Living healthy despite or because of the media by Lukie

Living Healthy despite or because of the media An interdisciplinary approach which tries to clarify the relationship between the current trend of disordered eating patterns and the media

By Alette Baartmans and Lukie Stalenhoef Final paper, School of Liberal Arts & Sciences, Utrecht University, July 2008

By Alette Baartmans (3071030) and Lukie Stalenhoef (3027740), Final interdisciplinary paper, School of Liberal Arts & Sciences, Utrecht University, July 2008

Mentor: Dr. Ria van der Lecq (Utrecht University, Liberal Arts & Sciences) Advisors: Dr. Erna Kotkamp

(Utrecht University, New Media Studies)

Dr. Esther Papies

(Utrecht University, Social and Organizational Psychology)

Image front page: http://www.smith.edu/ourhealthourfutures/eatingdisorders.html

Introductory Review

In this paper we have tried to address a problem that we feel is met in many environments: that of stabilizing healthy eating patterns. We think we could state (since this is only the introductory review) that at least nine of ten women in our own surrounding are struggling with their eating patterns by means of constant consideration. A few randomly heard statements illustrate this idea of ours: “Unbelievable, this hot, sunny weather early in the season. Unfortunately I can not enjoy it that much... not yet in summer-shape, you know.” “I had two candy bars and a whole bag of chips for dinner, but you know, if it wasn’t for the contraception, I would have my period by now.” “I’m having exams so I can not help what I eat, I will go on with my diet after it’s all over. O no, I mean, after I’ve celebrated the end of my exams... for three days.”

We want to thank our female friends and family for inspiring us, by these kind of statements, to work on this remarkable phenomenon and giving us a reason to get motivated when our own energy levels were dropping. Although we couldn’t catch our disciplinary advisors, Erna Kotkamp and Esther Papies, on making statements like these, we want to thank them for their time and effort. Because of their guidance and support we were able to produce this interdisciplinary paper based on the disciplinary knowledge we both gained in the last three years. At last we want to thank our mentor, Ria van der Lecq, for providing us the tool of interdisciplinary thinking by this unique bachelors program. Hereby we feel we’ve been given the change to become independent, critical, creative and unique students. We hope to give some evidence of that by this paper. 3

It feels great to complete our studies with this paper, which we feel reflects our enthusiasm, the knowledge and the skills weâ&#x20AC;&#x2122;ve received until now. We hope that, in the future, we will reflect on this paper as a good peace of work for a bachelor student, but also like a first step into the interdisciplinary world that has and will provide us many astonishments and questions, motivating us to learn new things everyday.

Index

Introduction

Disciplinary part 1 2

The social psychological perspective

2.1

The basic principles of eating and the main eating problems

2.1.1

The feeling of appetite: What determines our food intake

2.1.2

The worst case scenario: What are these eating problems

2.1.2.1 Obesity

2.1.2.2 Restrained eating

2.1.2.3 Anorexia nervosa and bulimia nervosa

2.2

What happens: The influence of the media input on cognition an

behaviour 2.2.1

The effect of presented food cues

2.2.2

The effect of the presented beauty standard

2.1.2.1 Body dissatisfaction and self-esteem

2.1.2.2 The social comparison theory

2.1.2.3 The self-evaluation model

2.1.2.4 The self-discrepancy theory

29 5

2.1.2.5 The Interaction model of social comparison 2.2 The role of the media: conclusions

31 33

Disciplinary part 2 3

The media studies perspective 3.1 Stereotypes in the media

3.2

34 34

3.1.1

The media

3.1.2

Media stereotypes

3.1.3

Gender

3.1.4

Female stereotypes

Research: the influence of the media

3.2.1

Mass media

3.2.1.1 Correlation studies

3.2.1.2 Experimental studies

New media

3.2.2

3.2.2.1 Pro-ana websites 3.3

The role of the media: conclusions

Integrative part 4

An interdisciplinary approach towards a positive new media

application

4.1 Media represented in the positive role

4.2 Previous research on preventing eating disorders by use of

the media 4.3 Advantages of the new media in preventing eating problems

4.4 Levels of prevention

4.5 Healthy Living: introducing our own application of prevention and 68 intervention

Discussion

References

1. Introduction

“Am I fat? Am I overweight? Like, you never think of it until you look at it” - Nichter & Nichter (1991), p. 93 “Every girl deserves to be beautiful just the way she is” - Dove Self-Esteem Fund since 2004 Click here2 to experience a new media introduction to the problem addressed in this paper. In this paper we will try to clarify the relationship between the current trend of disordered eating patterns and the (new) media. As can be seen by our new media introduction (on page 45), we are more and more confronted with cases of eating disorders in today’s world, whether it is causing over- or underweight. The media are often blamed for this currently acknowledged to be named epidemic (Gordon, 2000). This assertion is based on the fact that, in the last decades, new media devices have developed faster than ever before (Lister et al, 2003) which is in line with the increase of all kinds of weight problems (Herman & Polivy, 2002; Levine et al., 1998). But what exact conclusions can we draw from this? In this paper we will show, by taking on an interdisciplinary perspective between the social psychological science and the new media studies, that this accusation towards the media is based on various manners in which the media indeed contributes to the development of serious eating problems in women and girls in western society nowadays. We will, however, also argue that focusing too much on these negative effects have caused people to adopt a finite view of the media, while media, as we argue, also

“Onslaught”: Think unrealistic ads don’t affect young girls? Think again, http://www.dove.us/#/features/videos/default.aspx[cp-documentid=7049560]/

implies positive features which can even help us solve these eating problems in various ways.

In part one of this paper we aim to clarify the possible role of the media in the development of distorted eating patterns and following disorders. The focus on food in terms of diversity, but also in terms of warning and indicating risks, seems to increase. On the other hand the environment seems to push us toward a beauty standard of extreme thinness. This slender ideal is conveyed by many social influences, including family, peers, schools, athletics, business and health care professionals. However, the loudest and most aggressive purveyors of images and narratives of ideal slender beauty are the mass media (Groez et al. 2002), which we will focus on in this paper. Targeting markets to sell products such as diets, cosmetics and exercise gear, the media are said to construct a dream world of hopes and high standards that incorporates the glorification of slenderness and weight loss (Killbourne 1999; Levine & Smolak 1996). In doing so, “today’s media blurs the boundaries between glorified fiction and reality” (Thompson et al. 1999, p. 93). However, it seems exaggerated or at least over-simplified to exclusively blame the media for causing disordered eating patterns in the western society. Lately, research has shown that a limited view is adopted by society towards the role of the media, causing critics to find evidence for just negative effects, while positive effects can also be found (Häfner et al., in press). Media has the power to encourage self-esteem and motivate people to adopt healthy lifestyles. This founding has been a reason for us to investigate the other applications media have to offer in order to handle the current weight problems of society. So, in addition, we will reverse the causation by using the positive effects of the new media as a tool for resolutions. The question we will try to answer in the second part of this paper will therefore be: How can new media be useful in treating this problem? As mentioned we will adopt an interdisciplinary perspective in order to answer this question. In the following, we will argue why we think the two perspectives we have chosen to address this complex relation between media and the development of various eating problems, the science of social psychology and the studies of new media, are best. 9

At first, the social psychological perspective, the science which concentrates on the way in which peopleâ&#x20AC;&#x2122;s thoughts, feelings, and behaviours are influenced by the real or imagined presence of the social environment (Allport, 1985), will help us indicate the various causes of eating disorders and the cognitive processes underlying them. Assuming the media are powerful and an essential communicator in a social environment and assuming eating problems are outcomes of enraged cognitions, this seems to be the ideal perspective. One can argue though, that other sciences can contribute to the problem stated in this paper too. At first, the (beta) science of biology could also be helpful in demonstrating which physical processes underlie the development and effects of eating disorders. In the social psychological part of this paper however, we will indeed start with a small introduction on the biological baselines. But, as will become clear later on, experts have indicated that the various risk factors exposed to individuals by the social environment, form a more important contribution to the problem of eating problems than physical factors do (Austin, 2000). Other social sciences that could relate to the questions postulated are cultural anthropology, economics, political science and sociology. They are all related to specific aspects of the problem, respectively by explaining: the differences in existing in social environments (for instance, the beauty concept) and cultures, economic motives underlying the media applications, the way authorities try to intervene in the complex processes going on, and the way in which groups assign beauty standards. However, none of these perspectives explain all of these factors that contribute to our questions. Therefore, each of them might well be cited to clarify different aspects passing in this paper, but will not display the main focus. Our second focus on new media studies will help us clarify how â&#x20AC;&#x2DC;idealâ&#x20AC;&#x2122; images are being created by the media and how they could cause eating disorders. We can use this perspective to find out what treatment is affective and what devices are in stock in order to work with this problem of modern society. That the media are the main focus in this paper will not be a surprising choice. However, one can ask whether the focus is not too

specific, arguing that a focus on different kinds of communication by general communication studies would be better. We believe it is not, because by taking in this perspective, we ensure we are provided with an insight in all the various aspects of the media, which enables us to adopt specific statements about the exact working and solutions of the media. Taken together, we are confident that these two main perspectives will enable us to provide a complete and interesting interdisciplinary view.

Disciplinary part 1 2. The social psychological perspective

In this chapter the question which role the media plays in the development of disordered eating behaviour, will be answered. Below, we will postulate two mechanisms that show how and under what circumstances the media influences peoplesâ&#x20AC;&#x2122; eating behaviour. In order to come to these two (mostly separated) mechanisms, we will discuss all factors involved in this specific matter and clarify their operation regarding the problems. The one mechanism mainly focuses on the effects of overwhelming food cues, presented by the media, on overweight, while the other concentrates on the effects of the beauty standard communicated by the media on more various eating problems. Both mechanisms will show that media form in fact an important risk and maintenance factor in the development of disordered eating patterns. As mentioned before, we will found these mechanisms by using the science of social psychology, because we believe this specialisation provides us all of the information needed to answer what has been proved, by many researchers, to be a complex question of causation (Gazzaniga & Heatherton, 2006). The social psychology has been involved in the field of eating disorders since in the late nineties experts agreed that socio-cultural factors form a substantial contribution the development of eating disorders (Austin, 2000). The aim of the psychological, mostly correlational research has been to identify the factors that, in combination, cause serious eating disorders like anorexia nervosa, bulimia nervosa and obesity. However, if these serious eating disorders were to be our only focus we would have considered to take in a clinical psychological perspective, which deals with psychological dysfunction within individuals associated with distress or impairment in functioning (Barlow & Durand, 2005). This perspective would provide us a better insight at the clinical processes and the

physical risk factors underlying these disorders, but not on the social factors that have been proved to be substantial in this matter. Our second argument in for the social focus taken, is that in this paper we will present another group of individuals, first described by social psychological scientists in 1980 (Herman & Polivy), that also experiences eating pattern difficulties. The eating problems these â&#x20AC;&#x2DC;restrained eatersâ&#x20AC;&#x2122; encounters are less serious and threatening than the common admitted eating disorders, mentioned above. However, we will argue that paying attention to this specific group is of great importance in order to prevent these more serious disorders and, with regard to this paper, this group shows significant vulnerabilities toward the different ways in which media interfere with eating patterns. In the following, we will first turn our attention to basic principles that must be understood in order to read the rest of this paper. After that, we will discuss the factors and theories underlying the relation between media and eating patterns in order to compose the two mechanisms which offer clarification about the main factors and processes. In the last decades, many psychological researchers have unsuccessfully tried to demarcate the main cause(s) of eating disorders. Overall, the predictive power of individual risk and maintenance factors seems limited. Several accepted risk factors for eating pathology appear to have less empirical evidence than originally thought. It seems to be the case that the development of these sorts of problems is caused by a whole scale of factors interacting together, none of them being a true requirement, some of them being more correlated with certain disorders than others (Polivy & Herman, 2002; Stice, 2002). The question does not seem to be if the different factors are influencing people, it is rather how and under what conditions they influence people. Moreover, the factors indicated until now are mostly found in correlations, rather than by empirical research (Polivy & Herman, 2002; Stice, 2002). We will have to take this notions into account, however, we will focus on the risk-factors presented by the media only. And therefore we are confident we can attain a clear view on the specific relationship between the media and the eating problems presented, whether based on correlational or empirical research.

