Young mental health ambassador discussions: body image

Research findings from Healthwatch Essex | August 2022

About Healthwatch Essex

Healthwatch Essex is an independent charity which gathers and represents views about health and social care services in Essex. Our aim is to influence decision makers so that services are fit for purpose, effective and accessible, ultimately improving service user experience. We also provide an information service to help people access, understand, and navigate the health and social care system.

Background

During monthly meetings with the Young Mental Health Ambassadors (YMHA), the ambassadors spoke frequently about body image and shared concerns of other young people having negative views of themselves and low self-esteem. They were enthusiastic to share their experiences and their thoughts on what could be damaging to a young person’s perception of themselves. Following further meetings, as a group, we decided to explore this in more depth and co-design a survey which would encourage young people to talk about their lived experience.

How we did this research

Preliminary discussions were held with the Young Mental Health Ambassadors to discuss how best to engage with young people. Due to the success of the previous YMHA Discussions project exploring the impact of COVID on young people’s mental health, as a group, we decided to continue using an online survey format to collect the views of young people and their parents and guardians. An online meeting was additionally held on 11 July to discuss the questions further in detail and to allow the opportunity for experiences to be shared in a safe place with other young people.

In March 2022, a Young Mental Health Ambassadors monthly meeting was dedicated to co-designing the YMHA Discussions survey. This was distributed by the ambassadors to friends and young relatives. Following feedback from the ambassadors who shared that their parents and guardians were keen to participate, a second survey was adapted to provide the opportunity for them to participate. The aim was to collect the wider perspectives of young people who had both had access to mental health services before and include those who had not.

The surveys were created on Google Forms and shared through the ambassadors, Healthwatch Essex online social media channels and website, Y.E.S. Tendring and Multischools Council.

In total, there were 54 participants, however not every question was answered by all participants. 26 young people aged 23 or under participated, with 28 parents and guardians also completing the survey.

Key findings

The meaning of body image

The young people’s interpretation of the phrase ‘body image’ was important for this project to gather an understanding of what it meant to them individually. All the young respondents shared very similar answers perceiving the phrase as the way that they viewed themselves and their bodies. However, alternatively, parents and guardians’ responses focused substantially more on how other people viewed their bodies, alongside their own perception of themselves.

The damage to young people’s body image

Other people’s comments

17 of the 26 young people responded that their body image had been affected by other people’s comments. These comments were mentioned by a variety of different people from friends, family and even comments from strangers online. They shared that any negative comments made to them or around them, especially at a young and influential age, had the potential to allow complexes to evolve that could have a long-lasting negative impact on them.

To coincide, adults who completed the survey raised concerns that they may be subconsciously affecting their children due to their own dieting and the way they spoke about their own bodies around their children. Some shared that they knew themselves that they had raised the topic of weight directly to their children too and they now question whether this may have impacted them.

A parent or guardian said: “Seeing role models such as us parents being self-critical, hearing people talk about certain foods as bad or good and hearing people say things such as ‘let’s be naughty’ when having treats such as cakes can damage a child’s body image”

The participants additionally wondered if different generations may have different views on body types which can cause comments to be made which are unintentionally hurtful. A number of participants shared that they didn’t believe comments about their body image had been made intentionally. However, they spoke of young people sometimes being very easily influenced and what someone may say as a passing comment, could stick with the comment recipient for the rest of their life.

A young participant said: “Elder generations don’t always have same views as younger people, which is completely understandable but also can be hurtful. It’s normalised to not be a very small size anymore, but older generations don’t always have this opinion.”

Participants shared experiences of being bullied where the main verbal abuse was orientated around their appearance and more specifically, their weight. They voiced that being bullied in turn can cause people to start to believe what is being told to them and make them self-conscious of how they look. In the online meeting, a Young Mental Health Ambassador shared a personal experience of having people make negative comments towards her weight at a young age, both by peers and relatives. As a direct result, she revealed that she had spent a large amount of money on tattoos, piercings, and hair dye to change the way that she looks.

Even from a young age, some participants expressed a wish for surgery to alter their appearance. It was additionally disclosed that some young people were concerned with how people viewed them and what others may think which caused them severe anxiety when meeting new people.

A young participant said: “Young people are affected by comments regarding things they can’t change. (Scars, complexion, texture, acne, height) Also things we shouldn’t have to change when young like weight.”

