Identifying Antecedents of Risky Appearance Management Behaviors

Abstract

Acts of appearance management include a range of activities to control the presentation of the body that one makes to self and to others. Appearance management behaviors (AMBs) can be divided into two categories: risky and non-risky. Risky AMBs can all be linked to some threat to health if engaged in for extended periods of time. We investigated body-related variables predicting engagement in three specific categories (i.e., cosmetic procedures, extreme dieting, use of diet aids) of risky AMBs with female undergraduates from the U.S. (n = 349) and from South Korea (n = 338). The predictor variables were objectified body consciousness (OBC) and body image investment (BII). Mediating variables investigated were body comparison (BC) and body satisfaction (BS). Across all risky AMBs investigated and with participants from both countries, as BC increased, BS decreased. Similarly, OBC and BII significantly predicted BC for both groups of women. For Korean women, OBC predicted engagement in cosmetic procedure and extreme dieting through BC. For U.S. women, OBC and BII predicted extreme dieting and use of diet pills through BS. Further, there was a difference between the two countries in terms of the specific risky AMBs engaged in. Korean participants engaged in cosmetic procedures followed by extreme dieting. U.S. participants engaged in the use of diet aids followed by extreme dieting.

Keywords

risky behaviors body comparison body satisfaction objectified body consciousness body image investment

Individuals in every nation engage in appearance management on a daily basis. Appearance management entails “all attention, decisions, and acts related to personal appearance” (Kaiser, 1996, p. 5). Appearance management behaviors (AMBs) include apparel and accessories selection, cosmetics and grooming procedures, modification of body form and size through dress (Rudd, 1997), and any other physical activities (e.g., exercise) one might undertake relative to his or her appearance (Lee & Johnson, 2009). Thus, acts of appearance management include a range of activities to control the presentation of the body that one makes to self and to others. Although there are multiple motivations for AMBs, many behaviors are shaped by expectations to achieve an aesthetic ideal¹ for appearance. Such expectations may be precursors to unhealthy behaviors (Lennon, Rudd, Sloan, & Kim, 1999).

Daily appearance management activities can be divided into two broad categories: risky and nonrisky. Rudd and Lennon (2000) noted the distinction between risky and nonrisky AMBs is a judgment call, but that risky AMBs can all be linked to some threat to health if engaged in for extended periods of time. Using this distinction, examples of risky AMBs include purging, tanning, smoking (to curb one’s appetite), and excessive exercise. Understanding factors that motivate or contribute to engaging in risky AMBs is important because many of these behaviors not only pose a threat to health (e.g., skin cancer) but can also ultimately result in death² particularly in instances where they evolve into eating disorders (Arcelus, Mitchell, Wales, & Nielsen, 2011).

Therefore, in this article, we present research that contributes to our overall research goal of the development of a comprehensive theory-based model of antecedents to engagement in risky AMBs. By identifying antecedents of these risky behaviors, appropriate strategies can be developed to deter risky AMBs in young adults and adolescents.

Our proposed model began with body-related variables as antecedents because the body is a key component of maintaining a nationally acceptable appearance. Our framework emerged from several different conceptualizations of how behavior toward the body can be influenced by beliefs, attitudes, and processes. We proposed that objectified body consciousness (OBC; beliefs) and body image investment (BII; beliefs) predicted engagement in risky AMBs (behaviors). We also proposed that body comparison (BC; process) and body satisfaction (BS; attitudes) mediated relationships between OBC, BII, and women’s engagement in risky AMBs.

In addition, important to model development is testing the proposed relationships across two countries. We tested our proposed relationships with individuals of the majority ethnic group within two different countries: the United States and South Korea (hereafter Korea). These countries were selected because physical ideals of feminine beauty in Korea have shifted toward big eyes, high noses, smaller faces, and thin bodies (Lee, Rudd, & Kim, 2001; Rudd, 1999). As these ideals are adopted, Korean women may experience social pressure to work toward achieving these ideals and be willing to engage in risky AMBs to do so (Lee & Johnson, 2009; Rudd & Lennon, 2000).

We also selected these two countries because there is evidence that young women living in both the United States and in Korea engage in risky AMBs. Within the United States, young adults and adolescents routinely practice body tanning (Yoo & Kim, 2012), and researchers have documented that both adolescent girls and young women skip meals, fast, smoke cigarettes, vomit, and take laxatives as a means to manage their weight (Neumark-Sztainer, 2005; Rudd & Lennon, 2000). Dieting is also prevalent with young Korean women (Nam & Lee, 2001). According to the Organization for Economic Development and Cooperation (Oh, 2004), Korea is the most diet conscious of the 13 Asian countries. As compared to women in the United States, body dissatisfaction among Korean women is more severe (Jung & Forbes, 2006; Nam & Lee, 2001).

