Adverse Effects of Social Pressure to be Thin on Young Women: An Experimental Investigation of the Effects of Fat Talk

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1 Adverse Effects of Social Pressure to be Thin on Young Women: An Experimental Investigation of the Effects of Fat Talk Eric Stice,* Jennifer Maxfield, and Tony Wells Department of Psychology, University of Texas at Austin, Austin, Texas Accepted 14 May 2002 Abstract: Objective: Experiments have found that pressure to be thin from the media promotes body dissatisfaction and negative affect, but the effects of social pressure to be thin have not been examined experimentally. Thus, this study tested whether social pressure to be thin fosters body dissatisfaction and negative affect. Method: Young women (N ¼ 120) were randomly assigned to a condition wherein an ultra-thin confederate complained about how fat she felt and voiced intentions to lose weight or a control condition wherein she discussed a neutral topic. Results: Exposure to social pressure to be thin resulted in increased body dissatisfaction but not negative affect. The effects were not moderated by initial thinideal internalization, body dissatisfaction, or social support. Discussion: Results support the assertion that peer pressure to be thin promotes body dissatisfaction but suggest that this factor may not contribute to negative affect. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: , Key words: social pressure; body dissatisfaction; negative affect INTRODUCTION Numerous researchers have proposed that sociocultural pressures to be thin promote body image, affective, and eating disturbances in young women (Levine & Smolak, 1996; Paxton, Schutz, Wertheim, & Muir, 1999; Striegel-Moore, Silberstein, & Rodin, 1986; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). There are several sources of these sociocultural pressures to be thin, including the mass media, families, and peers. These pressures to be thin take a variety of forms, such as glorification of ultra-slender fashion models, direct messages that one should lose weight (e.g., weight-related teasing), and more indirect pressures to conform to the current thin-ideal espoused for women (e.g., a friend s persistent obsessions about weight and appearance). *Correspondence to: Eric Stice, Department of Psychology, University of Texas at Austin, Austin, TX stice@psy.utexas.edu Grant sponsor: National Institute of Mental Health (MH01708). Published online in Wiley InterScience ( DOI: /eat # 2003 by Wiley Periodicals, Inc.

2 Social Pressure to be Thin 109 Theoretically, persistent messages that one is not thin enough result in dissatisfaction with one s physical appearance (Striegel-Moore et al., 1986; Thompson et al., 1999). These same pernicious messages are thought to foster negative affect, because appearance is a central evaluative dimension for women in Western culture (Stice & Bearman, 2001). The body dissatisfaction and negative affect that putatively result from pressure to be thin may, in turn, increase the subsequent risk for the emergence of restrictive dieting and eating pathology (Paxton et al., 1999; McCarthy, 1990; Stice, 2001). Specifically, elevated body dissatisfaction presumably makes it more likely that an individual will resort to restrictive dieting and unhealthy weight control efforts, such as laxative abuse, in an effort to conform to the current thin ideal. Furthermore, elevated negative affect may foster binge eating, because it is commonly believed that eating provides comfort and distraction from negative emotions. In support of these theoretical assertions, prospective research has found that perceived pressure to be thin from family, peers, and the media predicts subsequent increases in body dissatisfaction (Cattarin & Thompson, 1994; Field, Camargo, Taylor, Berkey, Roberts, & Colditz, 2001; Stice, 2001; Stice & Whitenton, 2002), although this relation was not significant in one study with a smaller sample (Byely, Archibald, Graber, & Brooks-Gunn, 2000). Perceived pressure to be thin has also been found to predict subsequent increases in negative affect (Stice & Bearman, 2001). Finally, perceived pressure to be thin predicted increases in dieting and eating pathology (Byely et al., 2000; Field, Camargo, Taylor, Berkey, & Colditz, 1999; Field et al., 2001; Stice, 2001; Wertheim, Koerner, & Paxton, 2001). Although longitudinal studies are an improvement over cross-sectional studies, they cannot rule out the possibility that some shared third variable explains the observed prospective relations. Randomized experiments more effectively rule out this possibility, although they can have limited external validity. Experiments have found that exposure to ultra-slender media images results in acute increases in body dissatisfaction and negative affect among young adult females (Cash, Cash, & Butters, 1983; Irving, 1990; Pinhas, Toner, Ali, Garfinkel, & Stuckless, 1999; Posavac, Posavac, & Weigel, 2001; Richins, 1991; Stice & Shaw, 1994). For example, one study found that a 3-minute exposure to thin-ideal images from a fashion magazine, compared with control images, resulted in increased depression, shame, guilt, stress, insecurity, and body dissatisfaction (Stice & Shaw, 1994). There is emerging evidence that the adverse effects of exposure to thin-ideal images are stronger for at-risk participants characterized by initial elevations in thin-ideal internalization and body dissatisfaction and by deficits in social support (Cattarin, Thompson, Thomas, & Williams, 2000; Heinberg & Thompson, 1995; Posavac, Posavac, & Posavac, 1998; Stice, Spangler, & Agras, 2001). For instance, exposure to televised thin-ideal images results in more pronounced increases in body dissatisfaction and negative affect for at-risk girls with initial elevations in thin-ideal internalization and body dissatisfaction (Heinberg & Thompson, 1995). Presumably, women who have internalized the thin-ideal are more adversely affected by social comparisons with thinideal images, because they are more interested in achieving this body type relative to women who have not internalized this ideal. Initial elevations in body dissatisfactin may render the social comparison processes more noxious, because these women s body images are theoretically further from the thin ideal than those of women who are satisfied with their bodies. Finally, the perception that one is accepted, valued, and supported by parents and peers presumably renders women more resilient to social messages that they may not be thin enough (Stice et al., 2001). Whereas the adverse effects of exposure to media-portrayed thin-ideal images on women s body satisfaction and affective disturbances have been documented in controlled experiments, to our knowledge, the effects of social pressures to be thin emanating

