts of exposure to images of ideal bodies on male body dissatisfaction: A review. Body Image, 5, 244-255.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.

Bucchianeri

M. M.

Arikian

A. J.

Hannan

P. J.

Eisenberg

M. E.

Neumark-Sztainer

(2013). Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body Image, 10, 1-7.

Byely

Archibald

A. B.

Graber

Brooks-Gunn

(2000). A prospective study of familial and social influences on girls’ body image and dieting. International Journal of Eating Disorders, 28, 155-164.

Calzo

J. P.

Sonneville

K. R.

Haines

Blood

E. A.

Field

A. E.

Austin

S. B.

(2012). The development of associations among body mass index, body dissatisfaction, and weight and shape concern in adolescent boys and girls. Journal of Adolescent Health, 51, 517-523.

Cash

T. F.

(2002). The Situational Inventory of Body Image Dysphoria: Psychometric evidence and development of a short form. International Journal of Eating Disorders, 32, 362-366.

Cash

T. F.

Fleming

E. C.

Alindogan

Steadman

Whitehead

(2002). Beyond body image as a trait: The development and validation of the Body Image States Scale. Eating Disorders, 10, 103-113.

Clark

Tiggemann

(2007). Sociocultural influences and body image in 9 to 12-year-old girls: The role of appearance schemas. Journal of Clinical Child and Adolescent Psychology, 36, 76-86.

Creswell

J. W.

(2007). Designing and conducting mixed methods research. London, England: Sage.

10.

Currie

Zanotti

Morgan

Currie

de Looze

Roberts

. . . Barnekow

(Eds.). (2012). Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: International report from the 2009/2010 survey (Health Policy for Children and Adolescents, No. 6). Copenhagen, Denmark: WHO Regional Office for Europe.

11.

Dixey

Sahota

Atwal

Turner

(2001). “Ha ha, you’re fat, we’re strong”; a qualitative study of boys’ and girls’ perceptions of fatness, thinness, social pressures and health using focus groups. Health Education, 101, 206-216.

12.

Espinoza

Penelo

Raich

R. M.

(2010). Disordered eating behaviours and body image in a longitudinal pilot study of adolescent girls: What happens 2 years later? Body Image, 7, 70-73.

13.

Field

A. E.

Camargo

C. A.

Taylor

C. B.

Berkey

C. S.

Roberts

S. B.

Colditz

G. A.

(2001). Peer, parent, and media influences on the development of weight concerns and frequent dieting among preadolescent and adolescent girls and boys. Pediatrics, 107, 54-60.

14.

Grabe

Ward

L. M.

Hyde

J. S.

(2008). The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies. Psychological Bulletin, 134, 460-476.

15.

Grogan

Richards

(2002). Body image: Focus groups with boys and men. Men and Masculinities, 4, 219-232.

16.

Hargreaves

D. A.

Tiggemann

(2006). “Body image is for girls”: A qualitative study of boys’ body image. Journal of Health Psychology, 11, 567-576.

17.

Helfert

Warschburger

(2011). A prospective study on the impact of peer and parental pressure on body dissatisfaction in adolescent girls and boys. Body Image, 8, 101-109.

18.

Hollander

J. A.

(2004). The social contexts of focus groups. Journal of Contemporary Ethnography, 33, 602-637.

19.

Ito

Baumer

Bittanti

boyd

Cody

Herr-Stephenson

. . . Tripp

(2010). Hanging out, messing around, and geeking out: Kids living and learning with new media. Cambridge, MA: MIT Press.

20.

Jones

D. C.

(2001). Social comparison and body image: Attractiveness comparisons to models and peers among adolescent girls and boys. Sex Roles, 45, 645-664.

21.

Jones

D. C.

(2004). Body image among adolescent girls and boys: A longitudinal study. Developmental Psychology, 40, 823-835.

22.

Jones

D. C.

(2011). Interpersonal and familial influences on the development of body image. In Cash

T. F.

Smolak

(Eds.), Body image: A handbook of science, practice, and prevention (pp. 110-118). New York, NY: Guilford Press.

23.

Jones

D. C.

Crawford

J. K.

(2005). Adolescent boys and body image: Weight and muscularity concerns as dual pathways to body dissatisfaction. Journal of Youth and Adolescence, 34, 629-636.

24.

Jones

D. C.

Crawford

J. K.

(2006).The peer appearance culture during adolescence: Gender and body mass variations. Journal of Youth and Adolescence, 2, 257-269.

25.

Jones

D. C.

Vigfusdottir

T. H.

Lee

(2004). Body image and the appearance culture among adolescent girls and boys. Journal of Adolescent Research, 19, 323-339.

26.

Keery

van der Berg

Thompson

J. K.

(2004). An evaluation of the Tripartite Influence Model of body dissatisfaction and eating disturbance with adolescent girls. Body Image, 1, 237-251.

27.

Krueger

R. A.

Casey

M. A.

(2000). Focus groups: A practical guide for applied research (3rd ed.). London, England: Sage.

28.

Lawler

Nixon

(2011). Body dissatisfaction among adolescent boys and girls: The effects of body mass, peer appearance culture, and internalisation of appearance ideals. Journal of Youth and Adolescence, 40, 59-71.

29.