2.1

The basic principles of eating and the main eating

problems 2.1.1 The feeling of appetite: what determines our food intake? People need food in order to survive and to function. However, eating is much more than simply survival. Eating serves an important cultural role, for instance in ways of sharing, celebrating and even in disseminating lifestyles and believes. Much of the social world revolves around eating. The action of eating seems to reflect a complex interaction between biology and socio-cultural influences on cognition (Gazzaniga & Heatherton, 2006). Some people eat a lot, some people eat less. Sometimes people eat because they feel they need to, sometimes just because they like to. As a consequence some people are overweight, some are normal and some are underweight3 4. But how do people determine when, what and how much to eat? Common sense dictates that eating behaviour is controlled by feelings of appetite and satiety. This regulation seems to simply depend on internal signals of the body that indicate a need for energy uptake, our ‘growling stomach’. Basically, weight regulation is a matter of energy homeostasis. Like other homeostasis systems this is a highly integrated process. Energy homeostasis implies a balance between anabolism and catabolism5. When the energy balance is negative this causes a condition of appetite, (normally) followed by food intake and energy storage. In case of a positive energy balance, the opposite occurs, (normally) causing reduced food intake and a reduction of fat mass.

This is determined by the Body Mass Index (BMI), which “is a number calculated from a person’s weight and height. BMI is a reliable indicator of body fatness for people”.

You can calculate your own body mass index on http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/english_bmi_calculator/bmi_calcul ator.htm. 4

Anabolism is the composing of smaller chemical matter into more complex chemical structures to store energy and catabolism is breaking down those complex structures, by which energy is released.

These negative feedback circuits help stabilize the size of fat mass over time (Woods et al., 1998). However, eating is greatly affected by learning (Gazzaniga & Heatherton, 2006). The ‘lipostatic model’ (Kennedy, 1953) of food intake holds that appetite onset can occur for several reasons like habits and learned associations, social factors, opportunity, and time of day (Woods et al., 1998). Food can be taken in for several reasons other than in response to internal signals. This causes the internal energy homeostatic system to work as a buffer, with the ability of storing energy by anabolism when more food than needed is taken in and the ability to release energy by catabolism when energy levels are dropping. In addition, recently it has been found that people are more responsive to the external environment than to internal biological cues. They even fail to demonstrate precise caloric compensation on the base of internal cues, because they are bad in indicating their food need on the base of their energy levels (Levitsky, 2005). Feeling hungry is hereby proved to be a mostly cognitive matter, rather than a physical one. So, evolution has provided us a seemingly perfect construction of weight control that balances energy intake, mostly coordinated by environmental cues, by means of physical buffers. Nevertheless, more and more people in western society are having trouble maintaining a healthy bodyweight. With extreme disorders such as obesity, causing people to have far too much fat mass, and anorexia and bulimia nervosa, causing people (mostly women) to have far too little fat mass, society seems dragged in an environment that is balancing between two evils. On one hand the “current environment is characterized by an essentially unlimited supply of convenient, relatively inexpensive, highly palatable, energy-dense foods, coupled with a lifestyle requiring only low levels of physical activity for subsistence”, as noted by Hill and Peters in 1998. So, where availability plays a part in food intake, as we have seen by the ‘lipostatic model’, our current environment provides availability of (mostly high calorie) food almost all the time. Social cues play a part in our society, because people are frequently being confronted with other people consuming, whether in real life or in commercials. On the

other hand we are constantly being warned for the consequences of eating too much and unhealthy food. And on top of that society is holding a beauty concept of very (even unrealistically) skinny people. All of this makes that the environment is overloading people with cues intervening with their eating pattern. While these cues seem formally determined by cultural habits like, in Holland, a slice of bread with cheese for lunch and a warm meal at six o’clock, an overload of additional environmental cues seems to determine peoples’ food intake these days. Could it be, since appetite seems to be a cognitive matter, that the loss of cultural structure for eating patterns indicates a loss of an evolutionary system that could help us determine food intake in an abundant society? Are people left clueless about how to correctly manage their own physical needs by this ‘media-driven society’, causing the seemingly perfect construction of internal weight control in combination with cultural standards restricting food intake to work insufficient and to be unable to preserve a constant and/or healthy body mass? In order to check these suggestions we need to determine the factors that are involved in the relationship between the media and development of more or less serious and threatening eating disorders. In order to this we first need to clarify some important aspects about the main eating problems which we will attend to in this paper: Obesity, restrained eating, anorexia nervosa and bulimia nervosa.

2.1.2.

The worst case scenario’s: what are these eating

disorders? 2.1.2.1

Obesity

Obesity is being diagnosed when people are approximately twenty percent over their ideal body weight, mostly based on BMI measures. Studies on obese children, raised by either their biological parents or by parents that adopted them, have indicated that about half of the variability in body weight can be considered the result of genetics (Sorensen et 16

al., 1992; Bouchard et al., 1990). Despite this large genetic influence, a trend toward more cases of obesity is visible. At the moment ten percent of the Dutch is suffering from this disorder (NOV, 2008), that is over thirty percent more than in 1981. If the current trend perseveres, this percentage will increase with fifty percent over the next two decades (RIVM, 2008). It has been found, however, that while genetics determine whether a person can become obese, the environment determines whether that person will actually become obese (Stukard, 1996).

2.1.2.2

Restrained eating

This apparently ‘weight gain provoking environment’ causes some people to weigh more than they would like, because of which they will try to lose weight (Gazzaniga & Heatherton, 2006). In the first place, this occasional successful dieting is eventually followed by weight gain, because of the body’s natural defence against weight loss, which slows down the metabolism and provokes less energy use. The second reason the dieting will fail in most cases, is because of (occasional) bursts of overeating or binge eating. In 1980, Herman and Polivy showed chronic dieters, whom they call restrained eaters, are prone to excessive eating in certain situations. Restrained eaters set certain dieting rules for themselves, by which they try to regulate their food intake (Herman & Polivy, 1980). This group is remarkable, because it’s their perception that determines whether they fail to live up to these rules or not. When they feel they have eaten too much, regardless of the actual accuracy of that feeling (they generally do not asses amounts of calories right, because of their own set rules and believes about food), they will overeat, which is called the ‘what-the-hell-effect’ (Herman & Mack, 1975). It seems this characteristic explains the finding that this group is somewhat heavier than the group of unrestrained eaters (Papies, 2008). Another characteristic of this group is the vulnerability for palatable, olfactory and cognitive food cues, as have been shown by Federoff and colleagues (2003). Restrained

eaters typically ate more of the food they were primed6 with, while unrestrained eaters did not respond or ate even less of the primed food. However, when restrained eaters are not primed with a food cue, they are actually eating less than unrestrained eaters (presumably, because of the rules they laid on themselves). Papies (2008) indicated that this vulnerability can be caused by the way restrained eaters experience food. She and her colleagues (Papies et al., 2007) discovered that restrained eaters, in contrast to unrestrained eaters, even spontaneously activate hedonic food thoughts when confronted with food cues. These thoughts can be seen as the evaluative meanings of the stimulus (food in this case) in terms of pleasure (Papies et al., 2007). So, restrained eaters almost directly connect a food stimulus to the pleasure it can bring them. They seem to have formed different mental association schemes7, in which food is associated with concepts like pleasure, rather than concepts like energy. This can indicate a genetic ground for this vulnerability, that has also been identified in patients suffering from obesity, in the form of a higher dopamine sensitivity (Gazzaniga & Heatherton, 2006).

2.1.2.3

Anorexia nervosa and bulimia nervosa

When restrained dieters keep failing to lose weight they will get further dissatisfied with their own body. This body dissatisfaction, mostly in line with damaged self-esteem (Gazzaniga & Heatherton, 2006), has been indicated to form an important risk factor for adopting more extreme behaviour to lose weight, and thereby developing serious and threatening eating disorders like anorexia nervosa and bulimia nervosa (Polivy & Herman, 2002). When people use weight and shape goal attainment, as a means to deal with problems of identity and control, while their body satisfaction is low, they are likely to develop serious eating problems. They refocus their attention onto weight, shape, and 6

Priming is the process by which recent experiences increase the accessibility of a mental scheme, trait or concept (Aronson, Wilson & Akert, 2005). By presenting conscious or unconscious stimuli to experimental subjects before taking tests psychologists try to manipulate people thought and the behaviour that follows. Schemes are hypothetical cognitive structures that help to perceive, organize, process, and use information. (Gazzaniga & Heatherton, 2006, p.263)

eating, by which they enter a domain in which they can gain emotional control. They feel better or more worthy about themselves because of their experience of control (Polivy & Herman, 2002). Individuals diagnosed with anorexia nervosa have an excessive fear of becoming fat and therefore refuse to eat (Gazzaniga & Heatherton, 2006). They perceive themselves to be fat in spite of being at least fifteen to twenty-five percent underweight. Persons suffering from bulimia also worry excessively about body weight issues. They typically switch between binge eating behaviour and extreme compensatory behaviour like selfinduced vomiting and excessive exercise. These patients are mostly of average weight or slightly overweight.

2.2

What happens: The influence of the media input on

cognition an behaviour Some scientists have suggested that the current ‘toxic environment’ contributes to the difficulties many people in western society experience with their weight regulation (Hill & Peters, 1998). But is the environment really interfering with our minds so much that it makes us sick? As have been indicated, eating disorders, as the ones described above, are certainly partially and in direct or indirect ways caused by environmental factors. Anyway, as important actors in the western environment, mainly the media are being accused for the increasing incidence of eating disorders. Two general, culture typical cues stand out in the media: overwhelming food cues and the current beauty concept. A slim beauty standard like ours is concentrated in cultures in which food is abundant, while in cultures of scarcity the beauty standard is much more likely to be rotund (Polivy & Herman, 2002; Wildes et al., 2001). In a society of abundance, thinness can be said to indicate that one has access to healthy food and the mental power to manage its intake, which makes one more advantageous. The slim beauty concept on itself seems to be nothing more than a logical cultural, even evolutionary, outcome (Wildes et al., 2001). We will have to see how this beauty concept is communicated by the media, which input is received, to indicate if there is any ground for blaming them. In first place the media seem to exaggerate the beauty concept, which is thus basically a logical socio-cultural consequence of the current context of western society, by constantly showing images of idealized slim physiques. They are said to distort reality, because the models they present are either naturally thin (on the left side on the normal distribution of body weight) and thus unrepresentative of normality, or unnaturally thin (by adopting a unhealthy low calorie diet themselves). The cognitive input they provide, by showing these unrealistic, but, what they call, ‘ideal’ images, motivates or even forces people to attempt to achieve slimness themselves, by adjusting their food intake. This will be further clarified below (Polivy & Herman, 2002).

Abundant food cues, presented by the media, can also be said to affect peoplesâ&#x20AC;&#x2122; food intake. This abundance also seems to be a logical outcome of the flourishing western society, in which innovation of all kinds of products, including many food products, plays an important part. Importantly, it is not only diversity and availability that has increased. To stand out in this fast growing crowd, marketing has become an important element for all kinds of companies in modern order to survive in this abundant society (Lister et al, 2003). The media take up the role of communicator in the advertisement. The way in which they present specifically food products is another input we will be examining. Until now, it seems that the way in which people cope with the enticements and expectations of the environment they life in, depends on the interaction between the specific environmental cues they receive and their individual features. By specifying the input provided by the media further and presenting the main, mutual connected, social psychological theories that show how this input can cause eating problems, we will constitute two underlying mechanisms. A rather simple one, with regard to the overwhelming food cues, and a complex one, with regard to the beauty standard communicated by the media.

2.2.1

The effect of presented food cues

As have been noted, food intake can occur for several reasons, like habits and learned associations, social factors, opportunity, and time of day (Woods et al, 1998). A need for food can thus be caused by various food cues, like the smell of a pizza, seeing an image of someone enjoying a tasty looking ice-cream, or your mother serving dinner. In current society, these food cues seem much more apparent and frequent than ever before. Some relatively new factors, following from the economic flourishing of western society, described above, influencing food intake are the food availability and portion size. This cheap, simply obtainable food, or fast food, is known for its large amount of fat (Hill & Peters, 1998). Restrained eaters, will be, as have been said, more vulnerable to temptations like these, because of their mental scheme of the food concept. 21

Another development in current environment does not contribute to social health either: the trend to discourage physical exercise. Advances in (media) technology and transportation reduce the need for daily physical activity. Moreover, the appeal to electronic games, television and computers tends to decrease our time spent on more active amusement (Hill & Peters, 1998). Taken together, there seems to be three ways in which the media can eventually cause overweight among vulnerable individuals. The media currently promote, in line with other developments like increasing portion size, much more and different kinds of unhealthy food products than before. Further, they make food more or actually constantly available through new media applications, like the internet. These two factors could easily provoke over eating in restrained eaters. In addition, new media tools also decrease the need to perform physical action, which applies more or less to all people nowadays. We have put these findings together in figure 1 to illustrate the rather simple mechanism that shows under what circumstances the media can cause people to gain weight.

