Positive body image and young women’s health: Implications for sun protection,cancer screening,weight loss and alcohol consumption behaviours

Abstract

This study examined the link between positive body image and a range of health behaviours. Participants were 256 women who completed an online questionnaire measuring body appreciation, body dissatisfaction, sun protection, cancer screening, seeking medical attention, weight-loss behaviour and alcohol and tobacco consumption. Results indicated that body appreciation was positively related to sun protection, skin screening and seeking medical attention and negatively related to weight-loss behaviour. Body appreciation explained unique variance, over and above body dissatisfaction, in sun protection, skin screening and weight-loss behaviour. These results have implications for interventions to improve adherence to health behaviours.

Keywords

body appreciation cancer health behaviour sun protection women’s health

Body image has been conceptualised as a complex and multidimensional construct that has the ability to influence quality of life, as well as affective, cognitive and behavioural functioning (Pruzinsky and Cash, 2002). Despite the broad understanding of body image as a multifaceted concept, theory and research in the body image field have previously been pathology focused (Williams et al., 2004), and has concentrated on negative aspects of body image (Tylka, 2011). In particular, body dissatisfaction had been the major focus (Grogan, 1999). This focus has meant that the multifaceted nature of body image has not been acknowledged (Pruzinsky and Cash, 2002). More specifically, there has been little research on the positive aspects of body image (Frisén and Holmqvist, 2010).

Broadly defined, positive body image refers to the love, respect, acceptance and appreciation held for one’s body (Tylka, 2011). Having positive body image allows individuals to accept all aspects of their body, even those which are contrary to media-portrayed ideals, and to appreciate the functions their body performs for them. Such individuals feel confident and happy with their body, and treat their body with care and attention (Tylka, 2011). Importantly, this construct is argued to be more than just the presence of low negative body image (Tylka, 2011), or the mere absence of body dissatisfaction (Wood-Barcalow et al., 2010). The small amount of literature examining the general construct of positive body image suggests that positive body image is associated with variables beyond body satisfaction such as optimism and self-esteem (e.g. Williams et al., 2004).

Until recently, research examining positive body image has been hampered by the absence of any reliable and valid measurement tool. Recognition of the need to operationalise positive body image beyond a lack of body dissatisfaction led to the construction of the Body Appreciation Scale (BAS) by Avalos et al. (2005). This scale has now been used in a small but growing number of empirical studies. Body appreciation has been shown to be related positively to self-esteem (e.g. Lobera and Ríos, 2011) and self-compassion (Wasylkiw et al., 2012), which refers to an attitude of kindness and caring towards oneself (Neff, 2003). A positive relationship has also been found with perceived social support and acceptance within personal relationships (Augustus-Horvath and Tylka, 2011). Negative associations have been reported between body appreciation and self-objectification (Augustus-Horvath and Tylka, 2011), which is the internalisation of an observer’s perspective of the body (Fredrickson and Roberts, 1997), as well as with having a non-anxious relationship with one’s God (Homan and Cavanaugh, 2013).

In her review of positive body image theorising and research, Tylka (2011) suggested that future research should examine more tangible real-world outcomes, and, in particular, how positive body image relates to attentiveness to the body and detection of disease. As yet, there has been no research investigating health-related outcomes of positive body image (operationalised as body appreciation) outside of the eating realm. Here, positive body image has been related to an intuitive eating (i.e. eating in response to internal physiological cues; Tribole and Resch, 1995; Tylka, 2006), style (Augustus-Horvath and Tylka, 2011; Avalos and Tylka, 2006), and negatively related to drive for thinness (Langdon and Petracca, 2010), eating disorder symptomology (Avalos et al., 2005) and engaging in weight-loss-related conversations with friends (Wasylkiw and Butler, 2013). Thus, this study aimed to investigate a broader range of health-related outcomes that could potentially result from positive body image. An understanding of the role (if any) that positive body image plays in specific health behaviours will not only assist in clarifying the theoretical conceptualisation of positive body image but may also benefit interventions and initiatives that attempt to increase health behaviour compliance.

There are many health-promotion campaigns, programmes and policies (in Australia, and elsewhere) that are designed to influence particular modifiable health behaviours in the population (Australian Institute of Health and Welfare, 2012). Such campaigns target either increases in health-promoting behaviours or decreases in health-compromising behaviours, or both. This study focused on health behaviours that feature in contemporary Australian health campaigns. In particular, the health-promoting behaviours of sun protection, and skin, breast and cervical cancer screening, and the health-compromising behaviours of unhealthy weight-loss behaviour and alcohol and tobacco consumption were examined as possible outcomes of positive body image. In addition, seeking medical attention when needed was included as a more general measure of engagement in health and because body image has been previously implicated as a barrier to engaging in medical care (Alegria Drury and Louis, 2002).