Leit

R. A.

Pope

H. G.

Gray

J. J.

(2001). Cultural expectations of muscularity in men: The evolution of Playgirl centerfolds. International Journal of Eating Disorders, 29, 90-93.

30.

Liamputtong

(2011). Focus group methodology: Principle and practice. London, England: Sage.

31.

Lyu

Gill

(2012). Perceived physical competence and body image as predictors of perceived peer acceptance in adolescents. Asian Journal of Social Psychology, 15, 37-48.

32.

Mäkinen

Puukko-Viertomies

L. R.

Lindberg

Siimes

M. A.

Aalberg

(2012). Body dissatisfaction and body mass in girls and boys transitioning from early to mid-adolescence: Additional role of self-esteem and eating habits. BMC Psychiatry, 12, Article 35.

33.

McCabe

M. P.

Ricciardelli

L. A.

(2005). A prospective study of pressures from parents, peers, and the media on extreme weight change behaviors among adolescent boys and girls. Behavior Research & Therapy, 43, 653-668.

34.

McSharry

(2009). Schooled bodies? Negotiating adolescent validation through press, peers and parents. Stoke-on-Trent, UK: Trentham.

35.

Mooney

Farley

Strugnell

(2009). A qualitative investigation into the opinions of adolescent females regarding their body image concerns and dieting practices in the Republic of Ireland (ROI). Appetite, 52, 485-491.

36.

Murnen

S. K.

(2011). Gender and body issues. In Cash

T. F.

Smolak

(Eds.), Body image: A handbook of science, practice, and prevention (pp. 173-179). New York, NY: Guilford Press.

37.

Neumark-Sztainer

Paxton

S. J.

Hannan

P. J.

Haines

Story

(2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244-251.

38.

Papp

Urbán

Czeglédi

Babusa

Túry

(2013). Testing the tripartite influence model of body image and eating disturbance among Hungarian adolescents. Body Image, 10, 232-242.

39.

Price

(2009). Body image in adolescents: Insights and implications. Pediatric Nursing, 21(5), 38-43.

40.

Ricciardelli

L. A.

McCabe

M. P.

(2003). Sociocultural and individual influences on muscle gain and weight loss strategies among adolescent boys and girls. Psychology in the Schools, 40, 209-224.

41.

Ricciardelli

L. A.

McCabe

M. P.

(2007). The pursuit of muscularity among adolescent boys. In Thompson

J. K.

Cafri

(Eds.), The muscular ideal: Psychological, social and medical perspectives (pp. 199-216). Washington, DC: American Psychological Association.

42.

Smolak

Levine

M. P.

(1994). Critical issues in the developmental psychopathology of eating disorders. In Alexander-Mott

Lumsden

D. B.

(Eds.), Understanding eating disorders: Anorexia nervosa, bulimia nervosa, and obesity (pp. 37-39). London, England: Taylor & Francis.

43.

Smolak

Murnen

S. K.

Thompson

J. K.

(2005). Sociocultural influences and muscle building in adolescent boys. Psychology of Men & Masculinity, 6, 227-239.

44.

Smolak

Stein

J. A.

(2006). The relationship of drive for muscularity to sociocultural factors, self-esteem, physical attributes, gender role, and social comparison in middle school boys. Body Image, 3, 121-129.

45.

Smolak

Thompson

J. K.

(2009). Body image, eating disorders, and obesity in children and adolescents: Introduction to the second edition. In Smolak

Thompson

J. K.

(Eds.), Body image, eating disorders, and obesity in youth: Assessment, prevention, and treatment (pp. 3-14). Washington, DC: American Psychological Association.

46.

Thompson

J. K.

Coovert

M. D.

Stormer

S. M.

(1999). Body image, social comparison, and eating disturbance: A covariance structure modeling investigation. International Journal of Eating Disorders, 26, 43-51.

47.

Tiggemann

(2011). Sociocultural perspectives on human appearance and body image. In Cash

T. F.

Smolak

(Eds.), Body image: A handbook of science, practice, and prevention (pp. 12-19). New York, NY: Guilford Press.

48.

Tiggemann

Gardiner

Slater

(2000). “I would rather be size 10 than have straight A’s”: A focus group study of adolescent girls’ wish to be thinner. Journal of Adolescence, 23, 645-659.

49.

Vaughn

Schumm

J. S.

Sinagub

(1996). Focus group interviews in education and psychology. Thousand Oaks, CA: Sage.

50.

Vincent

M. A.

McCabe

M. P.

(2000). Gender differences among adolescents in family and peer influences on body dissatisfaction, weight loss, and binge eating behaviors. Journal of Youth and Adolescence, 29, 205-221.

51.

Wang

S. S.

Houshyar

Prinstein

M. J.

(2006). Adolescent girls’ and boys’ weight-related health behaviors and cognitions: Associations with reputation- and preference-based peer status. Health Psychology, 25, 658-663.

52.

Wertheim

E. H.

Paxton

S. J.

(2011). Body image development in adolescent girls. In Cash

T. F.

Smolak

(Eds.), Body image: A handbook of science, practice, and prevention (pp. 76-85). London, England: Guilford Press.

53.

Westerberg-Jacobson

Edlund

Ghaderi

(2010). A 5-year longitudinal study of the relationship between the wish to be thinner, lifestyle behaviours and disturbed eating in 9-20-year old girls. European Eating Disorders Review, 18, 207-219.