3 110 Stice et al. from other sources have not been examined experimentally. This is an important lacuna in the literature, because theorists have ascribed great importance to pressures to be thin that occur in interpersonal transactions, such as with peers (Paxton et al., 1999; Thompson et al., 1999). Another benefit of examining the effects of experimentally manipulated social pressure to be thin is that one can be more certain that the perceived pressures to be thin are not solely in the eye of the beholder. It is possible that internalization of the thin ideal produces information-processing biases that cause people to simply perceive social pressures to be thin that may not be grounded in reality. Accordingly, the goal of this study was to investigate the effects of social pressure to be thin on women s body satisfaction and affective disturbances using an experimental paradigm. Qualitative interviews with young women (Wertheim, Paxton, Schutz, & Muir, 1997), and our own clinical experience leading body acceptance groups with adolescent girls and women, suggest that intense pressures to be thin emanate from peers. This qualitative data revealed that one of the more insidious forms of social pressure to be thin occurs indirectly when a thin peer complains about how fat she feels and how she needs to lose weight. This is because the implication is that the heavier observer is even more overweight and in even greater need of weight loss than the thinner peer who is obsessing about her weight. Another indication of the importance of peer pressure is that adolescent girls reported comparing themselves with immediate friends and other girls at school more frequently than they compare themselves with models, actresses, or family members (Wertheim et al., 1997). Therefore, we sought to manipulate such indirect peer pressure to be thin by having a slender and attractive undergraduate confederate either (1) complain about how fat she feels and enumerate the extensive steps she is taking to lose weight or (2) talk about a neutral topic. We hypothesized that exposure to peer pressure to be thin, relative to the control condition, would result in increased body dissatisfaction and negative affect. On the basis of past experimental findings with media exposure, we further hypothesized that these adverse effects would be stronger for participants with initial elevations in thin-ideal internalization and body dissatisfaction and initial deficits in social support. METHODS Participants Participants were 120 female undergraduate students from a large public university who ranged in age from 17 to 30 (mode ¼ 18). Twenty-two percent of the sample was Asian/Pacific Islander, 3% were Black, 60% were Caucasian, 13% were Latina, and 2% specified other or mixed racial heritage. Students participated in the study to satisfy a course research requirement. Procedure Each participant completed the experimental protocol on an individual basis. When the participant arrived at the laboratory, she was escorted into the experimental room along with the female confederate who was posing as another participant. This confederate was treated identically to the actual research participant throughout the experimental procedure. Two confederates were used in this experiment. The first confederate was a thin, attractive 19-year-old woman who was 5 foot 10 inches tall and 127 pounds (57.6 kg and 1.78 m). The second confederate was a thin, attractive 20-year-old woman