Similarly, in the United States, the number of individuals undergoing some form of cosmetic surgery is increasing. In 2012, the American Academy of Facial and Reconstructive Surgery stated that on average their members reported conducting 945 procedures per surgeon. Two thirds of these procedures were nonsurgical (e.g., Botox), and 80% were done on women. Increases were reported on cosmetic procedures for women under 25 years old (American Academy of Facial Plastic and Reconstructive Surgery, 2013). Likewise, in Korea, young women commonly undergo plastic surgery to improve their appearance (Seo, 2012). Double eyelid and rhinoplasty surgeries are widespread (Jung & Lee, 2006).

Literature Review and Hypotheses Development

OBC

Objectification theory (Fredrickson & Roberts, 1997) posits that women as part of their lived experience encounter sexual objectification. The general outcome of sexual objectification is “the experience of being treated as a body (or a collection of body parts) valued predominantly for its use to (or consumption by) others” (p. 174). In other words, women are treated as bodies, separated out from their persons, which exist for the use and pleasure of others. Although all women may not respond to sexual objectification in a similar manner, objectifying treatment has generally been identified as harmful to women.

One of the outcomes of objectifying treatment is that it “functions to socialize girls and women to, at some level, treat themselves as objects to be looked at and evaluated” (Fredrickson & Roberts, 1997, p. 177), or, in other words, to self-objectify. Because of sexual objectification, women learn to view their bodies as if they were outside observers (McKinley & Hyde, 1996). They “internalize cultural body standards so that the standards appear to originate from the self and believe that achieving these standards is possible even in the face of considerable evidence to the contrary” (p. 183). McKinley (1995) used the term OBC to describe both the supporting beliefs and the experience of the body as an object. OBC has been used to explain gender differences in body esteem (McKinley, 1998), to understand psychological well-being between mothers and daughters (McKinley, 1999), and to document behavioral differences in eating disorder recovery (Fitzsimmons-Craft, Bardone-Cone, & Kelly, 2011). OBC consists of three components: body surveillance, internalization of cultural body standards, and beliefs about appearance control.

Women who experience high levels of OBC engage in high levels of body surveillance to ensure that they “comply with cultural standards and avoid negative judgments” (McKinley & Hyde, 1996, p. 183). Ongoing body surveillance has negative consequences as young women and adolescents frequently experience negative emotions when they compare their bodies to ideals (e.g., models) or even peers and fall short (Bessenoff, 2006). To counter these negative emotions, these women may adopt risky AMBs to assist them in meeting their appearance goals and avoid negative judgments from others.

High levels of OBC are linked to internalization of cultural body standards. Cultural body standards provide one physical ideal to which a woman may compare her body (i.e., engage in BC) when she watches herself. As these standards are difficult if not impossible to achieve for most women, failure to achieve the standards can be a source of shame as well as reduce BS. Women’s attempts to achieve body standards and alleviate feelings of shame resulting from BC as well as to increase BS could include adoption of risky AMBs.

Finally, people who experience high OBC believe they are responsible for how their bodies appear as well as believe that if they try hard enough, they can achieve an appearance that meets with standards. Holding the belief that you are responsible for your appearance and can control it may also encourage adoption of risky AMBs when other AMBs fail to produce desired results. Thus, we hypothesized that OBC predicted engagement in risky AMBs (Hypothesis 1), BC (Hypothesis 2), and BS (Hypothesis 3).

BII

Body image is a multidimensional construct that includes subjective perceptual and attitudinal experiences about one’s physical appearance (Cash & Pruzinsky, 2002). These attitudinal experiences (body image attitudes) include an evaluative component and an investment component (Cash, 1994). The evaluative component includes body image satisfaction/dissatisfaction and felt discrepancies between self and ideal self.

BII has two components. The first component consists of individuals’ beliefs about the amount that their appearance influences their personal or social worth. The second component captures the extent to which an individual values and attends to appearance and is motivated to engage in grooming behaviors.³ Thus, individuals with high levels of BII agree that their appearance influences their personal/social worth, pay attention to their appearance, and are motivated to manage their appearance (Muth & Cash, 1997). BII could predict engagement in risky AMBs simply because these behaviors may be viewed as a means to an end. Nonrisky behaviors may not be working and a person may simply decide to try risky behaviors. BII may also be related to both BC and BS. Individuals who are motivated to manage their appearance may compare their bodies to others as a means to evaluate their management efforts. In addition, their management efforts may result in being more or less satisfied with their bodies. Thus, we hypothesized that BII predicted engagement in risky AMBs (Hypothesis 4), BC (Hypothesis 5), and BS (Hypothesis 6).

