Body image is the combination of one's thoughts and feelings towards one's own body (National Eating Disorders Collaboration, 2023). This article explores the interventions already implemented by educators and school nurses to promote a healthy body-image and encourage healthy social media usage.
The relationship between body image and social media is complex as there are both positives and negatives associated with exposure to online media (Harriger et al, 2023). There are a number of body positive role models on social media, who continuously promote healthy bodies, healthy diets and exercise. In contrast, there are also many celebrities and influencers whom young people seek inspiration from and who display unrealistic bodies by using filters or cosmetics in order to look a certain way (Emotion Matters, 2018). In addition, these people may promote unhealthy diets and lifestyles for young people (Packer et al, 2022). Many young people follow the latter with unrealistic body types, and when they cannot achieve the desired look they may develop a negative body image (Harriger et al, 2023). This has been shown to lead to a number of issues such as mental health deterioration and eating disorders (Emotion Matters, 2018).
Background
Research around social media has found that it can cause negative feelings toward oneself, especially in children and young people. In fact, the Mental Health Foundation (2019) found in one of its surveys that 40% of young people described social media as a source of worry, often leading to disordered, restricted and binge eating. In addition to this, the increased use of social media has been linked with young people feeling more dissatisfied with their bodies (Safe, Secure, Online, 2023). This is a substantial issue that needs to be tackled by school nurses, educators and the government in order to ensure that young people are able to thrive and succeed while engaging in a healthy lifestyle and having positive feelings toward their body.
It is concerning that so many young people feel that social media has an impact on their perceived body image and, despite this, one study shows that 91% of 15–16-year-old young people engage in some form of social media (Dixon, 2022). In addition to this, it has also been found that a quarter of children aged 3 to 4 years have their own profile on a social media platform. This suggests that exposure to the dangers of social media is happening at a younger age than ever before (Dixon, 2022). It also suggests that parents and carers of young people may be encouraging social media from a young age, which raises the question of how much adults are aware of the dangers posed by social media usage in children and young people. It is the role of the school nurse to promote a positive body image, healthy lifestyle and help build resilience in young people when they are exposed to potentially harmful content. In addition, school nurses, along with education and the government, need to ensure that the wider community is aware of the dangers in order to build a safer and healthier environment for young people to grow up in.
‘… 40% of young people in one … survey described social media as a source of worry, often leading to disordered, restricted and binge eating.’
Relation between social media and body image
Time spent on social media
The negative impact social media can have on adolescent body image is a recurring theme in recent literature. So is the suggestion that when social media use is regulated, and frequency and duration are reduced, young people have a more positive body image and greater self-compassion. Many recent papers highlight the dangers social media can pose to young people if used regularly and also the harm that it can do to a young person's body image and selfesteem (Salomon and Spears Brown, 2018; Roberts et al, 2022; Markey and Daniels, 2022; Mahon and Hevey, 2022; Choukas-Bradley et al, 2022; Maes and Vandenbosch, 2022; Harriger et al, 2023). In addition to this, the papers suggest that ongoing social media use can cause a reduction in the mental health of adolescents, which only compounds the issues associated with body image (Roberts et al, 2022).
A study by Roberts et al (2022) demonstrated that when 65 students participated in a 3-day social media ‘fast’ they showed a substantial increase in self-compassion toward their own body (Roberts et al, 2022). The American Psychological Association also found that young people who reduced their social media usage by 50% for around 3 weeks had a significantly more positive outlook on their overall appearance, compared to young people who maintained the same usage as previously (American Psychological Association, 2023). This suggests that when a young person is not engaging in social media their self-compassion toward their body improves greatly. It is important to note, however, that social media has become an integral part of modern life; therefore, it cannot be a realistic expectation for young people to completely cut social media out of their lives, nor is it accurate to exclusively portray it as ‘evil’. Hence, despite these findings, the complete removal of social media is highly unlikely to happen (Harriger et al, 2023). However, it is possible to infer that time spent off social media may be healthy for young people. This would suggest that; if school nurses, educators and parents can make young people aware of the dangers of social media then it may be possible to significantly improve their body image (Roberts et al, 2022). Unfortunately, only 65 girls were measured in Roberts et al's (2022) study, which is a small sample size to come to conclusions surrounding body image and social media. In addition, other recent research papers did not find that a complete fast of social media was beneficial, which may put these results into question.
