From negative to positive body image: Men’s and women’s journeys from early adolescence to emerging adulthood

Body Image 28 (2019) 53–65

Contents lists available at ScienceDirect

Body Image journal homepage: www.elsevier.com/locate/bodyimage

From negative to positive body image: Men’s and women’s journeys from early adolescence to emerging adulthood夽 Kristina Holmqvist Gattario ∗ , Ann Frisén Department of Psychology, University of Gothenburg, Sweden

a r t i c l e

i n f o

Article history: Received 21 June 2018 Received in revised form 6 December 2018 Accepted 6 December 2018 Keywords: Negative body image Positive body image Body appreciation Body image development Turning points Qualitative research Bullying

a b s t r a c t This study examined the developmental journeys of individuals who have overcome negative body image in early adolescence and developed positive body image on their way to emerging adulthood. Interviews were conducted with 15 women and 16 men (aged 26–27) recruited from a large longitudinal sample. Results demonstrated different patterns of positive body image development, but most participants had overcome their negative body image by age 18. Factors contributing to their negative body image in early adolescence included negative peer influence and discontent with life in general. Turning points included finding a new social context, experiencing agency and empowerment, and using cognitive strategies to improve body image. Characteristics of the participants’ current positive body image coincided with established features of positive body image; novel findings were that the women were more likely to think of positive body image as needing constant work to maintain and were also more likely to have a feminist identity, whereas the men were more likely to try to improve their body shape and perceive their body as resembling the ideal. In conclusion, body image interventions need to target not only matters related to physical appearance but also adolescents’ general sense of belonging, agency, and empowerment. © 2018 Elsevier Ltd. All rights reserved.

1. Introduction Negative body image, conceptualized as poor body esteem, body dissatisfaction, or body shame, dramatically affects the lives of many young people as it is linked to low overall well-being (Meland, Haugland, & Breidablik, 2007), low self-esteem (Davison & McCabe, 2006), depression (Ohring, Graber, & Brooks-Gunn, 2002), and disordered eating (Westerberg-Jacobson, Edlund, & Ghaderi, 2010). Adolescence is a critical time for body image development as many of the changes during this phase in life (biological, emotional, cognitive, as well as social) channel individuals’ attention towards their developing physical bodies. The few large-scale longitudinal studies examining long-term body image development demonstrate that most adolescents experience a dramatic increase in negative body image in early adolescence (Bucchianeri, Arikian, Hannan, Eisenberg, & Neumark-Sztainer, 2013; Eisenberg,

夽 This research was supported by grants from the Swedish Research Council for Health, Working Life and Welfare (grant number 2014-1729). We thank Åsa Nordström for assisting in the data collection and the participants for sharing their stories. ∗ Corresponding author at: Department of Psychology, University of Gothenburg, Box 500, 405 30 Gothenburg, Sweden. E-mail address: [email protected] (K.H. Gattario). https://doi.org/10.1016/j.bodyim.2018.12.002 1740-1445/© 2018 Elsevier Ltd. All rights reserved.

Neumark-Sztainer, & Paxton, 2006; Frisén, Lunde, & Berg, 2015) and maintain their negative body image throughout adolescence and into emerging adulthood (Frisén et al., 2015; Rogers, Webb, & Jafari, 2018). Body image in emerging adulthood tends to remain stable (Grogan, 2017). Altogether, these findings indicate that the adolescent years are critical for many in shaping the body image that they will subsequently carry with them into adulthood. Although the most common developmental pattern implies a drastic increase in negative body image in early adolescence followed by stability into emerging adulthood, investigations of individual trajectories demonstrate that there are also other patterns of body image development (Frisén et al., 2015; Nelson, Kling, Wängqvist, Frisén, & Syed, 2018; Rogers et al., 2018). One particularly interesting pattern, explored further here, pertains to individuals who, consistent with the majority, develop negative body image in early adolescence, but who then overcome their negative body image and develop positive body image on their journey to emerging adulthood. We are unaware of any in-depth study of this interesting developmental pattern, although the experiences of individuals following this trajectory may be of particular value to body image research, prevention, interventions, and clinical work. Indeed, these individuals have managed to overcome a negative body image and their experiences of their journey toward a pos-

54

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

itive body image can be helpful in distinguishing the factors that may help turn a negative body image into a positive one. This study will accordingly explore men and women’s development from a negative body image in early adolescence to a positive body image in emerging adulthood. One focus of this study is to examine the range of individual patterns of body image development that these men and women display. For example, does the change from negative to positive body image tend to happen gradually or does it take dramatic turns and, if so, when? Answering these questions will advance our understanding of positive body image development and provide valuable information about the stage at which interventions should be implemented. Another focus is to investigate the factors underlying this pattern of development from a negative body image in early adolescence to a positive body image in emerging adulthood. Specifically, what contributed to the participants’ negative body image in early adolescence? What characterized their positive body image in emerging adulthood? Perhaps most importantly, what were the turning points in their development? The answers to these questions can provide valuable knowledge of the factors characterizing negative body image that can be overcome, the factors that can help turn this negative body image into a positive body image, and the characteristics of positive body image that have been acquired. Several theoretical perspectives can help us understand the factors underlying individuals’ body image development. The dominant theoretical models (e.g., Smolak, 2012; Thompson, Coovert, & Stormer, 1999), however, tend to focus on the risk factors undermining body image development and do not specifically reflect on those that may promote positive body image (Tylka & Wood-Barcalow, 2015b). For years, it was assumed that positive body image was simply the opposite of negative body image, and the factors assumed to promote positive body image were therefore simply seen as the opposites of those undermining body image (Striegel-Moore & Cachelin, 1999). However, recent research into positive body image has provided evidence that this picture may be too simplistic. The few studies exploring the experiences, thoughts, attitudes, and behaviors of individuals with a positive body image have been helpful in conceptualizing positive body image as featuring body appreciation, functionality appreciation, body acceptance, inner positivity, interpreting information in a body-image–protective manner, and conceptualizing beauty broadly (Alleva, Tylka, & Kroon Van Diest, 2017; Frisén & Holmqvist, 2010b; Holmqvist & Frisén, 2012; Wood-Barcalow, Tylka, & Augustus-Horvath, 2010). Yet, previous studies have not specifically examined individuals’ journeys toward a positive body image and have therefore not considered the factors that may help turn a negative into a positive body image. In addition, previous studies have focused on adolescent girls’ and young women’s experiences of having a positive body image; in fact, only one sample of adolescent boys has previously been studied (Frisén & Holmqvist, 2010b; Holmqvist & Frisén, 2012). This indicates a lack of knowledge of young men’s positive body image and how it may differ from young women’s. This study accordingly adds to the literature by examining patterns of positive body image development in young men as well as women. In addition, it is the first study to qualitatively examine what characterizes positive body image in young men. When it comes to understanding the factors that can promote positive body image, specifically, theoretical models are still in their infancy (Halliwell, 2015). Longitudinal, quantitative studies have contributed insights into what can promote body appreciation, one of several aspects of positive body image, which is defined as individuals’ acceptance of, favorable opinions of, and respect for their bodies (Tylka & Wood-Barcalow, 2015b). For example, the acceptance model (Avalos & Tylka, 2006) suggests that social support and body acceptance by others are important factors promoting

body appreciation (Andrew, Tiggemann, & Clark, 2016; AugustusHorvath & Tylka, 2011; Avalos & Tylka, 2006; Tylka & Homan, 2015). This model emphasizes the importance of support and acceptance from others in promoting positive body image, but it provides little information about whether and how these aspects may play a role in turning a negative body image into a positive one. Also, there may be additional factors serving as turning points that are not covered in the model. Another theoretical model, the developmental theory of embodiment (2017, Piran & Teall, 2012; Piran, 2016), suggests that positive embodied experiences, that is, activities that enhance the awareness of bodily experience, connectedness with the body, and feelings of competence, empowerment, and inclusion, can promote positive body image. While this model has a wider scope than does the acceptance model, a deficiency is that it was developed based on assessments of girls and women only, and more research is needed to evaluate the application of the embodiment construct in young men. The acceptance and developmental theories of embodiment provide a preliminary idea of factors that may turn a negative body image into a positive one, but turning points need to be examined more thoroughly, through studies including both men and women. To obtain a deeper understanding of men’s and women’s journeys from negative to positive body image, it is essential to hear the stories of the individuals who have followed this particular developmental trajectory. Their reflections on their own body image journey can be valuable in order to identify factors with the potential to change the path of body image development and to understand individual body image trajectories. 1.1. Aim and research questions The aim of this study was to examine young men and women’s development from a negative body image in early adolescence to a positive one in emerging adulthood. Four specific research questions guided the investigation: (a) What are the different patterns of body image development displayed by individuals who start with a negative body image in early adolescence and then acquire a positive one on their way to emerging adulthood?; (b) What factors contributed to their negative body image in early adolescence?; (c) What factors served as turning points in their body image development?; and (d) What characterized their positive body image in emerging adulthood? 2. Method 2.1. Participants The participants, 15 women and 16 men (Mage = 26.19, SD = 0.48), were recruited from the longitudinal research project MoS (Mobbning och Skola [Bullying and School]), which has studied individuals’ body image development from ages 10 to 24 years (see, e.g., Frisén & Holmqvist, 2010a; Frisén et al., 2015; Gattario et al., 2015; Lunde & Frisén, 2011). In the first wave, 960 10-yearolds participated (515 girls and 445 boys). There have been in total six waves in the study, at ages 10, 13, 16, 18, 21, and 24 years. Rates of attrition have overall been low: 91% (n = 874) of the original sample participated at age 13 years, 79% (n = 758) at age 16, 74% (n = 715) at age 18, 64% (n = 607) at age 21, and 56% (n = 544; 302 women and 242 men) at age 24. In this longitudinal project, body image has been assessed using the Body-Esteem Scale for Adolescents and Adults (BESAA; Mendelson, Mendelson, & White, 2001 see Measures). To recruit participants to the present study, we used the mean score of the BESAA Appearance and Weight subscale items, since the Attribution subscale has displayed lower reliability than have the other two subscales (Mendelson et al., 2001). Expectation maximization

