ISSN 1089-5701

Volume 9 Number 3 Fall 2000
Mirror, Mirror... Kids and Body Image

• Table of contents
• Editorial: The Link Between Body Issues and Behavioral Problems
  James R. Whitehead and John H. Hoover

Body, behavior, and Self-Esteem

The Link Between Body issues and Behavioral Problems
James R. Whitehead and John H. Hoover / 130

Is Self-Esteem Only Skin-Deep? The Inextricable Link Between Physical Appearance and Self-Esteem
Susan Harter / 13

Social Physique Anxiety and Physical Activity Among Adolescents
Robert C. Eklund and Theresa Bianco / 139

On Teenagers and Tattoos
Andres Martin / 143

Tormented Lifestyle
Eric / 145

Coping with serious body problems

Sticks, Stones, and the Stigmata of Childhood Illness and Disability
Joan Fleitas / 146

Bad Body Fever and Deliberate Self-Injury
Polly Nichols / 151

Mirror, Mirror, on the Wall, Who Is the Thinnest of Them All?
Roger Verdon / 157

Operation Smile: "Changing Lives, One Smile at a Time" / 162

Fostering Positive Interventions

Norman Normal Twenty Years Later
James R. Whitehead with Paula Hedlund, Tim Delmore, and Rebecca Swift / 166

Helping All Students Feel Good About Physical Activity
Charles B. Corbin / 73

Understanding the World of the "Fat Kid": Can Schools Help Provide a Better Experience?
Kenneth R. Fox and Laurel P. Edmunds / 177

Listening to Girls Talk About Their Bodies
Mimi Nichter / 182

Book Review—Fat Talk: What Girls and Their Parents Say About Dieting
Mary Ruth Laycock and Becky Dornheim / 185

Fostering Positive Body Image in Children and Youth
Stephanie T. Snow, The Center for Effective Collaboration and Practice / 187

The Link Between Body Issues and Behavioral Problems

James R. Whitehead and John H. Hoover

The guest editors for this special issue highlight the myriad behavioral and adjustment problems that flow from negative self-perceptions about body image. These negative beliefs are often exacerbated by peer harassment.

"Numerous children grow up in the constant dread of being laughed at. Ridicule of children is well nigh criminal. It retains its effect on the soul of the child, and is transferred into the habits and actions of his adulthood."

– Alfred Adler on feelings of inferiority, p. 71 (1932)

The primary question asked by adolescents and preteens is "Who am I?" In North American culture, identity is often wrapped up with appearance and perceptions about appearance. For example, it has been estimated that about 60% of U.S. women and girls over the age of 10 at any given time will report that they are dieting (Berg, 1992; Pipher, 1995). Children show a similar pattern, with a recent study of body dissatisfaction and dieting in young children indicating that 50% of third-through sixth-grade boys and girls wanted to weigh less, and 16% had tried to lose weight (Schur, Sanders, & Steiner, 2000). In that study, interviews showed that children "are immersed in a culture where messages about dieting are prevalent, and that they soak up the information that is so widespread in their environment." However, the data suggested that "the family can play a powerful role in countering the development of eating concerns in young children" (Schur et al., 2000, p. 81).

Unfortunately, evidence of negative perceptions of self related to physical size and appearance is ubiquitous – although ethnic differences are invariably found. For example, in a recent study of eating disorder symptoms in 11- to 16-year-old Black and White girls, scores on Body Dissatisfaction and Drive for Thinness increased with age in White – but not in Black – girls. Elevated body mass index (that is, heaviness for one’s height) was found to be associated with several elevated eating disorder symptom scales, and these results corroborated the literature on the psychological costs of being overweight. Ethnic differences were clear – with Black girls being vulnerable to developing binge-type eating disorders, and White girls more vulnerable than Black girls to developing dietary restraint problems such as anorexia (Striegal-Moore, Schreiber, Lo, Crawford, Obarzanek, & Rodin, 2000).

Among these "costs" can be health risks other than lowered self-perceptions. In a study in a recent issue of Pediatrics (Strauss, 2000), it was found that over a 4-year period, decreases in self-esteem were mildly evident in obese boys and particularly noticeable in obese White and Hispanic girls. Moreover, decreasing self-esteem in obese children was associated with increased rates of sadness, loneliness, and nervousness, and in addition, children with low self-esteem were more likely to smoke cigarettes and drink alcohol.