BC and BS

BC is the process of evaluating one’s body against another’s (Van den Berg et al., 2007). Festinger’s (1954) theory of social comparison provides one reason why individuals may participate in BC. Social comparison theory posits that, in the absence of objective information, people make comparisons to others to assess their own abilities or attributes. Researchers have found that women, in particular, frequently make appearance-related social comparisons (Leahey, Crowther, & Mickelson, 2007). Even though Festinger noted that outcomes associated with comparison can be either positive or negative, outcomes of engaging in social comparison relative to beauty for women tend to be negative because women often make upward social comparisons (i.e., compare to others who are more beautiful than they are, compare to cultural ideals), consequently feel bad about their own appearances (Dijkstra & Barelds, 2011; Engel-Maddox, 2005), and experience reduced satisfaction with their bodies (Cattarin, Thompson, Thomas, & Williams, 2000). Body dissatisfaction has been identified as a potential trigger of dieting attempts (Stormer & Thompson, 1996) and linked to the development of eating disorders (Siever, 1994) and related behaviors. Thus, we reasoned that BC may result in low BS and dissatisfaction may trigger risky AMBs (e.g., skipping meals, purging) either as a coping strategy or a means to resolve unfavorable comparisons. We hypothesized that BC was related to BS (Hypothesis 7), that BC was related to engagement in risky AMBs (Hypothesis 8), and that it mediated relationships between OBC (Hypothesis 9), BII (Hypothesis 10), and engagement in risky AMBs. We also hypothesized that BS was related to engagement in risky AMBs (Hypothesis 11) and that it mediated relationships between OBC (Hypothesis 12), BII (Hypothesis 13), and engagement in risky AMBs (see Figure 1 for diagram of all proposed relationships).

Figure 1.

Diagram of hypothesized relationships.

Research Related to Risky AMBs

Researchers have documented that young women do engage in risky AMBs. Lennon and Rudd (1994) investigated the influence of attitudes toward gender role, self-esteem, BS, and AMBs. They tested both routine behaviors and ones they labeled painful (e.g., liposuction, breast augmentation) and body sculpting (e.g., dieting, fasting) with young women (average age 21). Participants with low self-esteem were more likely to consider use of painful AMBs (i.e., risky behaviors) than women with high self-esteem.

In subsequent research focused specifically on risky AMBs, researchers have documented that young women often practice risky behaviors in response to concerns about their body weight. For example, Rudd and Lennon (2000) had 95 women write essays about their AMBs. Over half of the women in their research reported that they had engaged in risky AMBs (e.g., purging, smoking to curb their appetite, use of laxatives) at some point in their life primarily to manage their weight. Subsequently, Lee and Johnson (2009) identified two variables that predicted engagement in risky AMBs with young women. Women who self-objectified reported they had engaged in at least one risky AMB as well as women who experienced conversations about improving or managing appearance with family members.

Method

Procedure

Upon receipt of institutional review board approval (#1111E06662) for use of human subjects, purposive samples were drawn from women enrolled at two large public universities within the United States and eight public and private universities within Korea. Instructors were asked to recruit undergraduate women to participate in a research project concerning their AMBs. Instructors at one institution within the United States offered extra credit for participation. All other participants were offered no incentives. Participants who agreed to volunteer were either directed to read a consent form and complete a questionnaire online or provided with a printed consent form and a questionnaire.

The questionnaire was translated into Korean by two of the three bilingual and bicultural researchers conducting the research. The third bilingual and bicultural researcher confirmed accuracy in translating the questionnaire and made a few minor revisions. To ensure the consistency of the meaning of each item in both questionnaires, the translated questionnaire was translated back into English and compared with the original English questionnaire by another bilingual and bicultural Korean residing within the United States. The sample consisted of responses from 349 U.S. participants and 338 Korean participants.

Measurements

The first section of the questionnaire asked participants to report on their risky AMBs. To assess engagement in risky AMBs, we adapted Lee and Johnson’s (2009) 8-item measure⁴ by adding another 10 risky AMBs. Additional behaviors included regularly skipping meals, using steroids, and getting injections to lose fat among other items.⁵ These items were embedded into a list of 61 nonrisky AMBs to increase the likelihood that participants would report on their risky AMBs. Engagement in each behavior was assessed using 5-point scales ranging from never (1) to always (5). Participants were asked to indicate how frequently they engaged in each behavior specifically to manage their appearance. Lee and Johnson did not report reliability.

