The Body Image Battle
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The Body Image Battle:
Improving Middle School Girls’ Level of Body Acceptance
Rachel L. Libben
University of Cincinnati
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Abstract
This paper describes a group work framework of a prevention program on poor body image for
6th grade girls as they enter middle school. The paper discusses the need for body image
education as a large number of girls are dissatisfied with their current shape or size and may even
go to extreme measures of combating the changes that occur during puberty. The group
framework is created for a small group of girls who are at-risk for eating disturbances or eating
disorders. The 10-session group will address topics such as self-esteem, cultural influences,
healthy habits, taking control of issues, and role models. The paper describes the importance of
prevention, the steps taken to plan and facilitate the group and specific activities or discussions
for each session.
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A Body Image group will be implemented for middle school female students. The group
will specifically be for incoming 6th grade students as they make the transition from elementary
to junior high. The group will be a psycho-educational group for adolescent females who are atrisk for poor body image and eating disturbances. The objectives are as follows:
1) Students will improve their body image.
2) Students will improve their self-esteem.
3) Students will increase knowledge in understanding cultural influences on body image.
4) Students will increase knowledge of healthy eating behaviors.
The purpose of the group will serve as a preventative intervention to eating disorders. The
group will meet for 10 sessions that last in duration of 45-60 minutes. The sessions will be held
during the school year, once a week. Evaluation will be completed before and after to determine
the success of meeting the group objectives.
Rationale
Research shows that “weight preoccupation and dissatisfaction with one’s body are
prominent issues for today’s adolescents” (Phelps et al., 1993). Although both genders can
develop body image issues, concerns with having a slim figure and weighing less are more
prevalent in adolescent females (Phelps et al., 1993). Daigneault (2000) states that “According
to Fisher, Golden, and Katzman (1995), 50% of adolescent girls see themselves as overweight
and engage in dieting behaviors”(Daignealut, 2000).
Body Image Dissatisfaction
Dieting behaviors in adolescent females create health concerns. Neumark-Sztainer
(1996) discusses the association of dieting to later eating disorders and eating disturbances
(Neumark-Sztainer, 1996). The “consequences of eating disorders can be severe, and mortality
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rates among cases can range as high as 10% due to starvation, cardiac arrest, or
suicide”(Neumark-Sztainer, 1996). Although not all adolescent females who diet progress to
eating disorders, dieting can have other serious consequences. Neumark-Sztainer (1996) states
that dieting is associated with “mental and physical symptoms such as fatigue, anxiety,
depression, constipation, amenorrhea, mental sluggishness, impaired performance in school, and
impaired growth” (Neumark-Sztainer 1996).
Physical health is not the only concern for adolescent dieting and unhealthy eating
behaviors. Kater, Rohwer, and Londre (2002) add, “disproportionate emphasis on controlling
external appearance creates a ‘disconnect’ with the deeper sense of identity and integrity upon
which healthy ego strength is built, contributing to depression in adolescent girls relative to
boys” (Kater et al., 2002). Self-esteem is often affected from the focus of achieving a slim body
(Brook & Tepper, 1996). Furthermore, body image issues and the subsequent unhealthy eating
habits that are learned during the adolescent years are difficult to change and can continue into
adulthood (Kater et al, 2002).
Middle School Concerns
As students leave elementary school and enter middle school, they are faced with many
changes. Akos (2005) explains that the junior high level was created due to the “recognition of
the developmental differences of early adolescents” (Akos, 2005). Akos and Levitt (2002)
discuss that “middle school and preadolescence is a formative period in development. Students
in middle school, in the midst of puberty, begin to establish an individual identity outside the
family unit (Berk, 1999)” (Akos & Levitt, 2002). Akos (2005) elaborates that “aside from
infancy, no other phase of life is characterized by greater, more rapid, and diverse development
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than early adolescence (Pruitt, 200)” (Akos, 2005). These influences can have an affect on a
student’s body image (Akos & Levitt, 2002).
“Whereas puberty for males is generally more positive, the physical changes girls
experience may factor into the increased prevalence among females of body dissatisfaction and
weight management behaviors”(Akos & Levitt, 2002). Girls are striving for the cultural ideal of
a thin female, yet they typically experience some weight gain during puberty (Akos, 2005). This
contentious time for body image and self-esteem create a need for school-based prevention
programs (Neumark-Sztainer, 1996; Kater et al., 2002). Neumark-Sztianer suggests, “prevention
programs should aim toward increasing adolescents’ understanding of the role of socio-cultural
factors on body image, and should include activities in which adolescents critically examine
social norms” (Neumark-Sztainer, 1996).