Type of social media
It has also been suggested by researchers that it is not necessarily the time spent on social media that decreases self-confidence in body image, but the types of social media young people are engaging with (Maes and Vandenbosch, 2022; Choukas-Bradley et al, 2022; Harriger et al, 2023). This suggests that there are some areas of social media that may play a positive role in an adolescent's life (Maes and Vandenbosch, 2022; Choukas-Bradley et al, 2022). It has been found that when young people view appearance-focused social media (ASM) and observe people's worth in society and popularity dictated by their body or physical attributes this may lead to a more negative body image (Harriger et al, 2023). The ASM platforms (such as Instagram or Snapchat) appear to play a greater role in body image negativity compared with Twitter or Facebook, according to research (Choukas-Bradley et al, 2022). This suggests that not all social media leads to a poor body image but young people who engage in photo-based media platforms are more likely to suffer with their body image (Harriger et al, 2023). In addition, adolescents are often exposed to idealised body types on photo-based social media platforms and when comparisons are made with themselves, they often fall short. This has been shown to lead to disordered eating, poor mental health, dissatisfaction with one's own body and in extreme cases eating disorders (Choukas-Bradley et al, 2022; Harriger et al, 2023). This demonstrates the seriousness of the role social media may play in body image and why further research must be carried out to look into this. In contrast, research has suggested that social media can have a positive impact on the body image of young people if appropriate forms are used. There are many positive role models on social media who may play a role in increasing the self-compassion a young person has toward themselves (Maes and Vandenbosch, 2022). Therefore, it is possible that there is a fine line between social media playing a negative role in how a young person feels toward their own body but also may play a positive role by demonstrating that all bodies are different (Maes and Vandenbosch, 2022).
Interventions
School nurses' role
A review of the literature suggests that there is a substantial lack of research into the role school nurses play in supporting young people with safe use of social media and in turn how they can improve body image. However, the literature suggests that as long as young people are aware of the difference between myth and reality on social media, they can use it as a positive tool in their life (Diedrichs et al, 2015). In addition, the literature suggests that young people need to be aware that many of their role models on social media use filters and blemish correctors to create idealised images that many young people aspire to but will never reach (Choukas-Bradley et al, 2022). It is clear that social media can be and often is damaging for the body image of young people. In saying this, the research also suggests that if adolescents are made aware of the potential risks then they can develop resilience toward social media and within their body image can be built, ensuring that they allow themselves to have greater compassion toward their own body (Harriger et al, 2023).
Whole-school approaches
School nurses should become more involved in making young people aware of the potential harms of certain types of social media, as this has been shown to be effective in building resilience against the potential dangers it poses (Choukas-Bradley et al, 2022). Whole-school approaches have been shown to increase scepticism, awareness of unrealistic appearances and popularity, meaning that young people have the skills to make an informed decision about how they feel toward certain types of social media (Diedrichs et al, 2015; Choukas-Bradley et al, 2022). However, it has been suggested that male and female adolescents engage in social media in a different way and their motivations for using it are entirely different (Harriger et al, 2023). Due to this, it must be considered whether a whole-school approach to interventions with social media would be effective or whether there would need to be separate interventions to truly provide young people with the knowledge required to make social media a safe place to engage with.
Media literacy programmes
Media literacy programmes can be a useful tool when supporting young people with poor body image due to social media. An experiment conducted in 2015 found that a single 60-minute session on body image immediately improved body image in girls, though boys showed no significant difference (Maes and Vandenbosch, 2022). There was a focus on media literacy, ensuring that young people were aware of the dangers of social media comparisons and unrealistic expectations. The media literacy programmes were found to be engaging; according to Diedrichs et al (2015), young people have reported to feel more knowledgeable about social media and the link with body image. In saying this, the body image sessions covered significantly more than social media, therefore it cannot solely be considered the reason for improved body image in these young people (Diedrichs et al, 2015), though it does highlight that an increased social media awareness can improve body image in young people. School nurses can learn from this that classroom-based approaches work in supporting young people to understand the potential risks and benefits of social media, in turn improving their overall body image. Despite this, researchers have advocated for teachers delivering these interventions so that students are not waiting for an outsider to schedule an appointment (Diedrichs et al, 2015). However, if school nurses work in partnership with schools and other members of the multidisciplinary team it may be possible to provide effective media literacy programmes to all young people. This may mean that school nurses would not be the most appropriately placed to deliver such interventions. It should be considered whether school nurses are able to incorporate this within other interventions, such as the National Childhood Measurement Programme, as that would provide a captive audience to promote body positivity and make young people aware of the issues associated with social media.