Figure 1: The simple mechanism in which media increases the risk to suffer overweight among vulnerable individuals.

Looking back at the homeostatic system underlying weight regulation, we can conclude that, in this way, energy is taken in by eating more, while less energy is used because of the decrease in physical activity. This will result in certain overweight and, as have been indicated before, for some people genetic vulnerability will in this case easily cause obesity. 22

2.2.2

The effect of the presented beauty standard

The incentives to unhealthy lifestyles, described in the last section, are far from being ignored. Public authorities, various organizations, scientists and even commercial businesses are trying to make people aware of these dangers. There are rules for information on wrappings; there are internet sites clarifying what is good and what is bad; logo’s on products tell you in a blink of an eye whether the product is ratified as being healthy or not; and commercials display happy, healthy people eating nothing but diet bars, or showing how some machine can get you the shape of Barbie herself in just five minutes a day. These examples indicate the risks of becoming overweight, which is unhealthy, but they also communicate the social-cultural norm for appearance, namely a thin one, indicating health. Another set of media, like magazines and advertisements, are taking this beauty standard of western society to extremes, by focusing on ultra skinny models (Groesz, et al., 2002). In this way, the media have some highly worrying effects on specifically women and girls living in that society. The beauty standard is admitted in the attitude held by society. In line with this, the society holds strong implicit negative attitudes toward fatness. As in many cases, the attitudes towards men and women are characteristic in the case of body features. In cultures of abundance, like ours, the idealization of slimness and derogation of fatness is more intense for females than for males (Vartanian et al., 2005). This corresponds with the fact that in our culture girls learn to use their bodies to attract others, whereas boys learn to use their bodies to master the environment (Stephens et al., 1994). Through showing these ‘perfect’ shaped female bodies, males and females alike will infer that a females body is her most important attribute and therefore a lifelong project and responsibility (Brumberg, 1997). “This ‘body project’ to reduce the discrepancy between the actual body size and the ideal body image” (Groesz, et al., 2002) results “in an unstable self-perceived body image that is responsive to social cues”(Martin & Kennedy, 1994, p.110). Gender roles, like these, are a significant part of cultures and unavoidable in this matter. Later on we will focus on the way in which these gender differences are 23

communicated by the media (3.1.4). For now, we will focus on the effects the current beauty standard, taken to extremes by the media, has on women and girls in particular. We will start with the presentation of two important individual aspects in this matter: self dissatisfaction and self-esteem. As will be shown later on, these aspects are highly integrated in the mechanism that specifies the relationship between the presented beauty standard by media and eating problems, as well in terms of risk factors as in terms of outcomes.

2.2.2.1

Body dissatisfaction and self-esteem

When negative feelings and affects about the self are channelled more specifically into negative feelings about the body, we talk about body dissatisfaction (Polivy & Herman, 2002). People can experience their own body as perfectly fine for them, while others think they are, for instance, a bit fat, but on the other, more problematic, hand people can see their perfectly healthy body as being too big or disproportionate. They can have a body size perception thatâ&#x20AC;&#x2122;s not at all realistic, which makes them feel dissatisfied with their body while there is no need to do so (Aronson et al., 2005). Although no main factors have been identified causing or being sufficient for developing eating disorders, body dissatisfaction is mentioned as a highly influential factor in most complex models on the topic (Polivy & Herman, 2002). What has been found, though, is that body dissatisfaction is the main motivation for people to start dieting, which, as we have seen, is done by restrained eaters (Gazzaniga & Heatherton, 2006). The second, important concept is that of self-esteem, which is highly related to the concept of body dissatisfaction; it can be described as the way in which people think about their own worth. This feeling of worthiness is mainly derived from the way in which others react to the individual. It is therefore easy reasoning that a low self-esteem can be caused by (perceived) rejection by others. People with low self-esteem are likely to conform to social norms, because they fear rejection of punishment by the group (Crutchfield, 1955; Asch, 1956). Looking at the social norms communicated by the 24

current social environment, especially the media, rejection of ones physical appearance can easily be felt. But other characteristics, like intelligence and creativity, can also contribute to peoples’ self-esteem. With people suffering from eating disorders, it is specifically their shape- and weight-based self-esteem which is reduced (Geller et al., 1998). Self-esteem has the power to moderate factors that heighten the risk of developing eating disorders. For example, women that score high on perfectionism and feel like they are overweight are at a higher risk of developing eating disorders. A high self-esteem, however, lowers that risk, while a low self-esteem combined with these factors almost certainly causes disorders (Polivy & Herman, 2002). It seems healthy to develop and maintain a somewhat higher self-esteem. Now, people usually have various psychological techniques to preserve their self-esteem. In the following, we will take a closer look at those techniques.

2.2.2.2

The social comparison theory

Human beings are driven to evaluate their selves, by means of opinions, abilities (Festinger, 1954) and appearance (Lockwood & Kunda, 1997). If objective, non-social means are not available, they will use comparison to other people to evaluate themselves. When others are not available to this physical and social comparison, the subjective selfevaluations are unstable. People therefore feel a strong need to check their own physical appearance, abilities or opinions in comparison to others in order to evaluate their selves (Festinger, 1954). In 1954, the year this theory was introduced, ‘the others’ were primarily people in direct vicinity, fifty-five years later, however, our ‘others’ are people all over the world and presented not only by direct contact but also by the various forms of media we are confronted with. The comparison to those unrealistically media images can be very harmful, because the media define who is beautiful and who is not. It has been found that the

media, in this way, may impose unconscious and mostly unwanted comparisons (Wood, 1989). The concept of social comparison has undergone a solid evolvement since it was first proposed by Festinger. The process of social comparison appears to be much more complex than originally realized. To start with: people do not just rationally compare themselves to the most proper target, they may seek many goals through social comparison (Wood, 1989). For instance, being able to shift between downward and upward comparison, gives people the chance to control the outcome of the evaluations to a certain extent. In general, people hold positive illusions about their own abilities and future prospects (Taylor & Brown, 1988). It is therefore more likely that they will compare themselves to successful others (Lockwood, 2002). This is in line with the original assertion that individuals tend to compare themselves with others whose performance exceeds their own (Festinger, 1954). In this way â&#x20AC;&#x2DC;superstarsâ&#x20AC;&#x2122;, for example, can serve as role-models, inspiring and motivating people to become their utmost best. Fortunately, downward comparison can help people repair their self-esteem when necessary, because it can make us feel better than the target individual. More recent research suggests that all this is not effective if the comparison target presented is not analogical to the target group (Lockwood, 2002). This is clarified by the self-evaluation theory, which is in line with the social-comparison model (Tesser, 1988).

2.2.2.3

The self-evaluation theory

In this theory, introduced by Tesser in 1988, two main variables are named, that determine whether and how comparisons are made: closeness of the target individual and the personal relevance of the performance dimension. This means, the closer someone is to you, the more influence a relevant comparison will have on your self-evaluation and, in addition, your self-esteem. However, in case of low (or no) relevance, a comparison will have no effect at al. For instance, when you play soccer, while your best friend plays baseball, him winning a national championship would not make you feel less of a soccer 26

player. However, it could make you feel less of a sportsman, if you had won nothing, because that is a more relevant comparison. Another example shows the role of closeness: when you, as a soccer player, see Wesley Sneijder score an amazing goal against France on the European Championship of 2008, it is not very likely that his performance makes you adopt negative evaluation, more likely it would motivate you to train harder (Tesser, 1988). Here another variable comes up: that of attainability. When the success of the target is perceived attainable, so if people feel they can attain comparable success they will be inspired and motivated. If not, however, they will be deflated and demoralized (Lockwood & Kunda, 1997). A final example will make the interaction between these three variables clear. If you are a friend of Wesley Sneijder, and you are a professional soccer player just like him, but you’re not selected for the Dutch national team, it’s relevant to compare yourself to him, because he’s similar to you by means of his soccer skills. You will be motivated by this comparison because you’re equally skilled and if you train harder, you might also attain a nomination for the national team. The effect of this comparison will be strong, because Wesley is your close friend. However, when your skills are worse than his, but you long to be as good as he is, a nomination in the national team is not attainable to you, you could feel seriously deflated. In addition, when he is not a good friend of yours, just a soccer player you see at television, the effect of the comparison will be less serious (Lockwood & Kunda, 1997; Tesser, 1988). The possible negative consequences of comparison affects the self-esteem, and consequently increases the risk of adopting disorders, like eating problems (Lockwood & Kunda, 1997). Fortunately, these negative consequences can be reduced by taking distance from the person who outperforms us or change the relevance of the performance. Another way to do that is by reducing the feeling of discomfort. This method is presented by the self-affirmation theory (Steele, 1988), which suggests that people will try to reduce dissonance-arousing threats to their self-esteem by focusing on some dimension unrelated to the threat. People can be relevant to you because of a few corresponding characteristics, in accordance to our example: soccer, age and sex, but certainly not all.

So, in our example you could be better looking than Wesley. He would be a perfect character to shift your focus to, in order to protect your self-concept. The self-evaluation model has shown us how people implement their selfevaluation, by which they form their self-concept and determine their self-worth. According to the self-evaluation model, by doing that, there seems to be no need to compare oneself to media images of ‘beautiful, skinny’ women, because at the most basic level they are not even real. However, media has been proved to affect all of us. For instance, we have seen how the media influences people’s implicit attitudes about fatness, on the beginning of this subsection. In addition, media seems to force us to comparison. Repeatedly confronting women with unrealistically, thin images give them at least the feeling of being ‘not perfect’. This is illustrated by the moderate degree of body-dissatisfaction that is normative among women nowadays, which encourages many of them to manipulate their size and shape (Gordon, 2000). Restrained eating women typically internalize the socio-cultural beauty standard (Stice et al., 2000), this in line with the finding that while all women have been said to hold negative (implicit) attitudes about fat people, they are stronger (and more often explicit) for restrained eaters (Vartanian et al., 2005). More important the internalization of the stringent (if not anorexic) and essentially unattainable ideals of beauty, can easily lead to body dissatisfaction and low self-esteem (Herman & Polivy, 2002; Stice et al. 1994). This is because women determine the way in which they want, and feel they have, to look, based on this internalized extreme beauty standard. The harmful effect of these specific internalizations is shown by the selfdiscrepancy theory.

