Mainstreaming Body Equity: An ETFO-Commissioned Research Report

From the moment children begin to think about their bodies, at age four, they want to be thin. By age eight, although both girls and boys are struggling with body image, girls experience the issue much more keenly. Girls, for example, may refuse to wear shorts, believing their legs are too fat. By age 12, many girls just won't risk exposing their bodies to ridicule. And by age 15, many girls react to constant teasing and harassment about their bodies by resorting to extreme weight loss and binge eating. Girls who internalize increasingly negative thoughts about their bodies may withdraw from physical activities and other learning experiences.

Conversely, a positive body image builds self-esteem and creates well-adjusted children who are enthusiastic about life's opportunities.

In the Spring of 2001, ETFO contracted with Carla Rice and June Larkin to research the literature related to programs that have improved the body image of 4-to-14-year-old girls. This lengthy report formed the basis for the development of Reflections of Me: The ETFO Body Image Project. What follows is a summary of that research.

Body image is a term that is widely defined as the representation of outer appearance-a person's inner perception of her body (Thompson, 1999).

The two major models suggested for understanding the emergence of these problems are the developmental and socio-cultural models. While in practice socio-cultural and developmental factors overlap and influence each other, distinguishing between them is useful because it enables us to describe social processes influencing girls' views, as well as the ages and developmental stages at which these processes begin to affect them.

In this summary, we list the developmental and socio-cultural processes influencing the emergence of body image dissatisfaction and eating problems in 4 to 14 year old girls, and the recommendations we have developed from our discussion of these processes in the full report. Although body image problems are generally taken to mean food and weight issues, we have also taken into account girls' non-weight-related body image concerns, including their concerns about shape, facial features, skin colour, and physical abilities.

Development Factors

The developmental model is unique in its investigation of the role of childhood and adolescent development in the emergence of body image problems; tracing when and how children develop a physical self-concept and internalize cultural criteria used to judge their physical traits. The model focuses on body image formation in childhood; the effects of parents' negative body comments and modelling; the influence of pubertal status and body mass index, and the effects of self-esteem on children's evolving body images.

Body Image Formation in Early Childhood

Because children notice bodily differences years before they attach values to them, prevention programs aimed at children as young as four years old must attempt to challenge social norms that dictate what is considered attractive or acceptable. At these young ages, children must be taught that all differences in size, colour, characteristics, ability and overall appearance are "normal."

Negative Body Comments and Modelling by Parents

Because the research to date has demonstrated negative effects of parental criticism and modelling on children's body images, body image prevention programs must address parental influences. This component of school-based programming must attempt to educate parents about the power wielded by their body-related words, attitudes and actions. Parents must be encouraged to challenge their own weightist, racist, colourist, and ableist attitudes in order to address the effects of these attitudes on their children's body images. Parents should also be encouraged to trust children's internal hunger and satiety cues, understanding that children will naturally eat appropriate amounts and varieties of foods if given the opportunity.

The Influence of Pubertal Status

Because most of the research to date implicates puberty in body dissatisfaction, prevention programs should encourage the acceptance of all menarcheal ages as normal, as well as provide information and opportunities for discussion about pubertal changes and their effects on girls' bodies and body images. Evidently, any deviation from a perceived acceptable pubertal age can result in negative body-esteem and self-esteem. This is evidence that prevention programs must focus on the erosion of such "norms."

Body Mass Index

Because a high body mass index makes girls vulnerable to harassment and poor body image, prevention programming should avoid weighing students, or engaging in any other activity that calls attention to the size of girls' bodies. Moreover, given that what is considered "normal" BMI may vary according to race and ethnicity, prevention programs might consider messages that encourage students to question the societal weight, height and other body "norms."

Self Esteem

Many researchers recommend that prevention programs include a focus on self-esteem. While studies suggest a focus on self-esteem alone does not seem to improve girls' body images in the long term, it does not exacerbate existing body image problems, and may even inoculate some girls against developing more severe problems. In some aspects of the prevention program, a single sex environment may provide a more positive space for improving self-esteem in girls.

Socio-cultural Factors

The socio-cultural model emphasizes the social factors or processes through which children and adolescents learn to assess their bodily traits and differences and attempt to conform to cultural expectations for their bodies.

Harassment

This factor includes harassment related to weight, disability, racial origin, and sexuality.

Prevention programs must adopt concepts of body image that include, and go beyond, weight in order to target sexual, racial and disabilityrelated harassment. Programs must challenge societal concepts of acceptable physical appearance so that children include the entire appearance spectrum in their concepts of what is normal. Researchers note that school-based body image programs must educate children about racial, sexual, physical and facial differences so that students understand and accept all bodies as normal. (Cooke Macgregor, 1990; Matter and Matter, 1989; Mulderji, 1996; Rousso, 1984.)

