Study links body image issues in adolescence to adult depression

Teenagers with negative body image are more likely to develop symptoms of eating disorders and depression in early adulthood, a new study suggests.

The research, believed to be the first of its kind, followed more than 2,000 twins born in England and Wales.

It found that higher body dissatisfaction at age 16 predicted greater symptoms of eating disorders and depression well into the twenties, even after taking into account family background and genetics.

Researchers say the findings strengthen evidence that negative body image is not just a reflection of poor mental health but that it can also contribute to it.

Lead author Dr Ilaria Costantini, from UCL’s division of psychiatry, said: “In the last 20 years there has been a concerning increase in depression and eating disorders among young people, so it’s important to find out what is driving this increase in order to develop ways to prevent mental health problems from occurring.”

The study, led by University College London (UCL) and funded by Wellcome, used data from the Twins Early Development Study, a long-running birth cohort tracking the health and wellbeing of twins born between 1994 and 1996.

By comparing identical twins, who share 100 per cent of their DNA, with non-identical twins, who share roughly half, the researchers were able to analyse the roles of shared genetics and environmental influences.

Study participants were asked at age 16 about body image concerns, including feeling “fat”, fearing weight gain and judging themselves by their weight or body shape.

Participants were also surveyed at age 21 about eating disorder symptoms, and at both 21 and 26 about depressive symptoms and body mass index.

The researchers found that higher levels of body dissatisfaction at age 16 were linked to higher eating disorder and depressive symptom scores in early adulthood.

Their twin study design enabled them to factor out the effects of shared genes and other environmental factors shared by the twins, such as the same family, neighbourhood and school, to determine that body image concerns in adolescence do appear to cause an increase in later mental health issues.

While both boys and girls showed links between body dissatisfaction and later mental health problems, the associations were stronger in girls.

Dr Costantini said this could reflect the greater cultural and social pressures placed on young women to meet unrealistic appearance standards.

The researcher said: “In Western societies we typically presume that young women are under greater pressure than young men to look a certain way, especially in relation to thinness, and our findings do suggest that these pressures may translate into stronger long-term mental health effects for girls.

“However, it is important to recognise that this may partly reflect the limited way in which body dissatisfaction was measured in this cohort.

“The items focused mainly on weight and shape, which tend to be more salient concerns for girls.

“If we had captured body dissatisfaction in a broader way, for example by including muscularity, height, skin, or other appearance-related concerns, our findings for boys might have been different.”

Senior author professor Francesca Solmi, from UCL’s division of psychiatry, said the findings underline the importance of tackling body dissatisfaction as part of wider public health strategies:

Solmi said: “It is vital that body dissatisfaction is tackled head-on during the teenage years across multiple settings, including in the school system, government healthcare strategies and in the wider culture.

“We need to create environments that value diversity in appearance and avoid sending harmful messages about weight or beauty ideals.

“That means working with families, schools, and the media to ensure we are not promoting unhealthy beauty and weight standards.”