Australia has the highest incidence of skin cancer in the world (International Agency for Research on Cancer, 2008), with skin cancer accounting for approximately 80 per cent of all newly diagnosed cancers each year (Cancer Council Australia, 2012b). As a result, different behaviours which provide protection from harmful ultraviolet radiation (UVR) are encouraged through specific campaigns, for example the ‘Slip, Slop, Slap, Seek, Slide’ (Cancer Council Australia, 2012c) and the ‘No tan is worth dying for’ (Cancer Council Australia, 2012a) campaigns. Although some links between tanning behaviour and higher body satisfaction (Yoo and Kim, 2012) and weight concern (O’Riordan et al., 2006) have been reported, minimal attention has been directed towards other sun protection behaviours such as hat or sunscreen use.

A related health behaviour is skin screening for moles and other abnormalities, which has been targeted by Australian health-promotion initiatives. In Australia, people are encouraged to scan for various cancers, including regularly inspecting all skin areas for suspicious looking moles (Cancer Council Australia, 2007). A cervical cancer screening programme for women between the ages of 18 and 69 years recommends Papanicolaou (pap) tests every 2 years (Department of Health and Ageing, 2009). Programmes for mammogram breast screenings presently target women aged 50–69 years, although younger women are also encouraged to be vigilant for any breast abnormalities (Department of Health and Ageing, 2012).

As noted by Ridolfi and Crowther (2012) in their review of body image disturbance and cancer screening, screening behaviours are especially pertinent to body image, as they require inspection (personally, and sometimes from a medical professional) of the body. Here, links between body dissatisfaction and discomfort (Chait et al., 2009; Jensen and Moriarty, 2008; Risica et al., 2008) and lower frequency of skin examinations have been reported. There is less research examining body image disturbance and breast and cervical cancer screening. One study (Chait et al., 2009) found no association between body disturbance and women’s breast screening behaviour or intention, while another (DeMaria et al., 2011) reported no association with gynaecological exam behaviour. More generally, however, Clark et al. (2009) reported that body image concern was one of the most frequently reported barriers to avoiding breast, cervical or colorectal screening.

Unhealthy weight-loss practices and alcohol and tobacco consumption are behaviours that can compromise health and have been a focus of health initiatives in Australia. Due to the increasing incidence of overweight and obesity in Australia, current dietary guidelines advocate for healthy weight management strategies (National Health and Medical Research Council, 2013). However, not all weight-loss strategies are healthy, for example, the diet industry promotes a variety of products such as shakes and pills (Ogden, 2003). Many previous studies have shown associations between body dissatisfaction and unhealthy weight-loss strategies and dieting (see Stice and Shaw, 2002).

Alcohol and tobacco consumption have been shown to be leading causes of disease and death in Australia, with tobacco consumption the largest risk factor for cancer-related burden of disease (Begg et al., 2008). Associations between body dissatisfaction (Kendzor et al., 2009; Stice and Shaw, 2003) or weight preoccupation (Clark et al., 2005) with cigarette smoking have been reported. One focus area of Australian alcohol-related guidelines is single occasion excessive alcohol use (or ‘binge-drinking’), and reducing risk of injury when binge-drinking (National Health and Medical Research Council, 2009). Binge drinking has itself been found to be associated with body dissatisfaction (Nelson et al., 2009).

In sum, the major aim of this study was to examine a range of diverse health behaviour outcomes of positive body image, which to our knowledge is the first study to do so. Relationships were also compared with body dissatisfaction, the most common measure of (negative) body image. It was hypothesised that body appreciation would be positively related to the health-promoting behaviours and negatively related to the health-compromising behaviours. Furthermore, body appreciation was predicted to explain additional unique variance in health behaviours over and above that explained by body dissatisfaction.

Method

Participants

Participants were 256 women aged 18–29 years (M = 20.11, standard deviation (SD) = 3.11) who were students at an urban university in South Australia. Participants’ mean body mass index (BMI) was 23.50 (SD = 6.01), which falls within the ‘normal range’ (World Health Organization, 2013). The majority of participants identified as Caucasian or White (89.1%), with 8.5 per cent Asian, 0.4 per cent Aboriginal or Torres Strait Islander, 0.4 per cent African and 1.6 per cent ‘other’.

Materials

Participants completed an online questionnaire which contained the measures listed below and was approved by the relevant institutional ethics committee. Participant consent was indicated by completion of the questionnaire.

Background information

Participants were asked their age, height, weight and ethnicity. BMI was then calculated as weight (kg)/height² (m²).