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

in SPSS was used to handle missing data when participants had fewer than four missing values on the BESAA on one occasion. Those recruited to this study met the inclusion criteria of (a) having participated in at least four of the six waves of the study, (b) having had low body esteem in early adolescence (ages 10 and 13 years), and (c) having high body esteem in emerging adulthood (age 24 years). Negative body image (at ages 10 and 13 years) and positive body image (at age 24 years) were defined relative to the BESAA scores of the larger longitudinal sample at those same ages. At each age, all participants were divided into four quartiles ranging from those with low body esteem (first quartile) to those with high body esteem (fourth quartile). We defined negative body image as having a BESAA score in the first or second quartiles, that is, lower than the median of the total sample (at age 10, < 3.46 for boys and < 3.30 for girls, and, at age 13, < 3.14 for boys and < 2.60 for girls). We defined positive body image as having a BESAA score in the fourth and highest quartile (at age 24, > 3.13 for men and > 2.96 for women). From a developmental perspective, we considered the participants’ relative position in body esteem in relation to their same-age peers a better indicator of their body image than using identical cut-off points for positive and negative body image at all ages. For consistency, throughout this paper we refer to individuals’ negative body image ‘turning into’ a positive one; however, negative body image and positive body image should not be considered opposites of one another, and aspects of negative body image may co-exist with positive body image (Tylka & Wood-Barcalow, 2015b). Yet, when examining body image development over time as in this study, it is necessary to be consistent in our conceptualizations of body image from wave to wave in order to study changes in development. Therefore, for the recruitment of participants to this study, we defined both negative and positive body image according to their levels of body esteem. In total, 25 men and 30 women met the inclusion criteria of having had negative body image in early adolescence and having positive body image in emerging adulthood. We set a predefined goal of including 30 participants (15 men and 15 women) in the study. Hence, we regularly contacted small sets of randomly selected participants from the 25 men and 30 women until we had achieved this goal. The final sample consisted of 16 men and 15 women. Their BESAA scores at age 10 years ranged from 1.95 to 3.89 (M = 3.18, SD = 0.52) for boys and 2.37–3.53 (M = 2.90, SD = 0.37) for girls; at age 13 years 1.43–3.95 (M = 2.98, SD = 0.75) for boys and 1.00–3.95 (M = 2.75, SD = 0.75) for girls; and at age 24 years 3.23–3.70 (M = 3.44, SD = 0.14) for men and 2.94–4.00 (M = 3.34, SD = 0.34) for women. For further illustration of their body esteem at different ages, see Figs. 1 and 2. Demographic data from age 24 years demonstrated that the participants’ highest educational level ranged from lower secondary school (n = 1), upper secondary school (n = 11), university degree initiated (n = 13), to university degree finished (n = 6). The majority of the participants were born in Sweden (n = 29) and the remaining were born in other European countries (n = 1) or in the Middle East (n = 1). Six of the participants had parents that were born in other countries than Sweden, mainly other European countries (n = 3) and the Middle East (n = 3). Twentyfive of the participants identified as heterosexual, one as gay, four as bisexual, and one participant preferred not to report his or her sexual orientation. 2.2. Procedure Eligible participants first received a written letter with information about the study. The study aim described in the information letter was “to gain a richer understanding of people’s thoughts and feelings about their bodies.” Participants were not informed of their BESAA developmental pattern (i.e., that they had transi-

55

Fig. 1. Female participants’ body image development (as measured combining BESAA Weight and Appearance; Mendelson et al., 2001) between ages 10 and 24 years. The median (dotted line) is from the larger longitudinal sample of participants (N = 960) from which the current sample was recruited. BESAA ranges from 0 to 4, with higher values indicating a more positive body image.

Fig. 2. Male participants’ body image development (as measured combining BESAA Weight and Appearance; Mendelson et al., 2001) between ages 10 and 24 years. The median (dotted line) is from the larger sample of participants (N = 960) from which the current sample was recruited. BESAA ranges from 0 to 4, with higher values indicating a more positive body image.

tioned from a negative to a positive body image) until right before the fifth and final part (e) of the interview, to prevent this information from affecting how they described their body image journey. Within a week of the participants’ receiving the information letter, we contacted them by telephone to ask whether they agreed to take part in the study. We used the contact information they had supplied online during their previous participation in the longitudinal study. As an incentive, participants were offered two movie tickets as well as a book published by the authors, which describes many of the previous findings of the longitudinal research project (Frisén, Holmqvist Gattario, & Lunde, 2014). Written consent was collected from each participant before the interview. Most participants were interviewed at the Department of Psychology, University of Gothenburg, in a setting made as comfortable as possible for them. If the participants lived in another city, we arranged to meet with them at a suitable place in their area (in total, eight men and five women). Interviews were audio recorded and lasted approximately 1.5 h. To ensure that the participants still had a

56

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

positive body image at the time of the interview, which occurred approximately two years after the age 24-year time point in the longitudinal study, participants were asked to fill in measures of body esteem and body appreciation in-between part (b) and (c) of the interview. After the interview, there was a short debriefing where participants were asked about how they experienced the interview and were able to ask questions about the study. The data collection was approved by the Regional Ethical Review Board in Gothenburg, Sweden, project name “Bullying and Body Image – A Longitudinal Study From Childhood to Adulthood,” protocol number T446-15. 2.3. Semi-structured interview An interview schedule was constructed in accordance with the guidelines provided by Smith and Osborn (2003). The interview topics were based on the existing body image literature, but also included parts that were more explorative. The different parts of the interview assessed: (a) a general idea of the participant’s current body image, (b) participants’ reflections on the influence of family and peers on their body image when growing up, (c) participants’ reflections on a picture of themselves that they liked and that they were asked to email us before the interview (this was also included to promote discussion of the participants’ current body image), (d) participants’ reflections on appearance ideals conveyed in the media, and (e) participants’ reflections on their body image journey. The questions for each part are presented in Appendix A. Introductory questions (e.g., regarding family and peer group constellations when growing up) were asked to help the participants remember their life as adolescents. Several unstructured questions were asked to follow up the different aspects raised by the participants. The following definition of body image was provided at the beginning of the interview: “Body image includes experiences, feelings, attitudes, and behaviors in relation to the body. It can relate to the body’s appearance, function, as well as health. People may differ in the importance they ascribe to these different aspects of their body image.” Right before the fifth and final part (e) of the interview where participants were asked to reflect on their own body image journey, participants were informed that they belonged to a group of participants who, in relation to the large longitudinal sample, had a negative body image in early adolescence and then had developed a positive one on their way to emerging adulthood. Two pilot interviews, conducted to discern any potential concerns with the interview, allowed the two interviewers (the first author and a trained research assistant with a Degree of Master of Science in Psychology) to discuss their biases. Both interviewers were 35-year-old females with experience in semi-structured interviewing and that were unknown to the participants. 2.4. Measures 2.4.1. Body esteem The BESAA (Mendelson et al., 2001), translated into Swedish (Erling & Hwang, 2004), was used to quantitatively assess participants’ body image throughout the broader longitudinal project as well as at the time of the interview. The BESAA consists of 23 items that can be divided into three subscales: Weight (weight-based body esteem; eight items; e.g., “I really like what I weigh”), Appearance (appearance-based body esteem; 10 items; e.g., “I like what I look like in pictures”), and Attribution (beliefs about how others view one’s body and appearance; five items; e.g., “People my own age like my looks”). Respondents indicate their degree of agreement with each statement on a Likert scale ranging from 0 = never to 4 = always, with higher scores indicating higher body esteem. For the present study, we used only the items on the Weight and Appearance subscales to create a mean score of the BESAA, because the

Attribution subscale has demonstrated lower reliability than the other two subscales (Mendelson et al., 2001). The two subscales have, in previous studies, displayed high internal consistency and test-retest reliability among Canadian adolescents and emerging adults (Mendelson et al., 2001). In the large longitudinal sample, reliability scores for the Weight subscale ranged from ␣ = .90 to .94 and for the Appearance subscale from ␣ = .89 to .92 at ages 10 to 24 years. 2.4.2. Body appreciation The Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a) was used to quantitatively assess body appreciation. The BAS-2 has a unidimensional factor structure and consists of 10 items measuring individuals’ acceptance of, favorable opinions of, and respect for their bodies (e.g., “I appreciate the different and unique characteristics of my body”). Respondents indicate their degree of agreement with each statement on a Likert scale ranging from 1 = never to 5 = always. Item scores are averaged, with higher scores reflecting higher levels of body appreciation. The BAS-2 has, in previous studies, displayed high internal consistency, testretest reliability, and construct validity, among U.S. community and undergraduate women and men (Tylka & Wood-Barcalow, 2015a). To translate the BAS-2 into Swedish (see Appendix B), the scale was translated by the first author and then back-translated by a research assistant (Brislin, 1970). The translations and backtranslations were reviewed and discussed until we agreed on the translation that we considered most adequate and relevant. The scale was pilot-tested before data collection. Lemoine et al.’s (2018) recent evaluation of an almost identical version of the Swedish BAS-2 that they based on our translation, demonstrated excellent psychometric properties in a sample of Swedish-speaking adolescents and young adults. The reliability score in our sample was ␣ = .83. 2.5. Analyses To answer research question (a) regarding the participants’ different patterns of body image development toward a positive body image, their body esteem scores from ages 10 to 24 years were extracted from the longitudinal database. Based on these scores, we created graphs illustrating the 31 participants’ individual body esteem patterns; see Figs. 1 (women) and 2 (men). We also calculated their body esteem and body appreciation scores collected at the time of the interview. To answer research questions (b) to (d), thematic analysis was used. Thematic analysis is used for the systematic identification and analysis of patterns, or themes, in data (Braun & Clarke, 2006). In the present study, research questions (b) to (d) guided the analysis so that the themes identified should reflect (b) what contributed to the participants’ negative body image in early adolescence, (c) what the turning points were in their development, and (d) what characterized their current positive body image. Three thematic analyses were accordingly conducted, one for each research question. The two authors started by separately reading the interview transcripts to become familiar with the data, assigning initial codes to meaningful features. During this process, the authors met regularly to discuss potential patterns and themes in the data. After having read the first 12 transcripts, the authors met and agreed on a preliminary coding scheme that the first author then used to code the remaining interviews. The two authors had regular contact during this process to discuss any necessary adjustments to the coding scheme. Only a few small adjustments were made to the preliminary scheme. Two individual case stories (one woman and one man) were chosen to illustrate the participants’ different body image journeys and portray the range of themes distinguished in their stories (see Appendix C).

