In a glamour-obsessed society which places high premium on physical beauty and form and promotes perfect body images through advertising, cinema and all-pervasive social media, there’s increasing pressure on adolescents to conform to improbable physical ideals. This growing body image obsession is prompting millions of teens worldwide to resort to extreme diets and punishing exercise routines with adverse physical and psychological consequences - Sruthy Susan Ullas
Bangalore-based class VIII student Rahul Kumar (13) hates morning school assembly. The smallest boy in his class, he is asked to stand first in line every day, while his friends, a foot or two taller than him, stand behind, “looking strong and manly”. Back home from school, he weighs himself every evening, stares into the mirror and sulks.
“He constantly compares himself with other boys in school and the neighbourhood and asks, ‘Why am I so small?’ We explained to him that his height is normal for an Indian child and that since we are not very tall ourselves it’s natural that he is of average build. But, we can’t mollify him,” says Lekha Kumar, Rahul’s mother, a resident of Bangalore. Last year Rahul signed up at the local gym and went on a super-protein diet. Academics, sports and co-curricular activities were abandoned. The gym-diet regimen continued for eight months, after which he insisted on taking vitamin/growth supplements. That was when Lekha realised it was time to seek professional help.
When 11-year-old Helen J, a class VI student of a top-ranked private school in Bangalore, began skipping daily, her parents initially believed their only child had discovered a new passion. But soon the skipping sessions continued into the wee hours of the morning, and her food intake was down to a daily scoop of ice cream. Helen’s paediatrician remembers her walking into the clinic covering her face because of her chubby cheeks. Recently this pre-teen was hospitalised for hypotension (low blood pressure) and extensive counseling.
Rahul and Helen are both suffering body image issues defined “as a person’s perception of physical self and the thoughts and feelings, positive, negative or both, which result from that perception” according to the National Eating Disorders Collaboration (Australia). In a glamour-obsessed society which places high premium on physical beauty and form and promotes perfect body images through advertising and cinema, there’s increasing pressure on adolescent as well as younger children to conform to improbable physical ideals. Constant exposure to idealised images of physical perfections such as flat abs, thin waists, toned arms, flawless complexions, bikini bods, etc are compelling a rising number of teens and children to chase the perfect body image ideal.
Moreover with the Internet-enabled social media such as Facebook, Twitter, Instagram, etc becoming ubiquitous, body shaming and bullying have acquired new meaning and momentum with a huge number of children suffering negative body image neuroses. Persistent negative body perception can result in depression, anxiety, anger, self-loathing, and eating disorders such as anorexia, bulimia, body dysmorphic disorders and exercise addiction.
Once dismissed as a western phenomenon, the obsession to look good is gripping Indian teens. A study published in the International Journal of Humanities, Arts, Medicine and Sciences (August 2016) on the ‘Prevalence of eating disorder cognitions among Indian adolescent girls’ found that 70 percent of the 1,080 girls aged 11-19 years surveyed had an “eating concern, 60 percent were troubled by their weight and 54 percent by their body shape”. Around 41 percent were under-weight because of self-starvation. Similarly, a 2017 study, which surveyed 1,811 adolescents including 956 male children in schools in the western Maharashtra city of Pune (pop. 3 million), reveals that boy students are obsessed about weight gain to build muscular bodies while teenage girls are hell-bent on “looking slim and good”.
Comments Dr. Vaishali Deshmukh, lead researcher of the Pune study and practicing paediatrician at the city’s Deenanath Mangeshkar Hospital and Research Centre, who also heads the hospital’s Nine-to-Nineteen clinic: “There is increasing pressure on teens from society, media and peers to conform with idealised body types. All girls are under pressure to be pretty and slim and boys to look strong and muscular. This psychological pressure to attain perfect beauty ideals influences their psyche to the extent that underweight girls we interviewed misperceived themselves as having normal weight and even being overweight in some instances, whereas almost 40 percent of overweight boys regarded themselves normal. Body image issues and resultant eating disorders were generally thought to be exclusive to teenage girls, but our study shows they are increasingly affecting adolescent boys as well.”
Artificial role models
Child psychologists warn that adolescents internalise popular media representation of men and women. For instance according to a 2013 study published by Rehabs.com, for teenage girl children, Barbie dolls project the perfect version of females with an “ideal figure” (5’9’’ tall and 49.8 kgs) while the media gives wide publicity to whippet-thin models who have starved their way to stardom. These models — fictional and real — set unrealistic physical standards for girl children, as only an estimated 5 percent of women can achieve the body type idealised by American media.