Positive body image

Positive body image, operationalised as body appreciation, was assessed by the BAS of Avalos et al. (2005) which measures the appreciation, acceptance, respect and attention given to one’s body. Participants rate 13 items on a 5-point Likert scale (from 1 = never to 5 = always). Exemplar items are ‘Despite my flaws, I accept my body for what it is’, and ‘I am attentive to my body’s needs’. Responses are averaged, and range from 1 to 5, with higher scores reflecting greater body appreciation. The BAS has been found to have a unidimensional factor structure, good internal reliability (α = .91–.94), 3-week test–rest reliability (r = .90) and convergent validity with samples of US college women (Avalos et al., 2005). In a previous study with Australian women (M age = 39.93 years, SD = 13.27 years), the BAS was found to have high internal reliability (α = .90) (Tiggemann and McCourt, 2013). For the present sample, the scale was also found to have high internal reliability (α = .93).

Body dissatisfaction

Body dissatisfaction was measured by the Body Areas Satisfaction Scale (BASS) of Brown et al. (1990) and Cash (2000). Participants rate on a 5-point Likert scale how dissatisfied or satisfied they are with their appearance overall, and with eight specific areas (e.g. face) or elements (e.g. muscle tone) of their body (from 1 = very dissatisfied to 5 = very satisfied). All items were reverse scored, summed and averaged to create a measure of body dissatisfaction. For women, the BASS has been reported to have good 1-month test–retest reliability (Cash, 2000), internal consistency (α = .82) (Cash et al., 2002) and good incremental validity (Giovannelli et al., 2008). For the present sample, internal reliability was acceptable (α = .80).

Sun protection

Five questions related to sun protection were adopted from the Cancer Council Australia’s National Sun Protection Survey (see Dobbinson et al., 2008). These questions examined specific behaviours such as wearing sunscreen and staying in the shade during peak UV hours in summer. Participants rated how often they performed each sun protection behaviour (from 1 = never to 5 = always). The 5 items were summed to create a total sun protection behaviour score ranging from 5 to 25. Internal reliability for this scale fell just short of acceptable (α = .64) in the current sample of women.

Cancer screening

There were three forms of cancer screening, those for skin, breast and cervical cancer. Skin screening was assessed with two questions regarding checking for sun spots and moles regularly, and getting moles and sun spots checked by a health professional (r = .52, p < .001), which were summed and averaged to create a skin screening measure. Similar questions assessed checking for breast lumps (r = .34, p < .001). A single item asked participants whether they receive pap tests when they are required. Participants rated all items on a 5-point Likert scale (1 = never to 5 = always), with higher scores reflecting more participation in the health behaviour.

Medical attention

One additional question asked whether participants see a doctor when needed and assessed general engagement in health which was rated on 5-point Likert scale (from 1 = never to 5 = always).

Weight-loss behaviours

Participants were asked to rate the extent to which they ‘Use weight-loss shakes, supplements or pills’, and had ‘Been on a diet in order to lose weight’ on a 5-point Likert scale (from 1 = never to 5 = always). These 2 items were moderately correlated (r = .53, p < .001) and were summed and averaged to create a single measure of ‘weight-loss behaviours’.

Alcohol consumption

Participants’ consumption of alcohol at risky levels was assessed using two questions from the Alcohol Use Disorders Identification Test (AUDIT) Alcohol Screen (Commonwealth Department of Veterans’ Affairs, 2003). The questions were ‘How many standard drinks do you have on a typical day when you are drinking?’ (from ‘1 or 2’ to ‘10 or more’) and ‘How often do you have six or more standard drinks on one occasion?’(from ‘never’ to ‘daily or almost daily’). Reponses for the two questions were standardised and summed to create one risky alcohol consumption score.

Tobacco consumption

Participants were asked two questions regarding their tobacco use from the National Drug Strategy Household Survey (Australian Institute of Health and Welfare, 2011). First, they were asked whether or not they smoke cigarettes, and second, with what frequency (‘Daily’, ‘At least weekly (but not daily)’, ‘Less often than weekly’ and ‘Not at all’).

Results

Body appreciation and health-promoting behaviours

Descriptive statistics for body image and health behaviour variables are displayed in Table 1. The mean score for sun protection behaviours indicates that on average, participants ‘sometimes’ performed behaviours such as wearing sunscreen and staying in the shade. As can be seen in Table 2 which displays the correlations between positive body image (body appreciation) and health behaviours, body appreciation was significantly positively related to sun protection.

Table 1.

Descriptive statistics of body image variables and health behaviours.