4 Social Pressure to be Thin 111 who was 5 foot 9 inches tall and 126 pounds (57.1 kg and 1.75 m). The first confederate had previously worked as a fashion model, and the second confederate had previously worked as an actress. The study was described as an investigation on the relation between mood and body satisfaction. Participants were informed that they would be randomly assigned to a negative affect or a neutral mood induction condition (in actuality all underwent the neutral condition). This cover story was necessary to keep participants blinded to the true nature of the experiment. After providing informed consent, participants completed the pretest battery, which assessed initial levels of all dependent variables. The participant and confederate were next shown the neutral video clip (a seascape video). When the video clip was finished, the confederate engaged the participant in a 3- to 5-minute prescripted conversation. In the pressure condition, the thin confederate complained about how dissatisfied she was with her weight and discussed the extreme exercise routine and restrictive diet that she was using to reduce her weight. In the control condition, the confederate conversed about neutral topics (classes she was currently taking and her plans for the weekend). The confederate was dressed in the same form-fitting outfit for all participants in an effort to standardize the experiment and eliminate the possibility that variation in dress might have biased the results. After the prescripted conversation, the experimenter reentered the room and asked the participant and confederate to complete the posttest battery that included measures of all the dependent variables, potential moderators, and other miscellaneous scales. On finishing the posttest battery, participants were asked what they thought the experiment was investigating. Finally, participants were given a debriefing sheet that described the true nature of the study and the reasons for deception. Measures Body Dissatisfaction An adapted form of the Satisfaction and Dissatisfaction with Body Parts Scale (Berscheid, Walster, & Bohrnstedt, 1973) was used to assess body dissatisfaction. This scale asks participants to indicate their level of current satisfaction with nine body parts (e.g., waist, thighs, and weight) on 5-point scales ranging from extremely satisfied ¼ 1to extremely dissatisfied ¼ 5. Items were summed for analyses. Research has found that this scale has acceptable internal consistency (a ¼ 0.94), temporal reliability (3-week testretest r ¼ 0.90), and predictive validity (Stice, 2001). Negative Affect The sadness, guilt, hostility, and fear/anxiety subscales from the PANAS-X were used to assess negative affect (Watson & Clark, 1991b). Participants reported the extent to which they were currently feeling 23 negative emotional states (e.g., sad, ashamed, angry, and nervous) on 5-point scales ranging from very slightly or not at all ¼ 1toextremely ¼ 5. Items were summed to form an overall negative affect composite. The PANAS-X has been shown to have acceptable internal consistency (M a ¼ 0.87), temporal reliability (2-month test-retest r ¼ 0.71), and convergent validity (Watson & Clark, 1991b). Furthermore, self-reported negative affect on the PANAS-X shows acceptable agreement with peer reports (Watson & Clark, 1991a). Thin-ideal Internalization Internalization of the thin ideal was assessed with the Ideal-Body Stereotype Scale- Revised (Stice, 2001). This scale asks participants to indicate their level of agreement with

5 112 Stice et al. 10 statements concerning what attractive women look like (e.g., Slender women are more attractive ) on 5-point scales ranging from strongly disagree ¼ 1tostrongly agree ¼ 5. Items were summed for analyses. This scale had acceptable internal consistency (a ¼ 0.89), temporal reliability (10-month test-retest reliability ¼ 0.63), as well as convergent, discriminant, and predictive validity (Stice, 2001). Social Support Items from the Network of Relationships Inventory (Furman & Buhrmester, 1985) assessed perceived social support from parents and peers using 5-point scales ranging from strongly disagree ¼ 1 to strongly agree ¼ 5. Separate 6-item perceived social support scales from parents and peers were formed. This scale possesses adequate internal consistency (M a ¼ 0.89), test-retest reliability (Mr¼ 0.69), and criterion validity (Furman & Buhrmester, 1985; Furman, 1996). RESULTS Questions used during the debriefing phase of the experiment indicated that one participant correctly guessed the hypothesis of the experiment. Her data were dropped, which resulted in a final sample size of 120. Preliminary analyses confirmed that there were no significant differences between the participants in the experimental and control conditions in terms of height, weight, age, ethnicity, parental education, body dissatisfaction, or negative affect at pretest. This pattern of findings suggests that randomization succeeded in creating equivalent groups. Nonetheless, repeated-measures ANOVA models were used to test for experimental effects, because this analytic technique controls for any initial differences in the dependent variables (even if they are nonsignificant). Preliminary analyses also confirmed that the experimental effects were not significantly different for the two confederates. A repeated-measures ANOVA model indicated that there were significantly different changes in body dissatisfaction from pretest to posttest across the experimental and control conditions (as indexed by the time-by-condition interaction; F (1/118) ¼ 6.70, p ¼ 0.011, variance explained ¼ 5.4%). Consistent with hypotheses, follow-up paired t tests indicated that there was a statistically significant increase in body dissatisfaction for the experimental group but that there was no significant change in body dissatisfaction in the control group (see Table 1). Thus, there was support for the hypothesis that peer pressure to be thin would lead to increases in body dissatisfaction. The magnitude Table 1. Means and standard deviations on the dependent variables for the experimental and control groups at pretest and posttest Pretest Posttest Dependent Variable M SD M SD Body dissatisfaction Control group (n ¼ 60) Peer pressure to be thin group (n ¼ 60) a b 8.20 Negative affect Control group (n ¼ 60) Peer pressure to be thin group (n ¼ 60) Note: Means within the same row with different subscripts were statistically significantly different (p < 0.05).

