Body Image among African American Adolescents
Body image is the concept of a person’s emotional self-perception, attitude, and belief about their own body. Body image can be the self-perception of their weight, skin color, hair, shape, height, or sense of self-control of their body. A positive body image is a product of the person’s understanding that their worth or esteem should not rely on their physical appearance.
Negative body image is associated with various psychological conditions, including but not limited to eating disorders, body dysmorphic disorder, depression, and anxiety. Childhood and adolescent obesity and overweight are some of the most common causes of negative body image (Truong et al., 2021).
However, malnutrition and body figures caused by chronic diseases such as type I diabetes also contribute to negative body and associated psychological sequelae. Williamson et al. (2018) summarized trauma, burns, skin conditions, congenital anomalies, and the impact of treatment such as chemotherapy as the other significant reported causes of poor or negative body image.
There are various treatment modalities such as physiotherapy, physical exercise, psychotherapy, and nutritional counseling. Some of these interventions usually aim to address the causes, while others aim to address the psychological outcomes of the negative body image.
According to (Bouzas et al., 2019), interventions aiming at improving body image should address physical exercise, dietary interventions, and behavioral treatments. Medications have been used to treat outcomes of poor body image, such as bulimia nervosa and anorexia nervosa. Poor body image can ed to misperception or dissatisfaction that manifest as self-interventions to correct.
Nutritional interventions can be used to maintain the body in the desired image or prevent the body from transforming into a state undesired of self in some situations. This paper aims to formulate a PICO question, present a literature search, and synthesize the evidence evaluating and comparing the effectiveness of psychotherapy and nutrition in improving body image among African American adolescents.
Significance of the Issue
Negative body image and associated psychological can cause significant morbidity and even mortality among adolescents. Eating disorders may lead to malnutrition and thus poor physical health (Tsakona et al., 2021). Depression and anxiety disorders can cause poor life quality and, to an extreme extent, suicidal ideations and intentions.
Understanding the best or most efficacious method for addressing body image among adolescents will provide the best evidence-based prevention of morbidity and mortality related to negative body image among adolescents. Body image has a significant impact on the outcomes of treatment of chronic diseases as well as health-seeking behavior (Sündermann et al., 2018).
This substantiates the need to address the health issue from all possible avenues and with the most effective strategies. This evidence-based paper focuses on nutritional intervention for adolescents with negative body image from body shape or size due to influenceable factors such as diet.
The PICO question formulated stated that “among African American adolescents (P), does psychotherapy (I) compared with nutrition (C) improve body (O)?” A literature search was conducted from ScienceDirect, PubMed, and Cochrane library databases using a set of keywords and Boolean operators. Studies were filtered manually and selected based on the relevance to the PICO question. The subsequent section of the paper synthesizes and summarizes the evidence from the five articles selected.
The selected studies contained mixed methods with varying levels of evidence. A study by Reas & Grilo (2021) compared the effectiveness of combining psychotherapy and pharmacology in managing eating disorders and resulting body image. This systematic review found that one study had reported binge eating disorder.
Overvaluation of body shape and weight is the critical cognitive feature of body image. According to this study, adjunct psychotherapy improves the pharmacological treatment of binge eating disorders and improves body image.
In Lithuania, Jankauskiene & Baceviciene (2019) assessed the relationship between body image concerns and body weight evaluation, nutritional habits, self-esteem, and physical activity in both adolescent girls and boys. This study included 579 adolescents, including 299 girls and 280 boys.
The participants were aged between 14 and 16 years old. Their crosses sectional study found that body image concerns did not promote healthy behaviors among adolescents. Thus, the study recommended educational programs rather than weight and direct nutritional-based interventions. However, higher body mass indices were associated with a higher drive for thinness and higher body dissatisfaction in both genders.
There is an increased risk of unhealthy eating with poor body image. The association between disordered eating patterns and poor body image is both ways. Rounsefell et al. (2020), in their mixed-methods systematic review, emphasized the role of social media campaigns to promote image-related content.
This study emphasized nutritional-related campaigns and behaviors as the best means to tackle negative body image among young adults. An older comparative prospective study by Klassen et al. (2018) was also a mixed-methods systematic review that examined the use of social media in promoting nutritional interventions among young adults to promote health campaigns.
The authors reviewed 21 studies and concluded that social media use for nutritional retreatment of related health conditions such as poor body image and eating disorders is acceptable and viable. However, concerns over poor engagement may influence the outcomes and the success of nutritional treatment in promoting improvement in body image among adolescents and young adults.
A comparative study by Sarrar et al. (2020) assessed the body mass index among 880 German school-attending adolescents. This primary source of literature data provided an understanding of psychopathology among German adolescents.
In their study, males were more overweight, but the psychological impacts of the body image were associated with high BMI. The risk of eating disorders is higher in female adolescents than in their male counterparts. The approach to negative body image based on these findings would favor postherpetic approaches. However, the nutritional basis of their findings was not reported.
Nutritional interventions aim at promoting healthy eating to improve body image. Niswah et al., 2021) conducted a cross-sectional survey in Indonesia to understand the association between body image perception and dietary and physical activity behaviors in adolescents. This study sampled 2160 adolescent boys and girls aged between 12 and 18 years in two districts in Indonesia. Nearly all adolescents reported the importance of physical appearance and body image.