	M	SD	Range
Body appreciation	3.23	0.79	1–5
Body dissatisfaction	2.92	0.67	1–5
Health-promoting behaviours
Sun protection	14.54	3.73	5–25
Screening behaviours
Skin screening	2.32	0.98	1–5
Breast screening	2.03	0.96	1–5
Pap tests	2.88	1.74	1–5
Medical attention	3.81	1.14	1–5
Health-compromising behaviours
Weight-loss behaviours	2.01	1.04	1–5
Alcohol consumption	0.13	1.77	−4 to +4
Cigarette smoking	1.93	0.26	1–2

SD: standard deviation.

Table 2.

Correlations between body appreciation, body dissatisfaction and health behaviours.

	Body appreciation	Body dissatisfaction
	r	r
Health-promoting behaviours
Sun protection	.17**	−.09
Screening behaviours
Skin screening	.16*	−.14*
Breast screening	.10	−.12
Pap tests	.08	−.05
Medical attention	.18**	−.20**
Health-compromising behaviours
Weight-loss behaviours	−.41***	.35***
Alcohol consumption	−.09	.14*
Cigarette smoking	.06	−.04
Multiple R ²	.239***	.215***

p < .05; ** p < .01; *** p < .001.

Participants on average performed cancer screening behaviours between ‘rarely’ and ‘sometimes’, and as can be seen in Table 2, the correlations between body appreciation and cancer screening behaviours were all positive. However, only the correlation with skin screening reached statistical significance.

For medical attention, participants reported that they sought medical attention when they needed ‘often’, and as predicted, body appreciation was significantly positively related to this behaviour.

Body appreciation and health-compromising behaviours

Participants on average reported performing weight-loss behaviours ‘rarely’. As predicted, body appreciation was significantly negatively correlated with weight-loss behaviours.

For alcohol consumption, the median category for the number of standard alcoholic drinks consumed when drinking was ‘3 or 4’ alcoholic drinks (24.8%). The median category for the frequency with which participants consumed six or more standard alcoholic drinks on single occasions was ‘less than monthly’ (30.6%). Body appreciation was not found to be significantly related to total alcohol consumption.

The vast majority of participants did not smoke cigarettes (N = 232), with 91.6 per cent indicating they do not smoke cigarettes at all, 4.4 per cent smoked cigarettes less often than weekly, 0.8 per cent smoked cigarettes at least weekly and only 3.2 per cent smoked daily. As seen in Table 2, smoking status was not significantly correlated to body appreciation. Although body appreciation was found to be higher in non-smokers (M = 3.24, SD = 0.76) than smokers (M = 3.05, SD = 0.91), an independent samples t-test revealed this difference was not significant, t(242) = −0.99, p = .32.

Relative contribution of body appreciation to health behaviours

Participants’ body appreciation was found to be negatively correlated with their body dissatisfaction as would be expected, r = −.80, p < .001. Table 2 displays the correlations between body dissatisfaction and the various health behaviours. As can be seen, the pattern of correlations for body dissatisfaction was somewhat different from that for body appreciation. In particular, while both variables were related (in the opposite direction) to skin screening, seeking medical attention and weight-loss behaviours, only body appreciation was related to sun protection, and only body dissatisfaction was related to alcohol consumption.

To formally test whether positive body image contributed unique variance, over and above body dissatisfaction, to any of the health behaviours, a series of hierarchical multiple regressions were carried out for each of the health behaviours. In each hierarchical multiple regression, body dissatisfaction was entered in Step 1, and body appreciation was entered in Step 2, to predict the health behaviour. The results of these analyses are provided in Table 3, with R²_change and F_change values in Step 2 indicating whether or not body appreciation offered additional prediction over and above body dissatisfaction.

Table 3.

Summary of hierarchical multiple regression analyses predicting health behaviours from body appreciation and body dissatisfaction.

	Step 1		Step 2
	Body dissatisfaction		Body appreciation
	R ²	F	R ² _change	F _change
Health-promoting behaviours
Sun protection	.008	1.83	.034	8.36**
Screening behaviours
Skin screening	.018	4.28*	.018	4.48*
Breast screening	.015	3.69	.003	0.77
Pap tests	.003	0.82	.008	1.92
Medical attention	.044	11.07**	.004	0.99
Health-compromising behaviours
Weight-loss behaviours	.118	32.18***	.049	14.15***
Alcohol consumption	.021	4.54*	.002	0.37
Cigarette smoking	.001	0.33	.000	0.00

p < .05; ** p < .01; *** p < .001.

As can be seen in Table 3, body appreciation explained significant unique variance in sun protection, skin screening and weight-loss behaviours. That is, body appreciation offered predictive value in these three health behaviours, over and above body dissatisfaction. The only initially significant behaviour for which body appreciation did not explain unique variance was seeking medical attention.