6 Social Pressure to be Thin 113 of this finding corresponds to a medium effect size according to the criteria proposed by Cohen (1988). Contrary to expectations, a repeated-measures ANOVA model indicated that there were no significant differences in the change in negative affect across the experimental and control conditions (as indexed by the time-by-condition interaction; F (1/118) ¼ 0.24, p ¼ 0.622, variance explained ¼ 0.2%). Paired t tests indicated that there were no statistically significant changes in negative affect from pretest to posttest for either the experimental or control conditions. Thus, the hypothesis that exposure to peer pressures to be thin would result in increases in negative affect was not supported. Hierarchical multiple regression analyses were used to test the hypothesis that the experimental effects might be more pronounced for participants with initial elevations in body dissatisfaction and thin-ideal internalization and initial deficits in social support. This was accomplished by regressing the posttest version of the dependent variable on a dichotomous variable representing experimental condition, the pretest version of the dependent variable, the main effect of the putative moderator, and the moderator-bycondition cross-product term. The first three terms were entered at step 1, and the crossproduct term was entered at step 2. The main effect terms were centered before forming the cross-product terms to reduce the unnecessary colinearity between terms as recommended by Aiken and West (1991). Separate models were estimated for each putative moderator for each of the two criteria. It might be noted that experimental condition showed significant main effects for body dissatisfaction, but not negative affect, in these regression models, paralleling the results from the repeated-measures ANOVA models described previously. In contrast to expectations, however, there was no evidence of significant moderational effects (all p values > 0.20). Within this context, it is important to note that our power to detect a medium effect size (10% of the variance explained) was 0.81 (given an N ¼ 120, an a ¼ 0.05, and a two-tailed inferential tests). Thus, the null interactive effects do not seem to be a result of insufficient statistical power. DISCUSSION The first aim of this study was to experimentally test whether exposure to peer pressure to be thin results in increased body dissatisfaction and negative affect. As hypothesized, exposure to peer pressure to be thin resulted in significant increases in body dissatisfaction relative to the control condition. It was noteworthy that such a brief and subtle manipulation of pressure to be thin would produce a finding that corresponds to a medium effect size. In retrospect, this might have been an overly conservative test of the effects, because the effects of verbal pressure to be thin had to rise above any social comparison effects that might have resulted, because attractive and thin confederates were used in all conditions. This is the first experimental evidence for the adverse effects of social pressure to be thin that we are aware of, although this effect does converge with the finding that peer pressure to be thin prospectively predicted increases in body image disturbances (e.g., Cattarin & Thompson, 1994). Theoretically, social messages that imply that one is not thin enough even if they are only implicit promote discontent with one s body. These results therefore provide support for the assertion that peer pressure is one mechanism by which the thin ideal is reinforced and body dissatisfaction is produced (Striegel-Moore et al., 1986). This finding adds to a mounting body of evidence that implicates sociocultural processes in the promotion of body image disturbances. That peer pressure to be thin apparently increases body dissatisfaction is alarming,

