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Training teachers to deliver body image lessons to
teenagers in schools could help improve body esteem
and reduce the risk of eating disorders, according
to new research by King’s College London’s Institute
of Psychiatry.
Body dissatisfaction in adolescence is common –
17-33% of teenagers report body dissatisfaction,
with the figure higher for girls than boys. It is
associated with a range of problems, from depression
and eating disorders, to cosmetic surgery use, over-
and under-exercising, obesity and unhealthy weight
loss behaviours such as smoking.
School-based interventions for body dissatisfaction
have been recommended by the UK All Party
Parliamentary Group on Body Image. Having
interventions delivered by teachers allows
programmes to have wide reach, to have minimal costs
and therefore to be sustainable in the long term.
Some schools have been relying on programmes that
are not evidence based. As well as potentially being
a waste of resources, there is concern that these
could cause harm.
Researchers set out to test the effectiveness of an
intervention called Me, You & Us. 16 classes of
adolescent girls from three different schools were
recruited to participate in the study. 261 of the
pupils were in the intervention group and received
six, 50-minute body image lessons delivered by their
school teachers.
Lessons focused on media literacy (where ideals of
beauty come from and critically analysing media
images), peer interactions (concerning ‘fat talking’
– discussions about weight and shape, and activities
on giving and receiving compliments) and positive
psychology principles (including boosting mood and
self-esteem).
The other 187 pupils received their lessons as
normal, and acted as the control group.
A
week before the trial began, all pupils completed
questionnaires to gather information about their age
and ethnicity, and to screen for the presence of
eating disorders including anorexia nervosa, bulimia
nervosa and binge eating disorder. Their body esteem
was assessed before the intervention began, after
the intervention had finished and at a three-month
follow-up.
The
researchers found that receiving the lessons had a
significant positive effect on the girls’ body
esteem, and this effect was maintained over the
three months of follow-up. At the start of the
study, 17% of pupils in the intervention group and
19% of pupils in the control group were in the
clinical range for body esteem.
After
the intervention, 32% of the pupils who were in the
clinical range for body esteem showed reliable
improvements after receiving the intervention,
compared to 8% in the control group. In the
intervention group, small but significant
improvements were found in the pupil’s thin-ideal
internalisation – the extent to which they endorsed
social ideals associated with thinness – and in
their self-esteem.
Importantly, there was no evidence of harm (i.e.
decreases in body esteem) from receiving the
programme. Three-quarters of pupils were either
neutral or positive about how enjoyable the lessons
were, and approximately two-thirds were neutral or
positive about the usefulness of the lessons.
Lead
researcher Dr Helen Sharpe, from the Eating
Disorders Section at the Institute of Psychiatry at
King’s said: “There is a need for safe and
effective, evidence-based body image interventions
that teachers can deliver in school. Our study
suggests that a teacher-delivered programme for body
image dissatisfaction is feasible, acceptable and
effective. However, substantial further work is
needed in refining the content of the lessons,
increasing the effectiveness, improving the
flexibility with which they may be used in different
schools, and exploring the best ways of providing
training for teachers so they are adequately
prepared for this role.”
The
study is published today in the British Journal of
Psychiatry.
The
research was supported by the National Institute of
Health (NIHR) Programme Grants for Applied Research
and the NIHR Biomedical Research Centre (BRC) at the
South London and Maudsley NHS Foundation Trust and
King's College London. The views expressed are those
of the author(s) and not necessarily those of the
NHS, the NIHR or the Department of Health.
For more information
Sharpe H, Schober I, Treasure J and Schmidt U.
Feasibility, acceptability and efficacy of a
school-based prevention programme for eating
disorders: cluster randomised controlled trial
British Journal of Psychiatry
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