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Understanding the Role of Cognition and Media in Body Image Disturbance and Weight Bias in Children, Adolescents, and Adults

Kim Bissell

Media and Body Size and Shape

Younger children spend approximately 25% of their time awake watching television, exposing them to television characters and images that reinforce notions about the importance of thinness and attractiveness (Harrison, 2000b; Yamamiya, Cash, Mlnyk, Posavac, & Posavac, 2005). During this important developmental stage, children are said to form many of their attitudes, beliefs, and perceptions about their own body shape and size and that of others (Smolak, 2008). If preventative measures aren't taken to address body image issues in these populations, they will find themselves living a lifetime with a negative body image. The general conclusion among researchers is that exposure to thin-ideal imagery is related to greater body dissatisfaction, lower body self-esteem, body dysmorphic disorder, self-discrepancy, and self-objectification in people of all ages (Harrison & Cantor, 1997; Jordan, Smisson, Burker, Joyner, & Czech, 2005; Richins, 1991; Tiggemann & Slater, 2004). This is one of several reasons the media are said to play such a crucial role in the overall development of an individual's body image (Bissell, 2004a, 2004b; Harrison, 2000a, 2001).

Despite the representation of the thin ideal in a mediated context, the recent increases in childhood and adult obesity suggest a mismatch. Rather than there being a middle ground in which an “average” adult or child would see himself or herself in the media, what is viewed represents an end of the body shape spectrum that is largely unattainable. More importantly, the presence of thin and attractive women and muscular men has led to increases in anti-fat bias (AFB) among children, adolescents, and adults (Wang, Brownell, & Wadden, 2004). Published studies indicate that understanding the complex factors related to weight bias and body dissatisfaction involve social, psychological, and even sociological variables (Grogan, 2008). Along these lines, it may be in understanding the cognitive disposition of children and adolescents that helps explain how or why these attitudes and beliefs about the self and others are formed. This chapter explores the role of cognition and media as it relates to body image disturbances and weight bias in children, adolescents, and adults. Specifically, this chapter examines the multidimensional factors related to an individual's body image on both ends of the spectrum and further examines how these variables relate to prejudice or anti-fat bias against others. Lastly, this chapter will synthesize work in the area of media, cognition, and body image from a theoretical perspective and offer suggestions for the direction of future research.

Relevant Background and Earlier Work in the Discipline

In the United States, as many as 10 million females and 1 million males fight a life and death battle with disordered eating. Forty-two percent of first to third grade girls want to be thinner. 81% of 10-year-olds are afraid of being fat. Furthermore, 91% of women recently surveyed on a college campus had attempted to control their weight through dieting (ANAD, 2010). Since the 1960s, the number of diagnosed cases of an eating disorder such as anorexia or bulimia has doubled, and health and psychological practitioners are seeing increases in disordered eating among preadolescents, women older than 30, non-Whites, and men – all traditionally not considered at risk for an eating disorder (Woodside et al., 2001). While recent news coverage of health issues has focused predominantly on the increases in obesity, especially in children, specialists in disordered eating argue that the societal gap is continuing to increase between those who are killing themselves with too much food and those who are killing themselves because of a lack of food (Landro, 2004).

Studies in the area of body image distortion suggest the media are one of many potential variables related to increases in disordered eating, especially in college and adolescent females (Harrison, 2000b; Harrison & Cantor, 1997; Stice, Schupak-Neuberg, Shaw, & Stein, 1994). The media are often held partially responsible for young females' desire to be extraordinarily thin because of the number of media messages promoting the “thin ideal.” Several studies over the last decade have examined this problem, looking at possible social, psychological, and biological correlates to the witnessed increases in disordered eating. More recent studies have also found body image distortion to be problematic for women and girls in countries including Canada (Gadalla & Piran, 2007), Brazil (Nunes, Barros, Anselmo Olinto, Camey, & Mari, 2003), Sweden (Sundquist, Qvist, Johansson, & Sundquist, 2003), and Qatar (Bener & Tewfik, 2006), and women of ethnicities such as Asian Americans (Phan & Tylka, 2006), African Americans (Lilenfeld, Jacobs, Woods, & Picot, 2008), and Hispanic women (Hrabosky & Grilo, 2007).

