The relationship between body image, mental health, and behaviour in children and young people

Body image and mental health

Supporting children and young people to understand their mental health and what affects it can be helpful for promoting healthy body image.

Similar to findings across adulthood and later life, body image concern and body ideal internalisation in childhood and adolescence have been linked to mental health problems.

• Body dissatisfaction and pressure to be thin have been linked to depressive symptoms in children aged 13-16 [1-2] and symptoms of anxiety disorders, such as social anxiety or panic disorder [13].
• Extreme weight control behaviours (e.g. taking diet pills, diuretics, or laxatives) have been linked to a higher likelihood of experiencing suicidal thoughts for girls and young women aged 17-20 [4].
• Body image concerns may increase the likelihood of non-suicidal self-harm behaviour among adolescents who are experiencing emotional difficulties [5].
• Body dissatisfaction may be linked to weight and body mass index (BMI) in children as young as 10, which may explain why young people who are overweight or obese report greater depressive symptoms and lower self-esteem than their peers [6,7].

As seen in adulthood and later life, it is likely that an interactive, bi-directional relationship exists between body image concerns and mental health during childhood and adolescence. For example:

• Young people who struggle with self-harm, eating problems, or body dysmorphia are especially vulnerable to body image concerns.
• Some anxiety problems and mood difficulties, like depression, can also increase negative self-talk and reduce the focus on self-kindness and self-care.

Body image and behaviour

During childhood and adolescence, body image concerns have also been linked to an increase in risk-taking behaviours.

• More than a third (36%) of adolescents agreed they would do ‘whatever it took’ to look good [8].
• One in ten adolescents had considered cosmetic surgery [9].
• One in ten secondary school boys said they would consider taking steroids to achieve their goals [9].

Body image concerns may also prevent young people from engaging in healthy behaviours.

• Some studies have found that children with body image concerns are less likely to take part in physical activities, while those with greater body appreciation are more likely to have healthy dieting habits, or avoid the use of alcohol or cigarettes [10,11].
• Almost a quarter of boys (24%) and over a third of girls (36%) avoid taking part in activities like physical education due to worries about their appearance [8].

Medication for mental health problems

Alongside effectiveness for the treatment and management of poor health, it is important to consider the impact that some mental health medications have on children and young people’s body image, self-esteem, and quality of life.

Weight gain is one of the most distressing and primary adverse effects of mental health medication [12,13]. Although not fully understood, this weight gain is likely a result of the drug’s effect on appetite and energy levels. As appetite increases and the sedative effect lowers physical exercise, food intake becomes unbalanced and weight is gained [14].

This can have the following impact on children and young people [12,15]:

• Elicits feelings of embarrassment, shame and hopelessness – particularly where the full effect of medication on the body is not explained to the young person.
• Negatively affects self-esteem and quality of life.
• Disrupts how and if a young person continues with their treatment correctly.
• Acts as a barrier to participation in physical activity.

Following good practice guidelines for maintaining positive heart health and metabolic health – for example, through the use of tools such as NHS England’s Lester Tool – can promote the effective monitoring of physical health in people with mental health problems, and potentially help to address body image concerns linked to weight gain [16].

Any conversations with children and young people about mental health medication and body image should be approached very carefully. Stigma and shame still exist around mental health medication and for many people, particularly those who are young, this can affect whether medication is taken correctly and safely.

References

[1] Sharpe H, Patalay P, Choo TH, Wall M, Mason SM, Goldschmidt AB, et al. Bidirectional associations between body dissatisfaction and depressive symptoms from adolescence through early adulthood. Dev Psychopathol. 2018 Oct 16;30(4):1447–58.

[2] Chaiton M, Sabiston C, O’Loughlin J, McGrath JJ, Maximova K, Lambert M. A structural equation model relating adiposity, psychosocial indicators of body image and depressive symptoms among adolescents. Int J Obes. 2009 May 10;33(5):588–96.

[3] Vannucci A, Ohannessian CMC. Body Image Dissatisfaction and Anxiety Trajectories During Adolescence. J Clin Child Adolesc Psychol. 2018 Sep 3;47(5):785–95.

[4] Crow S, Eisenberg ME, Story M, Neumark-Sztainer D. Are Body Dissatisfaction, Eating Disturbance, and Body Mass Index Predictors of Suicidal Behavior in Adolescents? A Longitudinal Study. J Consult Clin Psychol. 2008 Oct;76(5):887–92.

[5] Muehlenkamp JJ, Brausch AM. Body image as a mediator of non-suicidal self-injury in adolescents. J Adolesc. 2012;35(1):1–9.

[6] Austin SB, Haines J, Veugelers PJ. Body satisfaction and body weight: Gender differences and sociodemographic determinants. BMC Public Health. 2009 Dec 27;9(1):313.

[7] Goldfield GS, Moore C, Henderson K, Buchholz A, Obeid N, Flament MF. Body dissatisfaction, dietary restraint, depression, and weight status in adolescents. J Sch Health. 2010 Apr;80(4):186–92.

[8] Be Real. Somebody Like Me: A report investigating the impact of body image anxiety on young people in the UK. [Internet]. 2017.

[9] Credos. Picture of health? 2016.

[10] Andrew R, Tiggemann M, Clark L. Predictors and Health-Related outcomes of positive body image in adolescent girls: A prospective study. Dev Psychol. 2016 Mar;52(3):463–74.

[11] Kopcakova J, Veselska ZD, Geckova AM, van Dijk JP, Reijneveld SA. Is being a boy and feeling fat a barrier for physical activity? The association between body image, gender and physical activity among adolescents. Int J Environ Res Public Health. 2014

[12] Mccloughen A, Foster K. Weight gain associated with taking psychotropic medication: An integrative review. Int J Ment Health Nurs. 2011 Jun;20(3):202–22.

[13] Abosi, O et al. Cardiometabolic effects of psychotropic medications. 2018.

[14] Tondo, L and Baldessarini, R. Psychotropic medicines: increased appetite rather than weight gain. 2022.

[15] Soundy A, Freeman P, Stubbs B, Probst M, Coffee P, Vancampfort D. The transcending benefits of physical activity for individuals with schizophrenia: A systematic review and meta-ethnography. Psychiatry Research. 2014;220(1):11–9.

[16] NHS. New tool to give people with mental illness better care for their physical health. 2014.