7 114 Stice et al. because body dissatisfaction has emerged as one of the most potent risk factors for onset of eating pathology (Stice, 2002). Contrary to expectations, social pressure to be thin did not produce significant increases in negative affect. One possible interpretation of these null findings is that social pressure to be thin may play a limited role in promoting affective disturbances. If this is the case, this suggests that previously reported correlations between these constructs may be a product of some shared third variable. However, it is entirely possible that these null effects were observed because the experimental manipulation of pressure to be thin was too subtle to affect this outcome. Etiological theory suggests that social pressure to be thin directly promotes body dissatisfaction, which in turn increases the risk for negative affect (Stice, 2001; Thompson et al., 1999). Thus, negative affect is putatively a more distal consequence of pressure to be thin than is body dissatisfaction. If this explanation is correct, more powerful manipulations of peer pressure to be thin may be necessary to observe any effects on affect in a laboratory experiment. Another possible explanation for the null effects is that the negative affect measure used in this study might not have been sufficiently sensitive to detect experimental effects. Although this seems unlikely because the PANAS-X is a well-validated scale, this possibility should not be ruled out. We hope that future experiments will investigate the relation between social pressure and negative affect and that they will attempt to explore these possible explanations for the null effects observed in this study. This experiment also sought to test the hypothesis that the adverse effects of social pressure might be more pronounced for individuals with initial elevations in thin-ideal internalization and body dissatisfaction and initial deficits in perceived social support. These predictions were based on the emerging evidence that the adverse effects of exposure to thin-ideal media are more pronounced for these subgroups (e.g., Heinberg & Thompson, 1995; Stice et al., 2001). Somewhat surprisingly, there was no support for these interactive hypotheses. On the one hand, these results may suggest that most women are affected similarly by social pressure to be thin. However, it is somewhat unclear why such vulnerability factors are important for media pressure to be thin but not for social pressure to be thin. On the other hand, the absence of interactive effects might have resulted, because we did not have sufficient power to detect these higherorder effects. It is important to note, however, that if an even larger sample size is required to detect these interactive effects, they would likely be small in magnitude. It would be useful for future research to continue to explore the possibility that there are individual difference factors that moderate the adverse effects of social pressure to be thin. Limitations It is important to consider the limitations of this experiment when interpreting the findings. First, the manipulation of pressure to be thin was relatively subtle, because pilot testing indicated that more potent manipulations of peer pressure to be thin caused a substantial portion of participants to correctly guess the hypothesis of the experiment. Thus, this should be considered a conservative test of the effects of social pressure to be thin. Second, the use of undergraduate females as research participants limits the generalizability of the current findings to other populations. Third, the reliance on self-report measures for the outcomes represents another limitation. It would be desirable if future experiments of this nature used observational and physiological measures of the outcomes (e.g., behavioral ratings of affective expression and heart-rate data). Finally,

8 Social Pressure to be Thin 115 the fact that this experiment was conducted within the confines of a laboratory may limit the external validity of the findings. It would be useful if researchers developed a procedure to capture these effects in more ecologically valid settings. Implications The current findings have several implications for etiological models and future research. These results provide preliminary experimental evidence for the hypothesis that peer pressure to be thin promotes body dissatisfaction. These findings suggest that future experiments should attempt to replicate the findings regarding the adverse effects of peer pressure to be thin on young women. It would be particularly useful if future studies were able to conduct a more powerful manipulation of social pressure to be thin, so as to maximize the ability to detect effects for other outcomes. These results also suggest that it might be fruitful to attempt to document adverse effects of other aspects of social pressure to be thin. For example, it would be interesting to investigate the effects of in vivo social comparison processes with peers. To achieve this, one might manipulate the appearance of the confederate but hold the verbal interchange constant to determine whether exposure to attractive peers produces the increases in body dissatisfaction and negative affect observed in studies that expose women to media-portrayed thin-ideal images (e.g., Irving, 1990). Future research should also investigate in greater detail the factors that may amplify or mitigate the effects of social pressure to be thin or social comparison processes. In terms of prevention implications, our results suggest that interventions that render youth more resilient to social pressure to be thin may help reduce the risk for body image and eating disturbances. Programs that have attempted to make youth more resilient to media pressures to be thin have produced promising effects (e.g., Irving, DuPen, & Berel, 1998), and programs targeting peer pressures may also be successful. CONCLUSIONS Because past research has not experimentally assessed the possible adverse effects of social pressure to be thin, this study investigated the impact of peer pressure to be thin in a randomized experiment. Results suggested that exposure to peer pressure to be thin resulted in greater body dissatisfaction, which is an established risk factor for eating pathology. However, results suggested that peer pressure to be thin does not play a powerful role in the promotion of negative affect. Furthermore, there was little evidence of individual vulnerability factors that render some women more sensitive to the adverse effects of social pressure to be thin. Thus, results provide experimental evidence that peer pressure to be thin does have deleterious effects, but that these effects may be more circumscribed than previously suspected. Future studies should continue to explore the possible adverse effects of various types of social pressure to be thin and should search more broadly for individual vulnerability factors that accentuate these effects. Thanks go to Art Markman his input regarding the design of this experiment, to Heather Shaw and Gabriela Redwine for their comments on earlier drafts of this manuscript, and to Sarah Kate Bearman, Tierney Milton, Katherine Presnell, and Elizabeth Will for their assistance in conducting this experiment.

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