In which stage of adolescence is dissatisfaction with the body most prevalent

Body image relates to a person's perceptions, feelings, and thoughts about his or her body (Grogan, 2010). Body dissatisfaction is experienced by around 50% of adolescent females and 30% of adolescent males (Gallivan, 2014; Micali et al., 2014). It has a growing incidence among young populations, in both developed (Swami et al., 2010) and developing countries (e.g., Singh et al., 2015). Research has shown that body dissatisfaction has been found to predict psychological conditions such as low self-esteem (Paxton et al., 2006), depressive symptoms (Ferreiro et al., 2012; Stice and Bearman, 2001), and suicidal thoughts (Crow et al., 2008; Kim, 2009). In addition, research has identified body dissatisfaction as risk factor for a series of unhealthy eating and physical activity behaviours, including disordered eating (e.g., Gardner et al., 2000; Micali et al., 2015a; Neumark-Sztainer et al., 2006; Stice and Shaw, 2002), weight gain (e.g., van den Berg and Neumark-Sztainer, 2007), unhealthy dieting and lower levels of physical activity (Neumark-Sztainer et al., 2006).

Further, research has examined the role of body dissatisfaction on risky health behaviours. Risky health behaviours such as smoking, substance abuse, and drinking are prevalent during adolescence and have recognised negative effects on health (Biglan, 2004; Hawkins, 2012, World Health Organization, 2018). Smoking-related pathologies cause one in five deaths in the United States (General et al., 2014), and heavy drinking is the leading risk factor for ill-health, early mortality and disability among those aged 15–49 years in England (Burton et al., 2016). Similarly to body dissatisfaction, these behaviours tend to be initiated during adolescence (Biglan, 2004; Chassin et al., 1996) and often continue in adulthood (McCarty et al., 2004). Neumark-Sztainer et al. (2006) found that 13-year-old males with higher levels of body dissatisfaction were more likely to smoke at 17-years old. Similarly, Field et al. (2014) found that body image concerns were prospectively associated with drug use and binge drinking among United States (US) teenage males. Greydanus and Apple (2011) reviewed the relationship between self-harm and body dissatisfaction and noted a lack of longitudinal research on the topic, and on the prospective influence of body dissatisfaction on risky health behaviours more generally. Given the high prevalence of body dissatisfaction among young people, and in response to calls for research on the topic (Greydanus and Apple, 2011; Holzhauer et al., 2016), the first aim of the current study was to investigate the prospective association between body dissatisfaction and smoking, drug use, cannabis use, self-harming, gambling, and excessive drinking respectively.

A rich body of research indicates that eating disorders are a risk factors for later risky health behaviours (e.g., Field et al., 2012; Micali et al., 2015b, 2017; Sonneville et al., 2013). These include drug use (Micali et al., 2015b, 2017; Sonneville et al., 2013), excessive drinking (Field et al., 2012), cannabis use (Sonneville et al., 2013), and deliberate self-harm (Micali et al., 2015b, 2017). Adolescence is the developmental period in which eating disorders tend to peak (Micali et al., 2013); hence, it is important to monitor their rise to also prevent the increased possibility of later risky health behaviours. Given that body image concerns are a significant risk factor for disordered eating, it is possible that mediation is occurring. Therefore, the second aim of the current study was to assess whether disordered eating symptoms mediated the prospective relationship between body dissatisfaction and individual risky health behaviours.

In addition, most prospective studies exploring the association between eating pathology and risky health behaviours operationalise eating disorders based on the official classifications by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V; e.g., Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder) (e.g., Field et al., 2012; Micali et al., 2015b; Sonneville et al., 2013), rather than on the presence of individual disordered eating symptoms (e.g., dieting, purging, fasting, bingeing), which are arguably likely to be more common in the population. Importantly, Micali et al. (2017) found that, while purging, binge eating, and fasting behaviours in mid-adolescence were prospectively associated with drug use and self-harm, the frequency of these behaviours did not necessarily predict a greater number of adverse risky health outcomes. Arguably, a broader approach that takes disordered eating symptomatology into account can offer findings that apply to the wider population, and not only to those individuals who meet clinical diagnoses as denoted by the DSM-V. Therefore, the current study adopted a more inclusive approach to disordered eating by examining the prospective influence of a number of disordered eating symptoms on a range of risky health behaviours.

Using data from a longitudinal cohort of adolescent males and females living in the Southwest of England, UK (Avon Longitudinal Study of Parents and Children – ALSPAC; (Boyd et al., 2013, Fraser et al., 2013), this prospective study examined whether body dissatisfaction at 14-years old predicted a series of risky health behaviours (smoking, cannabis use, drug use, self-harm, gambling, medium-risk drinking, and high-risk drinking) at 21-years old. The first hypothesis was that body dissatisfaction would predict individual risky health behaviours. The second aim was to test to what extent the prospective association between body dissatisfaction at 14 years and risky health behaviours at 21 years of age was mediated by disordered eating symptoms at 16 years. The second hypothesis was that disordered eating symptoms would mediate this relationship (Fig. 1).

Study participants

The Avon Longitudinal Study of Parents and Children (ALSPAC) is a population-based prospective study of women and their children. Women living in the region of Avon, United Kingdom (UK), who were expected to deliver their baby between 1 April 1991 and 31 December 1992, were invited to take part in the study.

The children from 14,541 pregnancies were enrolled; 13,988 children were alive at 1 year. An additional 713 children were enrolled later on in childhood (phases 2 and 3). All mothers

Discussion

This study explored the effect of body dissatisfaction at 14-years old on risky health behaviours at 21-years old and the potential mediating effect of disordered eating symptoms at 16-years old on British females and males. It was found that body dissatisfaction at 14-years old predicted some risky health behaviours among females (smoking, cannabis and drug use, self-harm, and high-risk drinking) and smoking among males at 21 years of age, even when controlling for each relevant behaviour at

Conclusions

This longitudinal study is the first to explore the influence of body dissatisfaction in adolescence on a number of later risky health behaviours using a robust, longitudinal, population-based sample (ALSPAC cohort, UK). It revealed novel findings, whereby body image concerns at 14-years old predicted smoking, cannabis and drug use, self-harm, and high-risk drinking at 21-years old among a sample of British females, and smoking among British males. Amongst females, disordered eating symptoms at

Funding

The UK Medical Research Council and Wellcome (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors and they will serve as guarantors for the contents of this article. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). This research was specifically funded by internal research funding.

Acknowledgements

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses.

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