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

3. Results The first part of this section presents the participants’ body image development in quantitative terms. This includes descriptions of their body esteem as measured using BESAA from ages 10 to 24 years. It also includes their body esteem and body appreciation scores at the time of the interview. The second part of this section illustrates the participants’ body image in qualitative terms. We present the results of the thematic analysis and use fictive names to illustrate the themes. 3.1. Patterns of development from a negative body image in early adolescence to a positive body image in emerging adulthood The participants’ body esteem development from ages 10 to 24 years are illustrated in Figs. 1 (women) and 2 (men). The median at each age (indicated by a dotted line) is from the larger sample of participants (N = 960) from which the current sample was recruited. In line with the inclusion criteria, all 31 participants’ body esteem values were below the median at age 10 and/or 13 years and in the positive quartile at age 24 years. Although the participants were recruited based on the same inclusion criteria, the graphs show a range of individual patterns in the sample, providing brief preliminary insight into their many different trajectories from a negative to positive body image. Some participants experienced dramatic turns, both positive and negative, in their body image development before they finally stabilized around a more positive body image. Others experienced a steadier, gradual positive development toward a positive body image. Interestingly, a few participants did not experience any increase in body esteem, but rather maintained a similar level of body esteem while the larger longitudinal sample to which they were compared generally became more negative; this, in turn, resulted in the current sample’s more positive relative position. Note that most participants (11 women and 12 men) already reported above-median body esteem at age 18 years, overcoming negative body image according to the definition used here. However, it takes until the last measurement at age 24 for all participants to be in the most positive quartile. Clearly, however, age 18 seems to be the time by which most participants have acquired a more stable body image (no one is in the lowest quartile at this age) and have started their process of developing toward, or even maintaining, a positive body image. 3.2. Participants’ body esteem and body appreciation at the time of the interview Participants generally displayed high levels of body esteem at the time of the interview, indicating that they had maintained their positive body image from the 24-year measuring point. Women’s body esteem scores ranged from 2.50 to 3.78 (M = 3.16, SD = 0.42). Men’s body esteem scores ranged from 2.94 to 3.50 (M = 3.28, SD = 0.17). If we compare the participants’ body esteem at the time of the interview with the cutoff value used for recruiting them (i.e., BESAA scores > 2.96 for women and > 3.13 for men), two women and three men reported body esteem scores slightly below these cutoffs at the time of the interview. They were retained in the analysis, however, because all of them displayed relatively high levels of body appreciation (> 3.60). The participants generally displayed high levels of body appreciation at the time of the interview, further indicating their current positive body image (Tylka & Wood-Barcalow, 2015b). Women’s body appreciation scores ranged from 3.60 to 5.00 (M = 4.35, SD = 0.45). Men’s body appreciation scores ranged from 3.30 to 4.90 (M = 4.34, SD = 0.44). Compared with mean values of body appreciation previously obtained in U.S. community samples of men and

57

women (M for men = 3.46, SD = 0.86, M for women = 3.22, SD = 0.96; Tylka & Wood-Barcalow, 2015a), the present participants had significantly higher body appreciation, both men t(203) = –3.92, p < .01, and women t(205) = –4.51, p < .01. These results further demonstrate that the present sample experienced positive body image in line with recent conceptualizations (Tylka & Wood-Barcalow, 2015b), and not only high levels of body esteem. 3.3. Thematic analyses: the participants’ own descriptions of their body image development 3.3.1. What factors explained the participants’ negative body image in early adolescence? The factors forming the participants’ negative body image in early adolescence were: the perception of having a deficient appearance relative to peers, experiences of negative peer influence, and experiences of overall discontent and lack of self-esteem extending to the participants’ body image. 3.3.1.1. Perception of having a deficient appearance (13 men, 11 women). The majority of the participants experienced having a deficient appearance relative to peers in early adolescence (e.g., having been shorter, taller, chubbier, larger, or thinner than peers, or having protruding ears, bad acne, braces, or too-small or toolarge breasts). Some participants expressed that their perceived deficient appearance was related to maturing early or late in terms of puberty. Emma, for instance, said, “I was a bit chubby right before puberty and during high school. I felt like I wasn’t good enough.” 3.3.1.2. Experiences of negative peer influence (11 men, 11 women). The majority of the participants also experienced peer appearance teasing or even physical (e.g., being hit, pushed, or kicked) or verbal (e.g., being called nasty names) bullying at school. Appearance teasing often targeted the features of the participants’ appearance perceived as deficient by the participant. Jakob said, “I was always teased about my height. Everyone else was like one head taller than me so that was something they always commented on.” Kristoffer said, “People have hit me and spit on me. I’ve always been bullied, from the first day I went to school.” The theme also includes a few descriptions by participants who experienced high appearance pressure in their peer group at school. Jenny had a close friend who was very appearance-oriented and influenced her to engage in disordered eating: “She said that if she would be as tall as me, she would be thinner. Because then she would want to be a model. [. . .] She used toothbrushes to try to throw up food. So I tried it too. [. . .] Her eating disorder was somehow transmitted on to me.” 3.3.1.3. Overall discontent and lack of self-esteem extended to body image (8 men, 7 women). Several participants felt discontent with life in general and experienced low self-esteem in early adolescence and this, in turn, extended to their body image. The theme also includes experiences of having difficulties finding oneself or one’s place in life during early adolescence, or general feelings of failure and psychological ill-being. A shared feature of the experiences within this theme is that they are not directly related to the participant’s physical body, but still influence body image through their impact on the participant’s life and well-being in general. Karl, for instance, experienced difficulties at school because he had dyslexia, and when asked about his negative body image at this time he said, “I think it had to do with all of it. I wasn’t too happy about myself at all at that time.” 3.3.2. What factors served as turning points in the participants’ body image development? We identified three factors that served as turning points in the participants’ development from a negative body image to a pos-

58

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

itive one: the participants found a social context in which they felt belonging and acceptance, the participants developed a sense of agency and empowerment in their lives, and the participants started to actively use strategies to improve their body image. We coded for turning points when the participants described events or new ways of thinking that changed the direction of the participants’ life story. Although turning points were mostly identified on the basis of the participants’ reflections of their body image journey, they were also identified on the basis of events or new ways of thinking that they described occurred between their negative and positive body image. We identified more than one turning point in most participants’ interviews, so the themes may overlap. 3.3.2.1. Participants found a social context in which they felt belonging and acceptance (13 men, 11 women). Many participants said that having found a new social context in which they felt belonging and acceptance had been essential for their positive body image development. The new social context was provided by supportive and like-minded friends as well as affirmative and encouraging romantic partners. 3.3.2.1.1. Friends who were supportive and like-minded (10 men, 6 women). Many participants described how finding friends who were similar to them in their interests and/or personality represented a turning point for them. By feeling supported and accepted by peers and experiencing belonging, the participants became more confident in their bodies and their body image. Kristoffer, who had been bullied at school, described how finally finding new friends was a turning point for him: “After having gone through a long time of no positive [input] at all, I found people who respected me, who said that ‘you’re OK and we like you for who you are.’ [. . .] To me, it was like finding another family outside of my [original] family. I found a place where I was accepted and I felt like ‘wow, this is where I belong.’” 3.3.2.1.2. Affirmative and encouraging romantic partners (5 men, 5 women). Some participants described meeting a boyfriend or a girlfriend who, by giving encouraging appearance-reassuring comments, helped the participants to be more comfortable in their body. Sara described how her first boyfriend in ninth grade was a real “boost” to her body image: “I had a lot of acne at the time and couldn’t for the world understand why he still wanted to be with me, even though my face was full of acne. But he wanted to, and we were so in love.” Other participants described how having a partner with whom they could discuss difficult matters and that listened to them was a relief when experiencing negative feelings. 3.3.2.2. Participants developed a sense of agency and empowerment in their lives (13 men, 10 women). For the majority of the participants, positive body image development was also related to experiences of increased agency and empowerment. 3.3.2.2.1. Agency through the body (11 men, 10 women). Several participants started to use their body as a means to feel agency and control in life. Most frequently, this was related to excelling in physical activities or sports or, less frequently, in other bodyrelated activities (e.g., singing or exploring one’s sexuality). Elin said, “When I started training and dancing, that affected me a lot in the sense that I got a more positive. . . more control over my body.” A few women described using small acts of body activism (e.g., refusing to shave one’s legs) to gain power and control. This theme also includes descriptions of exploring and eventually finding one’s own personal style in clothing and grooming, and how this helped the participants to feel more confident in their bodies. Oskar, for instance, said, “I feel like I found a clothing style that fits with my body. And that has made me feel good about my clothes as well as the way I look.” 3.3.2.2.2. A general sense of agency and empowerment in one’s life (7 men, 8 women). Some participants developed a general sense of

