A source of thinspiration?

A source of thinspiration?
A source of thinspiration?
The biological landscape of media, body image and dieting
Aric Sigman
O
ver the past four decades women in
industrialised countries have become
wider, yet the ideal female physique,
as depicted by the media, has
become thinner. Twenty-five years ago, the
average fashion model was only 8% thinner
than the average woman. Today that figure
has risen to 23% (Derenne & Beresin, 2006).
During this time dissatisfaction with body size
and shape has become so prevalent among
girls and women that it is being described as
‘a normative discontent’ (Grogan, 2007).
More worryingly, body dissatisfaction is now
appearing at increasingly younger ages. In a
study by University of Central Florida, nearly
half of the 3 to 6 year-old girls said they
worried about being fat. Around one in three
would change a physical attribute, such as
their weight (Hayes & Tantleff-Dunn, 2010).
The use of diet pills among 15-17 year olds
has doubled in a five-year period (NeumarkSztainer et al, 2006). Female preoccupation
with physique and body dissatisfaction does
not appear to diminish across the age spans
and is now even exhibited by pensioners
(Tiggeman et al, 2001; Ferraro et al, 2008).
Yet body dissatisfaction is more than a
psychological and cultural issue. The methods
used by an increasing proportion of girls and
Body image, dieting
and eating disorders
are not a health
issue in Stone Age
societies (Irian Jaya,
West Papua).
Photo by A. Sigman.
The Biologist Vol 57 No 3 October 2010
women to alter body shape are more than
mere stylistic exercises in aesthetics. Body
dissatisfaction has serious implications for
female health and is a major risk factor for low
self-esteem, clinical depression, self-harm,
substance abuse, obesity, excessive dieting,
and mood and eating disorders. As body
dissatisfaction rises in increasingly younger
children, so too has the prevalence of eating
disorders and dieting. In the past decade, there
has been an 80% rise in the number of young
girls admitted to hospital with anorexia in
England (DOH, 2009). With a mortality rate of
between 10 – 20 per cent, the Royal College of
Psychiatrists states: ‘Anorexia Nervosa has the
highest death rate of any psychological
disorder.’ (RCP, 2008).
Neurological correlates
A meta-analytic review of 25 studies entitled
‘The effect of experimental presentation of thin
media images on body satisfaction’ concluded
– as have others – that ‘body image was
significantly more negative after viewing thin
media images… mass media promulgate a
slender ideal that elicits body dissatisfaction’
(Groesz et al, 2002). This negative effect is
frequently reported to be both strong and
immediate (Tucci & Peters, 2008). Analyzing
A source of thinspiration?
the brain activation patterns of females being
exposed to media images is now illuminating
the biological landscape of body dissatisfaction.
Neuroscientists at Brigham Young University
in Utah examined subconscious feelings about
body image through fMRI analysis of the
brains of healthy men and women who were
assessed psychometrically as being confident
about their bodies.
It is known that when humans engage in
serious self-reflection, activity increases in the
medial prefrontal cortex (mPFC). It is
suspected that this increased activation can
betray subconscious thoughts. When anorexic
and bulimic women view an overweight
stranger, the medial prefrontal cortex is
activated in ways that suggest extreme
unhappiness and, in some cases, self-loathing.
In this study the healthy women looked at
images of avatar-like models in skimpy bikinis.
Some images were overweight, some very
thin. On viewing each image the women were
told to imagine that someone else was saying
the model looked like her. When presented
with overweight images, the mPFC showed
increased activation in all of the women. Merely
imagining that they might be overweight
seemed to lead women to question their sense
of self, even though they claimed afterward
that the test was boring or meaningless.
Men showed no significant mPFC activation
while processing either type of equivalent
male image.
The researchers concluded that there are
‘sub-clinical’ issues with body image among
healthy women and a much finer line
between women with and without eating
disorders than previously thought. The lead
researcher commented, ‘This is kind of
validating the suspicion that most women are
teetering on the edge of an eating disorder. If
the brain response is so strong in these
apparently healthy women...’ (Owens, Allen &
Spangler 2010).
Related findings are also reported from
Hiroshima University where healthy women
and those with eating disorders were
presented with morphed images of themselves
and that of another woman. The pre-frontal
cortex and the amygdala (implicated in
processing emotional reactions such as fear,
threat, anxiety and emotional responses to
pain) were ‘significantly activated [in] healthy
women in response to their own fat-image’.
(Miyake et al, 2010)
Even the printed word elicits similar
neurological reactions. The study ‘Gender
differences in brain activity generated by
unpleasant word stimuli concerning body
image’ found that in women, words such as
‘obesity’, ‘corpulence’ or ‘heavy’ were
accompanied by increased activation in the
amygdala, while the left mPFC (associated with
decision making and rational thought) became
inactive. In men the response was the reverse.