The second section of the questionnaire contained established measures of OBC (McKinley & Hyde, 1996), BII (Cash, Melnyk, & Hrabosky, 2004), BC (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999), and BS (Cash, 2000).

OBC

The 24-item measure of OBC assesses the degree of an individual’s surveillance (viewing the body as an outside observer), body shame, and appearance control beliefs. A sample item is “I think a person is pretty much stuck with the looks they are born with.” The reported reliabilities were α = .72 for surveillance, α = .85 for body shame, and α = .89 for appearance control beliefs. High scores indicate high levels of surveillance, body shame, and belief that one’s appearance can be controlled.

BII

The 20-item measure of BII assesses beliefs that people may or may not have about their physical appearance and its influence on life. The scale has a reported reliability of α = .88 for women and .90 for men. A sample item is “I often check my appearance in a mirror to make certain that I look ok.” High scores indicate individuals believe that their appearance influences their personal/social worth and are motivated to manage their appearance.

BC

The 4-item BC measure assesses the degree to which individuals compare their body figure, weight, the attractiveness of their face, and their general appearance with those of other women. It had a reported reliability of α = .87. A sample item is “I compare my body figure with that of other women.” High scores indicate engagement in high levels of BC.

BS

Cash’s (2000) 8-item body areas satisfaction scale, a subscale of the Multidimensional Body–Self Relations Questionnaire, was used to assess BS. This scale measures satisfaction with face, hair, lower/mid/upper torso, muscle tone, weight, and height. Reported reliability of this measure is α = .74 for females. Low scores indicate high body dissatisfaction. In the final part of the questionnaire, items were designed to collect demographic information. Participants were asked to indicate their age, major, school year, ethnicity, and marital status.

Data Analysis

Path analysis is appropriate when hypothesized relationships have strong theoretical and empirical support (Pajares & Miller, 1994). Since we found empirical support for our hypothesized relationships, a maximum likelihood path analysis using Amos 7.0 was used to assess hypothesized relationships. The path model tested was as follows: OBC and BII influence engagement in risky AMBs; BC has an influence on BS; BC and BS mediate the influence of OBC and BII on engagement in risky AMBs. Internal reliability of the multiple items scales was assessed using Cronbach’s α (Krathwohl, 1998). Descriptive statistics were used to analyze demographic variables.

Results

Participant Characteristics

U.S. participants

Participants were between the ages of 18 and 32 (M = 20.4). They were primarily apparel design or retail merchandising majors (77.4%). Other majors included interior design, marketing, and communication. Most were Caucasian (77%) and never married (88.7%).

Korean participants

Participants’ ages ranged from 18 to 29 (M = 20.9). They also represented primarily apparel design or retail merchandising majors (66.7%). They were all Korean and never married.

Data combination

To be able to combine data across universities within countries, we tested for differences in responses on all measures. The t-tests between participants representing different universities within the same country indicated that there were no significant differences on any variables. Thus, we combined responses from all participants drawn from universities within the United States and responses from all universities drawn within Korea to form two groups.

Preliminary Analyses

Factor analysis

Principal component factor analysis with varimax rotation was performed to identify underlying dimensions of risky AMBs. For both groups, three factors were generated: cosmetic procedures, extreme dieting, and use of diet aids. Cosmetic procedures included items such as getting lip injections or laser eye surgery. Extreme dieting included behaviors such as binge eating. Use of diet aids included consuming diuretics or laxatives.

For the U.S. data, 1 item from use of dieting aids was eliminated (“I use diet pills.”) because it loaded similarly on more than one factor. For the Korean data, 3 items were removed due to low overall loadings (< .05) and due to loading similarly on more than one factor (see Table 1 for items in final measures). The cumulative variance explained by the three factors was 57.71% for the U.S. data and 45.44% for the Korean data. Previously hypothesized relationships were tested for each group of risky behaviors.

Table 1.

Exploratory Factor Analysis of Risky Appearance Management Scale Items U.S. Data.