Discussion

This study examined the relationship between positive body image and a range of health-promoting and health-compromising behaviours. While negative body image or body dissatisfaction has previously been found to be associated with some health behaviours, this was the first study to investigate how positive body image related to health behaviours beyond eating. Specifically, body appreciation was found to be positively related to sun protection, skin screening and seeking medical attention, and negatively related to weight-loss behaviours. On the other hand, body appreciation was not significantly related to breast screening, pap tests or alcohol-related or smoking behaviours. The finding for weight-loss behaviours confirms previous results demonstrating a negative association between positive body image and unhealthy eating behaviour (e.g. Augustus-Horvath and Tylka, 2011; Avalos et al., 2005; Avalos and Tylka, 2006; Langdon and Petracca, 2010). However, the relationships found between body appreciation and other health behaviours are novel.

This study found links between body appreciation and both skin screening and sun protection which have not previously been reported. Importantly, the results also demonstrated that body appreciation contributed unique variance in sun protection and skin screening, over and above that previously reported for body dissatisfaction (Chait et al., 2009; Risica et al., 2008). Given that Australia has the highest incidence of skin cancer in the world (International Agency for Research on Cancer, 2008) and that skin cancers account for the overwhelming majority of new cancers diagnosed in Australia every year (Cancer Council Australia, 2012b), these findings suggest a potential avenue for interventions and campaigns specifically aimed at young women to increase sun protection behaviours and screening for skin cancer. Such campaigns might choose to focus on the benefits of sun protection and skin screening for the body, as opposed to emphasising appearance-based negative consequences of not engaging in these behaviours (e.g. developing wrinkles).

Although not significant, the correlations between body appreciation and breast screening and receiving pap tests lay in the predicted direction. It may be that breast screening is not an appropriate measure in a young sample given that recommendations are strongly geared towards women aged 40 years and over (Department of Health and Ageing, 2012). However, no significant relationship between body dissatisfaction and breast screening in a more diverse sample of older women was reported in a previous study (Chait et al., 2009). Thus, the lack of significant association may be due to the nature of breast screening which involves a tactile rather than visual inspection of a relatively small and specific area of the body (Chait et al., 2009). This contrasts with screening for skin abnormalities which requires close visual attention directed to the whole surface of the body, consistent with the positive correlation found here between positive body image and skin, but not breast, screening. Similar to DeMaria et al. (2011), no relationship existed between body appreciation (or body dissatisfaction) and cervical cancer screening. This study’s findings add to the small body of work examining cancer screening, but support Ridolfi and Crowther’s (2012) call for more research in order to make definitive conclusions about the nature of the relationships between body image and cancer screening behaviours.

More generally, body appreciation was positively related to seeking medical attention when required, demonstrating a potential role for positive body image in overall motivation to enhance health. Seeking medical attention is a more global and far-reaching behaviour than specific cancer screening, and can contribute to the detection and prevention of a range of diseases. In addition, general practitioners have the ability to encourage regular screening practices and to promote a whole range of health behaviours in people who seek professional advice for medical problems (Dobson et al., 2012).

The results support previous links reported between body dissatisfaction and alcohol consumption (Littleton et al., 2005; Nelson et al., 2009), but interestingly no relationship with body appreciation was found. Alcohol intake is an important health issue in Australia, and is the focus of various campaigns as well as specific health guidelines. Our results suggest that targeting body dissatisfaction in health initiatives that aim to reduce risky alcohol consumption may be useful. Contrary to some previous findings (Clark et al., 2005; Kendzor et al., 2009; Stice and Shaw, 2003), the present study found no links between body image and cigarette smoking. However, this result is not surprising given the very low proportion of smokers in the present sample (8.4%).

In general, while body appreciation and body dissatisfaction were correlated with each other and were found to be related to some of the same variables, the pattern of correlations was not the same. In particular, the overall pattern suggests that positive body image might be more related to health-promoting behaviours, while negative body image might be more related to health-compromising behaviours. Future research might usefully investigate this interesting proposition. In addition, the regression analyses indicated that body appreciation was able to explain unique variance in some of the health behaviours, beyond that explained by body dissatisfaction. The unique contribution of positive body image to sun protection, skin screening and weight-loss behaviours presents convincing evidence that body appreciation does play a role in these health behaviours. Nevertheless, further research needs to comprehensively address the conceptual difference between positive body image and the absence of body dissatisfaction by examining multiple measures of the two constructs and how they relate to a range of social, health and well-being variables.

This study’s findings have some practical implications. Given that body dissatisfaction is now viewed as normative among young women (Rodin et al., 1985) and that they are confronted with flawless media images portraying the thin ideal on virtually a daily basis (Levine and Chapman, 2011), it is possible that strategies that seek to enhance positive body image may prove more successful than strategies that attempt to reduce body dissatisfaction. In particular, if girls and women can be explicitly encouraged to accept and appreciate all parts of their body, including its flaws, they should be better able to withstand media pressures.