Paradoxically, a recent study also indicated that attractiveness can be a risk. Davis, Claridge, and Fox (2000) reported that among women college students, facial attractiveness was a risk factor for eating disorders when perfectionism was combined with anxiety and hypercriticality. Nichter (2000) noted that thin women receive criticism on that basis from other females.

These associations have not gone unnoticed by professionals and other leaders. Recently, the British Medical Association (Morant, 2000) urged broadcasters and publishers to be more responsible with regard to their tendency to depict extremely thin women as role models. Their report attacked the cult of "bodily perfection" in the media, and its message was supported by Tessa Jowell, the British Minister for Women – who emphasized how poor body image can lead to low self-esteem, eating disorders, and other problems. Poor body image among girls and women is powerfully addressed by Mimi Nichter as well as by Mary Ruth Laycock and Becky Dornheim in this issue of Reclaiming Children and Youth (RCY).

Fortunately, research and program evaluations have also shown that these problems may be prevented or remediated. In a recent editorial in the British Medical Journal, Frubeck (2000) wrote that the most successful prevention/ treatment programs are those that combine diet and exercise within a framework of significant behavior change. More centrally perhaps, it was concluded that key settings for such programs are family, school, and primary care. However, although education is effective, maintaining school programs in the long term is difficult due to competition for curricular time, need for teacher supervision, and financial limitations.

Although this literature is fairly well known to many professionals, other issues, such as bullying and teasing based on body shape, are important to health and fitness professionals, as well as to those individuals working with troubled children and teens. For example, many social and behavioral problems can be traced to body-based issues. Students often identify body types or body image as the reason they or others are harassed by peers. Being overweight is one of the five most common reasons that boys and girls identified for being bullied. Being physically weak is the trait most commonly cited by boys who are chronic victims of peer abuse. (See Hoover & Oliver, 1996, for a review of these peer aggression issues.) Such abuse may even lead to tragic consequences, such as the recent school shootings in Kentucky and Colorado. We were attracted to the Web site maintained by Joan Fleitas, who has written about it for this issue of the journal. It is dedicated to the plight of youth who are physically stigmatized by medical conditions and procedures.

Similarly, young people with disabilities evidence "body behavior" problems at rates higher than those seen in the general population. For example, overweight and unhealthy sedentary lifestyles are noted as a particular problem among students and adults with developmental disabilities (Rubin, Rimmer, Chicoine, Braddock, & McGuire, 1998; Wells, Turner, Martin, & Roy, 1997). Pipher (1995), among others, has noted that many psychological and behavioral problems among adolescents can be traced to the desire to be alluring to the opposite sex. For example, early (and perhaps unhealthy) sexual adventures may be based on the desire to have physical attractiveness validated by members of the opposite sex. The articles by Susan Harter and by Robert Eklund and Theresa Bianco both address what occurs when youth and adolescents become over-concerned with projections of their appearance to the outside world.

Although initially it was our eyes and our hearts that led us to believe that unhealthy eating behaviors, overly strict dieting habits, and physical self-image problems are over-represented among otherwise troubled youth, research data now support that view (Neumark-Sztainer & Hannan, 2000). Excellent physical education programs, those all-too-rare ones that take individual needs and sensibilities into account, can often be a "thread" reconnecting disconnected youth with caring adults. Both body image and physical education reform are addressed in this issue. Several years ago, Whitehead (1987) wrote about physical education programs that support children with special needs in the physical dimension. His article is reprinted here along with responses to it by several physical educators from around the United States. Unfortunately, it appears that physical education programs that are often little more than employment opportunities for coaches are still all too common.

Another example of the association between body and behavior is the case of depression. Susan Harter’s notable work has explored the relationships between physical appearance and unhappiness, depression, and suicidal ideation. Her article in this issue of RCY particularly highlights the inextricable link between appearance and self-esteem and depressive outcomes of negative physical self-perceptions. As an aside, we thought that those individuals interested in this topic might like to note that in a recent meta-analysis, physical activity/exercise was shown to be as effective in treating depression as pharmacological interventions and better than psychotherapy (Craft & Landers, 1998). It seems that the relationship between movement and cognitive development, long understood by developmentalists, has received new and vital attention from researchers.