Social media

8 young people also shared that their body image had been negatively impacted by social media. Some spoke of believing that what they saw on social media was what society expected young people and their bodies to look like. The Young Mental Health Ambassadors expressed concern for younger generations who appeared to have access to social media and media in general from a younger age. They were equally concerned with the increase of photoshopped pictures being shared and that some people may not be aware that the photo they are looking at has been edited. The participants shared that the photoshopping contributed to the non-realistic point of view that society has on how both males and females should look like.

Social media accounts often suggest accounts to follow however these are often people with what are deemed as “perfect bodies.” The ambassadors referenced the Love Island cast a lot throughout the body image focused meeting. Seeing accounts which featured people from TV series like this who are considered to be very attractive could be triggering for some, including those with experience of eating disorders.

A Young Mental Health Ambassador said: “When photoshopping is done so well, people start to believe it.”

The young participants shared that Instagram was the most damaging social media channel for their body image due to being predominantly a photo sharing site. The presence of ‘influencer culture’ was mentioned multiple times by participants due to them being seen as “normal people” and not people in the public eye who may have paid for physical alterations to their body. Some revealed that they rarely see anyone else online who have similar body types to them which makes them feel different to other people of the same age. Participants spoke of seeing predominantly slimmer people becoming influencers online which they argued could make young people more aware of their own weight. They revealed that seeing different body types online would make them feel less self-conscious.

A young participant said: “Some social media accounts on TikTok and Insta where people show their workout routines, diets (‘what I eat in a day’ videos) and certain outfits can impact me more as the accounts are clearly focused more on the idea of one’s body.”

School uniforms and yearbooks

Interestingly, several young participants raised concerns around school uniforms. They spoke of uniforms not suiting all body shapes and sizes and that sometimes they felt their education was disrupted due to feeling distracted about how uncomfortable they felt. The young people shared that being able to allow small amendments to their uniforms would increase their happiness and confidence.

The Young Mental Health Ambassadors revealed that having photos shared in yearbooks could also be triggering. There were experiences shared of other students making negative comments about individuals yearbook photos. An ambassador shared that if a student refused, their year 7 photo would be used instead. Another ambassador responded saying that they specifically asked for their year 7 photo to be used instead to which the school refused and did not put any image in the yearbook. The ambassadors emphasised the importance of schools listening to students worries and concerns when using school photos.

Judgement and expectations

They additionally disclosed that they worried a lot about judgement from other people about the way they look. They spoke of feeling anxiety that people may think that they are lazy if they are overweight, and they wished that people realised that weight is not always easy to control.

Judgement was mentioned multiple times by the participants and was referred to when raising the topic of expectations of what people should look like. They spoke of people not understanding that not everybody wished to look the same and often young people want to embrace their differences but do not feel like they can.

A young participant said: “A lot of people online – influencers – seem to think everyone wants this ‘certain’ body type. Workout routines are often catered to achieving one style and sometimes people don’t realise that not everyone has the same goal – some people exercise to tone, stamina, train for a sport. But there are so many judgements on these people as there is an expectation that everyone wants/should want a specific body type.”

When it starts

When asked how young they were when they had first started thinking about their body image, the responses were nearly all the same with the sheer majority answering this had been between the ages of 8 and 14. Many participants shared that they could identify their body image views becoming more prominent when they hit puberty as this created an environment which encouraged them to compare themselves to their peers. One YMHA shared that for them, they started thinking about their body image when they were in primary school and the class was split up into male and female for PE changing times.

Negative comments were not specifically reserved for young people who believed that they were ‘under-developed’ but also for those who experienced development at an earlier age than their peers. Some young people disclosed that this led on to poor mental health not just at the time but also towards their later years due to feeling like they were different to other people and the way they looked.

A young participant said: “I was around 12/13 when body image was first discussed, the age when females’ bodies start changing quite a bit. It was brought up in a biological sense, but it contributed to negative thoughts and changes which were seen as bad.”

Parents who completed the survey revealed they were concerned for young people’s self-esteem now more than ever before due to the high exposure of bodies they deem unrealistic on social media and TV. Filters on applications like Snapchat and Instagram make it extremely accessible for young people to edit the way they look in photos and videos within seconds. This is a relatively new online feature whereas previously, people may have photoshopped their images however this required a certain level of skill and time.

A parent or guardian said: “My daughter is 14 and is already facially body conscious – using mascara, concealer etc when in reality she is blemish free, with naturally long thick eyelashes – I can’t understand why she feels she needs makeup. She is also heavily influenced by fashion, it’s sad. At 14 I was still none the wiser to any form of fashion or makeup, preferring to be out and about on my bike with friends.”

The impact on wellbeing and mental health

When asked, the young people shared that their mental health was often relatively dependent on how they felt about their body image. If they felt good about themselves, then overall they had positive mental health however alternatively, if they were feeling self-conscious, then this would create poorer mental health.