Racial Difference in Body Image

Prevention programs must be careful to attend not only to weight-related aspects of body image, but to all of the features that are implicated in girls' body dissatisfaction. By challenging social norms that define attractiveness, prevention programs can help girls to internalize concepts of beauty that embrace all physical differences.

Acculturation

Prevention programs must be attuned to the immigration process and bicultural experiences of ethnicminority Canadians in order to address adequately the spectrum of factors that influence the body images of Canadian girls.

Social Comparison and Friendship Cliques

Overall, this research suggests that prevention efforts aimed at girls should consider friendship cliques as a target for intervention. These interventions should begin with grade 4 girls and continue throughout the middle school years.

Socio-economic Status and Social Mobility

Prevention programs should be careful to recognize that differences in economic resources among students, may affect their body satisfaction and access to physical activity or healthy food. Programs that promote healthy weight and eating, without acknowledging access issues, may put low-income girls at greater risk for developing body image and eating problems. Given the lack of Canadian data, care should be taken in making any connection between social class, social mobility, and skin colour. However, social stereotypes about skin colour, social class, and character should be explored in a body image curriculum.

Mass Media Processing

Media literacy components of prevention programs must be careful to address the role of the media in facilitating body image dissatisfaction and a drive for thinness, without ignoring other social factors that exacerbate media messages for girls. Media literacy components of prevention programs should also critique both stereotypical representations of women of colour in the media, as well as the absence of media role models for ethnic minorities.

Efficacy of Eating Disorder Prevention Programs: Pedagogy, Content, Scope

With the aim of preventing serious eating disorders among girls and young women, researchers have measured the efficacy of prevention programs in:

• decreasing female students' drive for thinness, body dissatisfaction, weight control, dieting and problem eating; and
• increasing their body satisfaction, self-esteem, media literacy and ability to resist harassment. In general, researchers have attempted to test the effectiveness of three components of programs designed for elementary, middle and high school students - program pedagogy, content, and scope.

Pedagogical Approaches in Eating Disorder Prevention Programs

To date, prevention programs using four pedagogical approaches for children and youth at different ages and stages of development have been evaluated and tested;

• didactic, information-based programs;
• interactive, activity-based programs;
• empowerment-relational approaches; and
• dramatic-theatre interventions.

Recommendations

• Programs should avoid taking a didactic approach. Because informationbased programs do not result in attitudinal and behavioural changes, many researchers have concluded that pure information is highly insufficient for prevention.
• Curriculum should encourage active participation in lessons. Research demonstrates that active participation in prevention programs is a necessity. Efforts should be made to develop curriculum ideas encouraging group work, teamwork, games, play, drama and activities where students participate at every stage.
• Girl-focused participatory programs should be developed and implemented as part of a comprehensive prevention strategy. Participatory approaches that allow for the experiences of girls to shape the program have been shown to increase girls' body esteem, self-esteem and resistance to teasing (Dahlgren Daigneault, 2000; Friedman, 1996; Piran, 1999; Rice and Russell, 2001). These programs could be run as focus groups within the school, directly addressing body image determinants such as peer influence and competition, sexual harassment at school, and racism.
• Prevention programs that focus on accepting diverse bodies should be designed for children in kindergarten through grade 5 using creative and age-appropriate activities. Creative prevention interventions are clearly needed for children, who as young as age six, are developing appearancerelated prejudices and body image concerns. Theatrical interventions have shown success for this age group. The National Eating Disorder Information Centre in Toronto is developing a puppet project that could be distributed in Ontario elementary schools.

Content of Eating Disorder Prevention Programs

Researchers have also evaluated the effectiveness of various aspects of the content of programs on target populations. They have looked at the effects on girls' body image, information about nutrition, eating disorders and genetics, inclusion of a physical fitness component and focus on media literacy.