The authors believe that the mPFC is
responsible for the gender differences in the
processing of words concerning body image,
and may also be responsible for gender
differences in susceptibility to eating disorders.
(Shirao et al, 2005)
Electronic media and eating pathology
As visual media of thin female physiques
reaches further across the globe the
neurological alterations cited above may be
increasing among large sections of a
population and at younger ages. In a landmark
study, a multidisciplinary team from Harvard
Medical School travelled to Fiji to evaluate the
impact of the introduction of television on
body satisfaction and disordered eating in
adolescent girls. In Fiji, the ideal body weight
for females has always been very full, while
going thin – as Fijians refer to weight loss –
is a cause for concern, not admiration. Dieting
has been rare.
In 1995 television arrived and within three
years everything changed. The percentage of
subjects with pathologically high scores on a
test for disordered eating more than doubled
from 12.7% to 29.2% and three-quarters of the
study population reported that they felt ‘too
big or fat’. Dieting among teenagers who
started to watch television increased
dramatically to include two in every three girls
and the rate of self-induced vomiting to
control their weight, which had been rated as
non-existent before television arrived, leaped
to 11.3 per cent of that population. The girls
openly cited thin female characters in
American programmes as inspirations for
changing their bodies. Comments included
‘I feel fat … I just admire them. I want their
body, I want their size’.
The researchers describe the ‘dramatic
increase’ in disordered eating. ‘The impact of
television appears especially profound…
Western media imagery may have a
profoundly negative impact upon body image
and disordered eating attitudes and
behaviours, even in traditional societies in
which eating disorders have been thought to
be rare’ (Becker et al, 2002).
Diet-induced biological changes
A British study has found that more than one
in four adults in the UK is trying to lose weight
‘most of the time’ (Mintel, 2004) either due to
body dissatisfaction or genuine obesity. Yet
The Biologist Vol 57 No 3 October 2010
A source of thinspiration?
dieting is increasingly being found to be a
major biological event, causing significant
metabolic, neuroendocrine and epigenetic
alterations, in some cases paradoxically leading
to disease.
Tomiyama et al (2010) recently reported that
restricting calories to 1200 kcal per day
increased the total output of cortisol in
females. Cortisol is important for regulating
functions such as glucose metabolism and the
inflammatory process. Prolonged exposure to
high levels, however, can lead to higher blood
pressure, suppressed thyroid function,
impaired immunity, and increased intraabdominal fat – all of which contribute to
chronic disease states such as heart disease,
diabetes and cancer.
The study also found that monitoring
calories increased perceived stress and
concluded: ‘Dieting may be deleterious to
psychological well-being and biological
functioning’. Stress has been linked to overconsumption of calorie-rich foods and
concomitant weight gain in rodents, primates
and humans. In mice Latagliata et al (2010)
found that the stress of going on a diet affects
the release of norepinephrine, which makes
dieters hunt for food. The food-restricted mice
were even willing to tolerate electric shocks to
eat chocolate again because, through stress,
‘adaptive food seeking/intake can be
transformed into maladaptive behaviours’ via
‘top-down’ prefrontal cortical noradrenergic
control over eating disturbances.
Intermittent ‘yo-yo’ dieting is increasingly
practiced in response to body dissatisfaction. It
is generally ineffective in achieving enduring
weight loss and the reasons for failure are
become clearer. Cottone et al (2009) found that
the brains of rats alternating between healthy
and sweet (unhealthy) food in the way many
dieters do, showed highly significant
recruitment of neural circuits (CRF system)
involved in stress reactions and promoted the
‘compulsive selection’ of unhealthy food and
the undereating of healthy foods. This change
in dietary preferences was accompanied by ‘a
withdrawal-like state seen in drug dependence.’
Regarding the implications for the many
humans who diet in this way, the author’s state,
‘motivational processes can become perturbed
in individuals who experience repeated
contrasts in the intensity of hedonic stimuli
over time. Adaptively, such processes may shift
food-seeking and consummatory behavior
toward energy-dense, high-reward foods, while
devaluing efforts to obtain less energy-rich,
low-reward foods’. Cottone commented: ‘This
eating pattern leads to a vicious circle. The
more you cycle this way, the more likely it is
The Biologist Vol 57 No 3 October 2010
you cycle again.’ Weight cycling averaging only
2.5kg over two-year periods among normalweight individuals is strongly linked to ‘a
higher risk of cardiovascular disease and
death’. (Waring et al, 2010)
Gene expression
Many genes can be up-regulated or downregulated by changes in behaviour and
environment, through such external epigenetic
mechanisms. Nutrition and diet-induced
changes in gene expression are now
increasingly reported. Dahlman et al (2009)
randomly assigned overweight women to a
moderate-fat, moderate-carbohydrate diet or a
low-fat, high-carbohydrate hypoenergetic diet
for 10 weeks. Irrespective of the type of diet,
in adipose tissue ‘a total of 52 genes were
significantly up-regulated and 44 were downregulated as a result of the intervention.’
