The impact of appearance dissatisfaction on health

1. The impact of appearance dissatisfaction on health

2. Goals of this session: • To be able to: • Explain, using examples, how and why appearance can influence health behaviours • Explain how health behaviours might impact on appearance • Understand the often complex link between physical health and appearance • Reflect on how appearance issues might be relevant when discussing and promoting physical health with vocational trainees

3. Background: Levels of appearance dissatisfaction in the general population are very high: • In a study of more than 4,000 girls aged 10-11, 1 in 13 (around 7%) said they ‘never like my body’ and many felt pressure to have a ‘perfect body’ (Austin et al 2009) • 50‐70% of adolescent boys and girls in Western societies are dissatisfied with some aspect of their appearance, with girls wanting to be thinner and boys wanting to be more muscular (McCabe & Ricciardelli, 2004)

4. In a survey of over 1,000 women aged 30-74 years in Switzerland, more than 70% wanted to be thinner (although 73% of these were normal weight) (Allaz et al 1998)

5. This dissatisfaction can be a result of people thinking that they have not achieved the ‘ideal’ that is widely portrayed in the media: • Slim ideal for women • Muscular ideal for men

6. People who are dissatisfied or anxious in this way may try to alter their appearance, for example by doing things that they believe will change how they look. • However, these behaviours (the things they do) can have a negative impact on their health. • So, this session examines the impact that appearance dissatisfaction can have on physical health and encourages trainers to consider the role of appearance when discussing physical health matters with vocational trainees.

7. Activity: • List 6 things (behaviours) that a vocational trainee might do to change their appearance: • … • … • … • … • … • … • How might this behaviour impact on their health? • … • … • … • … • … • …

8. Whilst a lot of different health behaviours could influence appearance, this session uses the examples of: • Smoking • Physical activity • Eating and dieting

9. Health Behaviour 1: Smoking • The negative, sometimes fatal, impact of smoking is well known, including: • Poor circulation & heart problems • Shortness of breath • Increased risk of lung cancer • Erectile dysfunction • Fertility problems • Increased chances of miscarriage and low birthweight babies But it can also be an appetite suppressant, so some people who are unhappy with their weight think that smoking will help them to lose weight and therefore make them happier.

10. Research has found that: • Adolescent girls and adult women who are unhappy with the way they look are more likely to start and continue smoking • Around 50% of young women smoke in order to control their weight • Fear of gaining weight is a reason why some people don’t try to give up smoking

11. .. but smoking also impacts on appearance in other ways including.. • Wrinkles, especially around the eyes & lips • Damaged & stained teeth & gums • Pale, uneven skin colour • Stained fingers • Poor complexion • Hair loss • Sagging skin • Increased chance of developing skin conditions such as psoriasis • Increased risk of brittle bones & osteoporosis, which can result in curvature of the spine • Bad breath

12. Which twin smoked? (source: http://www.webmd.boots.com/smoking-cessation/ss/slideshow-ways-smoking-affects-looks)

13. Twin B smoked half a pack of cigarettes a day for 14 years, while her sister never smoked. Twin B also got more sun, damaging her skin from the outside, too.

14. Activity during the week: • If you want to see what you might look like if you were to smoke throughout adulthood, try using this app: Smoking Time Machine available from https://itunes.apple.com/gb/app/id605504270?mt=8&affId=1860684

15. A cautionary note: Whilst some research suggests that seeing how they might look in the future if they continue to smoke can encourage people to stop smoking, its important to be careful to ensure that this approach doesn’t reinforce negative views about ageing and appearance, or beliefs that some types of appearance are more or less acceptable than others.

16. Could smoking-related changes to appearance impact on other aspects of a person’s life? Consider this scenario: • Tom is 25 and smokes 20 cigarettes a day. He is going for an interview for a job as a waiter. When he arrives, the restaurant manager notices that Tom’s fingers are stained yellow and his breath smells….. • What happens next? Does Tom get the job?

17. In summary • Smoking has a detrimental impact on physical health. • Appearance is often a motivator to begin or continue smoking. • Smoking has an impact on physical appearance. • But interventions aiming to stop people smoking need to be careful not to promote negative views about ageing.