agency and control in life not directly related to their body. Several participants succeeded at work or in their studies and, by doing so, felt competent and gained self-esteem, which extended to their body image. Karl, for instance, who had difficulties succeeding in school because of his dyslexia, told us about how eventually managing to get employed had a positive impact on his whole life: “It [school] was a real struggle for me. And then, when I managed to get a job, and then another job, and things started going well. . . Everything just fell into place.” A few participants also described the empowerment they felt when they became adults and were finally able to make decisions for themselves. 3.3.2.3. Participants started to actively use strategies to improve their body image (12 men, 6 women). Many participants also described using various strategies to improve their negative body image: practicing body acceptance, avoiding or ignoring negative bodyrelated information, focusing on other things in life, and realizing that pursuing the ideal means having to sacrifice other things in life. 3.3.2.3.1. Practicing body acceptance (7 men, 4 women). Several participants tried to think of their body imperfections as part of themselves and began to accept their bodies. Simon, who had received negative comments about the size of his ears, said, “If you would tell me now that I have small ears I would say ‘Ok, what am I supposed to do about that? I have small ears. It’s not like I can make them bigger.’” 3.3.2.3.2. Avoiding or ignoring negative body-related information (1 man, 2 women). A few participants started to actively avoid or ignore negative body-related information, including appearance comments from peers and media images promoting the appearance ideal. Amanda said, “I’ve done some pretty drastic choices in my life because of this thing with my body. . . I don’t read the blogs I used to read. I don’t watch the TV-programs I used to watch. Because I noticed that they make me feel uncomfortable with my body.” 3.3.2.3.3. Focusing on other things in life (8 men, 7 women). Several participants started to pay attention to other things than their physical appearance. Instead, they focused on having a nice personality, being healthy, developing their intellect, learning new things, doing well at work, or more generally “other more important things.” Linnea said, “You need to let go of that constant focus on the body. It’s not useful to sit at home and read a magazine. It won’t help increase your self-esteem.” 3.3.2.3.4. Realizing that pursuing the ideal means having to sacrifice other things in life (7 men, 1 woman). A strategy that was brought forward almost exclusively by the young men was realizing that pursuing the appearance ideal was too strenuous and time-consuming and entailed giving up certain pleasures in life (e.g., food and drink). This ultimately led the participants to stop pursuing the ideal and become more satisfied with their bodies. Lukas told us that he regularly worked out, but that the goal of his training had changed over time: “I now exercise in order to feel good. That’s what’s important, not because I want big arms or abdominals or anything. That is such a waste of time. [. . .] I would have to quit my job in that case. It was different when I was a student and [I thought] ‘I want a six-pack, and I want all of that’. . . and now it’s more important for me to feel good.” 3.3.3. What characterizes the participants’ positive body image in emerging adulthood? Several features were identified as characteristics of the participants’ current positive body image. These included body appreciation, perception of the body as integral to the self, body acceptance, body attunement and self-care, mentoring others to like their bodies, filtering media images in a body-imageprotective manner, constantly practicing positive body image, feminist approach to body image, appearance-enhancing invest-

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

ment, and the perception of having a body that is close to the ideal. 3.3.3.1. Body appreciation (12 men, 12 women). The majority of the participants expressed appreciation of the features, functionality, and health of their bodies. Some participants, like Elin, had friends with health problems or experienced health problems themselves (e.g., back pain), and this new awareness of the body’s vulnerability made them appreciate their body’s health even more. Elin said, “One of my friends has gastric problems and another one has back problems, so I feel fortunate not to have any of that. I think more about that now than when I was younger.” 3.3.3.2. Perception of the body as integral to the self (1 man, 6 women). Some participants, the majority women, described viewing their bodies as integral to their self-identity. Emma said, “Every single part of my body is me.” Other participants emphasized that ethnic features that were earlier a source of discontent were now a source of pride as they were perceived to say something about the participants’ origins. 3.3.3.3. Body acceptance (12 men, 12 women). The majority of the participants accepted their bodies the way they were and did not strive to change their appearance in any way. Jenny, for instance, said, “I’m happy with my body. [. . .] I try to make the most of it. I don’t put any effort into trying to change it. I have accepted that this is the way I look.” 3.3.3.4. Body attunement and self-care (11 men, 8 women). Many participants described that they were attuned to their bodies, listened to how their bodies signaled pain, stress, and anxiety, and tried to adjust their activities according to these signals. Participants took good care of their bodies via health-promoting and stress-reducing activities (e.g., physical activity and relaxation). Sebastian said, “You only live once so you need to take good care of your body so it will last your whole life.” 3.3.3.5. Mentoring others to like their bodies (1 man, 6 women). Some participants, in particular women, tried to mentor other people (friends and family; e.g., the participants’ own children) to have a positive body image, by encouraging them to love their bodies and not to care too much about what other people think. Julia, for instance, told us that her female friends often asked her about what their male dates would think about their appearance and she would answer, “It doesn’t matter what he thinks, what matters is what you think. If you think you look good you look good, you don’t need anyone else to tell you that.” 3.3.3.6. Filtering media images in a body-image-protective manner (11 men, 10 women). Many participants expressed how they interpreted media images of current appearance ideals in a bodyimage-protective manner. This included being critical of the appearance ideals, describing them as objectifying, disempowering, retouched, unreal, non-functional, homogenous, unattainable, and even tragic. These participants did not identify with the models in the images and were not motivated to try to attain bodies like theirs. Peter said, “Just because a body looks healthy on the outside doesn’t mean it’s healthy on the inside. [. . .] and what good does it do to me that they look fit?” Filtering media images in a bodyimage-protective manner not only included filtering out negative messages but also filtering in beneficial media. For example, a few of the women were followers of body activists in social media. 3.3.3.7. Constantly practicing positive body image (1 man, 8 women). Some participants, almost exclusively women, described how maintaining a positive body image implies constant work, as they

59

were constantly exposed to societal messages asserting that they should not be satisfied with their bodies. Sara said, “It requires constant practice [not to care about negative comments]. If someone says that I’m short I usually say that I’m pretty happy with being short. I wouldn’t want to be taller. Because I’m a dancer and I would feel clumsy.” 3.3.3.8. Feminist approach to body image (5 women). A third of the female participants expressed having a strong feminist identity, using feminist arguments to fight appearance concerns, and possibly also engaging in various types of activism. Sara, who described herself as a body activist, told us about an incident she had on an internet dating site where a potential date asked her to send a full figure photo. Sara, who felt objectified by this request, confronted him: “The more I encounter these appearance prejudices, the more I speak out.” 3.3.3.9. Appearance-enhancing investment (11 men, 4 women). Several participants, mostly men, paid attention to the physical appearance of their bodies and strove to change their bodily appearance through strategies such as exercise. In contrast to the participants aligned with the theme “Filtering media images in a body-image-protective manner,” participants aligned with this theme may describe feeling motivated by the appearance ideals and viewing them as positive inspiration. Some participants, however, described that they were both critical of media images and engaged in appearance-enhancing investment. Alexander said that he exercised to be healthy, but “primarily in order to look good. I’ve got my own little goals and an ideal body that I strive for.” Karl described viewing appearance ideals as inspiring: “They are an incentive for me to make a change.” 3.3.3.10. Perception of having a body that is close to the ideal (9 men, 3 women). Several participants, again mostly men, perceived they have a body type not too far from current appearance ideals. When Axel was asked about how he felt about appearance ideals in the media, he said, “They are not a problem to me because I look more like them than most people. It’s an appearance ideal that fits my body.” Some of the men believed that they would probably be able to attain an ideal body if they wished to put the time and effort into doing so. 4. Discussion This study is the first to examine the experiences of individuals who have overcome having a negative body image in early adolescence and have developed a positive body image on their way to emerging adulthood. The study advances our understanding of different journeys to a positive body image and of the factors involved in this notable body image trajectory, including the risk factors for negative body image early in life, the factors that may serve as positive turning points, and the characteristics of positive body image in emerging adulthood. The graphs illustrating the participants’ different patterns of body image development reveal that the journey from a negative body image in early adolescence to a positive one in emerging adulthood can differ greatly. Some participants experienced dramatic turns, both positive and negative, in their body image development before finally stabilizing around a more positive body image. Others experienced a steadier, gradual positive development toward a positive body image. Regardless of the participants’ different developmental patterns, we found that most had developed a body image above the median of the large longitudinal sample by age 18 years. This finding, that it took until the end of adolescence for many individuals to make this developmental step, is noteworthy. It adds a novel finding to existing research into