Risky AMB Items	Factor 1: Cosmetic Procedures	Factor 2: Extreme Dieting	Factor 3: Use of Diet Aids	Eigen Value	% of Variance
U.S. data
I get botox injections	.89			5.72	28.95
I get liposuction	.81
I have lip injections	.82
I take steroids	.75
I get injections to lose fat	.70
I get plastic surgery	.70
I had laser eye surgery	.67
I get laser treatment on my face	.61
I do not eat to fit into certain clothes		.68		2.43	17.09
I crash diet to lose weight quickly		.66
I binge eat		.66
I purge		.64
I skip meals (e.g., breakfast, lunch, dinner)		.64
I detoxify my body by cleansing			.73	1.08	11.66
I use diuretics			.68
I use laxatives			.54
Korean data
I get botox injections	.68			1.97	14.07
I have lip injections	.62
I had laser eye surgery	.61
I get injections to lose fat	.55
I get laser treatment on my face	.54
I take steroids	.52
I get plastic surgery	.50
I do not eat to fit into certain clothes		.77		1.84	13.14
I crash diet to lose weight quickly		.76
I binge eat		.50
I use laxatives			.83	2.55	18.24
I use diuretics			.80
I get liposuction			.76
I detoxify my body by cleansing			.54

Note. AMB = Appearance management behavior.

For the OBC, BII, BC, and BS scales, a confirmatory factor analysis was conducted to assess their convergent validity. The results revealed several items with low loadings that were consequently removed. For OBC, items removed were “I never worry that something is wrong with me when I am not exercising as much as I should” and “Even when I can’t control my weight, I think I’m an okay person.” For BII, items removed were “I often check my appearance in a mirror just to make sure I look okay,” “If somebody had a negative reaction to what I look like, it wouldn’t bother me,” “My physical appearance has had little influence on my life,” and “What I look like is an important part of who I am” for BII. Items removed for BC were “face” and “height.”

Reliabilities

For the U.S. data, reliability for the risky AMB was α = .892 for cosmetic procedures, α = .728 for extreme dieting, and α = .652 for use of diet aids. Reliabilities were α = .930 for the BC measure, α = .812 for the BS scale, α = .937 for the BII scale, and α = .745 for the OBC scale. For the Korean data, reliability for the risky AMBs was α = .627 for cosmetic procedures, α = .633 for extreme dieting, and α = .783 for use of diet aids. The reliabilities were α = .885 for the BC scale, α = .718 for the BS scale, α = .874 for the BII scale, and α = .631 for the OBC scale. Since a Cronbach’s α of .6 or better is desired for any measurement scale (Robinson, Shaver, & Wrightsman, 1991), all scales were deemed acceptable.

Descriptive statistics

For the U.S. data, the overall mean for OBC was 3.23 (standard deviation [SD] = 0.45), 3.53 (SD = 0.53) for BII, 3.73 (SD = 1.03) for BC, and 2.95 (SD = 0.88) for BS. For the three dimensions of risky AMBs, the overall mean for cosmetic procedures was 1.07 (SD = 0.31), 1.80 for extreme dieting (SD = 0.83), and 1.29 for use of diet aids (SD = 0.88).

For the Korean data, the overall mean for OBC was 3.31 (SD = 0.40), 3.73 (SD = 0.63) for BII, 3.61(SD = 0.99) for BC, and 2.69 (SD = 0.73) for BS. For the risky AMB dimensions, the overall mean for cosmetic procedures was 1.35 (SD = 0.47), 2.04 for extreme dieting (SD = 0.76), and 1.20 use of diet aids (SD = 0.59). In sum, engagement in risky AMBs was relatively low overall with Korean participants reporting slightly higher frequency of engaging in cosmetic procedures, extreme dieting, and lower use of diet aids than U.S. participants.

Main Data Analyses: U.S. Data

Cosmetic procedures

Path analysis of the initial hypothesized model revealed that the model had a good fit with the data (χ²/df = 1.696, comparative fit index [CFI] = .996, nonnormed fit index [NNFI] = .980, incremental fit index [IFI] = .996, root mean square error of approximation [RMSEA] = .045). The analyses to examine the effect of OBC and BII on engagement in cosmetic procedures revealed that neither OBC nor BII had a direct influence. On the other hand, OBC and BII both positively influenced BC (B = .822, t = 7.142, p < .001; B = .663, t = 6.779, p < .001). Participants who were invested in their body image and had an OBC compared their body to others’ bodies. Thus, Hypotheses 2 and 5 were supported.

OBC had a significant negative influence on BS (B = −.564, t = −4.781, p < .001). Participants who scored high in OBC were dissatisfied with their bodies. Thus, Hypothesis 3 was supported. However, BII did not have a significant influence on BS. BC (B = −.228, t = −4.441, p < .001) had a negative influence on BS, supporting Hypothesis 7. Participants who scored high in BC were low in BS. However, neither BC nor BS significantly influenced engagement in cosmetic procedures.