There's little argument that the media content women and girls are exposed to and pay most attention to contain repeated messages promoting the thin ideal (Garner, Garfinkel, Schwartz, & Thompson, 1980; Silverstein, Perdue, Peterson, & Kelly, 1986; Wiseman, Gray, Mosimann, & Ahrens, 1990). Content analyses of entertainment television, fashion magazines, and advertisements have confirmed that the body shape standard found in media has become thinner (see above citations), even though greater diversity in the body type represented on television is beginning to be seen. The presentation of ultrathin models in the media, and certainly the presentation of thin models at the exclusion of average or overweight models, enforces the notion that there is one acceptable body type for women (Kilbourne, 1999). At the simplest level, this mismatch between the ideal and actual self could be responsible for the development of an eating disorder or the development of trait characteristics related to disordered eating, including body dissatisfaction (Bissell, 2004a; Richins, 1991), drive for thinness (Bissell & Porterfield, 2006; Harrison & Cantor, 1997), or physique anxiety (Bissell & Porterfield, 2006; Jordan et al., 2005).

Numerous studies have determined that the self-esteem of adolescent girls plummets significantly as they transition into their developmental teenage years (12–18), and young girls are said to lose confidence, self-esteem, and independence at an early point in adolescence, largely because of harmful cultural messages and societal pressures (Grogan, 2008; Kilbourne, 1999; Myers & Biocca, 1992; Pipher, 1994). During this critical developmental stage, girls may experience a loss of self-image and develop skewed attitudes about their competence and body image (Stice & Bearman, 2001; Stice, Killen, Hayward, & Taylor, 1999). This problem isn't specific to women though, as other studies have examined the relationship between these variables among men and boys and exposure to action/adventure films and action/adventure figures (Olivardia, Pope, Borowiecki, & Cohane, 2004; Pope, Olivardia, Gruber, & Borowiecki, 1999).

Sports Media Exposure and Sports Participation

Although it is clear that a number of factors – including media – influence young girls' propensity to develop an eating disorder, exposure to thinness-depicting (TDP) media has been shown to significantly predict the symptoms (Bissell & Porterfield, 2006). One question that remains unanswered is if children are exposed to media messages that tout the positive aspects of the body – like sports – is it possible the outcome might be different?

Bissell and Zhou (2004) examined entertainment and sports media exposure and four body image outcomes in college women. Exposure to the TDP media was the strongest predictor of negative body image outcomes, and sports media exposure was marginally related to more positive outcomes. However, when exposure to a specific type of sport was examined, different findings emerged. When respondents' exposure to sports identified as lean (gymnastics, ice skating, swimming, and diving) was examined, the findings suggest increased levels of all four body image outcomes: body dissatisfaction, drive-for-thinness, anorexia, and bulimia. Lean sports are those in which the body is often on display and that often require a smaller body mass index in order to be successful, whereby non-lean sports include sports where less of the body is on display and greater muscle mass will not necessarily be a detriment to overall performance (basketball, soccer). The fairly big limitation to the above findings is that exposure to women's sports on television is sporadic, infrequent, and difficult to measure. Findings from this study identify a need for the refinement of the sports media exposure scale because the results suggested that exposure to some types of sports media were related to more positive outcomes. The general findings from this study suggest that sports media exposure might be linked to more positive attitudes about the body, but that finding may be predicated on the type of sport to which women are exposed.

The research, although minimal, which has investigated the relationship between girls' self-esteem, body self-esteem, and sports participation indicates a positive correlation (Smolak, Murnen, & Ruble, 2000). During this time of emotional and physical maturation and uncertainty, there is reason to believe that girls who actively engage in sports will have higher self-esteem than their non-athletic peers, since sports participation affords girls the opportunity to develop physical competence and de-emphasize the importance of physical attractiveness as the greatest measure of their self-esteem (Daniels & Leaper, 2006). In a sport environment, girls can learn the value of teamwork and community involvement, form meaningful friendships, and girls may feel more confident and comfortable with who they are. Sports participation may also act as a beneficial mediator between TDP media exposure and low self-esteem, reducing the chances that young girls will develop an eating disorder (Cate & Sugawara, 1986). As noted below, media use, especially television use, by adolescents is high, so if girls spend less time doing things like watching television and spend more time doing physical activities like playing sports, that involvement could serve as a factor that helps elevate a girl's self-esteem.

