A Systematic Review Exploring the Effectiveness of Body Image Interventions Among Boys

Adolescent Research Review https://doi.org/10.1007/s40894-024-00246-y A Systematic Review Exploring the Effectiveness of Body Image Interventions Among Boys Latika Ahuja1 · Jekaterina Schneider1 · Mahira Budhraja1 · Phillippa C. Diedrichs1 · Heidi Williamson1 Received: 21 May 2024 / Accepted: 12 July 2024 © The Author(s) 2024 Abstract Body image concerns significantly impact boys’ physical and mental health. While several reviews synthesize evidence on body image interventions for mixed-gender adolescents, a systematic review exclusively focusing on boys is currently missing. Thus, this systematic review synthesizes evidence on universal psychosocial interventions targeting body image among boys and identifies effective approaches for enhancing their body image. Searches were conducted across seven databases until February 2024. Forty-one studies were included and assessed for quality across domains such as selection bias, study design, and methods. Three studies exclusively targeted boys, while 38 involved mixed-gender groups. Multiple therapeutic approaches were used across the interventions, including media literacy, socio-cognitive approaches, combined cognitive dissonance and media literacy, positive body image, compassion and mindfulness, and other approaches, with no single approach proving universally effective. Some promise for interventions employing positive body image and embodiment techniques was noted. Few interventions showed effectiveness on boys’ body image but most benefited girls. Further, findings were inconsistent across outcomes, with lower-quality studies driving evidence of effectiveness. These findings highlight that the effectiveness of current body image interventions among boys is inconclusive, emphasizing the urgent need for improvement or development of new interventions tailored specifically to address boys’ body image concerns. Keywords Body image · Body image interventions · Boys · Interventions · Psychosocial Introduction Body image relates to an individual’s perceptions, feelings, and thoughts about their body and appearance (Grogan, 2010). Based on self-evaluation, one can either be dissatisfied with one’s looks to experience a negative body image or love, appreciate, respect, and accept one’s body to experience a positive body image (Tiggemann, 2015). Alarmingly, a significant proportion of adolescents are currently discontented with their appearance, making negative body image a pervasive global public health issue within this demographic (Rodgers et al., 2023). Negative body image is associated with numerous adverse health outcomes, including depressive symptoms and disordered eating (Bornioli et al., 2021; * Latika Ahuja ; 1 Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Frenchay Campus, Room 3B026, Coldharbour Lane, Bristol BS16 1QY, UK Murray et al., 2016; Sharpe et al., 2018). Evidence suggests that adolescent girls typically report higher levels of body dissatisfaction than boys (Holsen et al., 2012; Kantanista et al., 2015), which has led to the development of targeted prevention and early intervention programs for this group. However, more recently, approximately 50–69% of boys have also been found to experience pressures to achieve a lean and “healthy” appearance (Dove, 2024). Despite this, limited research has focused on developing body image interventions specifically for boys. While previous reviews have examined the effectiveness of body image interventions among mixed-gender adolescents (Yager et al., 2013), women (Lewis-Smith et al., 2016), and men (Hendricks et al., 2023), as well as the potential of positive body image interventions (Guest et al., 2022), no systematic review has comprehensively synthesized all existing body image interventions (targeting both positive and negative body image) specifically for boys. Given the recent shift in body image literature to include boys and men, an up-to-date and critical synthesis of the existing evidence is necessary. Therefore, this systematic review aims to synthesize and critically Vol.:(0123456789) Adolescent Research Review evaluate the effectiveness of body image interventions among boys. Literature on Body Image Concerns Among Boys Historically, body image concerns among boys have received less attention in research and policy compared to girls, partly due to a limited understanding of how body dissatisfaction presents in this demographic (Health & Social Care Committee, 2022). Recent evidence, however, reveals significant body dissatisfaction among boys. About 68% of boys are unhappy with their height, 74% of boys feel insufficiently muscular, and 59% of boys experience pressures to conform to attractive standards (Dove, 2024), such as looking masculine and aligning with mesomorphic appearance ideals (Sicilia et al., 2023). These appearance ideals differ from the body ideals that girls and women commonly feel pressured to pursue (i.e., maintaining a slim, slender, and fair body, with a small waist and minimal body fat; Mingoia et al., 2017). Notably, the significant biological and psychological changes experienced during adolescence, which relate to changes in physical appearance, sense of identity, and ability to form intimate relationships, increase the risk of negative body image at this developmental stage among both boys and girls (Blum et al., 2021; Krasniqi & Cakirpaloglu, 2020; Sicilia et al., 2023). Regardless of whether boys desire to be thinner or more muscular (Calzo et al., 2015; Dakanalis et al., 2015), appearance-related concerns lead to high levels of distress and psychological issues, such as low self-esteem, depression, anxiety, suicidal thoughts, and an increased risk of eating disorders (Brausch & Muehlenkamp, 2007; Voelker et al., 2015; Walker et al., 2018). Alarmingly, to alter their appearance in pursuit of an “ideal” physique, 58% of boys engage in risky behaviors such as excessive exercise (27%) and unhealthy eating habits (31%), that negatively impact their quality of life (Dove, 2024; Gouveia et al., 2014; Yager & O’Dea, 2014). This underlines the need to address the unique appearance-related challenges boys face. However, it is important to note that much of the understanding around the nature and scale of body image concerns among this demographic is derived from studies that have been conducted among cisgender boys (Sicilia et al., 2023). Further, while some studies have demonstrated how the intersection of gender and body size influences body dissatisfaction, these studies were limited to adult men (Brewer et al., 2022; Strübel et al., 2020). Nonetheless, based on the findings of prior research, it is encouraging that negative body image is a modifiable risk factor, and early intervention can help prevent mental health issues among boys, including eating disorders, engagement in risky health behaviors, and depression, all of which (...truncated)