Recommendations

• Content should de-emphasize nutritional information: Nutritional information should not be included, nor should moralistic messages about food be given. If some nutritional information is incorporated, discussion should focus on the unalterable genetic component of body size and weight. It is very important that children receiving information about healthy food choices understand that these choices will not necessarily lead to a specific body weight.
• Programs should avoid specific discussion of eating disorders: Researchers now agree that information about eating disorders should not be given to pre-pubertal children, and that program planners should use caution when including this information in programs designed for any age group. Curriculum should not glamorize or normalize eating disorders (e.g. case studies of recovering peers).
• Programs should aspire to provide positive representations of diverse bodies: Curriculum should provide role models with diverse bodies and looks, people who are praised for their accomplishments and their appearance. Students should also learn to discern stereotypes in depictions of people with different bodies, including differences based on ability, colour and size. These messages should be highlighted in every activity for each age group.
• Programs should emphasize the genetic component of weight, shape and other body traits: Children should be exposed to the reality of the genetic component of body weight, the inevitability of gaining weight during puberty, and the biology of other body traits such as physical disabilities and facial differences. Programs should never try to teach children how they should change their bodies, but rather the differences between what they cannot control (pubertal changes, genetic components of size and ability) and what they can control (development of a multi-faceted identity, selection of realistic role models, and variety in nutrition and exercise). When physical activity is promoted, efforts should be made to emphasize pleasure and enjoyment rather than weight loss.
• Curriculum should avoid pairing healthy eating and weight messages with media literacy. Researchers agree that pairing nutrition and exercise messages with media literacy is counterproductive, sending mixed messages to girls and boys. Students' anxieties can be exacerbated when the message to accept diverse bodies promoted in media literacy conflicts with the message of food and weight control advocated in the healthy eating and weights curriculum.
• Programs should address the diversity o f body image problems among adolescent girls. Because weight may not hold equal importance for girls' body images in all racial and ethnic groups, programs should address the range of body image issues girls face, including concerns related to skin colour or tone, facial features, hair, and height. Just as prevention programs discuss the relationship between sexism and body image, they must also address the effects of racism, classism and ableism on girls' body images and eating patterns, and help them feel comfortable expressing their differing experiences of their bodies (Larkin, Rice and Bennett, 2000; Levine and Smolak, 2001; Piran, 1996, 1998; Rice and Russell, 2001).

Scope of Prevention Programs

Researchers have raised questions about the scope of prevention programs, investigating what populations should be targeted (teachers, parents, girls, boys, children or adolescents), as well as how comprehensive programs should be (whether they should extend beyond the curriculum to the playground, bus, cafeteria and hallways).

• Body acceptance messages should be repeated at different ages and stages of development. Repeated exposure to non-dieting, weight acceptance and body acceptance messages is necessary for all age groups, and messages should be integrated into as many aspects of school experience as possible (different school contexts, i.e., cafeteria, playground, etc.).
• Parents' body biases must be addressed. Because the comments that parents make about weight and shape have been shown to affect children in elementary school, and because these comments increase as children grow older, parents should be made aware of the power that they wield. Efforts should be made to include parents in the prevention programming as early as possible.
• Curriculum and training should address teachers' body biases. Classroom teachers need training to implement prevention messages effectively and to confront their own body biases and their potential to transmit such attitudes to students participating in prevention programs. Programs should schedule training sessions for teachers before the onset of the program in order to prepare them for facilitation and allow them to explore their own attitudes about fat, physical differences, disabilities and body image.
• Peer-Focused Programs should be created. Considering that peer influence becomes important as children reach puberty, programs designed for girls entering puberty should use mentoring and peer education approaches to addressing weight and body image issues.
• Curriculum developers should develop programs that encourage boys to examine their own beliefs about body image. Because boys are often unable or unwilling to critically examine their own beliefs and because they tend to move into a defensive posture when gender equity issues are discussed, some researchers have suggested that they be excluded from prevention programs (Nichter, 1999; Phelps, 1999; Piran, 1998). While researchers agree girl-only sessions are most likely a necessity as girls enter puberty, the mixed classroom and common curriculum are potential tools for change that should not be abandoned. To target boys safely in mixed classrooms, programmers should develop curriculum interventions and content that are more sensitive to girls and boys with "different" bodies.
• Prevention programs should extend beyond classroom lessons to include changes in the overall school environment. Considering that students receive negative messages about their bodies in peer interactions beyond the classroom, programs must encourage the development and enforcement of school policies that address racial, sexual, weight-related and disability-related harassment.

General Recommendations for Body Image Curriculum: Mainstreaming Body Equity

We suggest that prevention initiatives should be integrated into subjects across the curriculum. We envision a curriculum that promotes acceptance of diverse bodies in the classroom and encourages students to question conformity to societal body norms. We offer two general recommendations for achieving these learning goals and specific recommendations for reaching them with students of different ages.

Develop a New Curriculum Focus on Body Equity

We recommend that the Elementary Teacher's Federation not produce another resource focusing on healthy eating and weights but instead create a resource focused on body equity, organized in an age-and-stage appropriate way. A body equity curriculum would weave together the study of gender, disability, race and class through the body, addressing representation of bodies in popular culture, historical understanding of bodily differences, and the experiences of people who do not fit societal body norms.

Mainstream the Body Equity Message Throughout the Elementary School Curriculum

We recommend that the Federation develop prevention materials that mainstream the body equity message in its elementary school curriculum. Mainstreaming body equity in an institution implies that body image should be regarded as cutting across issues in all policy and curriculum development.