Although several studies have examined sports participation and disordered eating outcomes, most have not included media exposure as a factor. For elite and professional athletes, involvement in a sport at a highly competitive level consumes great amounts of time, but it is important not to discount the role of the media. Subsequently, it is argued that the media may still play a role in shaping girls' sense of self and sense of body self-esteem by presenting images representing “ideal beauty” and “ideal thinness,” even in media directed toward younger audiences. Bissell (2004a, 2004b) with Porterfield (2006), and with Birchall (2008) examined sports participation as a moderating variable in athletic samples ranging from adolescent girls, elite adolescent athletes, and collegiate athletes. The findings from these studies indicate that media exposure is indeed an important variable. In the one study, Bissell and Birchall (2008) surveyed eighty 8–18-year-old female athletes about their time spent playing sports, their sport type – lean or non-lean – media use, and body self-esteem. In terms of this sample's media use, participants' television viewing was found to be quite specific because they had such limited time with the media. Also important was participants' own sense of media influence on themselves, an attribute that suggests a good deal about their own emotional and psychological development and maturity. In this sample, it was found that the older athletes, between 14–18, were more likely to believe that television played an important and influential role in learning how to be a girl, and the differences between the older and younger girls' scores on this question were statistically significant.

Despite great participation in sports and athletics, adolescent athletes exposed to thin-ideal imagery had significantly higher levels of body image distortion (BID) than participants who were not exposed to as much thin-ideal TV. In a study with Division I collegiate athletes, Bissell and Porterfield's (2006) findings closely mirrored those from the study with adolescent athletes: Exposure to thin ideal television was a significant predictor of increased levels of body image disturbance (BID) – body dissatisfaction, drive for thinness, anorexia, and bulimia. Even though studies mentioned earlier have found higher incidences of BID in athletes classified as participants in “lean” sports, findings from this study indicated that it didn't matter what sport the participant played or how long the participant played the sport, dissatisfaction with body shape and size was high across the sample. This suggests that involvement in sport, while beneficial for younger girls, may serve as less of a buffer against other harmful variables such as media and peers as an individual grows and develops.

In another study with Division I collegiate athletes, Bissell (2004) found thin-ideal television exposure to be a significant predictor of four dimensions of disordered-eating symptomatology. In this study, sports media exposure was found to be related to decreased levels of BID; however, when a hierarchical regression model was run including exposure to other types of media, the relationship disappeared. This suggests sports media exposure may still be important in finding ways to combat negative body image, but additional research is needed to better understand that exposure. It is for this reason, and many others, that a more comprehensive picture of body image distortion should be developed.

In one of the seminal studies of the relationship between media and body image, Myers and Biocca (1992) found that women who watched even 30 minutes of television programming a day had greater body distortion than those who did not. Other studies examining entertainment media confirm these findings. Time spent with media is important, but the content exposed to is as important if not more so (Bissell & Birchall, 2008). Furthermore, what isn't known from some self-report measures is how much an individual is attending to the content. If the individual is sending text messages, surfing the Internet, or engaging in other activities, the effect of exposure might not be as great because the individual may not be engaging in the social comparison process. This opens the door for other theoretical explanations of the phenomenon, theories that explain specific use of the media and individual factors like cognitive processing styles. In addition to expanding the theoretical model, scholars more recently have concluded that a myriad of factors are relevant in better understanding the development of negative body image. While findings from earlier studies are important in better understanding the way individual, social, and mediated factors shape and influence the way women, girls, men, and boys come to think about their body shape and size, the thinking now is that those factors are more individualized. One key issue with earlier studies in mass communication and other disciplines is that they have often not been multidimensional and have excluded the consideration of other environments.