60

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

body image development in the critical phase of youth, suggesting that body image development can take positive turns late in youth development. However, the finding that none of the participants had a very negative body image at age 18 years and that no one was under the median at age 21 also indicates that this shift towards a positive body image takes place around age 18 to 21, not later. This could indicate that around the age of 18 years would be an ideal time for effective body image interventions. To understand the factors behind overcoming negative body image, we thematically analyzed the participants’ stories. We identified three factors that contributed to the participants’ negative body image in early adolescence, which partly coincide with previous findings on the risk factors for negative body image. The first is that most participants perceived themselves to have a ‘deficient’ appearance in comparison with their peers in early adolescence. They perceived themselves to be shorter, taller, chubbier, larger, or thinner than their peers, or had other deficient appearance features that troubled them. This finding supports previous research demonstrating that individuals’ own negative perceptions of their appearance in comparison with peers plays a major role in body dissatisfaction (Lev-Ari, Baumgarten-Katz, & Zohar, 2014). Another factor contributing to the participants’ negative body image in early adolescence was the experience of negative peer influence. The impact of peer appearance teasing (Menzel et al., 2010) and bullying (Duarte, Pinto-Gouveia, & Stubbs, 2017; Lunde & Frisén, 2011) as well as experiences of peer appearance pressure (Helfert & Warschburger, 2011) on adolescents’ body image is well established and in line with theoretical frameworks, such as the tripartite influence model (Thompson et al., 1999) emphasizing the influence of peers on body image development. However, the fact that many of the participants developed a positive body image despite being victimized in early adolescence is noteworthy and deserves further attention. It may be that the turning points identified here could also inform bullying interventions in order to reduce the negative impact of victimization on body image. For example, bullying interventions could guide adolescents into finding new social contexts in which they feel accepted the way they are, or encourage adolescents to develop effective coping strategies to improve body image, as identified in this study. The third and final factor contributing to the participants’ negative body image in early adolescence was perhaps our most novel finding in this part, and concerned a feeling of discontent with life in general and a lack of self-esteem extending to their body image. Indeed, many researchers have connected negative body image to low self-esteem (e.g., Davison & McCabe, 2006), but few theoretical models point to ‘discontent with life in general’ as a risk factor for negative body image. Depressive symptoms are often considered a consequence of negative body image, but recent research into the temporal association between the two factors has suggested that this may not always be the case (Sharpe et al., 2017). For some early adolescent boys (but not girls), depressive symptoms were the precursors of body dissatisfaction, indicating that how young people experience life is mirrored in how they experience their bodies. Previous research has also found experiences of life satisfaction to be correlated with less body dissatisfaction and more body appreciation in adolescents and young men and women (Góngora, 2014; Swami & Ng, 2015). We identified three factors that helped turn the participants’ negative body image into a positive one. A first turning point was that the participants found a new social context, for example, new friends or an encouraging romantic partner, providing them with a sense of belonging and acceptance that helped them improve their body image. The benefits of a new positive social context for body image development are plausible, considering that the participants’ negative body image in early adolescence was often related to negative peer relations (e.g., appearance pressure, appearance teasing,

or bullying). This finding is consistent with both the acceptance model, which proposes that social support and body acceptance by others can promote positive body image (Andrew et al., 2016; Augustus-Horvath & Tylka, 2011; Avalos & Tylka, 2006), and the developmental theory of embodiment (Piran & Teall, 2012; Piran, 2017), which emphasizes the importance of feeling included in desired social contexts for the development of positive body image. Although these models have been developed for girls’ and young women’s body image experiences, the present findings suggest that they can also be applicable to boys’ and young men’s experiences. In line with these findings, there are already some body image interventions that target and try to improve adolescents’ peer relations. However, the activities in these interventions tend to focus on body image-related discussions of the acceptance of diversity and on psychoeducational lessons about how peers can influence body image through appearance-related conversations and appearance comparisons (Bird, Halliwell, Diedrichs, & Harcourt, 2013; McCabe, Connaughton, Tatangelo, Mellor, & Busija, 2017). For the present participants, though, it was not the improvement of existing relations that enhanced their body image but the experience of finding a new social context. Parents and teachers can play an important role in encouraging adolescents to explore new social contexts to find one in which they feel belonging and acceptance. Another turning point in the participants’ positive body image development was related to increased agency and empowerment. The participants’ stories include a range of body-related experiences of agency and empowerment—for example, excelling in physical activities or sports, participating in acts of body activism, or exploring and eventually finding a personal style of clothing and grooming—and these experiences had helped the participants feel more confident in their body. Indeed, previous research has demonstrated that physical exercise generally improves body image, although the effects have been found to be smaller for adolescents than for older participants (Hausenblas & Fallon, 2006). Engaging in physical exercise has been suggested to encourage people to appreciate the functionality of their bodies, which is characteristic of positive embodiment and body image (Holmqvist & Frisén, 2012; Mahlo & Tiggemann, 2016; Wood-Barcalow et al., 2010). Exercise interventions targeting young adolescents have produced positive results in terms of increased body esteem, but have failed to maintain long-term effects (Burgess, Grogan, & Burwitz, 2006; Duncan, Al-Nakeeb, & Nevill, 2009). For the present participants, it was not only engaging in physical exercise that improved their body image but also the sense of excelling in that exercise. This may be one explanation of why exercise interventions do not successfully promote positive body image in all adolescents. In addition, adolescents may need to be given the choice of which physical activity to engage in, to promote that they find one that they enjoy, since enjoyable physical activity is key to positive embodiment (Piran & Teall, 2012; Piran, 2017). As indicated by the participants’ stories, however, various other body-related experiences and acts other than physical activity can promote young people’s agency and empowerment (e.g., singing, sexual exploration, body activism, or exploration of personal style of clothing and grooming), thereby also improving their body image. In addition, some participants’ stories included the development of a more general, non-body-related sense of agency and empowerment that could involve succeeding at work or in studies. This led to greater feelings of competence and self-esteem, which extended to their body image. Although the body-related and the non-body-related experiences of agency and empowerment may differ greatly from each other, they both give a sense of control over one’s life. Theoretically, these experiences are linked to the concepts of physical and mental freedom, as identified in the developmental theory of embodiment (Piran & Teall, 2012; Piran, 2017), as they contributed to the participants’ increased feelings

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

of competence and empowerment, both physically and psychologically. Intriguingly, this turning point of increased agency and empowerment, as well as the turning point of finding a new social context, both generally reflect the suggested core basic psychological needs that all humans share: autonomy (perceiving oneself and one’s behavior as an expression of the self), competence (a sense of confidence and self-efficacy) and relatedness (connecting to and caring of others, being cared for, and belongingness; Deci & Ryan, 2000). These connections can help provide a link between positive body image and the field of psychology more broadly. A third and final factor that served as a turning point in the participants’ body image development was their own active use of strategies to improve their body image. These strategies included practicing body acceptance, avoiding or ignoring negative bodyrelated information, focusing on other things in life than physical appearance, and realizing that pursuing appearance ideals means having to sacrifice other things in life. It is clear that many of the participants had successfully coped with and overcome their negative body image by actively regulating their thoughts regarding their bodies. We are not aware of any participant in this study who had received clinical treatment to address their negative body image, but it should be noted that some strategies used by the participants (e.g., practicing body acceptance) are strategies encouraged in Acceptance and Commitment Therapy (ACT) for treating body dissatisfaction as well as disordered eating (Fogelkvist, Parling, Kjellin, & Gustafsson, 2016). A cognitive strategy mentioned almost exclusively by the male participants was to realize that pursuing the appearance ideal meant having to sacrifice other things in life. As in the case story of Jakob, several of the young men had concluded that having an ideal muscular body would entail giving up some of life’s pleasures, such as certain foods and drinks, and being forced to spend most of their time in the gym. For these reasons, they deprioritized having an ideal body, which in turn helped them improve their body image. One may wonder why this cognitive strategy was not brought up by the female participants. One possible explanation is that engaging in one’s appearance and trying to pursue the thin ideal are some of the most central feminine norms that women need to adhere to in order to gain social acceptance (Kling, Holmqvist Gattario, & Frisén, 2017). Women may therefore find it more challenging than men to deprioritize this pursuit. Still, realizing that pursuing the ideal means having to sacrifice other things in life is likely to be a useful strategy for girls and women too, although interventions implementing this approach on girls will also need to challenge the associated feminine norms. Future research could further examine how this ACT-related component can be integrated into body image programs targeting both adolescent boys and girls. We identified several characteristics of the participants’ positive body image in emerging adulthood. Some are consistent with previous findings from interviews with young women (Wood-Barcalow et al., 2010) and adolescent girls and boys (Frisén & Holmqvist, 2010b; Holmqvist & Frisén, 2012) with a positive body image. These include, for example, the features of body appreciation, body acceptance, body attunement and self-care, mentoring others to like their bodies, and filtering media images in a body image-protective manner. Interestingly, we did not specifically ask about these themes in the interview and yet they map onto the definition of positive body image proposed by Tylka and Wood-Barcalow (2015b), which provides further evidence for the validity of their definition. This is particularly noteworthy considering that this is the first study to qualitatively explore positive body image in young men, suggesting that several of the features of positive body image found among women apply to men. Other identified characteristics contribute novel findings to the literature on what constitutes positive body image, adding to the complexity of the construct. The young women in particular