18. Smoking: tips for vocational trainers (1) • Encourage students to stop smoking, if they already do so • Support those who are trying to stop • Avoid reinforcing appearance ideals when talking about smoking – instead, focus on the benefits to physical health and the money that could be saved by not smoking.

19. Smoking: tips for vocational trainers (2) • Direct students to sources of support to help them stop smoking, and encourage them to use them. • Encourage healthy alternatives to smoking in order to control weight (see also the later slides on dieting and eating). • Be a good role model to your students.

20. Health Behaviour 2: Physical activity • The relationship between appearance/body image and physical activity is complex. • Appearance can be both a motivator to exercise, and a deterrent.

21. The benefits of regular physical activity (not only structured sport & exercise) are well documented, including: • Physical benefits: • Lower blood pressure • Improved cardiac functioning, muscle strength & lung capacity • Stronger bones (less osteoporosis) • Reduced disability • Reduced risk of some cancers (such as breast cancer, colon cancer) • Psychosocial benefits: • Improved quality of life • Improved mood • Reduced levels of anxiety and depressive symptoms • Improved body satisfaction

22. Physical inactivity in Europe:Yet despite the known benefits to health, research shows that most people in Europe don’t do the amount of physical activity recommended each week. These are examples of the percentages that don’t exercise at all: 16.6% 24.1% 18.4% 6.4% 16.4% (Haase, Steptoe, Sallis & Wardle, 2004; Varo et al, 2003)

23. Activity: • Why do you think many people don’t do the recommended amount of exercise each week? • How relevant to your students is appearance as a motivator to exercise?

24. Research shows: • Women are more likely than men to exercise in order to maintain or lose weight. • Exercising to change appearance (by toning muscle and/or losing weight) could be beneficial to health. • Noticing changes to their appearance once they start to exercise can motivate some people to keep physically active. • Its not entirely clear what activity, intensity and frequency of activity and exercise is needed to have positive effects on body image.

25. Research has shown improvements to body satisfaction after: • An 8 week brisk walking programme (Anderson et al 2006) • A 6 week programme of 40 minutes of circuit training per week (Duncan et al 2009). • Some evidence suggests that a single session of exercise can improve body satisfaction (Vocks et al 2009).

26. BUT… • Body image concerns and placing too much importance on appearance can lead to over-exercising, which can be associated with health issues including cardio-vascular problems, eating disorders and osteoporosis. • Health issues such as osteoporosis (weakened bone structure that can lead to curvature of the spine) can increase appearance-related concerns.

27. Another cautionary note: • When people are motivated to exercise because they want to change their appearance, its possible that exercising may actually increase their level of appearance-related concerns and dissatisfaction. • This may be because they start to compare their body, inappropriately, with other exercisers and/or start to monitor their own appearance more intensely. • This can lead to an increase in other unhealthy behaviours (for example unhealthy eating, excessive exercise or using steroids).

28. As well as prompting some people to be more physically active, appearance concerns can also be a barrier that stops some people exercising at all. ACTIVITY: • Sam is unhappy with how he looks and thinks he is overweight. His friend has suggested he goes to a gym, but Sam isn’t keen. • Why do you think Sam doesn’t want to go to the gym? • How might Sam’s friend influence how he feels, and whether he exercises? • What advice would you give to Sam?

29. Avicious cycle of exercise avoidance & appearance-concerns can be created: Avoidance of exercise High levels of social physique anxiety (worry that other people will judge their body negatively) Self-conscious about appearance Appearance concerns (Atalay& Gençöz2008: Townsend 2013)

30. With netball, I know a couple of girls that quit because they thought they were too big to wear a body suit • Quote in Slater & Tiggemann (2010)

31. Making exercise a social activity can increase the sense of enjoyment and the likelihood that someone will keep exercising.

32. People are more likely to keep exercising and physically active if: • they find it enjoyable • they are motivated by improving fitness and functionality, rather than by changing their appearance.