Among adolescent girls, poor body image was associated with an increase in dieting and a reduction in unhealthy nutrition. However, boys did not show a significant association between body image and physical activity behavior or dietary modification. From this study, nutritional interventions are seen as outcomes of the issue of body image among adolescents.
Evidence Integration into Practice
The evaluation of the selected evidence provided key insights concerning the PICO question. The five evaluated articles partially answered the PICO but either included the intervention or comparison or precursors to the health issue. The literature search did not return any recent studies in the past five years that compared the intervention and the comparison.
However, a more relevant study in 2014 found no differences in the effectiveness of nutrition and psychotherapy. The evaluation of the five studies revealed that nutritional outcomes of the body, such as body weight and shape and body image, affect each other directly or indirectly, and addressing the nutritional outcomes would be addressing the causes of poor body image. Using psychotherapy addresses the outcomes of poor body image.
The paucity of sufficient current data assessing the effectiveness of these interventions is enough to trigger research to answer this health problem. The concept of gender has come out in body image issues among adolescents and should be considered. The data acquired and evaluated addressed the health issue among other adolescents and were not specific to African American adolescents.
Body image results from self-perception and emotional feelings about physical appearance. Females are more likely to have poor body image than male adolescents. The evidence sources cited are majorly primary sources that address the research question from different perspectives. No studies compared the intervention and comparison interventions; thus room for further research. Utilization of social media to enhance and promote nutritional interventions but poor engagement is a major barrier.
Implementing both nutritional and psychotherapeutic interventions in nursing would promote improvement in body image but lacks backing higher-level evidence sources. Additional evidence is required to systematically review preexisting evidence and provide a higher level of reliable evidence to address the issue.
Bouzas, C., Bibiloni, M. D. M., & Tur, J. A. (2019). Relationship between body image and body weight control in overweight ≥55-year-old adults: A systematic review. International Journal of Environmental Research and Public Health, 16(9), 1622. https://doi.org/10.3390/ijerph16091622
Jankauskiene, R., & Baceviciene, M. (2019). Body image concerns and body weight overestimation do not promote healthy behavior: Evidence from adolescents in Lithuania. International Journal of Environmental Research and Public Health, 16(5), 864. https://doi.org/10.3390/ijerph16050864
Klassen, K. M., Douglass, C. H., Brennan, L., Truby, H., & Lim, M. S. C. (2018). Social media use for nutrition outcomes in young adults: a mixed-methods systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 15(1). https://doi.org/10.1186/s12966-018-0696-y
Niswah, I., Rah, J. H., & Roshita, A. (2021). The association of body image perception with dietary and physical activity behaviors among adolescents in Indonesia. Food and Nutrition Bulletin, 42(1_suppl), S109–S121. https://doi.org/10.1177/0379572120977452
Reas, D. L., & Grilo, C. M. (2021). Psychotherapy and medications for eating disorders: Better together? Clinical Therapeutics, 43(1), 17–39. https://doi.org/10.1016/j.clinthera.2020.10.006
Rounsefell, K., Gibson, S., McLean, S., Blair, M., Molenaar, A., Brennan, L., Truby, H., & McCaffrey, T. A. (2020). Social media, body image and food choices in healthy young adults: A mixed-methods systematic review. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia, 77(1), 19–40. https://doi.org/10.1111/1747-0080.12581
Sarrar, L., Vilalta, M., Schneider, N., & Correll, C. U. (2020). Body mass index and self-reported body image in German adolescents. Journal of Eating Disorders, 8(1), 61. https://doi.org/10.1186/s40337-020-00330-3
Sündermann, O., Rydberg, K., Linder, L., & Linton, S. J. (2018). “When I feel the worst pain, I look like shit” – body image concerns persistent pain. Scandinavian Journal of Pain, 18(3), 379–388. https://doi.org/10.1515/sjpain-2017-0163
Truong, K., Park, S., Tsiros, M. D., & Milne, N. (2021). Physiotherapy and related management for childhood obesity: A systematic scoping review. PloS One, 16(6), e0252572. https://doi.org/10.1371/journal.pone.0252572
Tsakona, P., Dafoulis, V., Vamvakis, A., Kosta, K., Mina, S., Kitsatis, I., Hristara-Papadopoulou, A., Roilides, E., & Tsiroukidou, K. (2021). The synergistic effects of a complementary physiotherapeutic scheme in the psychological and nutritional treatment in a teenage girl with type 1 diabetes mellitus, anxiety disorder, and anorexia nervosa. Children (Basel, Switzerland), 8(6), 443. https://doi.org/10.3390/children8060443
Williamson, H., Antonelli, P., Bringsén, Å., Davies, G., Dèttore, D., Harcourt, D., Hedin, G., Jurgutis, A., Stepukonis, F., Tural, Ü., Yalçın, A. D., & Persson, M. (2018). Supporting patients with body dissatisfaction: A survey of the experiences and training needs of European multi-disciplinary healthcare professionals. NursingPlus Open, 4, 8–13. https://doi.org/10.1016/j.npls.2018.05.001
Body Image among African American Adolescents Instructions
PICOT question: In African American Adolescents, does psychotherapy compared to nutrition improve body image?