One way that women and girls might actively learn to develop their appreciation for their bodies is by engaging in metacognitive acceptance techniques which have begun to show some success for general body image (Atkinson and Wade, 2012). Such techniques emphasise that thoughts, feelings and physical sensations are to be observed and experienced but not judged or actively modified (Baer, 2003). Thus, they may serve to prevent or ameliorate women’s tendency to engage in social comparison or rumination about their appearance. More broadly, engaging in mindful meditation may assist in the accurate and early detection of bodily needs or changes (Bishop et al., 2004). Another way that women and girls might increase body appreciation is to participate in embodying activities, that is, activities in which the mind and body are interconnected (Piran, 2002). These include organised sports and other physical pursuits such as rock climbing or yoga, which are not self-objectifying (e.g. Prichard and Tiggemann, 2008), and are postulated as potential precursors to positive body image (Menzel and Levine, 2011). Encouraging women to discuss exercise and physical activity with peers may also foster positive body image, as those women who engage in more exercise (as opposed to appearance) related conversations have been shown to hold more functional (as opposed to objectifying) views of their body (Wasylkiw and Butler, 2013).

Taken together, the findings allow us to add women’s physical health to the list of potential benefits associated with positive body image. Accordingly, they suggest that targeting positive body image might be one way to effect tangible improvements in women’s health. Thus, public health and other interventions designed to modify health-related behaviours, in particular health-promoting behaviours, might usefully incorporate positive body image into their protocols. Public health campaigns commonly deliver messages about the harmful consequences of an unhealthy behaviour (known as fear appeals) rather than offering a positive behaviour as an alternative (Rice and Atkin, 2001). Reframing these in the positive direction might improve their effectiveness.

There are some limitations to this study that should be noted. First, the sample comprised mainly young Caucasian university students, and so results may not generalise to other groups of women. Second, the self-report nature of the questionnaire may also have limited participants’ ability to accurately remember and report the degree to which they did or did not perform health behaviours. Third, the just below acceptable internal reliability for the sun protection measure means that results for this variable should be viewed with caution. Finally, the cross-sectional design means that it is not possible to determine causal or temporal relationships between the different variables. Although, as suggested by Tylka (2011), it is more logical to treat health behaviours as an outcome of possessing positive body image, it is also theoretically possible that engaging in healthy behaviours could lead to the development of positive body image. Alternatively, there might be a third variable that explains both. Future research should employ longitudinal designs that track the development of both positive body image and health-related behaviours over some time for a more definitive casual conclusion.

Despite its limitations, to our knowledge this is the first study to examine non-eating health-related outcomes of positive body image. In particular, the results demonstrate that positive body image is linked to the health-promoting behaviours of sun protection, skin screening and seeking medical attention, and negatively associated with the health-compromising behaviour of unhealthy weight loss. These findings have both theoretical and practical implications: first, in expanding the scope of positive body image, and second, in identifying a new target for promoting healthy behaviours.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

References

Alegria Drury

Louis

(2002) Exploring the association between body weight, stigma of obesity, and health care avoidance. Journal of the American Academy of Nurse Practitioners 14(12): 554–561.

Atkinson

Wade

(2012) Impact of metacognitive acceptance on body dissatisfaction and negative affect: Engagement and efficacy. Journal of Consulting and Clinical Psychology 80(3): 416–425.

Augustus-Horvath

Tylka

(2011) The acceptance model of intuitive eating: A comparison of women in emerging adulthood, early adulthood, and middle adulthood. Journal of Counseling Psychology 58(1): 110–125.

Australian Institute of Health and Welfare (2011) 2010 National Drug Strategy Household Survey Report (Drug statistics series no. 25. Cat. no. PHE 145). Canberra, ACT, Australia: Australian Institute of Health and Welfare.

Australian Institute of Health and Welfare (2012) Australia’s Health 2012 (Australia’s health series no.13. Cat. no. AUS 156). Canberra, ACT, Australia: Australian Institute of Health and Welfare.

Avalos

Tylka

(2006) Exploring a model of intuitive eating with college women. Journal of Counseling Psychology 53(4): 486–497.

Avalos

Tylka

Wood-Barcalow

(2005) The Body Appreciation Scale: Development and psychometric evaluation. Body Image 2(3): 285–297.

Baer

(2003) Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice 10(2): 125–143.

Begg

Vos

Barker

. (2008) Burden of disease and injury in Australia in the new millennium: Measuring health loss from diseases, injuries and risk factors. Medical Journal of Australia 188(1): 36–40.

10.

Bishop

Lau

Shapiro

. (2004) Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice 11(3): 230–241.

11.

Brown

Cash

Mikulka

(1990) Attitudinal body-image assessment: Factor analysis of the body-self relations questionnaire. Journal of Personality Assessment 55(1–2): 135–144.

