Do friends share similar body image and eating problems? The role of social networks and peer influences in early adolescence
Introduction
A concerning number of people continue to suffer from severe body image and eating disturbances. In the western world, as many as 2–3% of adolescent and adult females have a clinical eating disorder (Favaro, Ferrara, & Santonastaso, 2003; Kinzl, Traweger, Trefalt, Mangweth, & Biebl, 1999), and sub-clinical eating disorders have been estimated to be at least twice as common as full syndrome disorders (Hoek & Van Hoeken, 2003). High rates of eating disorders are concerning for health professionals as these disorders often require long-term, multidisciplinary interventions that are costly to the community (Agras, 2001). This is especially the case for anorexia nervosa which has one of the highest mortality rates of any mental illness (Keel et al., 2003).
In light of concerning prevalence rates and the significant resources involved in treating eating disorders, growing emphasis has been placed on the potential value of prevention and early intervention (Pearson, Goldklang, & Striegel-Moore, 2002). Researchers have argued that to prevent or intervene in the development of eating problems it is necessary to accurately identify and target early risk factors for eating disorders (Jacobi, Hayward, De Zwaan, Kraemer, & Agras, 2004). Targeting early risk factors is also indicated by longitudinal studies that have identified a developmental trajectory from minor body image distortions and dieting behaviours, typically starting during early to mid-adolescence, to more extreme weight loss behaviours (EWLBs) and clinical disorders, developing during mid- to late adolescence and early adulthood (Shisslak, Crago, & Estes, 1995).
To identify early risk factors for eating disorders researchers have examined a range of individual attributes and sociocultural factors associated with body image and eating problems. Individual risk factors consistently associated with body image concerns, dieting and binge eating have included body mass index or BMI (Cattarin & Thompson, 1994; Picot & Lilenfeld, 2003), low self-esteem (Button, Sonuga-Barke, Davies, & Thompson, 1996; Ghaderi & Scott, 2001), negative affect (Leon, Fulkerson, Perry, Keel, & Klump, 1999; Stice, Killen, Hayward, & Taylor, 1998) and depression (Graber, Brooks-Gunn, Paikoff, & Warren, 1994; Stice, Burton, & Shaw, 2004). These risk factors have been included in well-known theoretical models of the development of disordered body image and eating behaviours (e.g. Bardone, Vohs, Abramson, Heatherton, & Joiner, 2000; Heatherton & Polivy, 1992; McCarthy, 1990; Stice & Agras, 1998).
Sociocultural risk factors have also been implicated both theoretically and empirically in the development of body image and eating disturbances (Levine & Smolak, 1992; Striegel-Moore, Silberstein, & Rodin, 1986; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Theoretical models have included the family, media and peers as important sociocultural sources of influence in eating problems (Stice & Agras, 1998; Thompson et al., 1999). While significant research has focused on family and the media, peer influence has only received moderate attention in the literature. This is somewhat surprising as it has been established by both developmental theorists and clinical researchers that during adolescence young people attribute considerable importance to the attitudes, beliefs and behaviours of their peers (Coleman, 1980).
Theorists have suggested that peers are influential in the development of individual personality traits, physical characteristics and behavioural tendencies, especially in adolescence (Coleman, 1980; Epstein, 1989). Consistent with this suggestion, empirical research has demonstrated that young people tend to resemble their friends in appearance and social attributes (Berscheid, Dion, Walster, & Walster, 1971), as well as interests, attitudes and behaviours (Kandel, 1978b; Tolson & Urberg, 1993). Peers have been found to share similarities in risk-taking behaviours including smoking (e.g. Tolson & Urberg, 1993), drug use (e.g. Aseltine, 1995; Kandel, 1978b), alcohol consumption (e.g. Curren, Stice, & Chassin, 1997; Jessor, 1987) and delinquent behaviour (e.g. Matsueda & Anderson, 1998). Similarities in peoples’ attitudes and behaviours are known to be important in determining interpersonal attraction (Kandel, 1978a). Such attraction tends to be greater when individuals share mutually valued attitudes and behaviours (Kandel, 1978b; Tolson & Urberg, 1993). Given that body image concerns and eating disturbances typically develop during adolescence, it has been suggested that adolescent friends might also share similarities in mutually valued body concerns and eating behaviours (Crandall, 1988; Paxton, Schutz, Wertheim, & Muir, 1999; Pike, 1995).