Broader Contextualization of Relevant Factors: Body Image and Individual, Social, and Mediated Factors

The pervasiveness of thin-ideal imagery in multiple forms of media suggests that most girls and women are going to be exposed to thousands of messages touting the rewards of being thin and being attractive. However, several experimental studies have found that women are not equally influenced by these media messages. Individual characteristics such as cognitive processing styles, weight or body mass index (BMI), overall self-esteem, self-consciousness, and a tendency toward social comparison have been identified as relevant predictors (Fairburn, Shafran, & Cooper, 1999; Myers & Biocca, 1992) along with other individual, social, or mediated factors.

The development of poor body image or disordered eating behavioral patterns can be a product of the factors mentioned above alone or in combination. For example, Ricciardelli, McCabe, Holt, and Finemore (2003) examined what they called biopsychosocial factors relevant in predicting children's body image and body change strategies. They found that individual factors such as gender, age, race, and BMI were significant predictors of the examined outcome as well as social factors such as perceived pressure from parents, peers, and the media. Wang, Byrne, Kenardy, and Hills (2005) identified individual factors such as ethnicity and socioeconomic status as relevant predictors of body dissatisfaction in Australian children and adolescents, and Mikami, Hinshaw, Patterson, and Lee (2008) found some trait characteristics of ADD/ADHD to be relevant factors in disordered eating pathology in girls. Specifically, the authors found that what they called “baseline impulsivity symptoms” compared to symptoms such as inattention or hyperactivity best predicted disordered eating pathology.

As attention is turned to outside influences, factors such as an individual's home environment have been identified as strong predictors of disordered eating symptomatology (DE) in some individuals. For example, Canals, Sancho, and Arija (2008) found that when DE was identified in one or more parents in a household, children in that household were at an increased risk for the development of DE behaviors.

In an attempt to gain a more comprehensive picture of body image among children, Bissell conducted a pre- and posttest within-subjects experiment with 200 first–eighth grade boys and girls in the fall of 2009. Results from this study indicate that cognitive and rational processing styles, household dieting behavior, the Children's Eating Attitudes Test, and exercise attitudes were all related to participant self-discrepancy (Bissell & Hays, 2011; Bissell & Parrott, 2010). In a diverse sample with roughly equal numbers of boys and girls in all seven grades, Bissell and Parrott (2010) found that children who scored higher on the rational processing scale, meaning they were more likely to think carefully about things, had lower levels of self-discrepancy when asked to identify their actual and ideal body shapes. This was found for boys and girls, although the coefficient was higher for boys in the sample. Experiential processors, meaning those more likely to use their gut reaction and be more instinctive, demonstrated higher levels of self-discrepancy, and this was also true for boys and girls in the sample, although the R² was higher for girls than it was boys. This statistically significant relationship was found at the pre- and posttests across the sample.

Household dieting behavior also proved to be a relevant predictor of self-discrepancy in the same study, but this was only found for girls at the pretest. The household dieting scale measured the amount of discussion and behavior related to dieting in the participant's home. Results from the pretest indicate that in households where dieting and weight were frequently discussed or in households where the mother was frequently dieting, self-discrepancy was significantly higher.

Theoretical Perspectives

The complex relationship between media and body image distortion in women and girls has been examined using several theoretical frameworks: social comparison theory (Festinger, 1954), social cognitive theory (Bandura & Wood, 1989; Cash & Pruzinsky, 2004), self-discrepancy theory (Bessenoff, 2006; Higgins, 1987), cultivation theory (Gerbner & Gross, 1974; Levine & Smolak, 1996; Myers & Biocca, 1992; Tiggemann, 2005), and objectification theory (Bissell & Zhou, 2004; Cash & Pruzinsky, 2004; Fredrickson & Roberts, 1997; Slater & Tiggemann, 2002). Festinger's ground-breaking work in social comparison has led to a body of work using the theory as one possible explanation of body image disturbance. Festinger's belief that individuals frequently compare themselves to others on a variety of dimensions, including physical attractiveness and appearance, has supported a line of work examining individuals' comparisons between ideal others found in the media and themselves. Self-discrepancy theory is similar in concept in that the theory suggests individuals compare themselves to internalized standards, which are referred to as self-guides. The underlying premise of self-discrepancy theory is that discrepancies between the actual, ideal, and “ought” selves will result in emotional vulnerabilities, and in the context of studying body image distortion, these discrepancies may lead to outcomes such as body dissatisfaction, drive for thinness, or related outcomes. Both of the above theories help us better understand the role of the individual in the development of BID, whereas theories such as cultivation or social cognitive theory help explain the role of social or mediated factors.