2.2.2.4 The Self-Discrepancy theory While other people’s behaviour can threaten the self-esteem by means of social comparison, as can have been showed by the social-comparison model, people can also

be threatened by their own behaviour. This model shows the effect of peoples’ own behaviour and determines the system by which people prevent their self-esteem, when it is likely to drop because of that behaviour. The self-evaluation theory, introduced by Higgins, states that people become distressed when their sense of who they truly are – the actual self – differs from their personal standards. These standards are reflected in the type of person people aspire to be – the ideal self – and the type of person they believe they should be – the ought self (Higgins, 1999). Comparing these two desired selves to the actual self provides people with an important means of self-evaluation, by which they determine their own worthiness resulting in a feeling of lower or higher self-esteem. Then the theory predicts that, when people become aware of their failure to measure up to these standards, the blow this causes to their self-esteem generates emotional distress, along with the motivation to reduce the inconsistency associated with the self-discrepancy (Aronson et al, 2005). As noted above restrained eaters tend to internalize social norms, like rejecting fatness and the beauty standard set by society, therefore their ideal and ought selves will be highly influenced by those norms. We have seen that these norms are unrealistic, which implies that restrained eaters will feel an inconsistency about their appearance all the time. The following negative self-evaluations can easily lead to low self-esteem, increasing the risk to adopt disturbed eating patterns. But people do not just let that happen. They protect their self-esteem from getting hurt if such negative evaluations appear. They will (normally) try to narrow the created gap by using self-justification, that is putting a slightly different spin on the existing facts, that makes them feel better about their selves. This could cause people to adopt cognitions that seem absurd when received isolated (like ‘I can eat as much as I want when studying, because learning costs lots of energy’), but rather logical if you take into account the function these weird cognitions have (in this case not to guilty of binge eating). Not all discrepancy however will be neutralised in this way. When justification

requires too much or when similar cases of discrepancy are repeatedly felt, self-esteem could drop eventually (Aronson, Wilson & Akert, 2005). These three presented theories all contribute to the assumption that media have negative effect on peoples’ eating patterns. Prove for this assumption has been found by a meta-analytic review done by Groesz, Levine and Murnen in 2002. They concluded (on the base of 25 studies concerning the topic) that in general the “body image for females was significantly more negative after viewing thin media images than after viewing images of either average seize models, plus size models, or cars and houses”(the latter serve as the control condition in this research). This is “a small but relatively consistent and significant effect” (Groesz, Levine and Murnen , 2002, p.11). Specifically important in this review is the conclusion that the thinness of the models shown as ideals of beauty contributes to this negative effect! So while finding hard proof of media influence in this matter is difficult, this sum of all data gathered until 2002 verifies the insinuation towards the media. In order to compose the complex mechanism by the end of this section we will present one more model that determines our notion made on the beginning of this section, the interaction model of social comparison.

2.2.2.5

The Interaction model of social comparison

The interaction model of social comparison (Trampe et al., 2007), is applied here to the concept of body image, significant to this paper. This model suggests that the selfevaluative impact of physically attractive female body shapes is jointly determined by perceiver and target features. It was found that especially women, who are dissatisfied with their body, are likely to suffer negative self-evaluation consequences from exposure to images of physically attractive female individuals (Trampe, et al., 2007). This model shows, and proves our earlier made assumption right, that the answer to the central question of this paper can be found in a complex mechanism, in which assigning causality will stay to be the greatest challenge. 30

Taking all of the theories and factors discussed in mind we can compose our second mechanism (figure 2), which shows the way in which another media application could cause problems with weight, concerning both over and underweight (more or less serious). As we have seen, social comparison is at the base of everyoneâ&#x20AC;&#x2122;s self-esteem formation. When media present extremes, â&#x20AC;&#x2DC;beautifulâ&#x20AC;&#x2122; and thin body image standards for women this causes comparison almost automatically. Most people are able to preserve their self-esteem by using various tricks for self-evaluation. However, some individual characteristics heighten the risk for a negative evaluative outcome. Some people are more attracted to food because of their dopamine systems or family practice which could make them eat more and therefore develop some overweight. This overweight could then cause body dissatisfaction by social comparison, which is associated with low (shape and weight based) self-esteem.

Figure 2: The complex mechanism in which media increases the risk to restrained eating behaviour and eventually to suffer eating disorders.

This body dissatisfaction has been identified of being the main cause of dieting behaviour which often results in chronic dieting, in the form of restrained eating behaviour (Stice et al., 2000). Because individuals like these are constantly managing their eating behaviour and the self-esteem could become worse because of a possible downward movement of this mechanism, this behaviour can become obsessive in the form of bulimia or anorexia nervosa (Polivy & Herman, 2002). Body dissatisfaction and subsequent restrained eating patterns are also associated with obesity (Herman & Mack, 31

1975). As can be seen by this mechanism, a lot of back and forth influencing is going on, making it hard to point out where difficulties might have begun. We think the most important notion of this second mechanism is the fact that this highly interactive process is hard to escape from, because the internal vulnerability becomes worse when dieting fails. The feeling of failure will be caused by the comparison to extreme media images or to the ideal self based on those images. However, as showed by Papies (1988,) there are restrained eaters that obtain their dieting goals, and maintain a healthy weight and high self-esteem because of that success. The key to their success must be found in the same mental schemes that, due to food and pleasure associations, seem to cause the problem of restrained eating in the first place (Papies, 2008). We will get back to this hopeful group in the integrative part of this paper.

2.3

The role of the media: conclusions

In summary, we can say that for a woman living in western society to feel good about herself and her body, and to live up against other people’s expectations, it’s not only the fight against the inundation of high-caloric food cues she has to overcome, but also the fight against her own and other peoples expectations, based on the beauty standard presented by the media. Two different mechanisms have been composed to indicate the various ways by which the media present input, that causes, under certain circumstances, development of enraged eating patterns. The first, rather simply, mechanism shows three forms of media input that can lead to overeating and eventually obesity: the promotion of food products, making food more attainable and discourage physical exercise. The last factor seems to affect all people in society more or less, however the possible negative effect of the other two factors depends on the individual vulnerably for these food cues, which is especially seen in restrained eaters. The second, much more widespread, mechanism shows the way in which the extreme beauty standard, presented by the media, is involved in a complex system of social comparison and self-evaluation. In short it can be said that media offer standards for comparison, which provoke negative evaluations in vulnerable individuals. The body dissatisfaction and low self-esteem, following these evaluations, typically cause these people to adopt restrained eating patterns, which on their way make the vulnerability even worse, eventually causing more serious and threatening problems. By presenting these two mechanisms it is made clear that media can in fact increase the risks of developing restrained eating patterns, which are seen in a lot of ‘healthy’ people nowadays, and also eventually the risk of developing serious eating disorders.

Disciplinary part 1 3. The media studies perspective

3.1

Stereotypes in the media

In this first paragraph, the relationship between the media and stereotypes will be examined. First of all, it will be made clear which different kinds of media there are and which of them are relevant for this paper in which eating disorders is the main focus. Secondly, the stereotyping character of the media is being discussed. When we assume that the media form an important factor in creating a ‘thin-ideal’, we cannot deny the role of the media in creating stereotypes for girls and women. Also, the definition of ‘gender’ will be discussed since media images are playing an important role in gender role learning and identity formation as well as development of values and beliefs about body image (Arnett, 1995; Berchmans, 1998; Klein et al, 1993; Stice et al, 1994; Williams et al, 2003). Finally, the female stereotypes which can be present in the media will be described. Also an answer will be given to the question why there are still so many ‘ideal’ female stereotypes in the media while we know they are not representing the ‘reality’ we live in.

3.1.1 The media “When systematically studied (whether by media institutions themselves as part of their market research or by media academics inquiring critically into their social and cultural significance) we investigate the wider process through which information and representations of the media are distributed, received and consumed by its various audiences and is regulated and controlled by the state or the market”. -

Lister et al. (2003, p. 10) on the field of media studies

The term ‘media’ consists of different types of media, such as television, radio, newspapers, magazines and new media (European Commission, 1997). The term ‘media’ usually refers to communication media, the institutions and organisations in which people work (the press, cinema, broadcasting, publishing) and the cultural and material products of those institutions (Lister et al, 2003). In this paper, media frequently is referred to as ‘mass media’. A mass medium is a form of communication generated by shifting networks of individuals (e.g. writers, photographers, computer specialists, actors) and financial organizations (e.g. production companies, banks), all of whom are motivated in part to maximize profits by attracting and holding very large, heterogeneous and essentiality anonymous audience (Levine & Smolak, 1998). The messages which are send serve many purposes, including entertainment, education, government, and, of course, engagement of huge groups of people so that advertisers can sell them products (Levine & Smolak, 1996). Types of media which may be especially relevant to the prevention of eating disorders include fashion magazines, television and self-help weight-loss books, billboards, the opinion-editorial section of newspapers and computer networks (Levine & Smolak, 1998). Another form of media that is used in this paper is called ‘new media.’ New media are often referred to as ‘digital media’ or ‘digital new media’. For most of us this is a shorthand for “media that use computers” (Lister et al, 2003). More details about new 35

media are discussed in chapter two, because in chapter one the main focus will be on types of mass media.

3.1.2 Media stereotypes â&#x20AC;&#x153;Everything has its price. And image is everythingâ&#x20AC;? -

Immanuel Kant (Elliott 1996, p. 11)

No one would deny that the mass media are big business. According to the American Motion Picture Association, Hollywood films alone pulled in $9 billion in 2001, and that does not include the renting and selling of videos and DVDs (Media Awareness Network, 2008). Media are ubiquitous in American culture. In a 1999 Kaiser Family Foundation Report, researchers concluded that children from ages eight to eighteen spend six and one-half hours each day using print media, television, videos and video games, radio, CDâ&#x20AC;&#x2122;s and computers. Children of this age have easy access to media: 99 % have televisions at home and 65 % have televisions in their bedrooms. Through various forms of media, Americans are exposed to approximately 3.000 advertisements daily (Irving, 2001). It has been estimated that the average U.S. child encounters over 350 different characters in television drama each week. Never before have people been exposed to such a variety of different types of human beings and often television is the first (and maybe the only) time we encounter certain social and occupational groups. Our dependency on media representations of those groups may, in some circumstances, force us to rely on stereotypes. Media provide us with memorable images of groups that we are unlikely to encounter in real life. For example, in the United Kingdom, many of the ideas about prison life and the behaviour and activity of prisoners, is derived from watching the 1970s sitcom Porridge (Giles, 2003). Although initially helpful in raising the profile of such professionals, media representations of occupational groups are frequently criticised for being unrealistic. 36

There is an underlying assumption that television has a moral obligation to portray social groups as accurately as possible. Although this may be a reasonable assumption in the case of news media and current affairs of programming, in terms of fictional drama the price of distortion may need to be weighed against the artistic freedom credited to the writers. Nevertheless, inaccurate or stigmatised media representation is more contentious when it involves broader social groups, notably those defined in terms of age, gender, ethnicity, culture, sexual preference or health status (Giles, 2003). Hundreds of studies confirm that media influences attitudes and behaviour. Media, along with parents, schools and churches, plays a role in teaching young people and adults how to think, look and act (Irving, 2001). Media stereotypes are inevitable and unavoidable, especially in the advertising, entertainment and news industries, which need as wide an audience as possible to quickly understand information. Either from direct viewing or reading, media provide the lion’s share of our knowledge and beliefs concerning life outside of our direct experience (Elliott, 1996). Stereotypes act like codes that give audiences a quick, common understanding of a person or group of people—usually relating to their class, ethnicity or race, gender, sexual orientation, social role or occupation. But stereotypes can be problematic: they can reduce a wide range of differences in people to simplistic categorizations, transform assumptions about particular groups of people into ‘realities’ and perpetuate social prejudice and inequality (Media Awareness Network, 2008)8. One of the chief concerns about the portrayal of different social groups in the media is that the groups will be underrepresented. For example, within the televised group, men outnumber women by two to one, while there are more women than men in the world. However, underrepresentation is only one way in which different social groups may receive a raw deal from the media. A more pressing concern, perhaps, is that when members of the group are present in the media they suffer from misrepresentation (Giles

Media stereotyping – introduction, http://www.mediaawareness.ca/english/issues/stereotyping/index.cfm 8

2003). As Foucault pointed out, suffering because of under- and misrepresentation can be seen as a result from powerful juridical systems that appear to regulate life in purely negative terms â&#x20AC;&#x201C; that is, through the limitation, prohibition, regulation and control of individuals related to that structure (Butler, 1990). Increasingly, decisions at the media production level are based on financial considerations rather than political ones; for example the British Tabloid The Sun only eliminated racist spins in news stories during the 1980s after it realised that a significant proportion of its readership was black. The representation of certain groups may simply disappear from the screen if they are not perceived as central to the marketing strategies of advertising agendas (Giles, 2003). Media executives argue that the economics of the industry make it impossible to avoid stereotypes. Many commentators argue that media content is driven by advertising. Since at least 60 per cent of the movie industry's profits come from the international market, studios continue to pump out the same old stereotypes. All advertisers are chasing the elusive 18- to 34-year-old male market, because they have the greatest purchasing power (Media Awareness Network, 2008)9. As a result, stereotypical gender roles are being created.