Along with the physical changes and awareness of cultural ideals, peers begin to play a
more prominent role in the world of a middle school student (Akos, 2005). As adolescents are
trying to figure out their own identity, they also recognize that they are part of a social group
(Cob, 2001; Akos, 2005). This recognition spurs a need to be accepted by their peers. Akos and
Levitt (2002) state “there is a widespread desire among preadolescents to lose weight or attain a
different body type to be liked and accepted by the same and opposite sex peer (Ricciardelli &
McCabe, 2001)” (Akos & Levitt, 2002). Akos and Levitt (2002) continue to explain that the
need to fit these ideals create a competition within their peers for fear they will be judged (Akos
& Levitt, 2002).
Benefit of Group Work
The very issues of body image and adolescent changes described above also lend
themselves to the need of group work as a preventative counseling approach (Daignealut, 2000;
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Akos & Levitt, 2002; Scime, Cook-Cottone, Kane & Watson, 2006). Daignealut (2000) supports
the use of group therapy as an effect intervention technique as “group discussions can be
effective in challenging thinking about female and male role model behavior and can provide an
opportunity for students to receive feedback and support from peers who are also struggling with
eating issues”(Daignealut, 2000). Steen, Bauman and Smith (2008), strongly support the use of
group work within schools due to knowing that others in the group are experiencing similar
issues (Steen et al., 2008). Acknowledging these similar issues, members will progress through
the acceptance stage (Trotzer, 2006). During the acceptance stage “the therapeutic influence of
cohesiveness makes use of peer group dynamics as its key resource in the group. As members
experience genuine acceptance by fellow members, self-esteem is enhanced, ego is strengthened,
self-confidence is bolstered…” (Trotzer, 2006).
The prevention of body dissatisfaction has been made apparent by the aforementioned
research. The target population of at-risk adolescent females for body dissatisfaction and eating
disturbances due to developmental changes contrasting from the cultural ideal, would benefit
from group work in the school system promoting positive body image and thus self-esteem.
Method
One school counselor who has experience and training in group work will lead the group
process. The membership of the group will be voluntary and will consist of 4-10 girls depending
on interest and recruitment results. The counselor will advertise for the group as a girls health
discussion group. Posters will be displayed in the school hallways and teachers will be given
flyers to pass out to the girls in their class during homeroom. The posters and flyers will direct
the students to sign up in the school counselor’s office. Teachers and coaches will also be asked
to refer 6th grade girls they believe would benefit from this group. The teacher or school
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counselor will approach the student and encourage her to join a supportive girls group. Referrals
will also be considered from other students.
Once students express interest in the group, the school counselor will meet with the
students individually for screening. The counselor will make sure that the student will benefit
from the goal of the group and does not require more intensive therapy (Trotzer, 2006). During
the screening process, the counselor will also inquire about the student’s schedule in order gage
an appropriate group meeting time. The student will be given a permission slip to have their
parents sign and return before the start of the group. Parental consent will be required for each
girl in order to participate in the group, as the students are minors.
The group will be held during the school day to accommodate students who have to take
the bus or whose parents cannot drop them off early or pick them up late. Once the girls have
officially signed up for the group, schedules will be compared to find a period that works for all
the students and allows for minimal class absence. The goal will be to find a meeting time that
would normally be spent in study hall, homeroom, or lunch. If girls do have to miss class, a
letter will be sent to all teachers explaining the group and the need for the students to participate.
If any teachers have concerns they can address them with the school counselor and an alternative
meeting time will be attempted.
The meeting space will need to private to keep the group discussions confidential from
outside students and teachers. The space will also need to be large enough for all the group
members to spread-out as there will be physical activity within the group sessions. Ideally, a
space on the stage in the auditorium would provide nice floor space and should not be in use by
other students the majority of the year. If the auditorium space is in use by other students or staff
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members, the group can relocate to an unused classroom for a session or two to accommodate
other school activities that require the facility space.
The materials used throughout the program will be minimal to keep considerate of
financial restraints. A white board or paper on an easel will suffice for most discussions. Art
supplies will be used during some activities and videos may be watched either on a laptop or on a
television rented from the audio/visual department. The only supply that the girls will need to
supply is a yoga mat or a towel for the opening and closing ritual.
Borrowing the use of yoga for body image groups from Scime et al. (2006), basic yoga
components will be used as the opening and closing ritual for each session. Yoga will physically
warm up the girls and check them in to the group. The breathing and flow of yoga will also help
to clear the minds of the girls and prepare them for discussion. The physicality of yoga will also
be important to reflect on as the group discusses healthy behaviors.
Session Planning
The first two sessions focus on creating the security stage of the group process as
described by Trotzer (Trotzer, 2006). The group begins with the members having input in their
group name and rules. The second session introduces some knowledge for the girls to consider
regarding body image. This knowledge will be discussed and allow the girls to voice their
opinions and reaction without getting too in-depth to personal issues if they do not feel
comfortable.