12.

Cancer Council Australia (2007) Position Statement: Screening and Early Detection of Skin Cancer. Sydney, NSW, Australia: Cancer Council Australia.

13.

Cancer Council Australia (2012a) No tan is worth dying for. Available at: http://www.cancer.org.au/preventing-cancer/sun-protection/campaigns-and-events/no-tan-is-worth-dying-for.html (accessed 1 March 2013).

14.

Cancer Council Australia (2012b) Skin cancer. Available at: http://www.cancer.org.au/about-cancer/types-of-cancer/skin-cancer.html (accessed 4 February 2013).

15.

Cancer Council Australia (2012c) Slip, slop, slap, seek and slide. Available at: http://www.cancer.org.au/preventing-cancer/sun-protection/campaigns-and-events/slip-slop-slap-seek-slide.html (accessed 4 March 2013).

16.

Cash

(2000) The Multidimensional Body-Self Relations Questionnaire. User’s manual. Available at: http://www.body-images.com (accessed 1 March 2013).

17.

Cash

Fleming

Alindogan

. (2002) Beyond body image as a trait: The development and validation of the Body Image States Scale. Eating Disorders 10(2): 103–113.

18.

Chait

Thompson

Jacobsen

(2009) Relationship of body image to breast and skin self-examination intentions and behaviors. Body Image 6(1): 60–63.

19.

Clark

Rogers

Armstrong

. (2009) Comprehensive cancer screening among unmarried women aged 40–75 years: Results from the cancer screening project for women. Journal of Women’s Health 18(4): 451–459.

20.

Clark

Croghan

Reading

. (2005) The relationship of body image dissatisfaction to cigarette smoking in college students. Body Image 2(3): 263–270.

21.

Commonwealth Department of Veterans’ Affairs (2003) AUDIT (Alcohol Screen). Available at: http://at-ease.dva.gov.au/therightmix/resources/for-health-professionals/ (accessed 10 June 2012).

22.

DeMaria

Hollub

Herbenick

(2011) Using genital self-image, body image, and sexual behaviors to predict gynecological exam behaviors of college women. The Journal of Sexual Medicine 8(9): 2484–2492.

23.

Department of Health and Ageing (2009) National Cervical Screening Program. Available at: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-about (accessed 4 February 2013).

24.

Department of Health and Ageing (2012) BreastScreen Australia Program. Available at: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/breastscreen-about (accessed 4 February 2013).

25.

Dobbinson

Wakefield

Hill

. (2008) Prevalence and determinants of Australian adolescents’ and adults’ weekend sun protection and sunburn, summer 2003–2004. Journal of the American Academy of Dermatology 59(4): 602–614.

26.

Dobson

Byles

Brown

. (2012) Adherence to Guidelines: Findings from the Australian Longitudinal Study on Women’s Health. Canberra, ACT, Australia: Australian Department of Health and Ageing.

27.

Fredrickson

Roberts

T-A

(1997) Objectification Theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly 21(2): 173–206.

28.

Frisén

Holmqvist

(2010) What characterizes early adolescents with a positive body image? A qualitative investigation of Swedish girls and boys. Body Image 7(3): 205–212.

29.

Giovannelli

Cash

Henson

. (2008) The measurement of body-image dissatisfaction–satisfaction: Is rating importance important? Body Image 5(2): 216–223.

30.

Grogan

(1999) Body Image: Understanding Body Dissatisfaction in Men, Women and Children. London: Routledge.

31.

Homan

Cavanaugh

(2013) Perceived relationship with God fosters positive body image in college women. Journal of Health Psychology 18(12): 1529–1539.

32.

International Agency for Research on Cancer (2008) World Cancer Report 2008. Lyon: International Agency for Research on Cancer.

33.

Jensen

Moriarty

(2008) Psychosocial factors associated with skin self-exam performance. Journal of American College Health 56(6): 701–705.

34.

Kendzor

Adams

Stewart

. (2009) Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females. Eating Behaviors 10(1): 56–58.

35.

Langdon

Petracca

(2010) Tiny dancer: Body image and dancer identity in female modern dancers. Body Image 7(4): 360–363.

36.

Levine

Chapman

(2011) Media influences on body image. In: Cash

Smolak

(eds) Body Image: A Handbook of Science, Practice, and Prevention. New York: The Guilford Press, pp. 101–109.

37.

Littleton

Radecki Breitkopf

Berenson

(2005) Body image and risky sexual behaviors: An investigation in a tri-ethnic sample. Body Image 2(2): 193–198.

38.

Lobera

Ríos

(2011) Spanish version of the Body Appreciation Scale (BAS) for adolescents. The Spanish Journal of Psychology 14(1): 411–420.