Positive impacts

The participants shared that a positive perception of themselves was often motivating, and they encouraged themselves to eat better and exercise. Stories were shared of feeling confident trying different styles of clothing and socialising more often.

A young participant said: “If I feel like I have a good body image, I am encouraged to eat healthier, move my body and carry out activities that make me feel good. I also generally feel more confident experimenting with different clothes and styles.”

Negative impacts

The young people shared they had experienced low self-esteem and self-worth, especially when comparing themselves to other people of the same or similar age. For some, this had led to depression and a reluctance to leave the house and be seen by other people. The participants revealed they often felt self-conscious when meeting new people especially, believing that first impressions are lasting and would include negative thoughts on their appearance. If they did go out to socialise, some would actively try to avoid photos as they didn’t believe they would be happy with what they saw. For others, they revealed they felt like they were going in circles as they used food as a comfort when feeling uncomfortable with the way that they look, which had caused weight gain for some. This in turn affected the way they viewed themselves.

A young participant said: “If I feel negative about my body, it can go one of two ways – I either obsess about working out which doesn’t have a good effect on my body and mood, or I feel so disheartened and lazy that I eat badly and don’t move, which in turn makes my body and mood feel worse. I am also more conscious of the clothes I wear.”

During the YMHA meeting, the Ambassadors were specifically asked if body image can impact on a young person’s life and if so, how. They answered unanimously that their dieting is affected and emphasised just how influential celebrities are. They said that if a celebrity or an influencer says that a particular diet is good, young people may be influenced to follow it. They were concerned about this as they had heard of celebrities endorsing diets when they had surgeries performed to gain their body shape and weight secretly.

The young participants disclosed that their body image had also had an impact on their daily life, manifesting for some into strict dieting and daily exercise routines, leaving them feeling guilty if they do not stick by these. 16 young people revealed that their choice of clothing was also dictated by their body image with some actively avoiding mirrors and wearing certain items as they thought they were showing too much skin and areas they did not feel good about. They shared stories of feeling uncomfortable eating in public due to feeling self-conscious about their weight and what other people may be thinking.

What parents and guardians noticed

16 parents and guardians shared that they had noticed their children’s mental health and wellbeing be impacted by a negative body image with no parents or guardians sharing experiences of a positive body image and subsequent impact on wellbeing. Multiple participants disclosed their children had developed eating disorders, demonstrated excessive exercising and fitness regimes, and displayed behaviour deemed to be body dysmorphia. Experiences were shared of parents noticing their child had started visiting the gym more than often, could not be seen without makeup on and self-depreciating comments their child had attempted to hide with humour.

They revealed actively trying to monitor their child’s behaviour and enforce strong positive comments about their appearance in an effort to boost their child’s self-esteem.

A parent or guardian said: “Negative body image has led to my daughter developing an eating disorder. It also led to serious anxiety issues particularly social anxiety around what other people think of her. This has developed into a perfectionism anxiety in all areas of life meaning she struggles with school and sitting exams, et cetera.”

Very similarly to the young participants, the parents and guardians also shared that they had noticed physical adaptions to their child’s daily life which they believed was due to a negative body image of themselves. 13 parents and guardians disclosed that they had noticed their child be conscious of what they are wearing, with most comments revealing that their children had been opting for baggy clothing to hide body parts that they did not like. They had also noticed their children picking at food when in public, observing that this was different when in the comfort of their own homes.

A parent or guardian said: “She always wears makeup, and has her hair tidy and modern, along with wearing the latest style of clothing which puts pressure on budgets. She also picks at food when in company.”

Some parents and guardians shared that they had not currently encountered any challenges regarding their children’s body image however nearly all believed that they would do as their child got older.

Support offered to young people

The participants were asked what support they had been offered by their educational institutions around the topic of body image and areas they believed could be improved. It was evident from the findings that the participants believed that the support offered was inadequate, if offered at all.

A young participant said: “I think there’s little to no support at schools. They are concerned about how to keep you safe online but don’t worry about the effects social media has on a person. I think more motivational speeches should be done in school (we did have one in my school, and I found it useful and then listened to him out of school, I found his talks on YouTube.)”

Some participants shared that they hadn’t required support however 15 of the young people disclosed that they either had not been offered any support or what was offered, they had found disappointing.

Many of the young participants said that they strongly believed that there needed to be more education around mental health in general and that this should include low self-esteem and body image. Some recalled being given contact details for mental health services but they either felt like they did not require support from an external network as this seemed too serious or did not feel comfortable approaching a different organisation. They emphasised the importance of having trained mental health professionals or school nurses accessible to students if needed.