3.1.3 Gender â&#x20AC;&#x153;One is not born a women, but rather becomes oneâ&#x20AC;? -

Simone de Beauvoir (Butler 1990, p. 1)

As mentioned before, media images play an important role in gender role learning and identity formation. They can also contribute to the development of values and beliefs about body image (Williams et al, 2003). According to cultural anthropologist Kottak

The economics of gender stereotyping, http://www.mediaawareness.ca/english/issues/stereotyping/women_and_girls/women_economics.cfm 9

(2006), “human attitudes, values and behaviour are limited not only by our genetic predispositions, but also by our experiences during enculturation. Our attributes as adults are determined both by our genes and by our environment during growth and development” (p. 441). Sex differences are biological, but gender encompasses all the traits that a culture assigns to and inculcates in males and females. “Gender”, in other words, “refers to the cultural construction of male and female characteristics” (Kottak, 2006, p. 442). ‘Gender roles’ are the activities a culture assigns to each sex. Related to gender roles are ‘gender stereotypes, which are oversimplified but strongly held ideas about the characteristics of males and females. Despite individual variation in sexual orientation within a society, culture always plays a role in molding individual sexual urges toward a collective norm (Kottak, 2006). Judith Butler (1990) also talks about representation in relation to gender. According to her, representation is the normative function of a language which is said either to reveal or to distort what is assumed to be true about the category of women. Also, representation sets out the criterion by which subjects themselves are formed, with the result that representation is extended only to what can be acknowledged as a subject (Butler, 1990). So, if representations define the criteria for being a subject, it looks like the role of the media in creating stereotypes and thus subjects cannot be ignored. Assuming stereotypes and representations are creating attitudes, values and beliefs, also eating disorders can be formed as a result of that. Social and cultural forces have been identified as being factors in the development of eating disorders. The sociocultural influences thought to contribute to eating disorders include the thin ideal body image espoused for women, the centrality of appearance in the female gender role and the importance of appearance for women’s societal success. One of the strongest messengers of these socio-cultural pressures may well be the mass media, because they construct a dream world of hopes and high standards that incorporates the glorification of slenderness and weight loss (Groesz et al, 2002; Stice et al, 1994). “Today’s media blurs the boundaries between glorified fiction and reality” (Thompson et al, 1999, p. 93).

The media plays a role in developing a more international culture (Lister et al, 2003; Williams et al, 2003). Because of the role new media plays in our culture, McLuhan speaks of ‘a global village’. This term demonstrates the sense that new media takes away space and time barriers in human communication, enabling people to interact on a global scale (Lister et al, 2003). The characteristics of new media will be spoken later on, because now the main focus is on the role which mass media plays in our society. However, it seems relevant to state that as the world develops a more international culture based on a shared media experience (experiences which are also achieved by mass media such as the television or the radio) the prevalence of eating disorders is increasing worldwide (Williams et al, 2003). It has also been found that the increase in different kinds of eating disorders over the last several decades has coincided with a decrease in women’s ideal body weight, as portrayed in the media (Papies, 2008; The Renfrew Center Foundation, 2003; Stice et al, 1994). For example, officials in Fiji reported a sudden increase in anorexia and bulimia with the arrival of television in their communities (The Renfrew Center Foundation, 2003). Irving (2001, p. 261) even states that “as media depictions of ideal beauty change, so too do a culture’s norms, values and behaviours related to appearance.” In a longitudinal research conducted by Stice et al. (1994), a strong relation between media use and gender-role endorsement has been found. Also research has found positive relations between gender-role endorsement and internalization of the thin ideal. This leads to the idea of a route from media exposure to ideal-body stereotype internalization through gender-role endorsement (Stice et al, 1994). Research on the link between media culture and the rise in the prevalence of anorexia can be found in paragraph 3.2. First, the beauty ideals that are created by the advertising industry will be discussed.

3.1.4 Female stereotypes Many different cultural icons represent the physical ideal for women. Perhaps the consummate unattainable feminine ideal is the popular doll Barbie, whose busty figure and slim waist have always been physically impossible for a real-life woman to attain (Hatoum & Belle, 2004). Other known stereotypes are for example, the femme fatale, the ‘supermom’ and the ‘sex kitten’. Whatever the role, television, film and popular magazines are full of images of women and girls who are typically white and desperately thin. Many would agree that some strides have been made in how the media portray women in film, television and magazines, and that the last 20 years has also seen a growth in the presence and influence of women in media behind the scenes (Media Awareness Network, 2008)10. Nevertheless, female stereotypes, such as women professionals, politics or athletes continue to thrive in the media we consume every day. Although there has been a steady increase in the number of women professionals over the past 20 years, most mainstream press coverage continues to rely on men as experts in the fields of business, politics and economics. Also, media images of women in sports are very different from the familiar pictures of male athletes in action. Female athletes are increasingly photographed in ‘hyper-sexualized poses’ (Media Awareness Network, 2008)11. Although media are ubiquitous, the ‘reality’ that they depict is not. The average American women is 5’3 and ¾ tall and weighs 152 pounds; in contrast, teenage girls have described their ‘ideal girl’ as 5’7 tall, weighing 110 pounds and wearing a size 5. Although this ideal does not represent the average American women, it is consistent with the image of beauty portrayed in the media. It is estimated that 5% of women have the

Media portayals of girls and women: introduction, http://www.mediaawareness.ca/english/issues/stereotyping/women_and_girls/index.cfm 10

Media Coverage of Women and Women’s Issues, http://www.mediaawareness.ca/english/issues/stereotyping/women_and_girls/women_coverage.cfm 11

body build required to be a fashion model and that one in 40,000 women meet the approximate height, weight and shape requirements to be a fashion model (Irving, 2001). Why are standards of beauty being imposed on women, the majority of whom are naturally larger and more mature than any of the models? The roots, some analysts say, are economic (Malkin et al, 1999). By presenting an ideal difficult to achieve and maintain, the cosmetic and diet product industries are assured of growth and profits. And it’s no accident that youth is increasingly promoted, along with thinness, as an essential criterion of beauty. The stakes are huge. On the one hand, women who are insecure about their bodies are more likely to buy beauty products, new clothes, and diet aids. It is estimated that the diet industry alone is worth $100 billion (U.S.) a year. On the other hand, research indicates that exposure to images of thin, young, air-brushed female bodies is linked to depression, loss of self-esteem and the development of unhealthy eating habits in women and girls (Media Awareness Network, 2008)12. Media activist Jean Kilbourne concludes that, “Women are sold to the diet industry by the magazines we read and the television programs we watch, almost all of which make us feel anxious about our weight.” The real tragedy, Kilbourne concludes, “is that many women internalize these stereotypes, and judge themselves by the beauty industry's standards. Women learn to compare themselves to other women, and to compete with them for male attention. This focus on beauty and desirability effectively destroys any awareness and action that might help to change that climate” (Media Awareness Network, 2008)13. There have been efforts in the magazine industry to buck the trend. For example, Dove, a Unilever Beauty Brand, has launched the Campaign for Real Beauty, which challenged currently held beliefs and media portrayals of what real beauty is by

Beauty and body image in the media, http://www.mediaawareness.ca/english/issues/stereotyping/women_and_girls/women_beauty.cfm 12

Beauty and body image in the media, http://www.mediaawareness.ca/english/issues/stereotyping/women_and_girls/women_beauty.cfm 13

showcasing real women viewed as unconventional beauties in their advertising and outreach. The campaigned was fuelled by the results of their global study The Real Truth about Beauty in 2005 which demonstrated that women believe in a broader definition of beauty than the narrowly defined ideals most often portrayed in popular culture (Dove, 2006). However, advertising rules the marketplace and in advertising thin is ‘in’. Twenty years ago, the average model weighed 8 per cent less than the average woman — but today’s models weigh 23 per cent less. Advertisers believe that thin models sell products. When the Australian magazine New Woman recently included a picture of a heavy-set model on its cover, it received a truckload of letters from grateful readers praising the move. But its advertisers complained and the magazine returned to featuring bone-thin models. Advertising Age International concluded that the incident “made clear the influence wielded by advertisers who remain convinced that only thin models spur the sales of beauty products” (Media Awareness Network, 2008)14.

Beauty and body image in the media, http://www.mediaawareness.ca/english/issues/stereotyping/women_and_girls/women_beauty.cfm 14

3.2

Research: the influence of the media

In the following paragraph, various studies about the influence of media and the impact of the thin beauty ideal on women’s body-related attitudes and behaviours are being discussed. The relation between media and eating disorders has been the subject of investigation for the past two decades. In particular, investigators have explored the hypothesis that an increasingly thin standard of female beauty has led to increases in weight and shape preoccupation, dieting and disordered eating in girls and women. Investigators from a range of disciplines (anthropology, communications, history, philosophy and psychology) have used a variety of methods to examine the relationship between media and how girls and women regard the relationship between media and how girls and women regard their bodies (Irving, 2001). First, studies in the mass media are being discussed. We made a distinction between correlation and experimental studies, because the differences in which the results of both kinds of research methods can be interpretated differ a lot. The most important difference is that, in contrast with experimental studies, no causal relation can be found in correlation studies. A lot of research has been conducted in the field of mass media, but the internet is coming up as being an important influence on eating disorders too. Especially the so called ‘pro-ana’ sites cannot be dismissed in the field of research on eating disorders. The categories ‘mass media’ and ‘new media’ are being discussed separately in this chapter. Because of their different characteristics, the consequences they have on people and the way in which people use them also need to be examined apart from each other. Which phenomena, according to Lister et al, (2003), define new media can be found in the second half of this chapter.

3.2.1 Mass media 3.2.1.1

Correlation studies

In numerous correlation studies, girls’ and women’s’ level of exposure to media that depict a thin standard of beauty (e.g. fashion magazines) is associated with negative evaluations of one’s body and engaging in a greater number of disordered eating practices. Exposure to ‘ideal’ female bodies through the media is correlated with weight concern (Field et al, 1999; Harrison & Cantor, 1997; Posavac et al, 1998), body dissatisfaction (Becker et al, 2002; Harrison & Cantor, 1997; Stice et al, 1994; Wegner et al, 2000), reduced self-esteem (Wilcox & Laird, 2000), and disordered eating (Becker et al, 2002; Harrison & Cantor, 1997; Stice et al, 1994; Vaughan & Fouts, 2003) among women and girls. For example, Field et al. (1999) surveyed 548 fifth to twelfth grade girls and found that frequent readers of fashion magazines were two to three times more likely than girls who were infrequent readers to report that they had dieted to lose weight because of a magazine article. Murray et al. (1996) also found that eating disordered participants themselves believed that media exposure had contributed to their disorder; participants with eating disorders believed that they were more easily influenced by media than were their peers. The study of Stice et al. (1994) assessed the relation of media exposure to eating disorder symptoms and tested whether gender-role endorsement, ideal-body stereotype internalization and body satisfaction mediated this effect. In data from 238 female undergraduates, structural equation modelling revealed a direct effect of media exposure on eating disorder symptoms. Furthermore, linkages were found for gender-role endorsement, ideal body stereotype internalization and body dissatisfaction. The results support the assertion that internalization of socio-cultural pressures mediate the adverse effects of the thin ideal. Of course, based on the correlational research we cannot ascertain whether exposure to media causes the development of weight and shape preoccupation, dieting 45

and disordered eating practices. A number of investigators have tested causal hypothesises using experimental methods.

3.2.1.2

Experimental studies

In an early experimental study of researchers Hamilton and Waller (1993), the conclusion is made that anorexic and bulimic women overestimate their body sizes substantially more than comparison women. Comparison women were not affected by the nature of the photographs which contained ideal female bodies, while eating-disordered women were. Yet little was known about the process underlying this relationship; the factors that influence the overestimation. Understanding the psychological processes and mechanisms involved in the use and interpretation of media by women with eating disorders may be useful in understanding the relationship between media use and eating disorders (Williams et al, 2003). Harrison (2001) suggests that the self-discrepancy theory is utilisable in synthesizing the growing collection of studies demonstrating individual differences in sensitivity to the adverse effects of exposure to thin-ideal media. As mentioned before in part 1, subsection 2.3.1.1, this theory states that people become distress when their sense of who they truly are â&#x20AC;&#x201C; the actual self â&#x20AC;&#x201C; differs from their personal standards. This conclusion of Harrison (2001) was made in her study in which the prediction that the self-discrepancy theory would mediate the relationship between thin-ideal media exposure and disordered eating was being tested with 366 participants and two studies. Also the social comparison theory, discussed in section 2.3.2, has been proposed as a phenomenon that underlies the relation between media and eating disorders. Women may routinely compare their bodies with images of feminine beauty contained in the media and consequently become less satisfied with their own bodies (Posavac et al, 2001). Other studies also suggested that women who are already sensitive or anxious about their bodies are more likely to be influenced by the media (Heinberg & Thompson, 1995; Levine & Smolak, 1996; Stice et al, 2001). 46

In the study of Thomsen et al. (2002) the uses and gratifications (U & G) theory is identified as a mechanism that triggers eating disorders in some women but not in others. U & G researchers believe that the media user is in control. Rather than studying the person as a passive recipient of effects, researchers look at the motives for using media and the needs that media use gratifies. The dependency theory, an approach of the U & G theory, states people have come to depend heavily on outlets for information about all manner of topics. Individuals develop â&#x20AC;&#x2DC;dependency relationsâ&#x20AC;&#x2122; with media, because it provides information that enables us to understand the world and allows us to interpret our behaviour and compare ourselves with others (Giles, 2003). In line with this, the findings of Thomson et al. (2002) showed that anorexic women use fashion magazines articles related to their eating disorder. Anorexic women distorted magazine messages and images in an effort to reduce cognitive dissonance about having a life-threatening disorder.