Gender-responsive teaching
It is clear that there is a distinct lack of research into the role social media has on the body image of adolescent boys. The literature found is largely focused on girls' experience of social media and the impact it has on their body image. Though issues relating to body image are very prevalent in girls, the body image of boys cannot be ignored. The Mental Health Foundation has stated that millions of men in the UK have body image issues (Mental Health Foundation, 2022). If this is the case, why is there a lack of research into this area? It has been suggested that girls are more likely to focus on appearance-focused social media (ASM) than boys therefore they are more susceptible to poor body image due to this (Choukas-Bradley et al, 2022) though that does not mean that social media is not affecting adolescent boys. This means that the potential solutions highlighted by the research such as media literacy programmes and increasing awareness cannot be generalised to boys due to the limited research into this area, which may potentially lead to worse outcomes for them.
An example of this is that in body positivity campaigns, such as the Dove (2022) Real Beauty Campaign. Women are photographed and discussed regularly in this campaign whereas boys do not receive the same exposure. This is concerning as it means that adolescent girls are being taught resilience to social media and body image and boys are not receiving the same education. As data shows, 91% of all 15–16-year-olds are active on a platform of social media (Dixon, 2022) and it is undeniable that social media creates unrealistic and often unobtainable body standards that can affect both girls and boys (Salomon and Spears Brown, 2018). In addition to this, research has found that boys who have a negative body image are more prone to feelings of shame, sexual dysfunction, disordered eating and in some cases it can lead to depression (Salomon and Spears Brown, 2018). It is concerning that much of the research appears to ignore the role social media has on boys simply because they access less ASM. Further research should be conducted into the impact of social media on all genders in order to ensure that when any body image support is delivered in schools, to parents or children themselves it is possible to provide support for everyone who needs it.
‘ there is a distinct lack of research into the role social media has on the body image of adolescent boys. The research found in the literature review was largely focused on girls' experience of social media …’
‘In future, the role of school nurses could be to encourage self-compassion, discuss social media literacy and advocate for young people… By doing this, it may be possible to improve the outcomes of adolescents who are currently struggling with body image.’
Policy changes
The role of adults, such as parents, school nurses or educators is to advocate for young people to ensure they are kept safe online (Harriger, 2023). It is clear that not enough is done to protect young people from the potential body image harms of social media with 40% of young people citing social media as a factor in negative body image (Mental Health Foundation, 2019). The government must be encouraged to provide further protection; for example, by implementing certain conditions for edited photographs. In France a bill made its way to parliament, requesting a disclaimer to be shown alongside photographs posted on social media, so that young people can be made aware that this is not a realistic body expectation (Harriger et al, 2023). This is likely to make a difference to young people's perception of ‘influencers’ and ‘celebrities’. School nurses should advocate for young people by promoting policy changes with local and national government, even if this is likely to be a slow process.
Further recommendations for practice
Overall, it is clear that further research must be conducted to fully understand the role social media has on the body image of children and young people and the support that should be implemented to protect young people from the potential dangers of social media.
School nurses have a privileged role thanks to their healthcare background but are also able to support people both within schools and the home setting (Local Government Association, 2022). Despite this, school nurses do not currently play a significant role in supporting young people achieve a healthy body image. There is no research centred around the role of the school nurse in tackling this issue despite their background and the fact that they would be well placed to deal with this issue. In future, the role of school nurses could be to encourage self-compassion, discuss social media literacy and advocate for young people with teachers, parents or carers and the wider society. By doing this, it may be possible to improve the outcomes of adolescents who are currently struggling with body image.
Conclusions
Social media affects the body image of many children and young people around the world (Mental Health Foundation, 2022). Despite this, it is clear that social media is a part of contemporary life and there are also positives that stem from their use. Nonetheless, social media can pose a substantial risk to young people if they are not taught social media literacy (Harriger et al, 2023). In order for school nurses to provide support, there needs to be greater awareness around the risks and further research must be conducted into suitable and effective interventions.
KEY POINTS
- Social media usage can have a serious impact on children and young people's body expectations, and mental health and wellbeing.
- The impact on body image may vary according to both the amount of time spent on social media and the type of social media consumed.
- There is a lack of research into the role of school nurses in supporting positive body image in relation to social media.
- A whole-school approach can help toward tackling the negative impact of social media on body image.
- It is important that all genders are considered when rolling out media literacy programmes.