Tenomodulin (TNMD) is a transmembrane
glycoprotein. TNMD gene expression in
human fat tissue was down-regulated during
diet-induced weight loss, with a 65% decrease
after 18 weeks of dieting (Saiki et al, 2009). In
both breast and abdominal tissue, significantly
reduced expression of genes is observed in the
lipid metabolism and glycolytic pathways
following dietary energy restriction (Ong et al,
2009). The chronic dieting of anorexia nervosa
is also accompanied by epigenetic changes in
adipose tissue. Decreased body fat content of
patients with anorexia nervosa was
accompanied by a reduction in fat mRNA
adiponectin, leptin, interleukin-6 and CD68
expression, while resistin mRNA expression
was increased. (Dolezalova et al, 2007)
But in understanding the link between
exposure to visual media of thin female
physiques and the onset of eating disorders, to
what extent can body dissatisfaction induce
epigenetic changes which activate psychiatric
disorders such as anorexia nervosa? Harvard
Medical School molecular biologists
Abdolmaleky et al (2008), examining
epigenetic alterations of the dopaminergic
system in major psychiatric disorders, believe
that ‘environmental factors can influence DNA
methylation patterns and hence alter gene
expression. Such changes can be especially
problematic in individuals with genetic
susceptibilities to specific diseases. Recent
reports from our laboratory provided
compelling evidence that both hyper- and
hypo-DNA methylation changes of the
regulatory regions play critical roles in defining
the altered functionality of genes in major
psychiatric disorders’.
Psychological distress such as child abuse is
now found to leave epigenetic marks on DNA
A source of thinspiration?
Tonga, where big has
traditionally been
considered beautiful.
Photo by A. Sigman.
in genes that control our stress response, which
then increases the risk of suicide (McGowan et
al, 2009). A disturbed expression of
dopaminergic genes has now been identified in
eating disorders (Frieling et al, 2009). Can early
or prolonged body dissatisfaction also leave
epigenetic marks on DNA?
Media and evolutionary adaptation
Stepping back from the minutiae of gene
expression, it is now possible to view
exposure to high numbers of thin media
images in an evolutionary context, activating
an adaptive selection mechanism and
distorting it so it becomes mal adaptive.
Heterosexual human females maintain/adapt
their physical appearance in accordance with
sexual dimorphism – the systematic difference
in form between individuals of different sex. In
females, more subcutaneous fat and fat
deposits mainly around the buttocks, thighs
and hips are central to sexual selection. The
waist-hip ratio of any physique is very strongly
correlated to male perception of female
attractiveness across all cultures and
throughout history. This is a key health and
fertility indicator and core feature of feminine
beauty (Singh et al, 2007).
Exposure to visual images depicting
attractive females is found to alter women’s
perception of their own sexual attractiveness
and mating viability through a cognitive
comparison process referred to as the contrast
effect (Gutierres et al, 1999).
The contrast effect is the enhancement or
diminishment of perception, cognition and
related performance as a result of previous
exposure to a stimulus of lesser or greater
value in the same dimension (e.g. weight,
height, luminescence). Contrast effects are
ubiquitous throughout human and non-human
animal perception and cognition. In terms of
evaluating one’s own attractiveness, one
appears more attractive when contrasted with
a person less attractive and less attractive
when contrasted with one of greater
attractiveness. Indeed, women are most highly
satisfied with their own body image when
exposed to images of females wider than
themselves (Tucci & Peters, 2008).
Until recently these self-evaluations of body
attractiveness involved comparisons with a
relatively small number of other women in the
local mating pool. However, today’s culture is
unique: the points of comparison provided by
visual media which women use in their selfevaluations are not only profuse and
omnipresent but are demographically atypical,
with no geographic relevance to the given
female concerned. Such images are often of
women of high media status. As the Royal
College of Psychiatrists (RCP, 2010) stated:
‘There is a lack of reality-based imagery….
propagating unattainable body ideals ... the
norm through extensive use of digital
enhancement or airbrushing.’