61

described the necessity of constantly practicing body acceptance in order to maintain positive body image, as they were unceasingly exposed to various body-image threats, such as societal messages asserting that they should not be satisfied with their bodies as they are. Researchers have emphasized the idea of examining positive body image not only as a stable trait but also as a state that can fluctuate over time (Webb, Wood-Barcalow, & Tylka, 2015). Previous research has recognized this process of fluidity, for example in that women with a positive body image sometimes have ‘bad body image days’ but tend to recover to an overall positive body image (Wood-Barcalow et al., 2010). Based on these findings, more research is needed into when and why positive body image fluctuates and that further explores young women’s constant practice of maintaining a positive body image. In the case story of Sara, for example, we learned that every time she felt bloated due to her menstrual cycle, she reminded herself to appreciate it as a sign that her body was functioning properly. This can be considered a strategy of maintaining positive body image. A few of the young women also described having a strong feminist identity and used feminist arguments to address body image concerns and media ideals. Previous experimental research has demonstrated that exposure to a feminist perspective can improve young women’s body image (Peterson, Tantleff-Dunn, & Bedwell, 2006). A recent study of the role of social media messages in young women’s self-objectification found that strong feminist beliefs played an important protective role (Feltman & Szymanski, 2017). Yet, in focus group interviews, women themselves have pointed out the that their feminist awareness and cognitions cannot totally prevent them from experiencing body image concerns (Kling et al., 2017; Rubin, Nemeroff, & Russo, 2004). In fact, some women felt that their feminist cognitions sometimes led to more distress, as now they did not only experience body image concerns, but also felt guilty for continuing to engage in gender stereotypic behavior although they ‘should know better’ (Kling et al., 2017; Rubin et al., 2004). Feminist ideas, therefore, need to be cautiously implemented into body image interventions, and preferably in combination with ideas promoting a broader conceptualization of beauty in order to de-emphasize the conflict that feminist women may experience (Rubin et al., 2004) and compassion with body image threats such as body image flexibility via ACT (Rogers et al., 2018). Positive body image characteristics that were more common among the young men were making appearance-enhancing investments and perceiving one’s body as close to the ideal. These appearance-oriented characteristics were somewhat unexpected considering that positive body image has mostly been related to non-appearance-related, embodying activities (Tiggemann, Coutts, & Clark, 2014) and a functional, non-appearance-related view of the body (Alleva, Martijn, Van Breukelen, Jansen, & Karos, 2015; Frisén & Holmqvist, 2010b). The concept of “adaptive appearance investment” has, however, been discussed as one important component of positive body image, defined as “regularly engaging in appearance-related self-care, such as grooming behaviors that protect an individual’s sense of style and personality—it is enhancing one’s natural features via benign methods” (Tylka & WoodBarcalow, 2015b, p. 123). For the young men in the present study, appearance-enhancing investments often concerned paying attention to the physical aspects of their bodies or engaging in physical exercise to improve body shape. Although these behaviors could possibly be included among adaptive appearance investments, it can be difficult to distinguish between adaptive and maladaptive investments (Gattario & Lunde, 2018). However, according to the present findings, appearance-enhancing investments can be part of having a positive body image, at least among young men. More research is needed to understand how appearance-enhancing behaviors relate to positive body image.

62

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

The young men’s perception of having a body that resembles the male body ideal is likely to be of importance to their positive body image. With this perception, socially comparing themselves to male body ideals does not necessarily generate negative feelings, and instead, ideals can be viewed as positive inspiration, as described by some of the men. It should be noted, however, that although the men perceived themselves as being close to the ideal does not necessarily mean that they were objectively close to the ideal. Instead, they had ‘the feeling’ that the ideal was within reach. This was also expressed by some of the participants who said that they would probably be able to attain the ideal if they wished to put the time and effort into doing so. Why did the women with a positive body image not express this view? It may be that the male body ideal is perceived as more attainable by the men than the female body ideal is by the women. It may also be that it is more accepted for men in general to verbally express that they resemble the ideal as doing so can be seen as more coherent with the masculine gender role featuring characteristics such as self-reliance and dominance (Mahalik et al., 2003).

the participants now inhabit a positive body image and look back at their journey with “new eyes.” It is also possible that the participants did not remember all the aspects that were important for their positive body image development and therefore left out valuable information in the interviews. Future studies may benefit from methods that aim at helping the participants remember their adolescence, for example by asking them to bring in photographs of themselves as adolescents or conducting several interviews over multiple days, to allow participants time to reflect in between. Finally, the present study is limited in that it has examined only one pattern of body image development. It would be valuable for future research to focus on other patterns of body image development, for example, by assessing individuals who did not overcome their negative body image in early adolescence, or individuals who have had a stable positive body image from early adolescence and onwards.

4.1. Limitations

The present study examined the stories of individuals who overcame a negative body image in early adolescence and developed a positive body image on their way to emerging adulthood. Graphs illustrating the participants’ body image development reveal a range of patterns all leading to positive body image in emerging adulthood. However, most participants had already obtained a positive body image by age 18 years. Thematic analyses of the participants’ stories demonstrated that the factors contributing to their negative body image in early adolescence were that they perceived themselves as having a deficient appearance, had experiences of negative peer influence, or experienced overall discontent and lack of self-esteem that extended to their body image. Three factors served as positive turning points in the participants’ body image development: they found a new social context in which they felt belonging and acceptance; they developed an increased sense of agency and empowerment; or they used various cognitive strategies to improve their body image. Several of the characteristics that summarized the participants’ positive body image in emerging adulthood were in line with the findings of the few previous qualitative studies of positive body image. However, the present findings add evidence of new characteristics of positive body image, which may differ between men and women. Namely, the women in this study were more likely to think of positive body image as needing constant work to maintain, and were also more likely to have a feminist identity and address body image concerns by marshalling feminist arguments. In contrast, the men were more likely to engage in appearance-enhancing behaviors in order to improve their body shape, and were more likely to perceive their body as resembling the ideal. These gender differences are noteworthy considering that this is the first study to qualitatively examine young men’s positive body image. Overall, the present findings suggest that positive body image development can be related to adolescents’ specific body experiences, as well as to their life in general, general feelings of acceptance, belonging, agency, and empowerment. Based on these findings, we propose that body image interventions would benefit from taking a more ecological approach (Piran & Mafrici, 2012). This implies developing programs and actions that not only consider matters directly related to the physical body but also work with adolescents’ general sense of acceptance, belonging, agency, and empowerment. Interventions could also target the relation between adolescents’ bodies and their lives more broadly, for example by encouraging them to reflect on how their body can help them live a valued life. In addition, the present study gives hope that body image development can take positive turns late in adolescence.

It should be noted that the participants with a positive body image in emerging adulthood were recruited for this study based on their high body esteem at age 24 years as measured using BESAA. One may argue that high scores on BESAA, which assesses feelings about appearance and weight, do not adequately capture positive body image according to recent conceptualizations, but rather the lack of body dissatisfaction. However, to control for this limitation, we assessed the participants’ body appreciation (a component of positive body image) at the time of the interview. Our findings indicated that, compared with mean values of body appreciation previously obtained in community samples, the present participants had higher body appreciation, supporting the assumption that the members of the sample had a positive body image at the time of the interview. Several characteristics of the participants’ current positive body image were also in line with characteristics identified in other studies of positive body image (Tylka & WoodBarcalow, 2015b). In addition, it should be noted that using BESAA was helpful in identifying participants with a negative body image in early adolescence, and it was also the general measure of body image used in the longitudinal project from which the current sample was recruited. In fact, measures assessing specific components of positive body image (e.g., body appreciation) had not yet been developed when the longitudinal project started in the year 2000. Future studies could further explore how development of body esteem relate to development of body appreciation over time. Another limitation associated with the recruitment of participants concerns the fact that we were stricter in our criteria for positive body image in emerging adulthood than in our criteria for negative body image in early adolescence, considering that we defined positive body image as having a BESAA score in the fourth and highest quartile and negative body image as having a BESAA score below the median. This was chosen as the best solution because we wanted to ensure that the participants had a positive body image in emerging adulthood while still obtaining a sufficiently large sample. Another limitation worth mentioning concerns the thematic analyses and the fact that the themes identified in the analyses depended on our interpretations of the participants’ stories. Especially regarding the turning points, these were not always described as turning points by the participants, but were rather just parts of the participants’ descriptions of their body-image journeys. Also, it should be noted that many of the findings of this study are from participants’ retrospective reflections on their body image journey. It is possible that these reflections were affected by the fact that

4.2. Conclusions

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

Appendix A Interview topics and main questions: (a) General idea of current body image: • Could you please name the first three things that come to mind when you think about your body? Why do you think these specific things come to mind? • Is there anything that you are particularly satisfied/dissatisfied with when it comes to your body? Why? (b) Influence of family and peers on body image when growing up: • Could you tell me a little about the configuration of your family/peer group when you were growing up? • How did your family/peer group discuss aspects related to the body? • If your parents/peers commented on your body in any way, positively or negatively, what did they say? • If your parents did something to make you feel better about your body, what did they do? • What do you think your peers thought about how you looked when you were younger? • Do you think your parents/peers have influenced how you think and feel about your body? How? • If you had a romantic relationship with someone when growing up, do you think that person influenced how you think and feel about your body? (c) Reflections on their own picture: • Could you please tell me what the picture features? • Why did you choose this specific picture? • What is it that you like about this picture? • What kind of message does this picture send? • What does this picture say about you as a person? (d) Appearance ideals in the media: (Participants are shown a set of typical images of appearance ideals from the media). • What do you think when you see these images? • Are these examples of appearance ideals that you strive for? Why/why not? • Do you usually compare yourself to such images? Why/why not? • Do you feel down when you think about appearance ideals? Why/why not? • Do you have any specific strategies for coping with these images? (e) Reflections on their own body image journey: (Participants are informed about their positive body image development at this stage of the interview). • Why do you think you have been able to overcome a negative body image and develop a positive one? • What role do you think your physical appearance has played in your positive body image development? • What advice would you give to other people who are dissatisfied with their bodies—what should they do to feel better about themselves? Appendix B. The Swedish BAS-2 Directions for participants: Var god ange om följande påståenden stämmer in på dig aldrig, sällan, ibland, ofta eller alltid: 1 2 3 4

Jag respekterar min kropp Jag trivs med min kropp Jag tycker att min kropp har åtminstone några bra egenskaper Jag har en positiv inställning till min kropp