Figure 3: Compulsive cycle for media use and anorexia (Williams et al. 2003)

Currently, no model exists to explain the relationship between media use and anorexia. The study of Williams et al. (2003) used qualitative methods to explore the 47

underlying psychological processes and mechanisms to create a model for understanding this relationship. Interviews from 28 female participants were analyzed and coded for temporal, situational and motivational relationships between the anorexic behaviours and media use. The purpose of the analysis was to generate a theory upon which to base a model that could then be tested by more empirical methods. Results suggest that the relationship between anorexia and media use is not linear or causal, but involves an interactive, circular model similar to models used to explain other compulsive and addictive processes. Other researchers made this conclusion as well (Bushman & Anderson, 2001; Heinberg & Thompson, 1995). The compulsive cycle model introduced above (fig. 3) provides insight in the reasons why many women who are exposed to the media culture do not develop eating disorders. Various components all interact in creating vulnerability to media messages that may not exist for all women. Analysis of the interviews suggests that as young women grew more dependent on control of eating as a solution to life’s challenges, they also turned more frequently to the media in an effort to find solutions to their problems or to strengthen their resolve to control their eating. The failure of real life to instruct in roles and coping in behaviours resulted in turning to the media for comfort and instruction. Many participants even mentioned looking for role models through the media but not finding any real instruction, only the fantasy of escape. Media use also became part of a compulsive ritualization. Several women spoke of ‘needing’ the media for management of emotions and referred to media use as a compulsion. To summarize, the literature to date provides evidence that a thin ideal of beauty, which the media creates, is associated with disordered eating. Less clear is whether media, in conjunction with individual vulnerabilities, cause individuals to become preoccupied with their weight and to adopt disordered eating practices. Additional research is needed to understand how various individual difference factors interact with one another to influence individuals’ responses to media disordered eating. Media presentation of ‘idealised’ women cannot be the only factor responsible for eating disorders. However, the results from the studies mentioned show that the effect of media

is big enough to suggest that media presentation of idealised women’s stereotypes may have practical relevance.

3.2.2 New media “The new media are not bridges between man and nature: they are nature” -

Marshall Mc Luhan (Lister et al, 2003, p. 88)

A considerable amount of literature has examined the potential role of media as an influence for the cause and maintenance of eating disturbances. Historically, media had been defined as consisting of movies, television and magazines. However, a new form of media has recently been posited as a potential factor in the development of eating disturbances – the internet. Internet is a so called ‘new medium’. Examples of new media (media based on computer technology) are: mobile devices, E-mail, Video games, CDroms, Interactive television, Blogs and Podcasting (Harper et al, 2008). People nowadays talk about ‘new media’ rather then just ‘media’. But what is ‘new’ about new media? According to Lister et al. (2003) a whole range of different practices and processes are subsumed by this description. The term refers to a wide range of changes in media production, distribution and use which arrived since the mid-1980s. These are more than technological changes, they are also textual, conventional and cultural. A couple of distinctions are made by Lister et al. (2003) between the kinds of phenomena that are bundled up in the term media in order to make the field of study more manageable. The key terms in discourses about new media are: digitality, interactivity, hypertextuality, dispersal and virtuality. In a digital media process, input data (light and sound waves) are converted not into another object but into numbers: that is, into abstract symbols rather than analogues objects and physical surfaces. So, once coded numerically, the input data in a digital media production can immediately be subject to the mathematical processes of addition,

subtraction, multiplication and division through algorithms contained within software (Lister et al, 2003). Digital media offer us a significant increase in our opportunity to manipulate and intervene in media. These multiple opportunities are often referred to as the interactive potential of new media. The ability to see the effects of the intervention in real time is called interactivity. In communication theory it’s also used to describe human communication based on dialogue and exchange. At the ideological level, interactivity is understood as one of the key ‘value added’ characteristics of new media. Where ‘old’ media offer passive consumption, ‘new’ media offer interactivity. The term stands for a more powerful sense of user engagement with media texts, a more independent relation to sources of knowledge, individualised media user and greater user choice (Lister et al, 2003). Hypertext also distinguishes new media from the existing forms of mass media. It can be seen as “a kind of writing facilitated by computer technology in which documents are linked together to allow the reader to follow his or her own ‘path’ through a body of information or a narrative. Developed by Ted Nelson in the 1960s, the hypertext model forms the basis of the organisation of the World Wide Web” (Lister et al, 2003, p. 387). It’s a web of connections in which each unit carries a number of pathways to other units. The idea of hypertext rests upon the assertion that associative linkage of data is a more ‘natural’ model of information management than the conventional linear alphabetical methods of bibliography, because it appears to offer a better model of consciousness than linear storage systems. Dispersal is the product of shifts in our relationships with both the consumption and production of media texts. Traditional mass media can be characterised by standardisation of content, distribution and production process. With new media, on the other hand, many different users can access many different kinds of media at many different times around the globe using network-based distribution. So, through the period 1980-2000, our consumption of media texts has been marked by a shift from a limited number of standardised texts to a very large number of highly differentiated texts.

‘National’ newspapers are produced as geographically specific editions, networks and TV stations are surrounded by independent satellite and cable channels, the networked PC in the home offers a vast array of communication and mobile telephony and ubiquitous computing offer a future in which there are no ‘media free’ zones in everyday life. This sense of the increasing flexibility and informality of our interaction with media texts of all kinds is equally present in the field of media production (Lister et al, 2003). In the last ten years the term ‘virtual reality’ has become part of everyday language. The ‘virtual’ can be met in discussions of the Internet, immersive 3D technologies and in the transformation and convergence of older media as in digital cinema, video and computer animation. Alongside these uses, the ‘virtual’ is frequently cited as a feature of post-modern cultures in which so many aspects of everyday experience are technologically simulated. Older certainties about ‘reality’ have become problematic and questions arise about the kind of identity or sense of self that individuals who live in such cultures may have. Because of the ‘virtual’ culture we are living in now, also the role of new media in causing or maintaining eating disorders needs to be considered. In the next section the upcoming ‘pro-ana’ websites on the internet will be discussed (Lister et al, 2003).

3.2.2.1

Pro-ana websites

“Hunger hurts but starving works.” -

Pro-Ana Belgium15

“Nothing tastes as good as thin feels.” -

Live Journal Community16

Help Anorexia wet te voorkomen, http://www.pro-ana.be/

World’s largest pro anorexia site, http://community.livejournal.com/proanorexia

“Food is like art, to be looked at not eaten.” -

Fading Obsession17

The internet serves as a resource for adolescents and provides global access to a tremendous amount of information. Internet use is also associated with potential risk, because it provides adolescents with access to information on a broad variety of medical issues, including eating disorders (Norris et al, 2006). In fact, searching for ‘anorexia’ on any common research engine gives you plenty of information. Google offers 13.900.000 hits in only 0,26 seconds, including links to ‘pro-anorexia’ (‘pro-ana’) websites. ‘Pro-ana’ is the term for websites that promote and endorse the eating disorders’ lifestyle. The websites have recently emerged as an online movement supporting the virtues of anorexia and other eating disorders. Many offer information about eating disordered behaviours, support, motivations, techniques to lose or gain weight and a sense of community to individuals. Unfortunately, a lot of these websites contain controversial and dangerous content, because they promote anorexia as a lifestyle choice (Norris et al, 2006). To date, research on this topic is very limited. Two content analyses of sites have been conducted (Harper at al., 2008). Chesley et al, (2003) found that pro-ana sites with an average age of 16,7 years contained a biography (64 %), medical advice (58%), nutrition content (91%), methods to avoid detection (75%), ‘support groups’ (fostered competitions for weight loss) (49 %), motivation content (94 %; images 84%; writing 81 %) and mortality associated with anorexia (5%). They concluded that pro-ana sites are better organised, comprehensive and more numerous than sites based on recovery or professional services. The study of Norris et al. (2006) was the first to describe pro-ana websites both quantitatively and qualitatively. Besides describing the web characteristics of the first 20

Fading to perfection by faithful obsession, http://www.fadingobsession.com/thinspo/quotes.php 17

websites identified by three different search engines, they also provide a thematic analysis of the websites. A total of ten themes were extracted from the websites, which are present in figure 4. The most prevalent themes included control, strength and perfection.

Figure 4: prevalent themes extracted from the pro-ana websites (Norris et al 2006)

According to Norris et al. (2006) religious metaphors were present in more than three quarters of the websites. The most common example was the Ana Psalm and Creed. Messages centered predominantly on control, starvation and self-hate. At one particular website, followers were encouraged to make a pact with Ana and sign it in blood. Ana can be seen as a leader for this girls, an imaginary friend (Vasterman, 2006). A “letter from Ana” was found on most personal websites, with sentences like: “I will push you to the limit. You must take it because you cannot defy me. Pretty soon, I am with you always” (Norris et al, 2006). The most current study of Harper et al. (2008) evaluated the association between viewership and specific levels of body dissatisfaction, restrictive eating and bulimic symptoms. They made a comparison between three different types of eating disorder websites, namely: professional sites, pro-recovery sites and pro-eating disorder websites. 53

The conclusion of the study is that viewers of pro-ED sites have higher levels of eating and body image disturbances than the control group in four different outcome measures. America, among other countries, had prohibited these websites. In 2001, Yahoo got several websites off the air, but some say itâ&#x20AC;&#x2122;s hard to fight this movement because underground sites keep coming up (Vasterman, 2006). Because of the inevitable character of these websites, awareness of the existence and the content of this resources is essential for professionals who evaluate and treat adolescents with emerging or established eating disorders. The pro-ana websites have a tremendous potential to harm (Chesley et al, 2003).

3.3

The role of the media: conclusions

In disciplinary part two (the new media studies perspective), the role of the media regarding to eating disorders was examined. It seems that the mass media creates stereotypes by surrounding people constantly with the ideal beauty standard. By doing so, the media seems to create or maintain eating disorders and weight problems under adolescents. This can be found in not only correlational studies, but also in experimental research. The latter type of research has also focussed on the underlying processes and mechanisms involved in the relationship between media use and eating disorders. Results suggest that the social comparison theory and the social discrepancy theory, as well as the uses and gratifications theory, can be seen as processes which are involved in this relation. In part three, we will look at the media in a different way. Especially, we will focus on the characteristics of new media. In section 2.2, we already introduced the phenomena â&#x20AC;&#x2DC;new mediaâ&#x20AC;&#x2122; and its five most important features. In line, the potential of new media to harm because of its global influence is discussed. However, we feel we need to be critical about this. We wonder why research has focussed mainly on the harming effects of the media, instead of regarding the potential of the media to have positive outcomes on people. So, in the next part we will not look at how the media creates weight problems, but at how the media can be seen as a useful application to prevent the problems.

Disciplinary part 4. An interdisciplinary approach towards a positive new media application

Taken together, in the disciplinary parts of this paper both perspectives pointed out that to a certain extent the media can be held responsible for the problems many people experience with food intake, these days. In sum there have been described four different ways in which media intervenes with peoplesâ&#x20AC;&#x2122; eating patterns. From the social psychological perspective two different mechanisms are identified. The first mechanism shows that media could cause problems by means of making food more attainable through excessive presenting of food cues and providing new ways in which food can continuously and easily be attained (way one). In addition this mechanism shows that the use of various new media tools results in less physical activity (way two). In the second model media is showed to cause problems by communicating extreme stereotypes for comparison (third way). The stereotyping problem is also described as being the main concern for the new media studies perspective in the matter of eating problems. This perspective also ads a fourth way in which media contributes to eating problems. It shows that another typical social psychological influence on eating problems, the interaction with stimulating peers18, is made more easily accessible by the internet, seen on pro-ana websites.