Extreme dieting

All fit indices showed that the model had a good fit (χ²/df = 2.395, CFI = .997, NNFI = .967, IFI = .997, RMSEA = .063). Neither OBC nor BII exhibited direct influences on extreme dieting. Like the first analysis, OBC and BII both positively influenced BC (B = .822, t = 7.142, p < .001; B = .663, t = 6.779, p < .001). OBC had a significant negative influence on BS (B = −.564, t = −4.781, p < .001). BC (B = −.228, t = −4.442, p < .001) had a negative influence on BS, again supporting Hypothesis 7. Finally, there was a significant negative effect of BS on extreme dieting (B = −.164, t = −3.648, p < .001), supporting Hypothesis 11. Participants who were not satisfied with their body engaged in extreme dieting. BS mediated the relationship between OBC and engaging in extreme dieting supporting Hypothesis 12.

Use of diet aids

All fit indices revealed that the model had a good fit (χ²/df = 1.763, CFI = .996, NNFI = .980, IFI = .996, RMSEA = .047). Similar to the effects found in the analyses of the first two types of risky behaviors, there were significant relationships for both OBC and BII to BC (B = .822, t = 7.142, p < .001; B = .663, t = 6.779, p < .001). BII also exerted an influence on BS (B = −.564, t = −4.781, p < .001). Finally, there was a negative influence of BC on BS (B = −.228, t = −4.441, p < .001). Further, BS negatively influenced use of diet aids (B = −.116, t = −3.197, p < .001). As participants’ BS decreased, use of diet aids (e.g., laxatives) increased. BS mediated relationships between OBC and use of diet aids supporting Hypothesis 12.

Main Data Analyses: Korean Data

Cosmetic procedures

All fit indices revealed that the model had a good fit (χ²/df = 2.110, CFI = .992, NNFI = .961, IFI = .992, RMSEA = .057). The analyses to examine the effect of OBC and BII on engagement in a plastic surgery revealed that OBC and BII did not have a direct influence on engagement in cosmetic procedures. However, OBC and BII both positively influenced BC (B = .629, t = 4.419, p < .001; B = .560, t = 6.280, p < .001). Participants who were concerned with their appearance and had an OBC compared their body to other’s bodies. Thus, Hypotheses 2 and 5 were supported.

OBC had a significant negative influence on BS (B = −.398, t = −3.205, p < .001). Participants who scored high in OBC were dissatisfied with their bodies. Thus, Hypothesis 3 was supported. However, BII did not have a significant influence on BS. BC (B = −.095, t = −2.060, p < .05) had a negative influence on BS, supporting Hypothesis 7. Participants who scored high in BC were low in BS. Subsequently, both BC and BS influenced engaging in cosmetic procedures (B = .061, t = 2.367, p < .05; B = −.096, t = −2.703, p < .01). Participants who compared their body with others’ bodies and were not satisfied with their bodies indicated they engaged in cosmetic procedures supporting Hypotheses 8 and 11. BC and BS fully mediated relationships between OBC and BII and risky AMBs, supporting Hypotheses 9, 10, and 12.

Extreme dieting

All fit indices showed that the model had a good fit (χ²/df = 2.495, CFI = .990, NNFI = .952, IFI = .991, RMSEA = .067). Like the first analysis, OBC and BII did not have a direct influence on engagement in risky AMBs. OBC and BII both positively influenced BC (B = .629, t = 4.419, p < .001; B = .560, t = 6.280, p < .001). Also, OBC had a significant negative influence on BS (B = −.398, t = −3.205, p < .001). BC also had a negative effect on BS (B = −.095, t = −2.060, p < .05). Finally, BC had a positive influence on engagement in extreme dieting (B = 229, t = 5.657, p < .001), supporting Hypothesis 8. Participants who tended to compare their bodies with other bodies engaged in extreme dieting behaviors. There was no significant relationship between BS and extreme dieting. BC fully mediated relationships between OBC and BII and engaging in extreme dieting supporting Hypotheses 9 and 10.

Use of diet aids

All fit indices revealed that the model had a good fit (χ²/df = 1.443, CFI = .995 NNFI = .984, IFI = .995, RMSEA = .036). Similar to the effect of variables on engagement in the first two types of risky AMB (surgery, diet), there were significant influence of OBC and BII on BC (B = .629 t = 4.419, p < .001; B = .560, t = 6.280, p < .001) and the effect of OBC on BS (B = −.458, t = −3.769, p < .001). Also, there was a negative influence of BC on BS (B = −.095, t = −2.060, p < .001). However, neither BC nor BS had an effect on use of diet aids.