The goal of sessions 3-4 is to move the group through to the acceptance stage (Trotzer,
2006). In the acceptance stage, the girls are given topics that delve further into the body image
discussion by focusing on issues that do not require the girls to reveal information about them,
but discuss issues in general and as a whole. By providing topics on health the girls can get
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comfortable sharing within the group and accepting some areas of self-improvement in their
eating habits.
Sessions 5-7 set the groundwork for the responsibility stage (Trotzer, 2006). By this time
in the group process the girls should feel comfortable expressing their views and personal stories
in relation to eating habits and body image concerns. They should feel accepted and safe by
expressing their stories. In sessions 5-7 they are given more information to discuss where they
can make positive changes on physicality and being confident in who they are.
If the group progresses as planned, the group will continue through the working stage in
sessions 8-9 where they can discuss areas of their life that are not satisfactory (Trotzer, 2006). In
these sessions they will be asked to take control of issues in their life that pose problems and
think how they can be role models for others. The group members will be able to help each
other, which will increase self-esteem (Trotzer, 2006).
The closing stage will occur during the 10th and final session. The group will have the
opportunity to review all they have discussed and learned and address unfinished concerns or
business. The group will perform a final activity to say goodbye. They will also provide
evaluation information and feedback.
Session Details
The following pages will break down each session into the objectives to be met, specific
activities and discussion points:
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Security Stage
Session 1: Introduction and Group Planning
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et al., 2006).
The group will decide on a list of rules to follow
throughout their group sessions. Confidentiality will be
the only mandatory rule to start (Troter, 2006).
The group will brainstorm together choose a group name.
This ownership will provide a sense of power and control
to the group identity (adapted from Daigneault, 2000).
Members will complete the pre-evaluation gaining insight
on the level of the group’s body image satisfaction, selfesteem level, and awareness of media influence, and
healthy eating knowledge.
Each member will make a collage using art supplies and
magazine cutouts to show what represents them. They will
then each explain their collage to the group as an
introduction (adapted from Trotzer, 2006).
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Establish group rules
Name the group
Pre-evaluation
Get to know each
other
Yoga meditation
Discussion Points:
The importance of confidentiality will
be explained.
“Any similarities in the collages?”
“Did you put any physical
characteristics on your collage?”
“Discuss why you did or didn’t”
Session 2: Media Influence on Body Image
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Compare media images from magazines, television, and
advertising.
Watch video clips that discuss and show media influence:
The Photoshop Effect, Dove Evolution & Beauty Pressure.
Understand cultural
influences through
media
Yoga meditation
Sitting on their mats/towels with eyes closed reflecting on
their feelings from the group and focusing on the purpose
that they want to pursue. The leader will speak softly and
lead the group through this reflection time and summarize
the discussion (adapted from Scime et al., 2006).
Discussion Points:
“What do you think about when you
see these images/advertisements?”
“Do these women look like the
women you know and see around?”
“Were you aware of the amount of
Photoshop used in advertisements?”
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Acceptance Stage
Session 3: Healthy Habits
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Each girl will bring in a food diary from the previous 3
days. They will have tracked their food intake along with
emotions while they ate.
The food pyramid will be discussed along with the
importance of each recommended food category.
Understand healthy
eating habits
Yoga meditation
Discussion Points:
“ Are you getting the necessary
servings of each food group?”
“Do you notice any connections with
emotion and food intake?”
“Is your diet missing any important
factors that helps your body grow and
stay healthy?
“Identify one healthy goal to improve
on your eating habits”
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Session 4: Eating Disorders and Disturbances
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Definitions of eating disorders will be written on the
board.
The effects of malnutrition will be passed out on paper.
The girls will discuss eating habits that could lead to
disorders.
Understand the effects
of unhealthy dieting.
Yoga meditation
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Discussion Points:
“Based on what you learned about
healthy eating, what problems do you
think could occur from unhealthy
dieting?”
“Do you recognize any unhealthy
eating habit/ disturbances that you do
that might be similar?
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Responsibility Stage
Session 5: Self-esteem Boost!
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
List of “likes” about oneself (can be physical, emotional,
characteristics etc). Share with the group.
Sharing positives about each group member.
Appreciate the great
qualities of yourself.
Yoga meditation
Discussion Points:
Discuss the importance of reminding
ourselves and each other of the
positives – not what others see as
negatives.
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Session 6: Multicultural Views on Beautiful
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Compare pictures of the “ideal woman” in different
cultures and throughout time (adapted from Montana
Team Nutrition, 2004).
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Increase understanding
on different views of
beauty.
Yoga meditation
Discussion Points:
“Is there really an ideal Body?”
“What can you learn by comparing
different ‘ideal body’ images?”
Session 7: Physical Power
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Extended yoga practice moving through basic yoga flow.
If the leader is not familiar with yoga flow, a yoga
workout video can be use.