In its simplest form, social cognitive theory (Bandura, 1989) suggests that individuals learn via observation of others around them. Social cognitive theory could easily be linked to the underlying premise of cultivation theory, as both predict the ways an individual might come to model behavior, beliefs, and attitudes related to body image, especially after increased time spent viewing television. Cultivation theory can be used to explain the way initial impressions of a body image norm might be developed, as Gerbner and Gross (1974) proposed that individuals who spend more time viewing television will have perceptions about the real world that more closely resemble the world presented to them in a mediated context. This theory could be expanded to consider perceptions about body image and appearance norms because of earlier findings about the narrow presentation of ideal beauty and ideal body shape often found in entertainment media. Fredrickson and Roberts (1997) offer objectification theory as a possible explanation of how and possibly why women and girls may respond to mediated messages via harmful attitudes or behavior as the theory suggests women, or more specifically the female body, is placed in a social context as an object rather than a subject. Objectification theory offers us a theoretical lens for understanding how a female might be led to view herself, based on female representations often found in the media.

One rather ironic factor about the media is that they can serve both a positive and a negative role in the development of a young girl's sense of self, especially as it relates to body image, creating incongruencies that make it confusing and complicated for viewers. As young girls look to television and movie stars such as Miley Cyrus (Hannah Montana) or Ashley Tisdale (High School Musical), they see glamorized images, which are, to a large degree, of very thin girls. Cultivation theorists would argue that repeated exposure to these thin-ideal portrayals will lead to distorted body perceptions, just as it does for college-aged and older women, due to television's ability to shape perceptions of social reality (Chapter 2). Many scholars examining the development of distorted body image in men and women suggest that it is the repeated viewing over time of similar content that contributes to an individual's beliefs about social reality (Tiggemann, 2005).

Despite the growing waistlines of children and adults nationwide, the representation of the body remains fairly narrow; yet, obesity has been a societal problem for decades. The question then arises, why is it that media representations of body shape have remained relatively narrow where children and adults have become increasingly larger? More importantly, what type of effect is seen when mediated representations of body shape do not mirror reality?

Other Body Image Outcomes: Anti-Fat Bias and Obesity

Nearly one in three children in the United States is overweight or obese, including youths, from 2-year-old preschoolers to 18-year-old high school seniors, and children of every race, ethnicity, and gender. Recent estimates show weight issues among children and adolescents remain a top health concern for the nation (Hedley et al., 2004). One question that merits attention from this array of stakeholders deals with the social and cognitive ramifications of obesity. Several studies have examined the convergence of increasing obesity rates and the psychosocial effects on children's perceptions of weight in themselves and others, but surprisingly little attention is given to the variety of factors that are relevant in the formation of negative attitudes about overweight and obese individuals.

The increased public and media attention to the problem has led to what Wang, Brownell, and Wadden (2004) call the “stigma of obesity” (p. 1333). They argue that unlike bias against minority groups, bias or negative attitudes towards overweight individuals is accepted and sometimes encouraged. Social marginalization and the stigmatization of obesity in adults have been well documented as resulting in disadvantages in employment, education, healthcare, and interpersonal relationships (Puhl & Latner, 2007). For example, McEvoy (1994) found in her study of employment discrimination against the overweight that the more overweight the employee, the more likely he or she was to be discriminated against in the workplace. Puhl and Brownell (2001) found that obese individuals reported being discriminated against in public settings like grocery stores or restaurants. However, anti-fat bias and weight stigmatization are not confined to adults, as a growing body of research indicates that children may also be victims – and perpetrators – of anti-fat bias and weight stigmatization. While the existence and consequences of anti-fat bias have been documented, what remains unknown is how or when these biases or stereotypes about weight and obesity are formed in children.