63

5 6 7 8

Jag är uppmärksam på min kropps behov Jag känner kärlek till min kropp Jag uppskattar min kropps olika och unika egenskaper Mitt beteende visar min positiva inställning till min kropp, till exempel sträcker jag på mig och ler 9 Jag är bekväm i min kropp 10 Jag tycker att jag är vacker även om jag inte ser ut som attraktiva människor (t ex modeller, skådespelare) på bilder i media Appendix C To further illustrate the participants’ different body image journeys, the cases of Sara and Jakob are presented (for illustrated trajectories of their BESAA development, see Figs. 1 and 2). Sara Sara’s BESAA scores in the longitudinal research project were 2.98 (10 years), 2.80 (13 years), 2.74 (16 years), 2.71 (18 years), 2.71 (21 years) and 3.40 (24 years). Sara’s BAS-2 score at the time of the interview (age 26 years) was 4.00. In the interview, Sara described being unhappy with several aspects of her body as an early adolescent. She perceived herself to be shorter and skinnier than her peers, and as she entered puberty she suffered from facial acne, which she was very preoccupied with and strove to cover with makeup. She was also annoyed that her skin was much fairer than her peers’ skin and that she was unable to get a tan. From a young age, Sara was a dancer and spent much of her time in the dancing community. Appearance pressure was high in this context and many of her peers suffered from eating disorders. Although Sara did not develop an eating disorder, she clearly paid a lot of negative attention to her physical appearance. Several turning points were identified in Sara’s story. For example, she described how her first boyfriend in ninth grade was a real “boost” to her body image: “I had a lot of acne at the time and couldn’t for the world understand why he still wanted to be with me, even though my face was full of acne. But he wanted to, and we were so in love.” Sara also described several experiences in relation to feelings of increased agency and empowerment, and how these helped improve her body image. For example, in terms of sexuality, she said that she was very inhibited when she was younger, but that as she became older she learned to be more attuned to her body, her needs and desires. Sara also experienced empowerment in relation to the physical appearance of her body. She said that by having explored many alternative styles of clothing and makeup, she realized that she did not need certain clothing or makeup to be comfortable in her body, and that while she still occasionally enjoyed dressing up and wearing makeup, she preferred looking natural. Sara also said that she had worked hard to finally dare to “take up space” in the world and to have a voice in social contexts, by relying not on her physical appearance but on her personality. She also described actively using various strategies to improve her body image, such as trying to accept her body and not engaging with appearance ideals. At the time of the interview, Sara felt integrated with her body and had come to accept the acne scars on her cheeks, her short height, and her fair skin, although she admitted that she constantly strove to maintain acceptance of these aspects of her body. She said that her body image varied over the month with her menstrual cycle and that she needed to remind herself every time she felt swollen, to appreciate it as a sign that her body was functioning properly. Sara had a strong feminist identity, following feminist fat activist blogs. Her stance towards beauty ideals in the media was critical, although she admitted a part of her envied such beauty. In the future, she believed it would be an important task to teach her children to be accepting of their own appearance.

64

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65

Jakob Jakob’s BESAA scores in the longitudinal research project were 3.39 (10 years), 2.06 (13 years), 3.68 (16 years), 3.74 (18 years), 3.60 (21 years) and 3.49 (24 years). Jakob’s BAS-2r score at the time of the interview (age 26 years) was 4.20. In the interview, Jakob said that he was always much shorter than his peers and that, throughout early adolescence, felt as though he was always treated differently because of his height. He was pushed, beaten, and excluded from the peer group. Although he was comforted by his mother, who said that he was fine the way he was, it was hard for him to believe her. To endure this period in his life, he tried to focus on other things, such as doing well at school. The real turning point for Jakob, however, was when he started to do weight training at the gym, encouraged by a bet he had made with a peer. Jakob realized that weight training was different from all the other sports he had tried and disliked, and he enjoyed seeing the fast and increasing physical results of his dedication in the gym. His new hobby gave him a new, central role in the peer group: “When I started doing weight training, we had something in common. Something they wanted from me. ‘You’re more muscular than me, could you give some advice?’ . . . All of a sudden, people started to listen to me . . . I was no longer picked last in physical education. Sometimes they even picked me first. When people start acknowledging you, that really affects you from within.” Jakob’s increased confidence was also a springboard for him to dare to get to know new people and find friends with similar interests, not only related to weight training. At the time of the interview, Jakob still enjoyed weight training but said he had a soberer attitude to it and exercised because it was a natural part of his lifestyle. He did not put too much time into it any longer because “you need to have time to live a little as well.” Jakob came to accept his height and appreciated that his body was flexible and adaptable and could do many different things. He said that his weight training had helped him listen to his body and be more attuned to what it could and could not do. When exposed to muscular media images, his strategy was to think that the subject spent too much time training and had probably abandoned more important things along the way. References Alleva, J. M., Martijn, C., Van Breukelen, G. J., Jansen, A., & Karos, K. (2015). Expand Your Horizon: A programme that improves body image and reduces self-objectification by training women to focus on body functionality. Body Image, 15, 81–89. http://dx.doi.org/10.1016/j.bodyim.2015.07.001 Alleva, J. M., Tylka, T. L., & Kroon Van Diest, A. M. (2017). The Functionality Appreciation Scale (FAS): Development and psychometric evaluation in U.S. community women and men. Body Image, 23, 28–44. http://dx.doi.org/10. 1016/j.bodyim.2017.07.008 Andrew, R., Tiggemann, M., & Clark, L. (2016). Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Developmental Psychology, 52, 463–474. http://dx.doi.org/10.1037/dev0000095 Augustus-Horvath, C., & Tylka, T. L. (2011). The acceptance model of intuitive eating: A comparison of women in emerging adulthood, early adulthood, and middle adulthood. Journal of Counseling Psychology, 58, 110–125. http://dx.doi. org/10.1037/a0022129 Avalos, L. C., & Tylka, T. L. (2006). Exploring a model of intuitive eating with college women. Journal of Counseling Psychology, 53, 486–497. http://dx.doi.org/10. 1037/0022-0167.53.4.486 Bird, E. L., Halliwell, E., Diedrichs, P. C., & Harcourt, D. (2013). Happy being me in the UK: A controlled evaluation of a school-based body image intervention with pre-adolescent children. Body Image, 10, 326–334. http://dx.doi.org/10. 1016/j.bodyim.2013.02.008 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. http://dx.doi.org/10.1191/ 1478088706qp063oa Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1, 185–216. http://dx.doi.org/10.1177/ 135910457000100301 Bucchianeri, M. M., Arikian, A. J., Hannan, P. J., Eisenberg, M. E., & Neumark-Sztainer, D. (2013). Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body Image, 10, 1–7. http://dx.doi.org/10.1016/j.bodyim.2012.09.001

Burgess, G., Grogan, S., & Burwitz, L. (2006). Effects of a 6-week aerobic dance intervention on body image and physical self-perceptions in adolescent girls. Body Image, 3, 57–66. http://dx.doi.org/10.1016/j.bodyim.2005.10.005 Davison, T. E., & McCabe, M. P. (2006). Adolescent body image and psychosocial functioning. Journal of Social Psychology, 146, 15–30. http://dx.doi.org/10.3200/ SOCP.146.1.15-30 Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227–268. http://dx.doi.org/10.1207/S15327965PLI1104 01 Duarte, C., Pinto-Gouveia, J., & Stubbs, R. J. (2017). The prospective associations between bullying experiences, body image shame and disordered eating in a sample of adolescent girls. Personality and Individual Differences, 116, 319–325. http://dx.doi.org/10.1016/j.paid.2017.05.003 Duncan, M. J., Al-Nakeeb, Y., & Nevill, A. M. (2009). Effects of a 6-week circuit training intervention on body esteem and body mass index in British primary school children. Body Image, 6, 216–220. http://dx.doi.org/10.1016/j.bodyim. 2009.04.003 Eisenberg, M. E., Neumark-Sztainer, D., & Paxton, S. J. (2006). Five-year change in body satisfaction among adolescents. Journal of Psychosomatic Research, 61, 521–527. http://dx.doi.org/10.1016/j.jpsychores.2006.05.007 Erling, A., & Hwang, C. P. (2004). Body-esteem in Swedish 10-year-old children. Perceptual and Motor Skills, 99, 437–444. http://dx.doi.org/10.2466/PMS.99.5. 437-444 Feltman, C. E., & Szymanski, D. M. (2017). Instagram use and self-objectification: The roles of internalization, comparison, appearance commentary, and feminism. Sex Roles, 78, 311–324. http://dx.doi.org/10.1007/s11199-017-07961 Fogelkvist, M., Parling, T., Kjellin, L., & Gustafsson, S. A. (2016). A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. Journal of Eating Disorders, 4, 1–9. http://dx.doi.org/10.1186/s40337-016-0120-4 Frisén, A., & Holmqvist, K. (2010a). Physical, sociocultural, and behavioral factors associated with body-esteem in 16-year-old Swedish boys and girls. Sex Roles, 63, 373–385. http://dx.doi.org/10.1007/s11199-010-9806 Frisén, A., & Holmqvist, K. (2010b). What characterizes early adolescents with a positive body image? A qualitative investigation of Swedish girls and boys. Body Image, 7, 205–212. http://dx.doi.org/10.1016/j.bodyim.2010.04.001 Frisén, A., Holmqvist Gattario, K., & Lunde, C. (2014). Projekt perfekt. Om utseendekultur och kroppsuppfattning [Project perfect. About appearance culture and body image]. Stockholm, Sweden: Natur och Kultur. Frisén, A., Lunde, C., & Berg, A. I. (2015). Developmental patterns in body esteem from late childhood to young adulthood: A growth curve analysis. The European Journal of Developmental Psychology, 12, 99–115. http://dx.doi.org/10. 1080/17405629.2014.951033 Gattario, K. H., & Lunde, C. (2018). Appearance-related practices: Can they be part of a positive body image? In E. A. Daniels, M. M. Gillen & C. H. Markey (Eds.), The body positive: Understanding and improving body image in science and practice (pp. 111–134). Cambridge, UK: Cambridge University Press. Gattario, K. H., Frisén, A., Fuller-Tyszkiewicz, M., Ricciardelli, L. A., Diedrichs, P. C., & Yager, Z., et al. (2015). How is men’s conformity to masculine norms related to their body image? Masculinity and muscularity across Western countries. Psychology of Men & Masculinity, 16, 337–347. http://dx.doi.org/10.1037/ a0038494 Góngora, V. C. (2014). Satisfaction with life, well-being, and meaning in life as protective factors of eating disorder symptoms and body dissatisfaction in adolescents. Eating Disorders, 22, 435–449. http://dx.doi.org/10.1080/ 10640266.2014.931765 Grogan, S. (2017). Body image: Understanding body dissatisfaction in men, women and children (3rd ed.). New York, NY: Routledge. Halliwell, E. (2015). Future directions for positive body image research. Body Image, 14, 177–189. http://dx.doi.org/10.1016/j.bodyim.2015.03.003 Hausenblas, H. A., & Fallon, E. A. (2006). Exercise and body image: A meta-analysis. Psychology & Health, 21, 33–47. http://dx.doi.org/10.1080/ 14768320500105270 Helfert, S., & Warschburger, P. (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. http://dx.doi.org/10.1016/j.bodyim.2011.01.004 Holmqvist, K., & Frisén, A. (2012). I¨ bet they aren’t that perfect in reality:” Appearance ideals viewed from the perspective of adolescents with a positive body image. Body Image, 9, 388–395. http://dx.doi.org/10.1016/j.bodyim.2012. 03.007 Kling, J., Holmqvist Gattario, K., & Frisén, A. (2017). Swedish women’s perceptions of and conformity to feminine norms. Scandinavian Journal of Psychology, 58, 238–248. http://dx.doi.org/10.1111/sjop.12361 Lemoine, J. E., Konradsen, H., Lunde, J. A., Roland-Lévy, C., Ny, P., & Khalaf, A., et al. (2018). Factor structure and psychometric properties of the Body Appreciation Scale-2 among adolescents and young adults in Danish, Portuguese, and Swedish. Body Image, 26, 1–9. http://dx.doi.org/10.1016/j.bodyim.2018.04.004 Lev-Ari, L., Baumgarten-Katz, I., & Zohar, A. H. (2014). Show me your friends, and I shall show you who you are: The way attachment and social comparisons influence body dissatisfaction. European Eating Disorders Review, 22, 463–469. http://dx.doi.org/10.1002/erv.2325 Lunde, C., & Frisén, A. (2011). On being victimized by peers in the advent of adolescence: Prospective relationships to objectified body consciousness. Body Image, 8, 309–314. http://dx.doi.org/10.1016/j.bodyim.2011.04.010