Program Themes for Different Age Groups

Ages 4-7
Accepting Diverse Bodies

Ages 8-10
Promoting Body Acceptance and Building Resistance to Body-Based Harassment

Ages 11-14
Questioning Adherence to Body Norms

Dr. June Larkin is program director, Equity Studies Centre, Institute for Women's Studies and Gender Studies, University of Toronto. Dr. Carla Rice is a clinical program specialist, Body Image Project, Regional Women's Health Centre, Sunnybrook and Women's College Hospital. Maura Jette, M.A. Candidate, is a research assistant, York University School of Women's Studies. Body Equity is a concept developed by Carla Rice, Vanessa Russell, and Margaret Wells through the Toronto District School Board's Embodying Equity Program.

---

Bibliography

Cooke Macgregor, F. 1990. "Facial Disfigurement: Problems and Management of Social Interaction and Implications for Mental Health." Aesthetic Plastic Surgery, 14, 249-257.

Dahlgren Daigneault, S. 2000. Body Talk: A School-Based Group Intervention for Working with Disordered Eating Behaviours. Journal for Specialists in Croup Work, 25, 191-213.

Friedman, S.S. 1996. "Girls in the 90s." Eating Disorders, 4, 238-244. Larkin, j., Rice, C. and M. Bennett. 2000. "Body Based Harassment, Body Image and Disordered Eating Patterns: Clinical and Educational Implications." Paper presented at the Annual Conference of the Canadian Psychological Association, Ottawa.

Levine, M.P., and L. Smolak. 2001. "Primary Prevention of Body Image Disturbances and Disordered Eating in Childhood and Early Adolescence." In K.J. Thompson and L. Smolak (eds.), Body Image, Eating Disorders, and Obesity in Youth (pp. 237-260). Baltimore: United Book Press.

Matter, D.E., and R. M. Matter. 1989. "If beautiful is good, then ugly must be...: Confronting Discrimination Against the Physically Unattractive Child." Elementary School Guidance and Counseling, 24, 146-152.

Mulderij, K.j. 1996. "Research into the Lifeworld of Physically Disabled Children." Child Care, Health and Development, 22, 31 1-322.

Nichter, M., N. Vuckovic, N., and S. Parker 1999. The looking good, feeling good program: A multi-ethnic intervention for healthy body image, nutrition, and physical activity. In N. Piran, M.P. Levine & C. Steiner-Adair (Eds.), Preventing Eating Disorders: A Handbook of Interventions and Special Challenges, (pp. 1 75-193). Ann Arbor: Edwards Brothers.

Phelps, L., L. S. Johnston, and K. Augustyniak, K. 1999. Prevention of eating disorders: Identification of predictor variables. Eating Disorders, 7, 99-108. Phelps, L., M. Dempsey, J. Sapia, J. and L. Nelson 1999. The efficacy of a school-based eating disorder prevention program: Building physical self-esteem and personal competencies. In N. Piran, M.P. Levine & C. Steiner-Adair (Eds.), Preventing Eating Disorders: A Handbook of Interventions and Special Challenges, (pp. 163-174). Ann Arbor: Edwards Brothers.

Piran, N. 1999a. "The Reduction of Preoccupation with Body Weight and Shape in Schools: A Feminist Approach." In N. Piran, M.P. Levine and C. Steiner-Adair (eds.), Preventing Eating Disorders: A Handbook of Interventions and Special Challenges. (pp. 148-159). Ann Arbor: Edwards Brothers.

Piran, N. 1999b. "On the Move from Tertiary to Secondary and Primary Prevention: Working with an Elite Dance School." In N. Piran, M.P. Levine and C. Steiner-Adair (eds.), Preventing Eating Disorders: A Handbook of Interventions and Special Challenges. (pp. 256- 269). Ann Arbor: Edwards Brothers.

Piran, N. 1998. "A Participatory Approach to the Prevention of Eating Disorders in a School." In W. Vandereycken and G. Noordenbos (eds.), The Prevention of Eating Disorders (pp. 173-186). London: Athlone Press.

Piran, N. 1996. "The Reduction of Preoccupation with Body Weight and Shape in Schools: A Feminist Approach." Eating Disorders, 4, 323-333. Rice, C. and V. Russell. 2001. Embodying Equity: Working with Young Women at the Crossroads of their Bodies and Society. Toronto: Green Dragon Press.

Rousso, M. 1984. "Fostering Healthy Self-Esteem." The Exceptional Parent, December, 9-14.

Thompson, K., L. Heinberg. M. Altabe, and Tantleff-Dunn. 1999. Exacting Beauty: Theory, Assessment and Treatment of Body Image Disturbance. Washington: American Psychological Association.