The Role of the Media in the Development of Anti-Fat Bias

Decades of research on the media's influence on appearance norms and ideals shows that increased exposure to media, especially thin-ideal media, is related to a cultivation of perceptions about standards of beauty and thinness for the self and others. This type of exposure coupled with negative mediated representations of obese or overweight people may create or reinforce ideas about weight bias, especially in children. Certainly, the media may develop and nurture anti-fat bias (AFB) through the way television, magazines, and other sources present – or do not present – content. For example, a study by Latner and Stunkard (2003) found that children's media use, including magazines and videogames, was related to more negative attitudes toward obese youths. Television portrayals may be particularly problematic. Studies by Fouts and colleagues (2000, 2002) found that overweight characters are more likely to be the target of negative comments in television sitcoms. Negative comments also were backed by audience applause, which reinforced the negative comments and may lead the home audience to internalize gender and weight stereotypes. Television programs may also encourage anti-fat bias through the content viewers don't see. For example, studies have demonstrated that overweight people are underrepresented in television sitcoms, which may skew viewer perceptions of the prevalence of overweight people in the “real world” (Fouts & Vaughan, 2002).

In a study designed to measure anti-fat bias in young children, Bissell and Hays (2011) predicted that participants with greater exposure to the media would be more likely to exhibit greater anti-fat bias than those viewing less television; however, several other variables of interest were considered such as cognitive processing styles, demographic variables, and self-perceptions of body shape. Using two measures of explicit anti-fat bias and one measure of implicit fat bias, Bissell and Hays (2011) found in their study of 601 third to sixth grade children that fear of negative appearance evaluations and demographic variables were the strongest predictors of greater bias against overweight individuals. Television viewing was found to be a predictor of more positive assessments of overweight individuals, a finding contrary to what was predicted. However, when other variables were considered in a hierarchical regression model, these variables – fear of negative appearance evaluations, an assessment of an individual's own fear of being overweight, and demographic variables – were stronger predictors of negative assessments and prevailed statistically. The Implicit Association Test was also used in this study to measure participants' automatic associations of specific adjectives (good, bad, pretty, smart, funny, useless) to one of two words – thin or overweight. Quite consistently, a majority of the sample assigned the positive adjectives to the word “thin” whereas a majority of the sample assigned the negative adjectives to the word “overweight”. This simply suggests that on some level, unconscious or subconscious, many of the children in the sample held attitudes or beliefs about overweight individuals that were negative.

In a similar study, Parrott and Bissell (2010) conducted a pre- and posttest between-and within-subjects experiment with 200 children in grades 1–8. Their findings identified several important variables in terms of predicted correlates of anti-fat bias, and these variables included individual factors (demographics, cognitive processing styles), social factors (dieting behavior at home, exposure to overweight peers and family), and mediated factors (exposure to thin-ideal programming). Findings suggest that of all demographic variables examined, age was the strongest predictor of anti-fat bias. Experimental condition was also an important variable in the level of anti-fat bias a child exhibited. In this study, participants were randomly assigned to one of five groups, four experimental groups (each viewed an image of an overweight boy or girl or an image of a thin boy or girl) and one control group (no image exposure). Children randomly assigned to the experimental group who viewed either an image of an overweight boy or girl were significantly more likely to have higher scores on both measures of AFB, meaning they were more likely to assign negative attributes to overweight individuals, and this was compared to responses of individuals exposed to the thin boy or girl and participants in the control group.

Of the two cognitive variables used in the Bissell and Parrott study (2010) – the experiential and rational processing scales – both were found to be significant predictors of anti-fat bias. Furthermore, implicit attitudes representative of fat bias were also evident across the sample, and these implicit attitudes were related to explicit attitudes of fat bias. Of importance here is participant age. Older children were higher on the rational processing scale whereas younger children were higher on the experiential processing scale. This suggests that the more a child thought about the overweight subject in the photograph, the less likely the child was to admit a bias against being overweight or obese. This conclusion seems to be supported by the fact that higher levels of rational processing were related to decreased levels of fat bias, and older children exhibited lower AFB.

If age and rational processing style predict decreased levels of anti-fat bias, an important question seems to be at what age does the bias develop? The negative attitudes toward overweight individuals were the highest in the younger children, and this could be a product of them answering truthfully rather than being fearful of admitting how they felt about the overweight subjects in the photographs. The development of weight bias could also be a product of younger children being less familiar with what is considered to be socially acceptable.