Comparisons Between U.S. and Korean Data

According to the results of our hypotheses testing, there were differences in path coefficients between U.S. and Korean data. To evaluate whether these differences in parameter estimates were statistically significant, a chi-square difference test between pairs of groups was conducted. In the restricted model, a particular path was fixed to be equal across groups. The baseline model was estimated by allowing all model parameters to be free estimates. The difference in the chi-square value was compared between the baseline and the restricted model.

For the first factor of risky AMBs, cosmetic procedures, there were no statistically significant differences between the two groups in the paths between OBC, BII, BC, and BS. Thus, there were no significant differences in the effect of OBC and BII on BC and BS between U.S. and Korean participants. However, there was a statistically significant difference in the effect of BC on engaging in cosmetic procedures, χ²(1) = 4.258, p < .05, as well as of BS, χ²(1) = 5.752, p < .05. As compared to U.S. participants, BC and BS predicted engagement in cosmetic procedures for Korean participants. And OBC and BII were fully mediated by BS and/or BS. For Korean participants, as level of OBC increased, so did both BC and BS. As BC and BS increased, so did reports of engaging in cosmetic procedures. OBC was related directly to BS and indirectly through BC. In addition, as BII increased, so did BC. As BC increased, so too did reporting engaging in cosmetic procedures.

There were no statistically significant differences between the two groups in all relationships of variables regarding the second factor of AMB, extreme dieting. On the other hand, use of diet aids revealed a significant difference between the two groups, χ²(1) = 4.386, p < .05, on the relationship between BS and use of diet aids. As compared to Korean participants, BS level was more important to using diet aids for U.S. participants (see Figure 2 for diagram of differences).

Figure 2.

Diagrams of significant relationships.

Discussion

Consistently across all risky AMBs investigated and with participants from both countries, as BC increased, BS decreased. This finding is consistent with that of previous researchers (Cattarin et al., 2000; Dijkstra & Barelds, 2011; Engel-Maddox, 2005) and supports the premise of social comparison theory (Festinger, 1954) that indicates one outcome of BC is body dissatisfaction. In addition, significant relationships between OBC and BII and engagement in risky AMBs were often fully mediated by either BC or BS. Thus, both BC and BS are important triggers to these young women’s engagement in risky AMBs. These findings imply that efforts to reduce young women’s risky AMBs should focus on both BC and BS, as these variables facilitated the impact of OBC and BII. These efforts might include attempts to reduce the frequency of BC as well as attempts to identify appropriate comparison targets with the end goal of reducing negative outcomes (e.g., If you do not compare, you will not experience a negative outcome, or if you compare to appropriate targets, you will reduce the likelihood of experiencing negative outcomes). For example, in courses where the concept of body image is addressed, instructors can highlight that even though we have a tendency to compare our body to others’, this practice is a bad one. Comparing your body to others’ may result in motivation but more often than not it results in a reduction to self-esteem, especially if you do not realize that there are always going to be people with relatively “better” bodies and others with relatively “worse” bodies. Strategies that teach young women not to be afraid to be themselves and to set attainable goals for self-improvement could also be part of the discussion.

Similarly, increasing BS is important to reducing engagement in risky AMBs. Strategies aimed at young women could include the objective of developing a broad range of aspects of the body that one might be satisfied with such as one’s health as well as one’s performance across a range of human abilities. It is also important to assist young women in understanding the limits that exist to controlling one’s body attributes as well as limits to what one individual can physically achieve.

The relationships between OBC and BII and BC were also consistent across these two groups and support McKinley and Hyde’s (1996) conceptualization of how OBC exerts its influence on women as well as are consistent with research findings of Lee and Johnson (2009). McKinley and Hyde suggest that women with an OBC have internalized cultural standards and closely monitor their bodies to assess how well they are meeting these standards. Our data support the idea that having an OBC alone may not result in risky behaviors. Rather, it is OBC in combination with the practice of making comparisons to others’ bodies that may lead to engaging in some risky AMBs. Perhaps it is the body surveillance part of OBC that motivates BC as a means to assess whether or not one is meeting expectations. In addition, because increases in BC were related to decreases in BS and because BS mediated the relationship between OBC and engaging in some of the risky AMBs investigated, for some women engaging in some risky AMBs may be an outcome of internalizing body standards, viewing your body as an object you can control, watching your body to assess how well you meet those standards, comparing your body to some external standard, and experiencing body dissatisfaction.