33. Yet another cautionary note: • Its important to get the balance right.. excessive exercise can be detrimental to physical & mental health • Using performance enhancing drugs (e.g. steroids) can have a negative impact on health and appearance • Exercise environments (e.g. the presence & position of mirrors, or the images used on posters to advertise exercise classes) can increase appearance dissatisfaction and act as a barrier that stops people participating

34. Getting the balance rightACTIVITY: Which of these lifestyles would you prefer? Why? • Jack is 25 and single. He never drinks alcohol or eat fatty foods and goes to the gym for at least 3 hours every day. He rarely socialises because it would interfere with his lifestyle. He says he is unhappy. • David is 25 and single. He drinks alcohol about twice a week, eats a healthy diet but doesn’t deny himself less healthy food too. He has a busy social life but still fits in some form of exercise 3 times a week, often playing football with friends. He considers himself happy.

35. In summary: • Physical activity is beneficial to physical and mental health. • It may also improve levels of appearance concerns. • But people who are very anxious about their body and other people’s reactions to how they look tend to avoid exercise • Appearance concerns can also lead to excessive exercise, which has implications for health. • Exercising purely for appearance reasons is less likely to be effective and lasting than exercising for other reasons, such as enjoyment.

36. Physical activity: Tips for vocational trainers (1) • Encourage vocational students to exercise regularly, to improve their physical and mental health • Encourage them to engage in the exercise and activities that they enjoy • Emphasise the functional benefits of exercise and physical activity, not the impact it may have on appearance

37. Physical activity: Tips for vocational trainers (2) • Promote physical activity as an enjoyable social activity • Consider the appropriateness of any exercise-related images and facilities provided at your institution • Be a good role model to your students.

38. Health Behaviour 3: Eating & Dieting • 90% of all women aged 15 to 64 worldwide want to change at least one aspect of their appearance - with body weight ranking the highest. • Many women and men eat unhealthily as a way of controlling their weight.

39. Body dissatisfaction is associated with unhealthy eating. • It has also been linked to • increased dieting • less likelihood of eating fruit (compared with people who are satisfied with their bodies)

40. Unhealthy eating includes ‘crash’ diets and taking unhealthy food supplements and diet pills • As well as being unhealthy, any weight loss is often short-term – and ineffective dieting and low self-esteem can result in weight gain.

41. The

42. 50% of British girls aged 8-21 years have been on a strict diet • in order to be more attractive to other people • because of the way the media portrays women

43. The benefits of a healthy diet: • Healthy eating (e.g. a balanced diet including fresh fruit and vegetables, and avoiding excessive amounts of food that have high fat and sugar content) offers benefits including: • Improved cardio vascular functioning • Reduced chances of developing some cancers • Muscle and bone strength

44. ‘Disordered eating’ • This refers to eating patterns that do not warrant a diagnosis of a specific eating disorder such as anorexia nervosa or bulimia nervosa. It includes: • Skipping meals • Not eating, even when feeling hungry • Eating a lot of no- or low-calorie foods • It can lead to may lead to fatigue, depression or poor concentration – which affect ability to study or work.

45. ‘Disordered eating’ is also a risk factor for the development of diagnosable eating disorders. • 1.6 million people in the UK alone have an eating disorder such as anorexia nervosa or bulimia nervosa (BEAT, 2010).

46. The impact of eating disorders on health. • Possible consequences include: • Osteoporosis • Tooth loss and decay • Heart failure • Fertility problems • Increased chance of miscarriage • Mental health problems • They can also be fatal.

47. Acting as a role model to your students: • Research has found that trainee health and physical education teachers have high rates of dieting and disordered eating, self-induced vomiting, laxative use and slimming pills (Yager and O’Dea, 2009). • As well as being damaging to their own health, they may be ‘modelling’ these behaviours and passing on bad habits to their students.

48. People do not only engage in unhealthy eating behaviours in order to manage their weight: • A desire to be more muscular has been linked with consuming protein supplements and steroid use. • Steroids can lead to acne, enlarged breasts and shrunken testicles – issues which can cause appearance dissatisfaction.

49. In summary • The association between eating, dieting and appearance concerns is complex. • It can be challenging to promote psychological and physical well-being without reinforcing appearance ideals that could be contributing to distress in the first instance.

50. Eating and dieting: Tips for vocational trainers (1) • Promote the benefits of healthy eating rather than dieting • Promote the benefits in terms of improved physical and psychological well-being, rather than appearance • Don’t ask students to engage in activities such as keeping food diaries or weighing themselves – these can prompt appearance dissatisfaction and unhealthy eating behaviours.