Summary Discussion of Media Exposure and Anti-Fat Bias

Limited evidence exists examining the relationship between media exposure and an individual's likelihood to exhibit anti-fat bias or weight stigmatization. Content analysis of prime-time programming and children's programming suggests body shape norms are fairly narrow and could contribute to an individual's likelihood to uphold thinness as an ideal. The Bissell and Hays (2011) and Bissell and Parrott (2010) studies indicate that AFB and weight stigma are not just problems exacerbated by the media but that the individual and social factors (self-perception, demographics, household dieting behavior) can all contribute to an individual's development of negative attitudes toward overweight people. Media exposure remains an important variable though, as it is one of the several socializing agents and certainly a factor that helps shape an individual's view of social reality. This topic remains important to the scholarly community as a social issue because more children are becoming overweight or obese, and this trend appears to be increasing at an alarming rate.

Media and Obesity

Limited empirical evidence exists examining the relationship between media exposure and an individual's likelihood to be overweight or obese, simply because so many other factors – genetics, lack of physical activity, and increased consumption of high-calorie, low-nutrition foods and beverages – are equally (and sometimes simultaneously) relevant. A few general conclusions about the relationship between media and obesity can be made, however, and findings from more recent studies indicate that time spent with media is a key factor in an individual's likelihood to become overweight or obese. Morgenstern, Sargent, and Hanewinkel (2009) report a strong association between television viewing and obesity, and report in their study of just under 10,000 children from Germany and the United States that media use was directly related to participant BMI. For example, Morgenstern and colleagues found that when study participants had a television in their bedroom, their risk for overweight and obesity, essentially measured via BMI, was greater.

What isn't known from the studies reported above is which factor – BMI or media use – is a predictor or causal factor in the other. It could be argued that overweight or obese individuals, who are more likely to be sedentary, will spend more time with media because they spend less time on other activities. The notion of television being used as a displacement for other activities was confirmed by a Cecil-Karb and Grogan-Kaylor (2009) study in that when parents perceived their child's outdoor environment or neighborhood to be unsafe, they were more likely to restrict outdoor activities in lieu of indoor activities, such as spending time with the media. Parental perceptions of neighborhood safety were significantly associated with their child's BMI, which was significantly associated with time spent with the media.

While time spent with media is one important variable in understanding predictors of overweight or obesity, the content viewed may also be a relevant factor. For example, the media may be responsible for the development of attitudes and beliefs about food, nutrition, and health (Powell, Szczypka, & Chaloupka, 2010; Taras & Gage, 1995), and if a child's belief system is shaped by negative health messages in the media, that child may be at increased risk for being overweight or obese. A recent study published by the Institute of Medicine of the National Academies (IOM report) indicated that the current practices for food marketing put children at a health risk because dietary patterns begin early in childhood and are shaped by social, cultural, and mediated factors, including television advertising. As studies over the last decade have shown, food ads targeted toward children have often emphasized unhealthy options versus healthy options. They further report that in the ads targeted toward children, few health-related messages were found but of the ones with some mention of health, the message was related to the food containing natural ingredients or that the food was low in calories. For children who spend a great deal of time watching television each day, exposure to unhealthy food messages may prevail.

The Kaiser Family Foundation reported in its 2010 study (Roberts, Rideout, & Foehr, 2010), Generation M²: Media Use in the Lives of 8- to 18-Year-Olds, that total media use by children between the ages of 8–18 was just under 11 hours a day, which represents a significant increase from time spent with the media based on data collected in 2004 (approximately eight and a half hours per day) and data collected in 1999 (approximately seven and a half hours per day). As reported in a more recent study, elementary aged children spent several hours a day watching television programs on the Disney Channel, Nickelodeon, and the Cartoon Network and spent additional time on the websites associated with those channels as well as websites targeted toward children (webkins.com, neopets.com, and playhousedisney.com) (Bissell & Hays, 2011). Additionally, food products that are associated with a media tie-in and that have a corresponding “toy” make resisting the food even more difficult.