It has been noted that specifically adolescent girls learn certain attitudes toward body images and female dignity and behaviours from their peers (Levine et al, 1994) by example and encouragement, and by teasing if they fail to adhere to their peersâ&#x20AC;&#x2122; norms (Polivy & Herman, 2002). Another peers influence is shown by the fact that adolescent female friendship cliques tend to be homogeneous in regard to body images (Paxton et al, 1999).

Having identified these four negative ways in which the media contribute to the development of eating problems, we would like to ask: What is to say about the positive influence they might have? And in addition can we, by use of our two perspectives, come to a proposal for a proper new media use in favour of healthy eating patterns?

4.1

Media represented in the positive role

The media have been identified as an important factor that contributes to the current development of globalisation (Lister et al, 2003). As we have described earlier, this worldwide development towards a more international culture based on a shared media experience seems to indicate the increase in eating disorders. Since the problem of eating disorders increased remarkably in these last decades, research done on the topic expanded widely, including more and more different disciplines. In the late nineties, eating disorder experts came to a degree of consensus about the great significance of socio-cultural influences, rather than of familial or physiological influences, causing the social psychology to dominate most of the research done on the causes and possible solutions ever since (Austin, 2000). This social psychological perspective has not only offered more insight on the negative effects of the media and the various defending techniques we will discuss later, recent social psychological research has also indicated that the way in which we approach media, with regard to eating problems, has highly been influenced by the widespread bias of negative effects. H채fner (in press) and colleagues conducted three experiments to indicate that researches have always directed to negative effects of the beauty standard as communicated by the media, causing finite outcomes on media effects. This conclusion was based on the self-affirmation theory, described earlier in subsection 2.2.2.3 on page 26, which indicates that people are originally motivated to shift to other levels of comparison if the compared dimension (in the case of the beauty standard, the dimension of body shape) is offended. H채fner and colleagues (in press) showed that when people are asked about another dimension (athletic ability) after being confronted with an image of a feminine, thin woman, this helps to avoid negative consequences or even causes people to feel better about the athletic self. This effect was also found when the dimensions were turned around. In addition, they have shown that this affect also occurs spontaneously, which means that people are intrinsically motivated to inverse negative media effects. Until now, these defensive self-evaluations were simply not measured as no questions 58

addressed them, so this research concludes with the notion that “subtle changes in the way a study dealing with exposure to media images is introduced may have dramatic consequences” (Häfner et al, in press). So, it seems that the negative role of the media as main communicator of the thin beauty standard (first role) has to be subsided, because the negative comparisons the media images are provoking, can be converted into neutral or positive ones through our own mental defensive systems. The model of social comparison, as mentioned earlier, shows that there is also a way in which we can gain positive effects by upward comparison to media images. When people are presented with a desirable image which they think they can equalize they are motivated to do so. The problem is, however, that most of the media generally presents extreme stereotypes which cannot be attained. In 2004, Dove introduced the worldwide Campaign for Real Beauty, to change the way in which women and girls see and accept beauty, in order to free the current and next generation from beauty stereotypes (Dove, 2006). Until now, they “have reached 1,5 million lives through the dove self-esteem fund”, and they “are aiming to reach 5 million lives in 2010” (Dove, 2006). This campaign is set up broadly, including advertisements and an interactive website on which short movies on the topic, information for girls, parents and scholar mentors can be found. Also games that show the effects of Photoshop in order to reach the extreme beauty standard are present on the website (Dove, 2006). The overwhelming success of this site, proved by the enormous amount of women committed to the campaign until now, could be explained by the social comparison model. Dove offers images for comparison that are beautiful in several realistic ways and they are therefore attainable to everyone. As mentioned, this will provoke motivation and inspiration in women, rather than deflation. These two striking findings indicate that the media themselves are not ‘bad’, however, they are mostly applied in ways that can harm people, rather than do well. Assuming that we need to consider the different positive and negative sides the media can have, we will try to extend the ways in which media are applied for positive objectives by designing our own media application (Living Healthy) in order to help people maintain or

develop a healthy eating pattern. But, before we turn to this challenge, we will describe psychological methods and new media applications that have been proved successful until now. The focus will be on internet based interventions, because that is the base of our own application. By considering the pros en cons of former intervention attempts, we will demarcate further which applications we are willing to use. After this, we will explain on which level our intervention will take place regarding the four negative ways in which the media influences people and former practices of prevention.

4.2

Previous research on preventing eating disorders

Over the past two decades, several books and scores of articles have been published calling for more attention to the prevention of anorexia nervosa and bulimia nervosa (Vandereyken & Noordenbos, 1998; Shisslak et al, 1987; Crisp, 1988; Smolak & Levine, 1994; Battle & Brownell, 1996; Griffiths & Farnill, 1996). Eating disorders: The journal of treatment and prevention, the second major American journal on eating disorders, was launched in 1993 and illustrates the increasing interest in prevention. Professionals working in schools and community organisations have been very eager to devise ways to prevent young people from developing disordered eating, because eating disorder behaviours are so common among adolescents and young adults (Austin, 2000). For years, educators and counsellors have improvised prevention programmes based on the little information available (Sher, 1989; Kennedy, 1990; Mann et al, 1997). In 2000, empirical research on prevention intervention programmes was still in itâ&#x20AC;&#x2122;s first generation, despite the volume of writing about prevention strategies. Back then, less than two dozen had been published in the literature, so researchers were at the point of taking stock which new directions should be followed (Austin, 2000). Because of the technological advantages of the new media, the possibility of synchronous, online interventions in which group members can share their thoughts in real-time, using chat-room technology are introduced (Paxton et al, 2007, p. 693). Research in which an internet-based program was used for the preventing of eating disorders has led to several positive outcomes (Abascal et al, 2003; Celio et al, 2000; Griffiths & Christensen, 2006; Paxton et al, 2007; Zabinski et al, 2004). Compared to face-to-face treatment, online intervention seemed to have produced stronger or similar effects in the studies mentioned. Early computer-mediated approaches designed to reduce body image and eating symptoms in young adult women were largely psycho-educational. Participants at risk of eating disorders individually worked through an interactive program. One of them is the internet-based, structured cognitive-behavioural, intervention program called Student 61

Bodies, which described body image and eating issues and provided cognitive behavioural treatment strategies19. Since 1995, Student Bodies has been evaluated with hundreds of high schools and college students (Stanford School of Medicine, 2008). This program has produced greater reductions in body dissatisfaction or disordered eating symptoms when compared with wait list control groups (Paxton et al, 2007). Also, the program has been found to help women develop healthier dietary and improve their body image (Abascal et al, 2003). In 2006, a study of Taylor et al. combined the Student Bodies intervention with an online moderated20 discussion group to determine if it could prevent the onset of eating disorders in young women at risk. The core goals of the program were to reduce weight and shape concerns, enhance body image, promote healthy weight regulation, reduce binge eating and increase knowledge about the risks associated with eating disorders. It seemed that among college-age women with high weight and shape concerns, an 8-week, internet-based cognitive-behavioural intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of eating disorders. The methods which were used in this study show resemblance with the way we would like to use new media in order to create healthy eating disorders among women. After accumulating personal data about the participant, interviews were conducted by telephone and audio taped. These tapes were periodically reviewed by senior interviewers at each site to determine progress and interviewers received written and/ ore verbal feedback. In this sense, the background and motives of the participants will become clear (Taylor et al, 2006)

Cognitive behavior therapy is used by psychologists to change peoplesâ&#x20AC;&#x2122; cognition about certain believes in order to change their behavior.

Moderators (MODs) are people who have the power to regulate content on internet fora, message boards and mailing lists. They can lead discussions and keep them productive. In this study, discussion groups were moderated by a clinical psychologist or a psychology graduate student who was supervised by a clinical psychologist.

Each week, when a participant logged in to the program, she was directed to the updated weekly program content. Participants were expected to read the content and complete accompanying assignments, which included participating in the online group discussion, self-monitoring and/ or writing entries in a personal journal. Also, weekly emails were sent to participants to reinforce program participation and encourage participants who failed to comply with study expectations for participation (Taylor et al, 2006). This was the first study to show that eating disorders can be prevented in high risk groups. Which advantages of the new media contribute to the success of these internetbased programs is being discussed in the next section.

4.3

Advantages of new media in preventing eating

problems Based on the positive outcomes of research, traditional face-to-face modes of delivery for psychological interventions are rapidly being extended by the use if computer-mediated interventions, especially as a means to increase access for consumers (Paxton et al, 2007). In comparison with traditional face-to-face therapy, the new media has several advantages. First of all, internet-delivered interventions can potentially reach a large proportion of the population, independent of geographic location. A 2007 survey estimated that 71.1 % of the North Americans21, 75,9 % of the Australians22 and 59.9 % of the European Union members23 use the internet and this proportion is increasing (Internet Usage World Stats, 2008). Secondly, psychological problems are frequently associated with shame, so, in addition, the ability to access an intervention in privacy and a high degree of anonymity may also be an advantage (Paxton et al, 2007). As an online intervention, a unique feature of Student Bodies and other web-based programs is the ability to create groups seamlessly and transparently, without the participants having knowledge of how or why the groups were created and without stigmatizing anyone (Abascal et al, 2003). Also, internet-based discussion groups make a treatment program more supportive, engaging, interactive and less didactic, because a discussion allows for feedback, individualization, modelling and support (Abascal et al, 2003; Zabinski et al,

Internet Users in the Americas – December 2007, http://www.internetworldstats.com/stats2.htm

Internet Users in Oceania and Australia – December 2007, http://www.internetworldstats.com/stats6.htm

Europian Union Internet Users – November 2007, http://www.internetworldstats.com/stats9.htm

2004). As we have mentioned before, new media offers a powerful sense of user engagement with media texts, because of its’ interactive character. Consequently, Zabinski et al. (2004) have suggested that “synchronous communication [online contact] better mimics face-to-face interactions, because sentences are immediately displayed on the screen for other participants to respond to in real time” (p. 914). With new media, many different users can access many different kinds of media at many different times around the globe. So, the flexible character of new media can also spare time and costs for the users. People can attain treatment for their eating disorder at the time they would like, around the working hours, at home. Also, people can be treated right away, in stead of wasting time waiting on a ‘traditional’ waiting list and spare costs. Because it’s cost-effective and it reaches a large population, the Dutch Trimbos Instituut expects a ‘revolution’ in the physical health care with four million Dutch using internet treatments in the future (ICT zorg, 2007). Finally, we believe the virtual character of our society needs to be considered when women are treated, because so many aspects of everyday life are technologically simulated. Lister et al. (2003) have stated that older certainties about ‘reality’ have become problematic. Questions arise about the kind of identity or sense of self that individuals who live in such cultures may have. So, should not there be paid more attention to the virtual reality individuals live in? In contrast to the tradition type of treatment, an internet-based intervention could be more capable of intervening in our virtual, new medial environment. For example, by using hypertext, linkages could be made to other websites, videos or articles online. Of course, besides the advantages mentioned, there are also disadvantages of new media which need to be discussed. Research that has been conducted the last few years which used online group discussions also encountered problems. However, also possible solutions are being proposed by researchers. A disadvantage of the internet could be that it is harder for the therapists or moderators to detect the need for a supportive responsive to a participant in the absence of nonverbal cues. This may result in less empathy being expressed, because if a 65

participant is quiet, it is difficult to determine when she is thinking, still typing, in need of support or not concentrating (Paxton et al, 2007). However, to minimize this problem, therapists can explicitly check the thoughts and feelings of participants and convey their own responses using more emotionally expressive language than would be typical in a face-to-face situation (Paxton et al, 2007). Also, video, as well as telephone contact is possible. Webcams could be part of the chatting so that non-verbal communication is part of the internet program. Abascal et al. (2006) found that a concern in delivering Student Bodies is ‘contamination’ in the online group discussion. “For example, when a pilot study of Student Bodies was delivered to the students at a high school, several students with lower body image concerns posted negative messages about their experience with the program” (p. 2). These messages could have an adverse impact on women with high weight concerns. It could also create a non-supportive and even hostile environment. A possible solution to this problem is to split the participants into different online groups based on their assessed risk and motivation to work on their body image. The results of Abascal et al. (2006) suggest that this seems a successful method of working with different types of individuals. Also, they mentioned that providing a separate experience is one of the first steps to providing a combined universal and targeted intervention in which different levels of intervention and strategies are met.