Role models of adolescent boys too have become increasingly muscular and unrealistic. From Indian cartoon characters like Chota Bheem to American fictional superheroes such as Hulk, Batman and Wolverine, and six-packed action movie stars with exaggerated physiques, popular media is projecting male role models boasting unattainable physical strength and perfection. Moreover adolescent boys and girls on the cusp of adulthood are unable to discern digitally enhanced and heavily photoshopped pictures of celebrities.
Social media impact
In the new millennium, explosion of the social media has exacerbated the obsession of adolescents with developing super bods even as body shaming has become commonplace. A 2016 study published in Research Gate Journal highlights that intense social media activity (Facebook, Instagram, Twitter, Snapchat, etc) is linked to negative body images and eating disorders, in both adolescent boys and girls.
“Intrusive media exposure of millions of teens worldwide is becoming dangerous. Youngsters spend a disproportionate amount of time on WhatsApp, Facebook, Snapchat and Instagram, posting selfies and monitoring likes and comments. As adolescence is the time when one develops self-identity, not getting enough ‘likes’ on a photo or receiving adverse comments can quickly affect an adolescent child’s self-esteem and push 
her into depression. A rising number of parents are consulting with us to help their children cope with this problem. Eating disorders which do not reach the diagnostic threshold of anorexia or bulimia, are common as is fall in academic performance and self-esteem. Moreover sensitive teens often withdraw from social life and suffer severe anxiety and depression,” says Dr. John Vijay Sagar Kommu, professor of child and adolescent psychiatry at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore.
Intense peer pressure is one of the major causes for the growing dissatisfaction of teens with their own bodies. A ten-year (March 2002-12) retrospective review of adolescents who visited the child and adolescent psychiatry outpatients service at NIMHANS, published in 2016 in the Andhra Pradesh Journal of Psychological Medicine, highlights that they “were teased by family members and friends for being plump, some were compared to their siblings and friends and their initial weight loss was even appreciated prior to the onset of these symptoms”.
“Bullying and pressure from family including parents and peers is a prime cause of children becoming obsessed with their body images. I once encountered a nine-year-old-boy who refused to change into his swimming costume as he feared his friends would tease him. Some children who take to swimming to attain the ‘ideal figure’ quickly exhibit symptoms of anorexia, refusing to eat a normal, healthy diet fearing weight gain. Many parents also foolishly persist with commenting on their children’s weight gain and loss instead of emphasising good health and fitness,” says Nisha Millet, former national swimming champion and founder of Nisha Millet’s Swimming Academy, Bangalore.
Dieting & bingeing
The most common recourse of teenagers to attain the perfect body image is crash diets and food fads. Comments Samarpita Chakraborty, a Mumbai-based media professional and mother of a male class XII student who has become obsessed with building six pack abs. “He has cut down on rice and sweets, and upped his protein intake — eggs for breakfast, fish for lunch and chicken/sausages for dinner in addition to taking a protein powder blended into milk after a daily workout of 90 minutes in the gym. All this began after he suddenly found an admiration for Arnold Schwarzenegger, the Terminator hero.”
Nutritionists warn against diet modifications without proper guidance. “Children don’t know the consequences of drastic dieting and bingeing. Physical growth and development is adversely affected by calorie-restricted diets,” says Shiny Chandran, a Chennai-based sports nutritionist and weight management specialist, who is also the first Olympic Council-certified sports nutritionist in India. Chandran advises parents to counsel their children on following a balanced diet and healthy lifestyle. “It’s important that parents explain to their children the advantages of following a balanced diet and active lifestyle. Apart from a balanced diet comprising carbohydrates and proteins, adequate sleep is also essential for muscle growth. Excessive time online and use of cell phones, gaming, watching TV for long hours adversely affects physical growth. Excessive weight loss is not healthy and can lead to complications,” she warns.
While sculpting the ideal body image is a major preoccupation of teens, another big obsession, according to dermatologists is “white skin and flawless complexion”. “A rising number of teens are consulting us for beauty treatments. The most common complaint is acne or pimples, followed by worries about dark skin tone, but we counsel against use of skin lightening creams and procedures in younger age groups,” says Dr. Mukta Sachdev, head of the dermatology department of Manipal Hospital, Bangalore. As an example, Sachdev cites the case of a 17-year-old teen who wanted a lips filler because a Facebook friend commented that her lips were too thin. “We counselled her against it. Most dermatologists are aware of the body image issues teens are experiencing and caution them against performing peels or cosmetic procedures unless necessitated by accident or physical injury,” she says.