39.

Menzel

Levine

(2011) Embodying experiences and the promotion of positive body image: The example of competitive athletics. In: Calogero

Tantleff-Dunn

Thompson

(eds) Self-Objectification in Women: Causes, Consequences, and Counteractions. Washington, DC: American Psychological Association, pp. 163–186.

40.

National Health and Medical Research Council (2009) Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra, ACT, Australia: Commonwealth of Australia.

41.

National Health and Medical Research Council (2013) Australian Dietary Guidelines. Canberra, ACT, Australia: Commonwealth of Australia.

42.

Neff

(2003) Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity 2: 85–101.

43.

Nelson

Lust

Story

. (2009) Alcohol use, eating patterns, and weight behaviors in a university population. American Journal of Health Behavior 33(3): 227–237.

44.

Ogden

(2003) The Psychology of Eating. Oxford: Blackwell Publishing.

45.

O’Riordan

Field

Geller

. (2006) Frequent tanning bed use, weight concerns, and other health risk behaviors in adolescent females (United States). Cancer Causes & Control 17(5): 679–686.

46.

Piran

(2002) Embodiment: A mosaic of inquiries in the area of body weight and shape preoccupation. In: Abbey

(ed.) Ways of Knowing in and through the Body: Diverse Perspectives on Embodiment. Welland, ON, Canada: Soliel Publishing Inc., pp. 211–214.

47.

Prichard

Tiggemann

(2008) Relations among exercise type, self-objectification, and body image in the fitness centre environment: The role of reasons for exercise. Psychology of Sport and Exercise 9(6): 855–866.

48.

Pruzinsky

Cash

(2002) Understanding body images: Historical and contemporary perspectives. In: Cash

Pruzinsky

(eds) Body Image: A Handbook of Theory, Research, and Clinical Practice. New York: The Guilford Press, pp. 3–12.

49.

Rice

Atkin

(2001) Public Communication Campaigns (3rd edn). Thousand Oaks, CA: SAGE.

50.

Ridolfi

Crowther

(2012) The link between women’s body image disturbances and body focused cancer screening behaviors: A critical review of the literature and a new integrated model for women. Body Image 10(2): 149–162.

51.

Risica

Weinstock

Rakowski

. (2008) Body satisfaction effect on thorough skin self-examination. American Journal of Preventive Medicine 35(1): 68–72.

52.

Rodin

Silberstein

Striegel-Moore

(1985) Women and weight: A normative discontent. In: Sondregger

(ed.) Psychology and Gender. Lincoln, NE: University of Nebraska Press, pp. 267–307.

53.

Stice

Shaw

(2003) Prospective relations of body image, eating and affective disturbances to smoking onset in adolescent girls: How Virginia slims. Journal of Consulting and Clinical Psychology 71(1): 129–135.

54.

Stice

Shaw

(2002) Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research 53(5): 985–993.

55.

Tiggemann

McCourt

(2013) Body appreciation in adult women: Relationships with age and body satisfaction. Body Image 10(4): 624–627.

56.

Tribole

Resch

(1995) Intuitive Eating: A Recovery Book for the Chronic Dieter. New York: St. Martin’s Press.

57.

Tylka

(2006) Development and psychometric evaluation of a measure of intuitive eating. Journal of Counseling Psychology 53(2): 226–240.

58.

Tylka

(2011) Positive psychology perspectives on body image. In: Cash

Smolak

(eds) Body Image: A Handbook of Science, Practice, and Prevention (2nd edn). New York: The Guilford Press, pp. 56–64.

59.

Wasylkiw

Butler

(2013) Body talk among undergraduate women: Why conversations about exercise and weight loss differentially predict body appreciation. Journal of Health Psychology. Epub ahead of print 16 May. DOI: 10.1177/1359105313483155.

60.

Wasylkiw

MacKinnon

MacLellan

(2012) Exploring the link between self-compassion and body image in university women. Body Image 9(2): 236–245.

61.

Williams

Cash

Santos

(2004) Positive and negative body image: Precursors, correlates, and consequences. In: 38th annual meeting of the association for the advancement of behavior therapy, New Orleans, LA, 18–21 November.

62.

Wood-Barcalow

Tylka

Augustus-Horvath

(2010) ‘But I Like My Body’: Positive body image characteristics and a holistic model for young-adult women. Body Image 7(2): 106–116.

63.

World Health Organization (2013) BMI classification. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html (accessed 30 January 2013).

64.

Yoo

J-J

Kim

H-Y

(2012) Adolescents’ body-tanning behaviours: Influences of gender, body mass index, sociocultural attitudes towards appearance and body satisfaction. International Journal of Consumer Studies 36(3): 360–366.