K.H. Gattario, A. Frisén / Body Image 28 (2019) 53–65 Mahalik, J. R., Locke, B. D., Ludlow, L. H., Diemer, M. A., Scott, R. P. J., & Gottfried, M., et al. (2003). Development of the conformity to masculine norms inventory. Psychology of Men & Masculinity, 4, 3–25. http://dx.doi.org/10.1037/1524-9220. 4.1.3 Mahlo, L., & Tiggemann, M. (2016). Yoga and positive body image: A test of the embodiment model. Body Image, 18, 135–142. http://dx.doi.org/10.1016/j. bodyim.2016.06.008 McCabe, M. P., Connaughton, C., Tatangelo, G., Mellor, D., & Busija, L. (2017). Healthy me: A gender-specific program to address body image concerns and risk factors among preadolescents. Body Image, 20, 20–30. http://dx.doi.org/10. 1016/j.bodyim.2016.10.007 Meland, E., Haugland, S., & Breidablik, H. (2007). Body image and perceived health in adolescence. Health Education Research, 22, 342–350. http://dx.doi.org/10. 1093/her/cyl085 Mendelson, B. K., Mendelson, M. J., & White, D. R. (2001). Body-Esteem Scale for adolescents and adults. Journal of Personality Assessment, 76, 90–106. http://dx. doi.org/10.1207/S15327752JPA7601 6 Menzel, J. E., Schaefer, L. M., Burke, N. L., Mayhew, L. L., Brannick, M. T., & Thompson, J. K. (2010). Appearance-related teasing, body dissatisfaction, and disordered eating: A meta-analysis. Body Image, 7, 261–270. http://dx.doi.org/ 10.1016/j.bodyim.2010.05.004 Nelson, S., Kling, J., Wängqvist, M., Frisén, A., & Syed, M. (2018). Identity and the body: Trajectories of body-esteem from adolescence to emerging adulthood. Developmental Psychology, 54, 1159–1171. http://dx.doi.org/10.1037/ dev0000435 Ohring, R., Graber, J. A., & Brooks-Gunn, J. (2002). Girls’ recurrent and concurrent body dissatisfaction: Correlates and consequences over 8 years. The International Journal of Eating Disorders, 31, 404–415. http://dx.doi.org/10. 1002/eat.10049 Peterson, R. D., Tantleff-Dunn, S., & Bedwell, J. S. (2006). The effects of exposure to feminist ideology on women’s body image. Body Image, 3, 237–246. http://dx. doi.org/10.1016/j.bodyim.2006.05.004 Piran, N. (2016). Embodied possibilities and disruptions: The emergence of the Experience of Embodiment construct from qualitative studies with girls and women. Body Image, 18, 43–60. http://dx.doi.org/10.1016/j.bodyim.2016.04. 007 Piran, N. (2017). Journeys of embodiment at the intersection of body and culture: The developmental theory of embodiment. San Diego, CA: Elsevier, Academic Press. Piran, N., & Mafrici, N. (2012). Preventing body image problems: Ecological and activism approaches. Encyclopedia of Body Image and Human Appearance, 674–679. http://dx.doi.org/10.1016/B978-0-12-384925-0.00107-3 Piran, N., & Teall, T. (2012). The developmental theory of embodiment. In G. McVey, M. P. Levine, N. Piran & H. B. Ferguson (Eds.), Preventing eating-related and weight-related disorders: Collaborative research, advocacy, and policy change (pp. 171–199). Waterloo, ON: Wilfred Laurier Press. Rogers, C. B., Webb, J. B., & Jafari, N. (2018). A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018). Body Image, 27, 43–60. http://dx.doi.org/10.1016/j. bodyim.2018.08.003

65

Rubin, L. R., Nemeroff, C. J., & Russo, N. F. (2004). Exploring Feminist Women’s Body Consciousness. Psychology of Women Quarterly, 28, 27–37. http://dx.doi.org/10. 1111/j.1471-6402.2004.00120 Sharpe, H., Patalay, P., Choo, T.-H., Wall, M., Mason, S. M., & Goldschmidt, A. B., et al. (2017). Bidirectional associations between body dissatisfaction and depressive symptoms from adolescence through early adulthood. Developmental Psychopathology, 30, 1447–1458. http://dx.doi.org/10.1017/ S0954579417001663 Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 51–80). London, UK: Sage Publications. Smolak, L. (2012). Body image development – Girl children. In T. F. Cash (Ed.), Encyclopedia of body image and human appearance (pp. 212–218). London, UK: Academic Press. Striegel-Moore, R. H., & Cachelin, F. M. (1999). Body image concerns and disordered eating in adolescent girls: Risk and protective factors. In N. G. Johnson & M. C. Roberts (Eds.), Beyond appearance: A new look at adolescent girls (pp. 85–108). Washington, DC: American Psychological Association. Swami, V., & Ng, S. (2015). Factor structure and psychometric properties of the Body Appreciation Scale-2 in university students in Hong Kong. Body Image, 15, 68–71. http://dx.doi.org/10.1016/j.bodyim.2015.06.004 Thompson, J. K., Coovert, M. D., & Stormer, S. M. (1999). Body image, social comparison, and eating disturbance: A covariance structure modeling investigation. The International Journal of Eating Disorders, 26, 43–51. http://dx. doi.org/10.1002/(SICI)1098-108X(199907)26:1<43::AID-EAT6>3.0.CO;2-R Tiggemann, M., Coutts, E., & Clark, L. (2014). Belly dance as an embodying activity? A test of the embodiment model of positive body image. Sex Roles, 71, 197–207. http://dx.doi.org/10.1007/s11199-014-0408-2 Tylka, T. L., & Homan, K. J. (2015). Exercise motives and positive body image in physically active college women and men: Exploring an expanded acceptance model of intuitive eating. Body Image, 15, 90–97. http://dx.doi.org/10.1016/j. bodyim.2015.07.003 Tylka, T. L., & Wood-Barcalow, N. (2015a). The Body Appreciation Scale-2: Item refinement and psychometric evaluation. Body Image, 12, 53–67. http://dx.doi. org/10.1016/j.bodyim.2014.09.006 Tylka, T. L., & Wood-Barcalow, N. (2015b). What is and what is not positive body image? Conceptual foundations and construct definition. Body Image, 14, 118–129. http://dx.doi.org/10.1016/j.bodyim.2015.04.001 Webb, J. B., Wood-Barcalow, N., & Tylka, T. L. (2015). Assessing positive body image: Contemporary approaches and future directions. Body Image, 14, 130–145. http://dx.doi.org/10.1016/j.bodyim.2015.03.010 Westerberg-Jacobson, J., Edlund, B., & Ghaderi, A. (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. http://dx.doi.org/10.1002/erv.983 Wood-Barcalow, N., Tylka, T. L., & Augustus-Horvath, C. (2010). “But I like my body”: Positive body image characteristics and a holistic model for young-adult women. Body Image, 7, 106–116. http://dx.doi.org/10.1016/j. bodyim.2010.01.001