To date, research examining the role of peers in body image and eating problems has primarily focused on individual perceptions of peer influence. Findings suggest that perceived peer influence is important in adolescent body attitudes and eating behaviours (Lieberman, Gauvin, Bukowski, & White, 2001; Wertheim, Paxton, Schutz, & Muir, 1997). In several studies, perceived peer pressure to be thin was more strongly associated with disordered eating attitudes and behaviours in adolescent girls than perceived pressure from alternate sources such as family, male friends or the media (Matsumoto, Kumano, & Sakano, 1999; Stice, 1998). Moreover, both perceived peer talk about weight loss and perceived peer dieting have been associated with individual dieting attempts by adolescent girls (Levine & Smolak, 1992; Levine, Smolak, & Hayden, 1994; Wertheim et al., 1997). These findings provide indirect support for the notion that adolescent friends share similarities in their body attitudes and weight loss behaviours.
Theorists have suggested that friendship similarities derive from both selection and socialisation processes (Ennett & Bauman, 1994; Epstein, 1989). According to selection, girls chose friends with whom they share similar beliefs and behaviours about the importance of body weight and shape. Via socialisation, peer discussion about thinness and dieting then increase preexisting similarities and promote group members to engage in dieting as a means of achieving thinness. An alternate explanation is that girls only perceive their friends to be dieting and that similarities in weight- and eating-related attitudes and behaviours do not exist (Paxton et al., 1999).
Only a small number of studies have assessed whether female friends share actual similarities in body image and eating behaviours. These studies used social network methodology (Scott, 2001; Wasserman & Faust, 1994), which involves examining the overlap in individuals’ self-reported friendship links to identify cohesive peer groups, often referred to as cliques. Based on clique groupings, researchers then examine whether similarities exist between friends in their body attitudes and eating behaviours. Crandall (1988) prospectively examined friendship cliques among young adult females in two college sororities over the course of an academic year. By the end of the year individual binge eating scores could be predicted from clique binge eating levels. Pike (1995) used a cross-sectional design to examine binge eating among adolescent females in grades 9 through 12. Results indicated that grade 9 and 10 students shared similar levels of self-reported binge eating to their friends. However, friendship similarities were not observed in grade 11 and 12 students. Pike suggested that there might be specific time points when peer group similarities are more prominent.
Paxton et al. (1999) used social network analysis to examine body image and eating similarities among grade 10 females. Clique members had similar scores on measures of body image concern, dietary restraint and EWLBs. In contrast with previous findings, however, within-group similarities were not identified for binge eating. More recently, Meyer and Waller (2001) examined change in body image attitudes, dietary restraint and binge eating in a group of women commencing prearranged share living at university. After 14 weeks the study found significant convergence in self-reported body image attitudes and dietary restraint, which were socially valued by group members, but divergence in attitudes and behaviours relating to bulimia, which were not mutually valued by group members. Although, Meyer and Waller (2001) only examined a small sample , their findings indicate that socialisation contributed significantly to changes in body concerns and eating behaviours in young adult women.