The data suggest that for the Korean participants, BC may be more important to understanding how OBC and BII impact engagement in risky AMBs (e.g., cosmetic procedures, extreme dieting) than BS. One possible explanation for the importance of BC is that whether or not Korean women are satisfied with their bodies, they engage in some of these risky AMBs. If that interpretation is true, their engagement in extreme dieting or cosmetic procedures could reflect a desire to conform to the behaviors of significant others or participation in an accepted way of behaving rather than as a means to increase individual BS. Support for this reasoning comes from research findings wherein researchers have reported some of these risky behaviors are common behaviors within Korea (Nam & Lee, 2001; Seo, 2012). It is also possible that other personal traits (e.g., personality traits) mediate relationships between BS and these risky behaviors for Korean participants. Future researchers may want to further investigate these and other potential explanations for the influence of BS.

For U.S. participants, it appeared that BC along with BS was important to understanding some risky AMBs. In both of the instances where there were significant relationships to risky AMBs (i.e., extreme dieting, use of diet aids), OBC and BII exerted their influence through BC to BS and then to subsequent risky behaviors. If this is how OBC and BII exert their influence, then these risky AMBs are in response to body dissatisfaction and reinforce the need to address dissatisfaction in efforts to reduce risky AMBs.

It is also noted that there is a difference between the two countries in terms of the specific risky AMBs impacted by these variables. Namely, Korean women reported engaging in cosmetic procedures followed by extreme dieting as compared to U.S. women who reported engaging in the use of diet aids followed by extreme dieting. This difference may be due to differences in what comprises beauty. For example, researchers have suggested that beauty for Korean women is constructed from facial attributes rather than the body, while the reverse appears to be true for U.S. women (Frith, Shaw, & Cheng, 2005; Jung & Lee, 2009). Another reason why U.S. women may have reported higher incidents of using diet aids might be the U.S. women’s relatively heavier weights than Korean women’s weights overall. Comparison of a reliable indicator of body fatness, or body mass index (BMI)⁶ of the women from the two countries indicates the average of 19- to 29-year-old Korean women’s BMI according to a national health and nutrition study was 21.2 (The Korean Ministry of Health and Welfare & Korean Centers for Disease Control and Prevention, 2013),⁷ whereas the average BMI of 20- to 39-year-old U.S. women was 26.9 for non-Hispanic White alone and 31.9 for non-Hispanic White, non-Hispanic Black, Hispanic, and Mexican American combined (Flegal, Carroll, Kit, & Ogden, 2012).

The fact that the proposed model of relationships was tested with participants from two different countries and the findings that some of the relationships were consistent within both points to the value of testing theoretical relationships in a range of national contexts to develop models that have application across nations. Even though there were differences in how OBC and BII exerted their influence, and there were differences in what specific behaviors were impacted by these variables, there were important similarities indicating both concepts can have applicability when trying to understand risky AMBs within both groups.

Suggestions for Future Research and Limitations

Future researchers could continue to identify and test body-related variables for their influence on women’s engagement in risky AMBs. Examples of additional body-related variables that could be examined include body image satisfaction, self-consciousness about appearance, body appreciation, and self-compassion. Additional psychological (e.g., personality, self-esteem, need to conform, anxiety, security) and sociocultural variables (e.g., influence of family, influence of peers, socioeconomic position, religious beliefs, media influence) can be tested to build a broad model that reflects the range of antecedents to risky AMBs. Research concerning engagement in risky AMBs could be replicated with men as well as adolescent girls and boys. Research efforts could continue to be conducted cross-nationally to contribute to the development of nonculture-bound models and theories. Other aspects of appearance management (e.g., attitudes) in addition to behaviors or in combination with behaviors could be investigated to further understanding of this important concept.

As with any research, there are limitations with this study. First, due to the nature of the samples drawn, our results cannot be generalized beyond the participants in the research. Second, our U.S. sample was comprised of mostly Caucasians. Although Caucasian is the majority ethnic group in the United States, other groups such as African Americans or Hispanics may have different beliefs, attitudes, and processes on body and appearance, which may lead to different behavioral outcomes than those tested in this research. The inclusion of diverse ethnic groups within a country as a sample is suggested for future study. Third, the majority of the samples in both countries were students in fashion-related majors. The group of students may be more tuned into body and appearance issues than students studying other subjects, which may have skewed our results. Fourth, reliability analyses revealed that some of the measures utilized had relatively low reliabilities. This suggests that results related to these variables must be viewed as preliminary and in need of further substantiation.

Footnotes

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

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