Gain knowledge of
healthy exercise
habits.
Yoga meditation
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Discussion Points:
“How does it feel when you use your
body?”
“What kind of physical activity makes
you happy?”
“Can you exercise too much?”
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Working Stage
Session 8: Taking Control
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Group Discussion discussing obstacles or view people
have that limit them. (e.g.bullying, sexist expectations).
Problem solve as a group.
Gain control and
power over outside
influences.
Yoga meditation
Discussion Points:
“Do you have something or someone
that is holding you back?”
“What can you do to over come this
obstacle?”
Sitting on their mats/towels with eyes closed reflecting on
their feelings from the group and focusing on the purpose
that they want to pursue. The leader will speak softly and
lead the group through this reflection time and summarize
the discussion (adapted from Scime et al., 2006).
Session 9: Role Models
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Each group member shares who their role model is and
why.
Understand what
makes a good role
model.
Yoga meditation
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
discussion. The girls will be asked to silently focus on a
positive goal they want to pursue (adapted from Scime et
al., 2006).
Discussion Points:
“What do you respect most about
your role model?”
“Are you a role model to someone?”
“What would you want them to
respect about you?”
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Closing Stage
Session 10: Closing
Objectives:
Activity:
Yoga warm up
Sun Salutations to connect the body and mind (adapted
from Scime et.al, 2006).
Discussion about the group process and new knowledge.
Review of group
process and sharing of
unfinished business.
Saying Goodbye
Post-evaluation survey
& Satisfaction Survey
Yoga meditation
Discussion Points:
“Is there anything you want to share
with the group about your time
together?
Crystal Ball Exercise (Trotzer, 2006). Group members
will pass around an imaginary crystal ball and describe
what they see for themselves and other members in 5
years.
Complete surveys during group and turn in to leader
before leaving.
Girls will sit on their mats/towels in silent reflection as the
leader leads them through a summary of the group
experience. The girls will be asked to reflect on their
knowledge and to remind themselves that they are
beautiful as they are (adapted from Scime et al., 2006).
Evaluation
Following the completion of the final session, the girls will turn in their post-evaluation
forms to the counselor. The counselor will then evaluate if the objectives were met and
determine if the group was a success by comparing the pre-evaluation and post-evaluation
results. The evaluation consists of the same 4 questions for both evaluations. Each question
addresses one of the four group objectives. The students are asked to choose on a scale of 0 –10
for each answer. The questions are as follows:
1.) On a scale from 0-10 how happy are you with your body?
0
1
2
3
4
5
6
7
8
Complete dislike
body!
9
10
I love my
2.) On a scale from 0-10 how much do you think culture/media influences your view on
your body?
0
1
2
3
4
5
6
7
8
9
10
No influence at all
complete influence
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3.) On a scale of 0-10 how well do you understand the effects of unhealthy eating habits on
your body?
0
1
2
3
4
5
6
7
8
9
10
Not at all
expert
4.) On a scale of 0-10 how awesome do you think you are as a whole person?
0
1
2
3
4
5
6
7
8
9
10
Not awesome
super awesome
The average for each score will be collected and then compared to the average for the
post-evaluation. If the average increases by at least 1 number for each objective the group will
be considered a success. If the group average per question does not increase then reconsideration
of the group approach needs to be implemented. Further research should be conducted as to how
the group can be more effective in meeting the objectives.
Group members will also be given a feedback survey during the last group session. The
survey will be used to judge the feelings and satisfaction from the group members regarding their
thoughts on the process and outcome (Trotzer, 2006). The feedback survey will be used in
regards to improvements and changes before a new group begins. The survey questions are as
follows:
How well did you enjoy the group experience on a scale of 1-4? (4 being the most enjoyable)
Did you feel comfortable with the leader? (4 being most comfortable)
What was your favorite part of the group?
Was there anything you did not like at all? Please share.
Do you have any suggestions for the group process or for the leader you would like to
share?
The group framework sets to address body image acceptance within middle school girls
as a preventative measure against eating disturbances and disorders. It sets to increase cultural
awareness and self-esteem. The group process facilitates a safe conversation zone for the female
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students to address issues or concerns they have regarding their changing bodies. The group
provides them with tools to use outside of the group as they face constant images of the perfect
body ideal. The importance of this topic deserves further research and implementation in school
systems.
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References
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Counseling, Vol. 9 (2), 95-103.
Akos, P., Levitt, D. (2002). Promoting Healthy Body Image in Middle School. Professional
School Counseling, Vol. 6 (2), 138-144.
Beauty Pressure [Video file]. Retrieved from
http://www.youtube.com/watch?v=Ei6JvK0W60I&feature=related
Brook, B., Tepper, I. (1996). High school students’ attitudes and knowledge of food
consumption and body image: implications for school based education. Patient Education
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