Latest research indicates that body dissatisfaction is the leading cause of anorexia nervosa (an eating disorder which prompts excessive dieting) and bulimia nervosa (binge eating followed by purging). These eating disorders lead to malnutrition, which affects multiple organs, results in vitamin deficiency, anaemia, hypotension, bradycardia, hypothermia, muscle loss, and electrolyte imbalance. Moreover psychiatric comorbidity including depression, obsessive-compulsion disorders and suicidal ideation are other consequences.
“Parents have to assume a proactive role in monitoring and counseling today’s teenagers. They need to educate their tweens and teens that there is no exact age for the onset of puberty. There are early bloomers and late bloomers. While early bloomers get more attention from the opposite sex, others face tremendous peer pressure, and loss of self-confidence. Parents should closely monitor their children, be supportive and encouraging and simultaneously set boundaries. For instance parents should prohibit children below age 12 from weights training as their growing bones can get easily damaged. Aerobic exercises and outdoor sports are better alternatives,” says Dr. Anuradha H.S, a pediatrician with over 20 years of experience and chief consultant of Tots to Teens Healthcare, Bangalore.
Aarti C. Rajaratnam, director of the Child Guidance Centre and Counselling Clinic, Salem/Chennai and ParentsWorld columnist, believes that parents should be the first line of support for teens struggling with body image issues. “All teens experience a phase described as ‘imaginary audience’ where they feel that everyone is watching them. This escalates their biased sense of a poor body image, a sentiment prejudiced by media role models. Parents should solicit the advice of nutritionists if required, to plan well-balanced diets and monitor children’s exposure to television programmes and movies that send wrong messages about body types and well-being. This includes advertisements glorifying size zero or the use of products such as fairness creams. Instead they should help children develop hobbies and skills that make them feel empowered. They should also ensure that family members and friends don’t ridicule their children’s physical attributes. In India, even mere acquaintances believe they have the right to advise other people’s children on all matters, particularly weight gain or loss. Parents should join children in exercise workouts and ensure that they support the idea of fitness and well-being, rather than the myopic goal of weight loss,” says Rajaratnam.
Indeed among child psychologists, nutritionists and health counselors, the opinion is unanimous that adolescents should learn — or be taught — the art of accepting themselves. In that, lies true beauty.
Tell-tale signs of negative body image syndrome
A 2016 study of eating disorders in children and adolescents in India published in the AP Journal of Psychological Medicine advises parents to look out for tell-tale symptoms which indicate whether teens are suffering harmful negative body image issues. They tend to:
Avoid high calories food
Experience weight loss
Fear loss of control over food consumption
Experience significant anxiety and distress at meal times
Restrict food intake fearing weight gain (anorexia)
Suffer from amenorrhoea (irregular menstrual periods in girls)
Exercise addiction
Self-induced vomiting
Bingeing and episodes of uncontrolled eating followed by purging (bulimia)
Using medications to lose weight
Exhibit irritability and suffer mood swings
Research and fantasise about suicide
Exhibit depression
Suffer body dysmorphic disorder — preoccupation with real or perceived body flaws and consequent mood changes
Developing positive body image
Psychiatrists, pediatricians and counselors interviewed for this cover story advise parents to follow this 5-point guide to help adolescents develop positive body image.
Discuss the importance of fitness. Support the idea of fitness and well-being rather than weight loss and gain.
Educate children about ideal heroes. Children need to be told that celebrities with superbods have the support of full-time fitness trainers who design their exercise workouts, nutritionists and professional make-up artists, and plastic surgeons to make them look flawless. In addition, photographs splashed in the media are heavily photoshopped and/or digitally enhanced.
Choose unconventional role models. Introduce children to alternative heroes who are talented achievers without super bods.
Teach children to love themselves. Boost children’s self-esteem by highlighting their acumen, skills and unique capabilities. Encourage them to develop non-academic hobbies and interests.
Educate children about the natural physical evolutionary process. It’s important to counsel children and help them to understand that their physical growth is dependent on several genetic and environment factors.
Monitor children’s social media access. Restrain children from constantly posting photos on Facebook, Instagram, etc. Also prohibit membership of body building and fitness forums which project exaggerated body images.