In short, from an increasingly earlier age,
females today are exposed to evolutionarily
novel stimuli that deceive cognitive and
neurological processes whose function
developed to evaluate other females in a
small-scale local mating pool. The result is the
widespread body image distortion and
dissatisfaction, reported above, and adaptive
behaviours often at odds with sexual
dimorphism and sexual selection. As females
use atypical media physiques to establish
cognitive norms as points of comparison and
adapt their self-presentation accordingly
through misguided dieting and disordered
eating, it has for many become a case of
‘keeping up with the Boneses’.
The Biologist Vol 57 No 3 October 2010
A source of thinspiration?
Conclusions
There has been a decided shift in position by
scientists and prominent medical bodies in
considering media images as being causative.
Spettigue and Henderson (2004), for example,
concluded: ‘The media is a causal risk factor
for body dissatisfaction, negative effect and
eating pathology’.
The Royal College of Psychiatrists has issued
a 'Statement on the influence of the media on
eating disorders' (2010). ‘The media has a role
in both providing a social context for the
development and maintenance of eating
disorders ... achieved by propagating
unobtainable body ideals and the acceptability
of dieting leading to lowered mood, body
dissatisfaction and eating disorder symptoms.
There is a lack of reality-based imagery’.
In their ‘Summary and Call for Action’, they
demand the ‘use of role models throughout the
mass media that cover a diversity of weight,
shape, age… cessation of the use of
underweight models… raising awareness of
use and extent of digital manipulation of
images through use of a kite mark’.
There is good reason for these strong
reactions as few realise the sheer prevalence
and mortality rate of anorexia nervosa. In the
UK, 1.4m females currently have an eating
disorder. Of these 140,000 have anorexia
(NICE, 2004) and with a 10% mortality rate,
approximately 14,000 will die. If only 5% of
these deaths could hypothetically be attributed
mainly to the effects of exposure to thin media
physiques, this equates to 700 deaths. This is
far greater than the number of women in the
UK killed each year through domestic violence
(approximately 100) or from heterosexually
contracted HIV/AIDS (38) per annum.
A decade ago, the British Medical
Association’s Board of Science and Education
demanded ‘a more responsible editorial
attitude towards the depiction of extremely
thin women as role models’ (BMA, 2000). Yet
matters have become much worse.
Traditionally, suggestions that media images
are causative are deflected by the
rationalisation that ‘the media merely reflects
society and are being used as a scapegoat for
body dissatisfaction and eating disorders’.
However, the biological sciences have now
provided a deeper understanding of the
precise role of media physiques in these
pathologies. In other areas of child and public
health, exposure to causative risk factors for
disease are ultimately controlled through
legislation. As thin media physiques are now a
biologically based medical issue, it raises the
question of whether assertive guidance should
in future emanate from the Department of
The Biologist Vol 57 No 3 October 2010
Health as opposed to the Department for
Culture, Media and Sport.
There is already a precedent for media
policy and legislation based upon the
biological characteristics of people
represented on television screens, for
example, there is racial diversity and gender
legislation. The BBC, for instance, ‘is
committed to reflecting the diversity of the UK
audience… in its output on TV, on radio and
online.’ At the same time, an ongoing issue is
the de-selection of females whose biological
characteristics include grey hair and/or
wrinkles on all electronic media networks in
most Western industrialised countries.
Following this logic, female physique is yet
another biological parameter which could be
considered an aspect of diversity.
Both the BMA and the RCP have called for
media physiques ‘that cover a diversity of
weight, shape, age…’ Implementing this
policy will require a new-found enlightened
intolerance towards images deemed harmful,
i.e. the incorporation and active exclusion of
media physiques according to their degree of
risk to young female viewers. While most
concern has surrounded thin fashion models,
greater risk may lie in the more everyday
ambient images of ‘permarexic’ – visibly
unhealthily thin – children’s television
presenters, actresses and innocuous
newsreaders who form the backdrop to the
visual lives of girls and women. At a practical
level, a minimum standard of risk
acceptability would have to be established
based upon visual physique parameters such
as waist-hip ratio and dress size. Alternatively,
ensuring that a roughly accurate proportion
of female media images are an average UK
dress size 16.
This may seem an extraordinary form of
social medicine but the evidence suggests that
‘a lack of reality based imagery’ in media is
causing health problems in a very large
number of women and young girls. And so it
appears that while men eat food, women have
a relationship with food. This relationship has
grown increasingly dysfunctional. Forty years
after the debut of body politics, biology is
explaining more precisely why fat is a
feminine issue.
Dr Aric Sigman FSB is a Fellow of the Royal Society of
Medicine and Associate Fellow of the British Psychological
Society. He was recently invited to address the European
Parliamentary Working Group in Brussels on ‘The Impact of
Television and Screen Media’ on child health and well-being.
Further reading and references can be found at
www.societyofbiology.org/biologist
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