2025-26 Doctoral Researcher Cohort

Health, Wellbeing and Social Care

(University of Lincoln)

Main supervisor: Dr Kamila Irvine

Second supervisor: Prof David Dawson

Research project title: Body Happy Schools Programme (BHSP): Whole School Culture Change

Research description: In 2021 the Women and Equalities Committee’s inquiry into body image found that 66% of children in the UK feel negative about their body most of the time (Women and Equalities Committee, 2021). The NHS has revealed that the number of children seeking treatment for eating disorders has more than doubled in the past six years, while waiting times have increased (Newlove-Delgado et al., 2023; NHS England, 2022). Research shows negative body image in children as young as five; many studies have found children report negative body image symptoms including body dissatisfaction, thin-ideal internalisation, weight bias, food restriction, and disliking the way they look (Damiano et al., 2015; Davison et al., 2003; Murnen et al., 2003). Body image is a multi-dimensional construct that embraces the conscious perception of the physical self, including body-related attitudes, thoughts, feelings, and behaviours (Cash, 2002; Cash et al., 2002). Negative body image can manifest itself as body dissatisfaction, body shame, low self-esteem, and low self-worth. It is associated with mental health issues such as depression, anxiety, low mood, and increased risk of disordered eating and eating disorders (Mitchison et al., 2016; Neumark-Sztainer et al., 2007; Prnjak et al., 2021). Additionally, research shows that 1 in 5 girls do not raise their hand in class for fear of being judged over how they look, and 36% of girls and 24% of boys regularly avoid exercise and PE due to worries about appearance, indicating that negative body image not only affects the mental health of young people but also their academic attainment and engagement in health-promoting behaviours (Girlguiding, 2017; Halliwell et al., 2014).

Moreover, research conducted by the World Health Organisation has found that children in higher weight bodies are 63% more likely to be bullied in school which is directly at odds with school PSHE curriculum, body inclusion policies, and antibullying policies, contributes to negative mental health, and makes it a safeguarding issue (World Health Organisation, 2017). In the UK, there currently is no statutory education in schools on body image. It is important to note that longitudinal research demonstrates that body dissatisfaction does not serve as a motivator for engaging in healthy behaviours but rather predicts behaviours that put children and young people at risk for weight gain, poor mental health, and poorer overall health (Andrew et al., 2016; Lowe et al., 2019). For example, body dissatisfaction has been found to predict lower levels of physical activity, lower levels of fruit and vegetable intake, and unhealthy weight control behaviours, i.e. purging, vomiting, excessive exercise (Neumark-Sztainer et al., 2006). As such, negative body image such as body dissatisfaction is a public health concern. Early intervention may help prevent its onset and be protective in the long-term. Positive body image has been shown to be uniquely associated with well-being, self-care, intuitive eating, and health-promoting behaviours (Andrew et al., 2014; Linardon et al., 2021a; Linardon et al., 2021b). Positive body image is also multi-faceted, encompassing body acceptance, appreciation, gratitude, and respect towards one’s body, its features and functionality, regardless of what it looks like (Tylka & Wood-Barcalow, 2015; Wood-Barcalow et al., 2010). When children learn to respect their bodies, regardless of their appearance, and how it measures up to others, they are more likely to engage in body-positive and health-promoting behaviours such as intuitive eating and physical activity (Frisen & Homqvist, 2010). They are also less likely to be susceptible to develop disordered eating as body appreciation and intuitive eating are positively associated with psychological well-being and lowered risk of disordered eating (Denny et al., 2013; Hazzard et al., 2020; Tiggemann & Clark, 2016). As such, interventions should focus on encouraging positive change to enhance the desire to care for one’s body regardless of how it looks.

Existing interventions to enhance body image in children tend to focus on media literacy classes, resilience building, and self-esteem, via workshops, games, or classes. These tend to be delivered as a one-off occurrence, where no additional changes in the school environment take place. These studies typically demonstrate initial/immediate impact, however, effects drop off at follow-up particularly for boys, and often no effects are observed for certain key variables (Bird et al., 2013; Forbes et al., 2023; Guest et al., 2021; Matheson et al., 2020).

It stands to reason that one-off/sporadic interventions are insufficient if there are no additional changes in the environment or continuation of body-respect messaging, as some authors have suggested (Forbes et al., 2023; Guest et al., 2021). The reason is that children and young people are continuously surrounded by negative body messaging, e.g., via media, family, as well as weight stigma and diet culture prevalent in society (Jones et al., 2004; Neumark-Sztainer et al., 2010; Rogers et al., 2019; Stice et al., 2003). Indeed, the key theories that explain how body image is developed and maintained such as the Socio-Cultural Tripartite Influence Model and Cognitive-Behavioural perspective specify the influential impacts of cultural socialisation and interpersonal experiences via peers, media, and family. Seeking to alter social factors which are known to increase general population risks is in line with extant recommendations (Cash, 2012; Shroff & Thompson, 2006). As such, culture change to foster positive body image may be the answer, i.e. the mechanisms of change could involve boosting the body esteem and respect, and challenging societal norms, which then lead to improved body satisfaction. School culture is not static, it is continuously being constructed and shaped through interactions of staff members, students, and personnel of the school at large (Hinde, 2004). In order to influence change, we need to influence the values, beliefs, behaviours, rules, and ethos that serve as the foundations of the school culture (Hinde, 2004). The Body Happy Org (BHO) are dedicated to creating culture change regarding bodies, food, exercise/movement, body diversity, and self-acceptance. They recognize that body image issues are not solely individual problems but rather systemic challenges that require collective action centred around culture change to secure well-being in the future. This project is therefore interested in systemic school culture change to promote positive body image via the teachers, staff, pupils, and ethos of the school. The proposed intervention has been designed to train teachers in the area of body image. Currently there is no statutory training or coverage of the topic on the curriculum, but it is fundamental to the wellbeing, safeguarding, and academic attainment of all students (Initial teacher training, 2023; Personal, social, health and economic education, 2021). All staff in a school setting are fundamental to creating the culture and environment within it, which is why any culture change and body-positive environment building must start with reaching the adults who work with the children, rather than just the children themselves. The BHO programme also includes resources for teachers to deliver lessons to the pupils in their care, and this study will also measure the impact of these teaching resources on the students. Furthermore, the programme includes direct work with students via Schemes of Work, interactive workshops, and assemblies. Importantly, this programme focuses on prevention and social change, with the aim of reducing the number of children requiring intervention in the longer term.

To conclude, at present a number of school-based body image interventions have been developed, demonstrating limited success. Given that negative body image can develop at a young age it is important to develop approaches that are preventative, i.e., addressing potentially existing negative body image as well as creating an environment that can support the fostering of positive body image.

In this study, we aim to evaluate the effectiveness of the Body Happy Schools Programme (BHSP), a whole-school culture change approach. We will employ a case-series design, with three individual schools serving as separate cases. This design will enable us to determine whether the BHS approach has an observable effect in any single school and, more compellingly, across multiple schools, thereby demonstrating a significant replication of effect in accordance with case-series standards (Smith, 2013).