The young people revealed that starting the conversation around body image would be a good starting point for educational institutions as currently they believe this topic is not being addressed. They were also keen to promote and encourage discussions around how to recognise mental health conditions, the importance of body positivity and the impact of social media on body image.

A young participant said: “When I was at school, nothing was ever addressed on body image. Initiating these conversations would be a good start – also education on eating disorders and the fact that a negative body perception can be a catalyst for other things.”

During the online session, a Young Mental Health Ambassador shared that there were basic mental health services at their school and college where they presumed that students could talk about their body image and insecurities, but they didn’t think the services were very good. Another shared that there wasn’t ever anything specifically mentioned around body image however they had known of conversations turning toxic when talking to teaching staff. One ambassador who lives in Essex was handed leaflets for mental health services in Cambridgeshire, which she found very unhelpful. The ambassadors questioned whether at college, the students time there is so short that there was no real attention paid to their students’ mental health. They thought that the staff were more focused on students turning up instead of the student’s mental health.

Concerns about weighing in schools

Parents and guardian participants raised concerns on their children being weighed in primary school and questioned whether this could affect children’s body image if they are not happy with their weight. They were additionally concerned that this could create the thought process of a negative body image. Parents were confused at the results when they said that their child was overweight as often, they did not agree and shared that they were doing everything that was advised in relation to exercise and healthy eating. Other parents and guardians disclosed that they had been disappointed by the support offered by school nurses if their child had been deemed over or underweight and they would have appreciated advice, even if in a written format.

A parent or guardian said: “My child has just had his height and weight done as a year 6. He came back as being in the higher bracket of being nearly overweight. I didn’t tell my son what the letter said as I thought this would upset him to the point that he wouldn’t want to eat to lose the weight as he is beginning to be more aware of what body image is about.”

The majority of both young participants and parents and guardians all agreed that educational institutions should include information on mental health and body image. A focus was made on secondary schools due to the age of the young people and the potential to be able to easily include the topic of body image within the PSHE curriculum.

A parent or guardian said: “When I was at school, there was no help at all. After seeing my daughter go through it, it seems there still isn’t a lot of support, even now. People need to be more sympathetic and be trained as invisible conditions are just as bad as physical ones.”

Recommendations

From the engagement conducted with the Young Mental Health Ambassadors, the young participants and parents and guardians, clear common themes were evident and from this, the below recommendations are to be considered:

1. Schools and colleges to include educational sessions to develop young people’s knowledge surrounding mental health and body image. The young participants revealed that they are exposed to a particular body type as seen on social media. They wished for it to be taught to children that different bodies are normal and learn more about what they see online may not necessarily be accurate.
2. Educational institutions to offer support when students may require it to help alleviate a negative body image or low self-esteem. Many of the young participants shared they had received disappointing support in relation to body image and low self-esteem if offered at all. This could additionally be in the form of supporting a young person accessing a local mental health service if the school or college do not feel they are best suited to help the student.
3. Mental health services to run social media campaigns to provide information to young people around how social media images may not always be accurate, how to build their self-esteem and where to go if they require support. The young people shared that social media played a significant part in their negative body image especially due to their high exposure to online platforms. Due to this, this would be an effective way of reaching out to young people on a higher mass.

Conclusion

The Young Mental Health Ambassadors recognised in themselves the impact that having a negative body image was having on their mental health and wellbeing and noticed that this was prevalent within their peers too. By co-designing a survey with the young people, it ensured that we were asking the right questions when gathering relevant information from the participants.

We received a high amount of feedback from a variety of age groups including parents and guardians however, many of the responses were similar with key themes being evident.

A large proportion of the young participants revealed that negative comments made by people around them, whether intentional or not, had the potential to cause long-lasting low self-esteem. Parents and guardians also recognised this themselves and noticed that there could be occasions when family members make comments, even about themselves, which could be triggering for young people.

Social media was additionally revealed to be damaging to young people’s body image as they are often susceptible to photoshopped imagery causing them to compare themselves to other people. To help counteract what the young people are exposed to online, mental health organisations should create online campaigns to help signpost young people to services and show them that social media is not always accurate.

Lastly, it would be recommended that educational sessions are delivered to young people, potentially within the PSHE curriculum. By notifying young people that educational institutions can support them during this time could help alleviate the probability of further mental health disorders occurring which was seen with some of the participants. If the educational institution does not feel like they are appropriate to aid the student, the young person should be supported when reaching out to an external organisation.