A significant paradox exists in the delivery of physical education services to U.S. students. We preach the gospel of fitness and lifelong activity but often discriminate in practice against the most needy youngsters – those who are overweight and who evidence sedentary lifestyles. Rather, we cater to persons gifted in the physical domain; physical education courses become feeder systems, in essence, for interscholastic athletics.

With these body-related factors in mind, we proposed to the editorial board of this journal that an issue be dedicated to physical education and body image concerns. In a manner of speaking, we were motivated to introduce helping professionals who read RCY to the types of topics addressed by physical education and fitness experts, with an eye toward bringing these professionals together in the cause of reclaiming troubled young people.

James R. Whitehead, EdD, taught physical education in England for 13 years before returning to school at Arizona State University. Since 1988 he has been at the University of North Dakota, where he is currently an associate professor of physical education and exercise science. His teaching specialties are exercise psychology and fitness/wellness education. His research interests are motivation and physical self-perceptions and the application of theory in those areas to fitness promotion and education. Dr. Whitehead is a fellow of the AAHPERD Research Consortium and of the American College of Sports Medicine.

John H. Hoover, PhD, is director of the Bureau of Educationa1 Service and Applied Research at the University of North Dakota. His research interests include child-on-child aggression, rural service-delivery issues, and the transition to adult life of persons with disabilities. Dr. Hoover can be contacted at: Center for Teaching and Learning, Box 7189, University Station, University of North Dakota, Grand Forks, ND 58202-7189; 701/777-2513.

Adler, A. (1932). Understanding human nature. London; George Alan & Unwin.
Berg, F. M. (1992, July/August). Harmful weight loss practices are widespread among adolescents. Obesity and Health, 69 – 72.
Craft, L. L., & Landers, D. M. (1998). Effect of exercise on clinical depression and depression resulting from mental illness: A meta-analysis. Journal of Sport and Exercise Psychology, 20, 339-357.
Davis, C., Claridge, G., & Fox, J. (2000). Not just a pretty face; Physical attractiveness and perfectionism in the risk for eating disorders. International Journal of Eating Disorders, 27, 67 – 73.
Frubeck, G. (2000). Childhood obesity: Time for action, not complacency (Editorial). British Medical Journal, 320, 323.
Hoover, J. H., & Oliver, R. (1996). The bullying prevention handbook: A guide for teachers, administrators, and counselors. Bloomington, IN: National Educational Service.
Morant, H. (2000). BMA demands more responsible media attitude on body image (News). British Medical Journal, 320, 1495.
Neumark-Sztainer, D., & Hannan, P. J. (2000). Weight-related behaviors among adolescent girls and boys. Archives of Pediatric and Adolescent Medicine, 154, 569-577.
Nichter, M. (2000). Fat talk: What girls and their parents say about dieting. Cambridge, MA: Harvard University Press.
Pipher, M. (1995). Hunger pangs. Holbrook, MA: Adams.
Rubin, S. S., Rimmer, J. H., Chicoine, B., Braddock, D., & McGuire, D. E. (1998). Overweight prevalence in persons with Down syndrome. Mental Retardation, 36, 175-181.
Schur, E. A., Sanders, M., & Steiner, H. (2000). Body dissatisfaction and dieting in young children. International Journal of Eating Disorders, 27, 74 – 82.
Strauss, R. S. (2000). Childhood obesity and self-esteem. Pediatrics [On-line], 105(1), 15.
Striegal-Moore, R. H., Schreiber, G. B., Lo, A., Crawford, P., Obarzanek, E., & Rodin, J. (2000). Eating disorder symptoms in a cohort of 11 to 16-year-old black and white girls: The NHLBI Growth and Health Study. International Journal of Eating Disorders, 27, 49-66.
Wells, M. B., Turner, S., Martin, D., & Roy, A. (1997). Health gain through screening coronary heart disease and stroke: Developing primary health care services for people with intellectual disability. Journal of Intellectual and Developmental Disability, 22, 251 – 263.
Whitehead, J. (1987, August). Norman Normal: A tale of physical triumph. Journal of Physical Education, Recreation, and Dance, 58, 82 – 87.

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