In measuring a child's knowledge of nutrition and food preferences, it is important to examine media as one driving component in the development of knowledge, beliefs, and attitudes about the foods they consume. Media are often blamed for the increases in childhood obesity, but beyond articulating that children spend too much time with media, little is known about how the specific content children are exposed to may influence their thoughts and decisions about the foods they consume. Lowry, Wechsler, Galuska, Fulton, and Kann (2002) report in their study of high school students' media use and their rates of sedentary lifestyles and obesity that one in three White students, one in two Hispanic students, and three in four Black students watched more television per day than what is recommended by the American Academy of Pediatrics (two hours per day). Most importantly, the authors report that in their sample, television viewing was found to be positively related to the consumption of high-fat foods and those participants who were overweight were also more likely to spend more time with television.

The general conclusion from these studies is that television viewing may be negatively related to children's food preferences, food intake, and nutritional knowledge because it may not only shape what they view to be healthy and good for them, but it may also shape their preferences for specific foods and affect how much food they eat while watching television.

The results of these studies shed light on the myriad factors that need to be considered in relevant theory development. From a theoretical perspective, cultivation theory is appropriate in better understanding how the media, especially television, may shape a child's sense of nutritional knowledge and food preferences. Given the conflicting messages found in some advertisements related to food – “it's fat free” or “low in fat” – children who are heavier viewers of television may find themselves more confused about healthy food choices than those who are exposed to less television. Even if advertisers are slowly addressing growing concerns related to obesity in children, the underlying premise of cultivation theory is that over time, viewers will adopt a view of the real world that more closely resembles that of the mediated world. Thus, it is especially important to have a clearer picture of the specific content children pay attention to and if newer technologies such as TiVo decrease the amount of time children spend watching advertisements.

With overall obesity rates on the rise and childhood obesity increasing in every state in the United States, understanding the social effect this has on children is an area in need of more scholarly attention. While the health consequences of obesity are irrefutable, the psychological damage associated with weight stigma or bias can also be quite detrimental. If children are engaging in unhealthy eating habits or if their preferences for food only include foods low in nutritional value, they may be setting themselves up for a lifetime of weight stigmatization on a societal level and health problems on an individual level. Knowledge of nutrition and food preferences may very well be directly related to an individual's weight and body shape, and in light of the research documenting that overweight characters in mediated contexts are perceived as deviants and that samples ranging from preschoolers to adults adhere to negative attitudes about overweight people, it seems evident that people who are overweight can face bias, prejudice, and discrimination in several contexts.

Directions for Future Research

Given the complexity of the body image distortion and weight stigmatization phenomenon, researchers must continue to study these issues from an interdisciplinary approach. Cognitive processing styles, an individual's home and social environment, and media exposure are just some of the important factors that may help us better understand the way individuals process messages about the body. Through media literacy intervention programs, some individuals, especially children, may be better equipped to challenge messages that uphold thinness as a norm or ideal. Furthermore, through health literacy programs, individuals may be taught about the long-term consequences of extreme thinness or obesity and thus might take steps to prevent that from happening. More simply, we must educate children that social comparison with any target other will often lead to a negative outcome. More importantly, body image should be viewed in the context of health and not shape, size, or weight.

It is difficult to change the way people think, but it is important to take these steps through media and health literacy programs. Perceptions and beliefs about body image have developed and become entrenched, in part, because of the social, cultural and mediated emphasis on appearance and the thin ideal. A very important consideration in future studies is the perceived “realness” of mediated messages. With increased attention focused on the digital enhancement in still and moving images, it is possible women may be less inclined to feel the images influence them about their own body shape and size. The goal for future research should be to continue to find ways to combat the negative and/or harmful messages often found in entertainment media and to find ways to keep women and girls from destroying their physical and mental health at such early ages. Body image distortion is a mental health issue that could easily escalate to a public health crisis if preventative measures – on both ends of the body image spectrum – are not addressed. Some women and girls may be injuring themselves with too little food whereas others may be injuring themselves with too much. Regardless of where on the body image spectrum an individual is, the psychological and health consequences of extreme thinness or obesity are quite clear. The body of work in this area has proven useful in gaining better understanding of the way body image perceptions are formed and shaped. The key now is to continue this research with attention to an interdisciplinary approach so a more comprehensive picture of body image perceptions can be gained and women and men can start focusing on the things their body can do rather than how their body looks.

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