4.4

Levels of prevention

Before we introduce our intervention which will clarify the way in which we believe the new media could be helpful in preventing eating disorders, we must be clear about the levels and the strategies which are acknowledged in the pas two decades of research in the field of eating disorders and which ones we will focus on. Primary, secondary and tertiary levels of prevention are being described in Principles of Preventive Psychiatry by Caplan (Austin, 2000). Within this schema, people who do not yet show signs of illness are targeted by primary prevention. Secondary prevention aims at people who may already experience symptoms or signs of the problem but may not yet have the full-blown disease. Finally, tertiary prevention refers to efforts that improve the course of a disease or minimize the harmful consequences once illness has been diagnosed (Austin, 2000). According to Catalano and Dooley (1980), prevention should be further divided into reactive and proactive strategies. Reactive prevention includes strategies that improve coping responses and the individual’s resistance to potentially harmful stressors. In comparison, proactive prevention pays attention to strategies that eliminate causal agents. “Reactive prevention can occur before or after the stressor, but is aimed at preparing the individual to react effectively to the stressor. […] In contrast, proactive prevention attempts to avoid the stressor altogether” (Catalano & Dooley, 1980, p. 22). Austin (2000) concludes in his review that the research conducted so far has mainly focussed on primary prevention research, because they’re “using strategies to train participants to view media and cultural messages relating to the thin ideal with a critical eye and to foster psychological resilience to the pressure to control weight at any cost “ (p. 1256). They’re concentrating mainly on training girls how to adapt to their environment.

4.5

Living Healthy: Introducing our own prevention and

intervention application Based on the previous discussed, already exciting media application on preventing eating disorders, we have chosen to model our application in the form of an interactive, internetbased, structured, cognitive-behavioural intervention called Living Healthy. This intervention will be managed by three groups of psychological therapists specialized in the field of restrained eaters, individuals suffering from anorexia or/and bulimia nervosa, and individuals suffering from obesity. These three groups are based on their assessed risk and motivation to work in their body image, according to Abascal et al. (2003). In order to do this we considered them in terms of seriousness and weight, represented in figure 5. In this way, the secondary and the tertiary level of prevention are being met.

Type

overweight

healthy

underweight

normal

unrestrained

enraged

unsuccessfully

successfully

(successfully

restrained

restrained)

obesed

anorexic and bulimic

disordered

Figure 5: The dimensions on which we based our choice for the three different groups we are willing to help with our application.

Some of the groups mentioned in the figure will not be treated by our program, because some people are able to maintain a healthy eating habit despite the environmental pressure. For example, people that follow normal eating patterns can be slightly over- or underweight, but are of no concern in this matter. Two dimensions of enraged eaters are also not included in our program, because most restrained eaters, while 68

suffering from overweight, seem to manage their dieting goals effectively which makes them successfully restrained eaters. However, some of these successfully restrained eaters persist in dieting after reaching a healthy weight, causing underweight. These individuals will soon be added to the group of anorexic patients on our website, because deliberately causing underweight is seen as a disorder. When people are assigned to a certain group, one of the therapists will be conferred to them as their personal coach. This therapist will take care of a step by step plan, formed in consultation with other members of the specific team of therapists, to lead the way to a healthier eating pattern. Another role of the therapist is to remain repeatedly in contact, by which they can communicate their treatment techniques. In order to provide an ultimate climate within the designed program, the therapist can rely on several interactive, structured cognitive-behavioural tools. Below, we will further explain which specific tools will be used and presented in our online environment LivingHealthy.com in order to support people in developing healthy eating patterns. Some will be used in one or two specific groups, others will be offered to all members assigned to the community. The tools will focus merely on the ability of individuals to improve their coping responses and resist potentially harmful stressors. Because we will offer an alternative environment which enables individuals to cope with their environment, we can say we concentrate on proactive strategies. It almost seems impossible for individuals to avoid the media nowadays, so weâ&#x20AC;&#x2122;re not using active strategies in our proposal. Procedure of registration. In order to make an account on our website, several steps must be undertaken. At first, individuals will have to address different kinds of information about their physical and mental characteristics, including data like weight, length and illness history. To make sure a realistic portrait of the new clients is attained, he or she will be introduced by phone, including a personal interview. The third way in which information about the clients will be attained, is by taking several psychological tests like a Body-dissatisfaction scale (Stice, 2002); an Eating Disorder ExaminationQuestionnaire (Fairburn & Beglin, 1994); and a self-esteem scale (Rosenberg, 1965). 69

These kinds of tests mostly exist of questionnaires and are designed to find out the real ideas and problems people have, instead of their own interpretation of such. Designing an avatar, reflecting the ideal self. One of our first aims, when people start with the online program, will be to let people compose an avatar24 of the ideal self. As has been noted by the self-evaluation model, people hold specific ideas about the way other people in society would like to see them (their ought self) and the way they would like to see themselves (ideal self). The avatar will focus on the ideal self. The instruction, by conducting this image of the ideal self, will be to take a picture of the self wearing nothing but underwear and indicating (with or without their face), by use of a specific tool provided by the website, and to indicate which things you would like to change about yourself. The personal therapist will see if the ideal self is realistic and will provide an attractive image of the ideal self by means of attainability. For example, wanting to have less broad shoulders is hardly attainable if itâ&#x20AC;&#x2122;s caused by the way your skeleton is composed, however, wanting to have a flat belly is attainable. In the case of anorexic and bulimic individuals, a somewhat other strategy will be undertaken in which the therapist will provide a healthy but also beautiful ideal self by adding some wait onto the original image of the actual self. It can be assumed that the people who assign to LivingHealthy.com are motivated to change their way of life, so therapists can show them more healthy possibilities of body shape in which beauty is contained. By representing this avatar each time clients log on to the environment, they will be motivated, according to the social comparison model, to try and equalise this attainable image of the ideal self . Personal blog. By holding up some sort of personal diary, clients can reflect on their own process. By doing this, it is made possible for the therapist(s) to obtain insight in the mental considerations of the client, which can lead to adjustments in the original mode of operation for the individual. Also, clients can comment on each others blog, for example to encourage them in their process of becoming healthier. In this way, interactivity is being created.

An avatar is a visual representation of a participant in a shared digital environment (e.g. in online chat). Itâ&#x20AC;&#x2122;s an interface for the self (Lister et al, 2003).

Progress measurement will also be done by maintaining contact through (optional) face to face or telephonic contact, by which information can be obtained about the progress a client has made. As we have noted, it is important for people suffering from lower self-esteem to feel secure, especially when it comes to communicating about their uncertainties. By providing the service to make more intimate contact, this feeling of security is being looked after. Another way in measuring progress, is by conducting psychological tests, like the ones mentioned before, by which change in cognitions can be measured, and in addition offering tests to measure the profit people seem to gain from being assigned to this community and the feelings they have about the community, like the On-Line Support Scale (Winzelberg et al. 2000) and the Multidimensional Scale of Perceived Social Support (Dahlem et al, 1991). Cognitive association training. As has been stated before, several studies indicate that restrained eaters can be helped by holding up their dieting behaviour in order to become successfully restrained eaters. These successfully restrained eaters are characterised by the fact that they automatically activate the dieting goal by receiving food cues instead of activating hedonic thoughts about the presented food, as can be seen by unsuccessful restrained eaters. The challenge seems to be to change the cognitive association schemes held by restrained eaters. This can be done by cognitive-behaviour therapy. The exact idea of this therapy needs additional research, which we are confident will be done soon, since the topic of restrained eating seems ‘in’ in social psychological research and the group is growing real fast. Therefore, it seems reasonable it will be on the agenda in several health care domains. Online Media Literacy Lessons. By providing a series of five interactive literacy lessons on the way the media works and cognitive internalization of the thin, an unrealistic beauty standard is tried to be reversed. Information will be given by discussing the following topics: ‘We are not all the same’; ‘What tactics do the media use’; ‘Who places this pressure on us, and what can we do about it’; ‘Praising the good (like Dove) and protesting the bad’; and ‘what do you think, are media harmful?’. This method has proved to work on reduction of internalization scores before (Wiksch et al, 2006).

Chatting. It is one of the basic actions taken up when problems like these are being received: bringing people in contact with their fellow sufferers. Of course, as we have seen, in the case of anorexia and bulimia, mutual motivation forms a danger. Therefore the chat room we will provide must be managed by the therapists on the background, figuring as moderators. Keep an up to date archive. By processing all information gathered around the individuals registered, the ultimate digital databank for social and clinical psychological research is created. Not only can they conduct longitudinal research on specific cases, they can also easily conduct all sorts of statistical measures upon the various different groups with regard to different characteristic like e, self-esteem etcetera. The easiness by which this information is gained and held up to date could provide the ideal environment for fast development in studies about the different factors and exact mechanisms underlying these eating problems, something that is, as shown, an ongoing and complex search. Promoting our environment. As holds for many forms of research, the amount of subjects strongly contributes to the credibility and significance of the research, because, as we argue, it is of great importance to gather as many information as possible. In order to attain a great group of participants we will use several advertisement techniques. First, we will try to contact people that are not receiving any help yet by addressing their problem and finding solutions with an advertisement on websites and other environments which the individuals of the different eating disorders group typically visit. For example, this has been done by the ANBN25 on pro-ana sites, but can also be done on sites addressing more normal dieting strategies. The second way in which we will address the possibilities of our application, is by informing doctors and therapists about the possibilities our prevention strategy has to offer. We argue, that letting doctors and therapists refer their patients to our website LivingHealthy.com will not be immoderate, concerning the great advantage of the research that can be done on this

Eetstoornissen, http://www.anbn.be/

subject and which can contribute in substantial ways to the work done by those doctors and therapists. Altogether, we believe that an alternative online environment like we address above, can have great positive influence of the prevention and intervention on eating problems and disorders, frequently seen in modern society. Perhaps this idea of ours is a vision describing a future in which, according to Trimbos Instituut (ICT zorg, 2007), the physical health care will be largely taken over by internet treatment programs like ours. The media are in fact (partly) to blame, but they also provide the solutions for leading this society towards a future in which a healthier and more balanced eating pattern can be achieved.

Discussion

Because we have introduced an application (Living Healthy) which does not exist yet, we feel we need to consider the pros and cons and account for the reasons why we believe this intervention is an outcome for therapists and clients related to the problem of eating disorders nowadays. The tools we chose to insert are partly taken over from applications that have already shown to be successful in conducting useful information about the clients and letting them develop a healthier lifestyle. Others are more based on our own social psychological findings. The reason why we proposed these tools, is because we believe an integrative, mutually influenced corporation between the social psychology and the new media studies could lead to a new insight in how to treat health issues in the future. For instance, the tool we took over as a way in which restrained eaters could possibly change their cognitive association schemes in order to attain their diet goals, derives from our integration. This tool has to be further developed and examined of course, but we think further research would be a great continuation of this paper. We also tried to avoid some problems previous researchers occurred. For example, to improve they way in which therapists can become aware of the nonverbal clues of clients, and thus to create more empathy, webcams are introduced in the chat room and the possibility of having a traditional face-to-face treatment is also offered. The interviews could contribute to a feeling of security and to a more accurate portrait of the clients. The other problem we are trying to avoid is the one of â&#x20AC;&#x2DC;contaminationâ&#x20AC;&#x2122;, as mentioned earlier, which could lead to a non-supportive and even hostile environment . To avoid this, we made divided in three different groups and considered them in terms of seriousness and weight. Also the moderators are keeping an eye during discussions, so

that they could remove information if necessary. This also has proven to be successful in the past. Altogether we feel our integration has been proved to be useful as well in determining negative effects as in the development of useful tools to counteract the eating problems in modern society. Therefore we suggest further research has to be done, combining these to perspectives, in order to make way for applications, like the one we described.

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