Taken together, the preceding studies identified similarities in body image attitudes and eating behaviours among female social groups. Results were mixed with regard to binge eating, with only two of the four studies identifying clique similarity. Although, these findings are consistent with sociocultural theories that emphasise the importance of peer influence in weight concerns and disordered eating, further research is needed to clarify conflicting results for binge eating. Moreover, no known studies have assessed whether similarities are identifiable earlier in adolescence. This is surprising given that: (a) early adolescence is a high-risk period for the development of body image and eating disturbances, which are known risk factors for the later development of clinical eating disorders; and (b), around this time girls start to place increasing importance on the attitudes, values and behaviours of their friends. Examining females during late adolescence and adulthood, when more severe problems have already developed, provides somewhat limited information for the identification of early risk factors and in turn, the development of prevention and early intervention programs. Thus, the first aim of this study was to examine the extent of peer similarity in body image and eating problems in early adolescence, using a large community sample. Specifically, it was hypothesised that there would be significantly greater between than within clique variability on measures of body image concern, dietary restraint, EWLBs and binge eating, after controlling for relevant physical and psychological variables.
If similarities in body image or eating behaviours were identified, the second aim of this study was to examine whether cliques classified as high and low on these measures could also be characterised by their average scores on physical, psychological, behavioural and peer influence variables. Measures of perceived peer influence included friends’ concern with thinness and dieting, friends as a source of influence, peer pressure to lose weight and be thin and weight-related teasing (Paxton et al., 1999; Thompson & Heinberg, 1993). Average clique alcohol intake, cigarette use and impulsivity were also examined because: (a) substance use and risk taking have been associated with body image and eating disturbances (e.g. French et al., 1997; Garry, Morrissey, & Whetstone, 2003); and (b), within-group similarities in substance use have been identified in adolescent samples (e.g. Ennett & Bauman, 1994; Jessor, 1987). Significant correlations were expected between average clique body image and eating behaviours, and average scores for cliques on physical, psychological, behavioural and peer variables.
The third aim of this study was to examine the characteristics of girls who were not classified part of a friendship clique. Research in the substance use area found that adolescents who are not part of a friendship network are more likely to smoke (Ennett & Bauman, 1994). Based on this finding, it might also be the case that girls who are not members of a school-based clique have different body attitudes or eating behaviours to clique members. To explore whether this is the case, clique members and non-members were compared on body image, eating, physical and psychological measures. In addition, the two groups were compared on measures of perceived peer influence, number of close friends outside school, impulsivity and substance use.
The final aim of this study was to examine whether girls’ perceptions of their friends’ weight- and shape-related attitudes and behaviours contributed to the prediction of individual body concerns and eating behaviours. Specifically, it was hypothesised that elevated scores on measures of perceived peer influence would contribute significantly to the prediction of individual body image concern and eating behaviours, after accounting for the contribution of relevant physical, psychological and behavioural variables.
Section snippets
Participants
Participants were grade 7 female students from 10 girls’ schools in New South Wales, Australia. Schools were selected from a range of socioeconomic and geographic areas and included five private schools, three state schools and two Catholic schools. In total, 1094 students participated in the study with a mean age of 12.3 years (SD=.52), ranging from 10 to 14 years. This represented an overall response rate of 71.4%. The majority of participants were born in Australia (84.1%), followed by Asia
Data transformations
To normalise skewed distributions square root transformations were applied to the following variables: DEBQ-R, EDI-B, EWLB, weekly alcohol and cigarette intake, and weight-related peer teasing. Analyses were conducted using both transformed and untransformed scores. As both methods yielded similar results, the untransformed results have been reported for ease of understanding. Where minor differences were identified in the pattern of results the transformed data have been reported and this has
Discussion
The present research focused on expanding the understanding of peer factors in body image and eating problems during early adolescence. This is the first known study to investigate whether friendship similarities exist in body image attitudes and eating behaviours in a large cohort of girls entering adolescence. The results of this study extend on previous research in a number of ways. First, clique analyses indicated that during early adolescence friendship group members shared similarities in
Acknowledgements
The authors would like to thank Professor Susan Paxton for her suggestions regarding the planning and implementation of the study and Dr. Alan Taylor for his helpful statistical advice. Thanks also go to the students who participated in the research and the school staff who kindly assisted with the implementation of the study. Dr. Hutchinson was supported by a Research Training Fellowship from the New South Wales Institute of Psychiatry and an Australian Postgraduate Award Scholarship.
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